Rochelle Ann Grand
Chicago,IL
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
14
14
years of professional experience
Work History
Community Health Services Representative II
Centene Corporation
12.2021 - 03.2024
- Conduct non-clinical general health assessments to refer members to appropriate services, resolve concerns on member’s behalf, and gather information for medical providers and staff working within the organization
- Educate, coach and support members to understand disease prevention and achieve good health outcomes, including diabetes, high blood pressure, mental health, substance use
- Conduct telephonic and in-person outreach to locate individuals and families in the community who are hard to reach
- Screen for eligibility and benefits
- Identify members without a PCP and refer to Member Services
- Screen members by priority for case management (CM) assessment
- Lead and developed 9 HEC team reps and assisted with creating processes that increased HEC team productivity and accuracy
- Supplied guidance on reference tools to assist team with properly supporting member and provider services
- Assist with coaching, training, and developing daily work processes
- Identified team opportunities where training is identified.
Referral and Surgery Coordinator – Orthopedic Group
Little Company of Mary
08.2017 - 12.2021
- Scheduling and overseeing surgery schedule including pre-operative testing for patients
- Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list
- Verify eligibility and benefits.
Patient Care Information Associate
Advocate Christ Medical Center
01.2017 - 08.2017
- Act as a resource person for all hospital associates and partners in customer service matters
- Partner with all team members in Guest Services and all departments in the medical center to meet the needs of our customers
- Provides information to guests, associates and partners as needed, required, or determined per individual situations
- Implements action plans in response to performance monitoring results as directed by the manager or coordinator.
Office Manager/Biller
Inswan Home Health Agency
08.2010 - 08.2016
- Implements action plans in response to performance monitoring results as directed by the manager or coordinator
- Clarify health insurance coverage for coordination of benefits to process claims
- Research and determine status of medical related claims
- Collaborate with internal team and external client to research and resolve any disputes or discrepancies in billed amounts and/or payment transactions
- Oversee daily Billing Department functions, including medical coding, charge entry, claims, payment posting, and reimbursement management
- Analyze provider billing practices by utilizing code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA and CMS code edit criterion
- Review complex medical records to ensure billing is consistent with medical record for appeals, adjustments, and miscellaneous/unlisted code review
- Identify potential billing errors, abuse, and fraud
- Document, track and resolve all plan providers’ claims projects.
Education
Certified Illinois NA -
06.2016
BS Nursing -
Olivarez College Parañaque, Philippines
03-2008
Philippine Professional License in Nursing -
Skills
- Customer Service And Support
- Organizational Skills
- Adaptability and Flexibility
- Task Prioritization
- Problem-Solving
- Adaptability
- Analytical Skills
- Interpersonal Skills
- Teamwork and Collaboration
- Professional Demeanor
- Attention to Detail
- Excellent Communication
- Self Motivation
- Experience in leadership
- Team Collaboration
- Issue Research
- Goal Setting
- Decision-Making
- Analytical Thinking
- Multitasking
- Problem-solving abilities
- Team building
- Continuous Improvement
- Reliability
- Active Listening
References
References available upon request.
Timeline
Community Health Services Representative II
Centene Corporation
12.2021 - 03.2024
Referral and Surgery Coordinator – Orthopedic Group
Little Company of Mary
08.2017 - 12.2021
Patient Care Information Associate
Advocate Christ Medical Center
01.2017 - 08.2017
Office Manager/Biller
Inswan Home Health Agency
08.2010 - 08.2016
Certified Illinois NA -
BS Nursing -
Olivarez College Parañaque, Philippines
Philippine Professional License in Nursing -
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