Aileen Rivera
Warwick
Summary
Healthcare Operations specialist with extensive experience in physician billing, claim resolution, and denial management. Proficient in enhancing revenue integrity and operational efficiency through effective training and mentoring. Deep understanding of Epic workflows and payer communication, leading to improved reimbursement outcomes and reduced claim discrepancies.
Overview
24
24
years of professional experience
Work History
Senior Physician Billing Associate
Boston Children's Hospital
04.2025 - Current
- Ensure timely and accurate charge capture and claim submission for physician services.
- Investigated and resolved claim denials, billing discrepancies, and outstanding balances to ensure accurate revenue capture.
- Prepared and submitted insurance appeals (including AI appeals in EPIC) with supporting documentation to meet payer deadlines.
- Collaborated with management and operational teams to address and resolve complex billing issues efficiently.
- Verify demographic and insurance data through payer portals and direct payer communication.
- Provide training and onboarding support for new billing staff.
- Provided mentorship to new billing staff to ensure a smooth onboarding process.
- Respond to inquiries from patients, insurance carriers, and internal departments.
Case Coordinator I - Expert Medical Services
Teladoc Health
09.2020 - 04.2025
- Managed complex telehealth medical cases from enrollment through completion for national and global members.
- Coordinated with clinicians, providers, and internal teams to expedite case progression and enhance service delivery.
- Communicated regularly with patients and providers regarding case status, medical records collection, and care coordination.
- Managed medical records, facilitated provider referrals, and coordinated scheduling to optimize workflow.
- Verified member eligibility and maintained detailed case documentation in case management systems.
- Performed clinical quality review of reports and documentation for accuracy and completeness.
- Monitored performance metrics to uphold compliance with operational workflows and maintain quality standards.
- Assisted leadership with operations training and onboarding of new staff and providers.
- Facilitated mentorship sessions to support new staff in adapting to their roles.
Catheterization Coordinator/ Billing Coordinator
Columbia University Medical Center - Multi-Specialty
07.2015 - 08.2020
- Coordinated procedural scheduling and managed clinical operations for pediatric cardiac catheterization services, ensuring timely and efficient patient care.
- Managed pre-procedure workflows including authorizations, diagnostic testing coordination, and patient clearance.
- Managed billing operations, patient registration, insurance verification, and charge review to optimize revenue cycle processes.
- Reviewed TES edits, charge corrections, adjustments, and coding issues (ICD-9, HCPCS) to ensure compliance and accuracy in billing.
- Provided CPT and ICD-10 coding guidance for procedure authorizations.
- Functioned as the liaison for billing and operational activities between clinical teams, revenue cycle, and hospital finance.
- Supported administrative operations, clinical documentation management, and patient communication.
- Facilitated mentorship for new employees to improve their performance.
Home Health Claims Specialist
AccentCare of NY
03.2015 - 07.2015
- Investigated and resolved claim denials and underpayments to recover lost revenue.
- Ensured timely claim filing and payer follow-up, optimizing reimbursement processes.
- Managed accounts receivable follow-up for Medicare, Medicaid, and commercial claims to maintain cash flow.
Professional Fee Biller - Central Billing Office
South County Hospital
07.2014 - 11.2014
- Audited claims for coding accuracy, verified modifiers, and ensured LCD compliance to maintain billing integrity.
- Conducted A/R follow-up, executed charge corrections, submitted claims, and reconciled payments to ensure timely revenue capture.
- Addressed and resolved billing issues through effective communication with providers and payer representatives.
Claims Specialist
Columbia University Medical Center - Multi-Specialty
08.2002 - 06.2014
- Investigated and resolved insurance denials, billing errors, and reimbursement discrepancies to enhance claims accuracy and revenue recovery.
- Managed full revenue cycle operations, ensuring accurate charge entry, timely payment posting, and effective A/R follow-up to optimize cash flow.
- Processed appeals and coordinated with provider offices to swiftly resolve referral or authorization issues, improving patient care access.
- Assisted patients with payment plans, billing inquiries, and financial guidance.
- Facilitated mentorship programs to support new staff in their professional development.
Education
High School Diploma -
Morris High School
The Bronx, NY06-1989
Skills
- Revenue Cycle Management
- Epic (Hospital & Professional Billing)
- Medical Coding
- Compliance Wire
- Patient Data Security
- Healthcare Analytics
- IDX / Crown
- Kno2
- Ambra
- PowerShare
- ISpace
- Microsoft Office
Core Expertise
- Revenue Cycle Operations
- Hospital & Professional Billing
- Denials & Appeals
- A/R Management
- Epic
- Medicare/Medicaid Compliance
- Claims Resolution
- Payer Relations
- Process Improvement
- Team Training
Timeline
Senior Physician Billing Associate
Boston Children's Hospital
04.2025 - Current
Case Coordinator I - Expert Medical Services
Teladoc Health
09.2020 - 04.2025
Catheterization Coordinator/ Billing Coordinator
Columbia University Medical Center - Multi-Specialty
07.2015 - 08.2020
Home Health Claims Specialist
AccentCare of NY
03.2015 - 07.2015
Professional Fee Biller - Central Billing Office
South County Hospital
07.2014 - 11.2014
Claims Specialist
Columbia University Medical Center - Multi-Specialty
08.2002 - 06.2014
High School Diploma -
Morris High School