Rachel Coward

• Provides remote direct consumer outreach support by making outbound and receiving inbound telephone calls, sending and receiving emails, text messages, and setting up virtual and in-person appointments for individuals and families. Provides in-person assistance by attending enrollment events and health fairs.
• Assists consumers with all aspects of enrollment and/or renewal processes for Marketplace and/or Medicaid applications including: Profile creation and update, Explanation of Eligibility Determination, Plan Comparisons
• Walking through enrollment process with consumer, ensuring correct data is captured and input appropriable.
• Escalating or referring to other departments or state agencies as applicable to include local and federal resources.
• Ensure all project-identified, state and federal regulations, processes, policies, and procedures are executed and followed as applicable.
• Successfully participate in hybrid work structure that includes remote work from home AND attendance at local community events, health fairs, and other assigned venues to reach targeted population and provide enrollment or educational outreach assistance.
• Represent CMS and Cognosante within local community in professional manner.
• Provide accurate and timely documentation of daily activities and results.
• Analyze needs of consumer with strong interpersonal skills and use of probing questions.
• Escalate issues related to consumer or tools when appropriate.
• Other additional duties as assigned by program leadership.

• Managed staff performance of staff by proactively addressing deficiencies and training weaknesses.
• Leveraged technology platforms for efficient management of client accounts, policy changes, claims processing, and billing inquiries.
• Maintained personnel files and regularly conducted audits to verify accuracy of information.
• Maintained compliance with industry regulations by conducting regular audits of policies, procedures, and employee practices. Familiar with federal and state regulations and maintain them within agency.
• Responsible for familiarizing employees with all laws and regulations, and make available copies of rules available for their use.
• Responsible for completion, maintenance and submission of such reports and records as required.
• Maintained current organizational chart to show lines of authority to client level.
• Clearly identify public services provided by agency in geographic area in which these services are available.
• Maintain office facility for agency which is large enough for efficient staff work, adequately equipped, and which provides for safe working environment, meeting local ordinances and fire regulations.
• Ensure accuracy of public information materials and activities.
• Develops cooperative relationships with other agencies for exchange of information and services and with community agencies to foster understanding of agency programs.
• Contact local, state and national associations and participate in meetings and conventions.
• Responsible for recruitment and selection of employees based on applicants’ credentials and qualifications including training and licensure.
• Uses consistent and non-discriminating process to select employees as follows:

a. Conducts personal interviews on all applicants at time of recruitment and selection.

b. Obtains two written or verbal follow-up of employment references and job history.

c. Verifies education, experience, training, licensure or certification, as appropriate to job responsibilities.

d. Selects and employs qualified individuals without regard to gender, race, age, creed, handicap, sexual orientation, or national origin.

• Coordinated and conducted orientation programs for all new employees, including introduction to the organization, staff and employee rules and responsibilities.
• Ensures that all employees receive ongoing education, including in-services, training and other activities to maintain and improve staff competence.
• Ensures that all employees meet their required mandatory training, keeps records of in-services and files employee's certificate of attendance in employee personnel folder.
• Ensures that all employees are meeting performance expectations stated in his/her job descriptions.
• Ensures that all employees are in compliance with mandatory requirements for employment.

Responsible for other miscellaneous duties including the following:

a. Maintains strict professional ethics, confidentiality and privacy of the client and/or family members

