Rachelle Brown
Columbus,OH
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Provides excellent communication with a desire to direct everyone like a friend or family member.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Volunteer Child Advocate Coordinator
Franklin County Clerk of Clerks
Columbus, Ohio
03.2021 - Current
- Website: Casa.franklincountyohio.gov
- Interviewed clients individually and in groups to assess situations, capabilities and problems.
- Counseled parents on proper child-rearing choices.
- Recommended placement to Franklin County Clerk of Courts based on child's well being and families situation.
- Supported families and children through the kinship, fostering and personal crisis's.
- Provided case management services to families and provided assistance with filling out community service program applications.
Volunteer Human Trafficking Mentor
Catch Court
Columbus, Ohio
09.2019 - Current
- Website: Municipalcourt.franklincountyohio.gov/Departments-Services/Specialized-Dockets/CATCH-Court
- Helped organize and implement programs and projects to aid community and individuals.
- Cultivated relationships and maintained regular communication with nonprofit agencies, schools, and social service agencies to solicit community needs.
- Taught classes and presented self-help or information sessions on subjects related to education and career planning.
- Prepared students for later educational experiences by encouraging to explore learning opportunities and persevere with challenging tasks.
Volunteer Board Member
Joseph’s Coat Board
Columbus, Ohio
03.2022 - 02.2023
- Website: Www.josephscoatcolumbus.com
- Engaged in fundraising and resource development efforts by reaching out to interested partners and donors.
- Brainstormed new business policies and directed program operations.
- Approved organizational strategies, budgets and business decisions.
- Participated in various committees to meet specialized goals.
- Utilized networks and resources to inspire collective action and achieve organizational goals.
- Focused on expanding outreach
- Monitored financial affairs of organization and fulfilled fiduciary responsibilities.
- Fostered collaboration and development of new practices by business leaders.
- Attended board meetings and reviewed meeting agendas.
Family Engagement Coordinator
Columbus City Schools
Columbus, OH
03.2022 - Current
- Advises and trains families to address issues and to advocate on behalf of their child's education.
- Coaches and mentors’ families on how to be engaged members of the academic team.
- Advises and trains families to address issues and to advocate on behalf of their child’s education.
- Connects families to community-based services, school counselors, and/or social workers.
- Expands volunteer opportunities.
- Coordinate events to support family engagement.
- Maintains open communication with families regarding important school information.
- Email, family bulletin board, newsletter, etc.).
- Maintains effective working relationships with law enforcement, court officials and medical professionals to give families comprehensive and effective support to decrease barriers so students are successful in school.
- Reviewed and analyzed violent crime reports to identify crime trends to support requests for funding for different community programs.
Community Health Worker Supervisor
Franklin County Public Health
Columbus, OH
04.2019 - Current
- Served as a go-between for community members and health/social service agencies.
- Created partnerships for Franklin County Public Health to expand the HUB Pathways program.
- Assisted with training and development of new staff.
- Built individual and community capacity by increasing health and self-sufficiency through a range of supportive and community-based services.
- Helped community members understand their health conditions and develop ways to improve their health and well-being.
- Provided basic health services such as monitoring blood pressure or providing first aid.
- Advised clients or community groups on issues related to diagnostic screenings, such as breast cancer screening, pap smears, glaucoma tests, or diabetes screenings.
- Conducted home visits for pregnant women, newborn infants, or other high-risk individuals to monitor their progress or assess their needs.
- Assisted families in applying for social services programs.
- Helped patients develop health management plans and goals.
- Coached patients’ ineffective management of their chronic health conditions and self-care.
- Assisted clients in utilizing community services, including scheduling appointments with social services agencies, and assisting with the completion of applications for programs for which they may be eligible.
- Assisted with COVID call center and interviews to track outbreak and spread of Coronavirus and Monkeypox.
- Created and tracked reports for the Centers for Disease Control.
Healthcheck Coordinator
Buckeye Health Plan
Columbus, OH
10.2014 - 04.2019
- Provided direct outreach and community resources to Medicaid recipients, PFK members, and families
- Monitored implementation of program policies and practices
- Coordinated and facilitated community-based presentations
- Assisted with planning and coordinating events to expand health literacy and knowledge in the community
- Assisted with providing outreach campaigns to improve HEDIS measures and NCQA scores.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Answered inbound calls, chats and emails to facilitate customer service.
