Ariel Rivers-Moya

In this role, I currently Lead Shared Services under the Central Clinical Ops team while covering Business Operations under our IT team. I am directly accountable for the full build of our Contact Center Operations, Outreach/Engagement Activities and Technical Package for our Clinical staff. My projects include individual authority over Call Center technology procurement and implementation for Telephony, CRM, Workforce Management, Quality Assurance, Translation Services, AI Analytics, Geospatial Analytics, Routing Optimization and Field Clinical equipment.

Additionally, I have:

• Worked closely with our ELT Team to produce business cases and operational strategy to foster improvements across the organization.
• Established departmental KPI goals, Training guides, Team scripting and QA techniques for inbound and outbound call center agents.
• Spearheaded innovative approaches to resource allocation and strategic planning.
• Drafted and distributed P&L reports to influence critical business decisions.
• Developed project budgets and managed build/integration cost.

In this role, I oversaw daily Operations for Billing and Collections of a 300 person team. This included, Inbound and Outbound omnichannel communication (calls/chats/emails and text) in California, Panama, The Philippines, Texas and North Carolina.

• Responsible for meeting, and exceeding, the established metrics of 5 centers and their Contact Center Leadership team, Learning & Development and Quality Assurance teams by established performance goals for employees and providing feedback/improved training to support them on reaching those milestones.
• Developed and maintained relationships with Off shore resource support teams, numerous technology vendors and facilities through a structured account development process that I created.
• Set aggressive targets with incentives for employees to drive company success and to strengthen motivation.
• Documented and responded to all BBB correspondence within strict timeframes.
• Established and maintained a positive work environment through collaboration, active listening and leadership engagement to enhance productivity and improve end of year retention objectives.
• Responsible for monthly trend analysis and forecasting

For Optum, I managed five teams in a Healthcare Operations Patient Support Call Center while concurrently working an after hours position as an Inpatient Acute Care Manager.

Patient Support: This Leadership role equated to over 79 agents reporting directly to me for teams such as, Claims, Appointing Authorizations, Quality Assurance, Workforce Management and Triage. My duties included:

• Interviewing, hiring, onboarding and training new staff through effective forecasting, staff planning and workforce optimization
• Monitoring interactions and executing Monthly Performance Plans with agents and leadership team to discuss training opportunities and improvements in customer service and/or productivity.
• Followed-through on all critical inter-departmental escalations to increase patient retention and satisfaction rates.

Acute Care Management: Although promoted to Contact Center Supervisor within one year from this leadership role, I remained to work weekends and after hours to avoid low staffing and maintain my Clinical skills. In this position, my responsibilities included:

• Coordinating the integration of social services and home care programs to ensure a successful transition of care without readmission.
• Facilitating admission into skilled nursing facilities/acute rehabs when necessary to ensure patients are able to meet an appropriate level of care for home.
• Collaborating with the Interdisciplinary team to facilitate smooth admission, discharge and post discharge for my patients with all appointments, medications and equipment necessary.

As a LVN Admissions Director, I was responsible for reviewing medical records, level of care, high-cost medications/equipment and patient history to determine their capacity for rehabilitation within our facility and within parameters of their insurance. Additionally, as a licensed nurse, I worked on the floor to administer medications, perform necessary treatments and lead a team of Care Coordinators, Patient Advocates and wait staff through night shifts.

• Successfully exceeded bed count requirements for 3 out of 4 quarters resulting in bonuses and the ability to hire additional staff.
• Responsible for managing and directing the admissions process, this included consistent communication with hospitals, doctors' offices, nursing homes, and other related businesses.
• Maintained relationships with legal and financial professionals, senior organizations, assisted living and senior housing facilities, appropriate special interest groups, churches and other community contacts to drive business for Admissions
• Collaborated with interdisciplinary team of healthcare and social service providers to address patients' needs through effective intervention and care planning.

In this role, I was responsible for the full build of the Member Services Contact Center through a Third Party Administrator in Wyomissing, PA. This Contact Center build included hiring, training and onboarding for eligibility/enrollment, authorizations, claims, and Member Services. Additionally, this included the procurement of the appropriate Contact Center Technologies, such as a Salesforce, Cisco, Avaya, EZ Claim and IDX.

• Responsible for team creation and staff performance for all positions.
• Personally, reviewed all incoming referrals to approve or deny authorization based on submitted medical data and level of care and forwarded necessary referrals to our companies Medical Director if I felt further review was necessary in order to authorize services.
• Assisted in the created of plan documents such as the Summary of Benefits and Coverage (SBC), Schedule of Benefits and Certificates of Insurance for 2013 and 2014
• Maintained updated knowledge of internal processes and industry best practices to optimize service delivery.
• Developed, implemented and collated customer satisfaction surveys for improved insight.
• Met customer call guidelines for service levels, handle time and productivity.