Rachelle Hunter
Southfield,MI
Summary
Dedicated professional with a strong background in customer service and healthcare, equipped with exceptional written and verbal communication skills to foster positive interactions and enhance patient experiences. Proven analytical and problem-solving abilities contribute to effective decision-making and the resolution of complex issues. Eager to leverage a diverse skill set in a dynamic role prioritizing client satisfaction and operational excellence. Committed to continuous improvement and delivering high-quality service in fast-paced environments.
Overview
13
13
years of professional experience
Work History
Care Navigator
Centene- Meridian Health Plan of Michigan
Detroit, MI
07.2022 - Current
- Evaluates the needs of the members, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome
- Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care
- Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans
- Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner
- May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
- Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
- May perform on-site visits to assess members’ needs and collaborate with providers or resources, as appropriate
- May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits
- Other duties or responsibilities as assigned by people leader to meet the member and/or business needs
Automated Group Reporting Help Desk Technician
Arrow Strategies- Blue Cross Blue Shield of Michigan
Southfield, MI
10.2021 - 01.2022
- Provided customer service to external Agent and Group customers with the web-based enrollment and billing tools that Automated Group Reporting supports.
- Additionally, special assignments as requested and analyzed membership reports, resolving external customer membership issues.
- Navigated between various computer programs while servicing customers.
- Documented all calls in call tracking system.
Experienced Customer Service Specialist – HMO, Medicaid, Individual, PPO, POS
Priority Health
Southfield, MI
08.2013 - 10.2021
- Is the members first point of contact for the organization and work quickly to determine and meet members needs
- Acts proactively on members’ behalf with routine benefits and authorization processes.
- On occasion speak with Priority Health Case Managers to assist them with our members needs
- Investigated, processed, resolved, and responded to member, provider or beneficiary inquiries received via telephone, e-mail, chat regarding benefits, eligibility, materials, forms, ID cards, PCP changes, complex inquiries and quality of care issues.
- Provide members with an explanation of benefits and assist them with enrollment.
- Assist members with enrolling in medical and dental plans.
- Directed and/or adjudicated claim-related inquiries.
- Processed premium payments for members.
- Educated new and existing members, providers, or beneficiaries concerning Priority Health policies and procedures and specific benefits through welcome calls and daily telephone inquiries and written correspondence.
- Documented each contact in Priority Health Facets system.
- Updated member information following customer service guidelines (this includes PCP changes, address changes, and ordering of ID cards).
- Set up transportation for Medicaid and Healthy Michigan members.
- Checked Medicaid and Healthy Michigan members’ eligibility in MI Health System.
- Navigated between various computer programs while servicing customers.
Staff Information Specialist
Karmanos Cancer Institute
Detroit, MI
12.2012 - 08.2013
- Answered all customer calls to the Karmanos toll free phone numbers.
- Responsible for identifying and interpreting the needs of any caller transferred to my line and disseminating accurate information regarding KCI employees, programs and/or services, as well as triaging, transferring calls and paging providers as appropriate.
- Responsible for assisting in the notification by telephone and mail of patients displaced as a result of cancelled or adjusted clinics
- Responsible for responding to email requests.
- Responsible for following appropriate on-call procedures for KCI clinicians and services
- Scanning and uploading signed Rx Forms, Provider Order Forms and VA referrals.
- Paging/text paging doctors and nurses.
- Navigated between various computer programs while servicing customers.
Education
Master of Science - Healthcare Administration
Central Michigan University
Southfield, MI01.2019
Bachelor of Science - Healthcare Administration
Madonna University
Livonia, MI01.1995
Skills
- Patient confidentiality
- Care coordination
- Healthcare systems
- Resource identification
Languages
English
Native or Bilingual
Interests
- Music
- Fashion
- Road Trips
- Train Travel
- Exploring famous landmarks, historical sites, and cultural attractions in a new destination
- Sharing travel tips, recommendations, and insights with fellow enthusiasts
- Horseback Riding
- Enjoy hobbies that combine physical activity with outdoor exploration
- Volunteering
Training
Medical Terminology Courses, HIPPA Training, Evicore Advanced Imaging Training, Vital Authorization Training, CHAMPS, LENS, Facets, EMVP, E-Billing, ISIM, Members Edge
Timeline
Care Navigator
Centene- Meridian Health Plan of Michigan
07.2022 - Current
Automated Group Reporting Help Desk Technician
Arrow Strategies- Blue Cross Blue Shield of Michigan
10.2021 - 01.2022
Experienced Customer Service Specialist – HMO, Medicaid, Individual, PPO, POS
Priority Health
08.2013 - 10.2021
Staff Information Specialist
Karmanos Cancer Institute
12.2012 - 08.2013
Bachelor of Science - Healthcare Administration
Madonna University
Master of Science - Healthcare Administration
Central Michigan University