- Created a Benevolence Committee for employees in need could request funding for crises and emergency expenses.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Handled escalated customer inquiries, concerns, complaints and grievances.
- Received and processed claim information, and communicated with internal and external customers via phone and other communication channels.
- Took an average of 100 calls daily that included overriding medication denials. member education and assisting with negotiating single case agreements.
- Served a Product Service Expert and Team Lead to assist with achieving quality assurance metrics.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
- Researched medical claims for validity to resolve discrepancies.
- Coordinated benefits with medical insurance plans and Medicare providers.
- Analyzed contracts and claim systems to apply appropriate benefit amounts.
- Discussed job performance problems with employees, identifying causes and issues to find solutions.
- Consulted with managers to resolve problems relating to employee performance, office equipment and work schedules.
Dual Member Services Lead
Molina Healthcare
Columbus, OH
09.2013 - 10.2014
- Responded to telephone inquiries from both Molina Members and Providers accurately and proficiently.
- Developed an internal benevolence committee to assist employees in crisis situations and throughout hardships.
- Researched Molina Healthcare guidelines to ensure it met Medicaid guidelines.
- Assisted with training and development of new staff.
- Sent out weekly reminders and team stats as needed.
- Supported Quality Assurance for the Member Services department and provided coaching to new employees.
- Advised callers of outstanding HEDIS services needed.
- Gathered information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions.
- Trained new employees.
- Managed, processed and reviewed claims for Medicaid and Medicaid.
- Created single case agreements with non-contracted providers for unique cases.
- A Service Member Expert to assist with training and coaching.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Planned and conducted investigations of claims to confirm coverage and compensability.
- Documented specific claims by completing and recording forms, reports and logs.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Processed claims for payment or forwarded to appropriate personnel for further investigation.
- Transcribed data to worksheets and entered data into computer to prepare documents and adjust accounts.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
Ancillary Services Representative III
Progressive Medical
Westerville, OH
08.2008 - 09.2010
- Obtained authorization to coordinate care for members with Medicaid, Medicare, and other private insurance carriers
- Kept track of medical history, progress, and care plans
- Worked with a team of medical Doctors and nursing staff to provide quality care
- Provided timely and accurate updates to member's insurance companies
- Found in home healthcare agencies, rehabilitation centers, DME, infusion therapy companies, and mail
- Contacted pharmacies to assist with mail order delivery requests for homebound patients
- Negotiated rates with non-participating providers in the event participating provider could not be located
- Trained new staff on quality control procedures and HIPPA regulations.
Education
Bachelor of Science Social - Work Candidate
OHIO UNIVERISTY
01.2024
Community Health Worker -
THE OHIO STATE UNIVERSITY
02.2019
Nursing Assistant Certification -
COLUMBUS STATE COMMUNITY COLLEGE
06.2006
Skills
- Claims
- Contact tracing
- Community Outreach
- Customer Service
- Community Referrals
- Consulting
- Data Analytics
- Home Visits
- Microsoft Office
- Medicaid
- Project Management
- Problem solving
- Planning & Organizing
- Resource Specialist
Certification
Community Health Worker Certification
Nursing Assistant Certification
Mental Health CPR
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
There’s no shortage of remarkable ideas, what’s missing is the will to execute them.
Seth Godin
Timeline
Volunteer Board Member
Joseph’s Coat Board
03.2022 - 02.2023
Family Engagement Coordinator
Columbus City Schools
03.2022 - Current
Volunteer Child Advocate Coordinator
Franklin County Clerk of Clerks
03.2021 - Current
Volunteer Human Trafficking Mentor
Catch Court
09.2019 - Current
Community Health Worker Supervisor
Franklin County Public Health
04.2019 - Current
Healthcheck Coordinator
Buckeye Health Plan
10.2014 - 04.2019
Dual Member Services Lead
Molina Healthcare
09.2013 - 10.2014
Ancillary Services Representative III
Progressive Medical
08.2008 - 09.2010
Bachelor of Science Social - Work Candidate
OHIO UNIVERISTY
Community Health Worker -
THE OHIO STATE UNIVERSITY
Nursing Assistant Certification -
COLUMBUS STATE COMMUNITY COLLEGE
Community Health Worker Certification
Nursing Assistant Certification
Mental Health CPR
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