b. Participates in personnel policies revisions, when requested

c. Assumes responsibility for own personal and professional growth

• Assists with developing and implementing Agency’s Quality Improvement Program
• Assists in implementation of approved recommendations and assessing agency’s success in correcting problems.
• Reviews all reports of complaints, errors, incidents, and grievances to ensure that they are fully documented and properly handled in timeframe and manner specified by agency’s policy.
• Implementing governing body directives and ensuring that appropriate service policies are developed and implemented.
• Ensuring staff development including orientation, in-service education, continuing education and evaluation of staff are current and include Quality Improvement initiatives
• Directing and monitoring organizational Performance Improvement activities.
• Coordinated program for risk management which encompasses written guidelines and provides for supervision of workers on cases with risk factors, such as: contagious disease, infections, AIDs, hepatitis, TB and other situations in which client or worker is at risk.
• Assured confidentiality of client records.
• Promotes and maintains agency environment that is in compliance with federal, state and local regulatory agencies
• Consults with staff when necessary to ensure and maintain safe, efficient and quality client care/services Preparing, distributing, tabulating, and evaluating of results of questionnaires directed to clients, families, employees/contractors and referral sources to determine their satisfaction with agency's services.
• At least annually, reviews all job descriptions to ensure consistency with recruitment and hiring practices, and with state and national requirements Appraises staff performance during their probationary period and annually, provides teaching and counseling necessary to enhance delivery of services and development of direct care staff.
• Identifies and evaluates client needs and appropriateness of home care by reviewing initial intake screening form before assignment of direct care staff.
• Participates in community related functions as necessary.
• Assists with orientation of new professional staff to familiarize them with Agency policies and procedures.
• Ensures that all pertinent paperwork is in client record and is complete.
• Ensured agency’s continuing education program i.e. in-service education and continuing training Maintains a current client roster with necessary information
• Updates logbooks and schedule sheets
• Prepares weekly schedule for field staff and provides copies for distribution
• Controls and monitors schedule changes
• Checks compliance of visits done (on master schedule) after all notes are matched to charges, brings resolution of any scheduling problems
• Assists in relaying messages to field staff, office staff and community liaisons Maintains all staff and contract personnel files
• Maintains master files of personnel evaluations.
• Keeps all evaluation forms current
• Sends deficiency notices to personnel
• Assists in miscellaneous bookkeeping functions to include full-time and part-time payroll procedures
• Posts workers' salaries on appropriate records, prepares all information needed to prepare checks and payroll reports, verifies all payroll deductions and reconciles cash payments related to those deductions
• Processes accounts payable according to agency policy, posts expense and income to appropriate accounts, reviews all phone charges monthly
• Supervises and coordinates credit and collection to include completion of all necessary paperwork and data entry
• Manages credit and collection activities on past due accounts participates in any and all collection activities of problem accounts.
• Supervises completion of all required insurance, Medicare and Medicaid forms in a timely manner
• Supervises and follows up on receiving signed service agreements and deposits.
• Assists with audits
• Verifies and assures time slips are signed and in office on time, assures there are notes for each entry on time slips
• Takes care of any necessary payroll and billing adjustments
• Prepares written performance evaluations of field staff and recommend wage adjustments for them
• Supervises field staff in regard to punctuality, reliability, assignments and related matters
• Disciplines field staff to include making recommendations for termination, this involves counseling and making recommendations regarding suggested discipline or corrective action where performance problems exist.
• Maintained compliance with industry regulations by conducting regular audits of policies, procedures, and employee practices.
• Optimized resource allocation by monitoring agent productivity levels and adjusting staffing as needed for maximum efficiency.
• Negotiated contracts with carriers for competitive pricing structures that attracted new clientele while retaining existing customers.
• Facilitated open communication channels within the agency environment that promoted collaboration towards shared goals among staff members.
• Streamlined internal processes to improve overall efficiency and reduce operating costs for the agency.
• Protected client and co-worker confidentiality, maintained data privacy compliance and adhered to HIPAA restrictions.
• Managed agency budget and finances, implementing cost-saving measures while maintaining a high level of service quality for clients.
• Continuously sought opportunities for professional development through training courses, seminars, and industry conferences, ensuring an up-to-date knowledge base.
• Built a culture of accountability within the organization by establishing clear expectations for individual performance.
• Assisted in recruiting, hiring and training of team members.
• Observed each employee's individual strengths and initiated mentoring program to improve areas of weakness.
• Recruited, hired, and trained initial personnel, working to establish key internal functions and outline scope of positions for new organization.
• Tracked employee attendance and punctuality, addressing repeat problems quickly to prevent long-term habits.
• Coached employees through day-to-day work and complex problems.

• Self-motivated, with strong sense of personal responsibility.
• Worked effectively in fast-paced environments.
• Skilled at working independently and collaboratively in team environment.
• Proven ability to learn quickly and adapt to new situations.
• Managed time efficiently in order to complete all tasks within deadlines.
• Organized and detail-oriented with strong work ethic.
• Paid attention to detail while completing assignments.
• Used critical thinking to break down problems, evaluate solutions and make decisions.
• Demonstrated strong organizational and time management skills while managing multiple projects.

• Provided excellent customer service to patients, family members, and healthcare providers during intake process.
• Maintained strict confidentiality of patient information, adhering to HIPAA guidelines and company policies.
• Reduced errors in patient data entry with thorough verification processes and attention to detail.
• Completed intake assessment forms and filed clients' charts.
• Coordinate benefits and billing with primary and secondary insurance including Medicaid.

• Verified patient benefits and created patient files for EMR and paper files.

• Submitted and maintained authorizations for numerous private insurances.
• First point of contact with coordination of care involving internal and insurance case managers.
• Billing of all private insurances on weekly basis involving approximately Manage eligibility of approximately 800 patients on daily basis. •Responsible for writing and tracking approximately 800 recertification physician’s orders.

• Responsible for troubleshooting and building relationships with outside providers offices.

• Remained current with training and sought new training opportunities to further personal growth.
• Participated in community events representing U.S. military and recruited interested parties.
• Maintained Secret Clearance.
• Defined project deliverables and monitored status of tasks. • Received over 100 phone calls daily and maintained 99% approval within quantifiable metrics.

• Recommended process and system improvements and implemented training to new staff.

• Supervised work of 22 team members, offered constructive feedback on work performance

. • Tested new databases for software applications and developed SOP's

• Drafted documents for internal meetings.