Destiny Rivera
Haverstraw,USA
Summary
Detail-oriented Utilization Management Coordinator with expertise in prior authorization and insurance verification. Manages high-volume workloads while ensuring compliance and optimizing processes for improved patient care. Skilled in CPT and ICD-10 coding, with experience in training staff to streamline authorization processes and enhance operational efficiency.
Overview
11
11
years of professional experience
Work History
Utilization Management Coordinator
Hamaspik Choice Inc
Spring Valley, USA
01.2021 - Current
- Process and manage 40+ daily prior authorization requests for infusion therapy, outpatient hospital services, CHHA, dialysis, and related care
• Utilize CPT & ICD-10 coding to ensure accurate approvals and denials
• Review patient records to determine medical necessity and compliance
• Communicate with providers, nurses, and case managers to coordinate care
• Maintain accurate documentation in fast-paced, deadline-driven environments
• Handle email support, data entry, and case tracking efficiently
• Train and onboard new employees on workflows and systems - Facilitated communication among patients, healthcare providers, and insurance representatives to streamline authorization processes.
- Documented utilization management activities to maintain compliance and show effectiveness.
Utilization Management Analyst
Montefiore Diamond Care
Yonkers, USA
01.2017 - 01.2021
- Analyzed utilization trends and identified performance improvement opportunities
• Coordinated services including DME, home care, and transportation
• Assisted with member outreach and non-clinical assessments
• Contributed to quality improvement reports and data analysis - Developed strategic reports for management that guided decision-making initiatives.
- Conducted research on industry trends to provide leadership with actionable best practices.
Physician Assistant
Digestive Disease & Nutrition Center
White Plains, USA
01.2015 - 01.2017
- Processed prior authorizations for MRI, CT scans, and GI procedures
• Managed scheduling, patient intake, and administrative workflows
• Utilized EMR system (Medent) for accurate documentation - Oversaw patient registration, insurance verification, form completion and appointment scheduling to maintain operational efficiency.
- Verified appointment times with patients, preparing charts, pre-admission and consent forms.
- Managed patient records and ensured accurate data entry.
Education
Anthem College Online
01-2012
Sanford Brown College
Cleveland, OH01-2011
Diploma -
Lakewood High School
Lakewood, OH01-2010
Skills
- Utilization Management & Case Review
- Medical Necessity Determination
- Prior Authorization & Insurance Verification
- CPT & ICD-10 Coding
- Claims Review & Denial Management
- Healthcare compliance
- EMR/EHR Systems (Centricity, Practice Fusion, Medent, Guiding Care, EPIC)
- Workflow Optimization & Process Improvement
- Quality Assurance & Performance Improvement
- Analytical Thinking & Problem Solving
- Provider, Nurse & Case Manager Coordination
- Patient Communication & Support
- High-volume management
- Data entry accuracy
- Training & Onboarding of New Staff
- Time Management & Independent Work
- Bilingual Communication (English / Spanish)
Timeline
Utilization Management Coordinator
Hamaspik Choice Inc
01.2021 - Current
Utilization Management Analyst
Montefiore Diamond Care
01.2017 - 01.2021
Physician Assistant
Digestive Disease & Nutrition Center
01.2015 - 01.2017
Anthem College Online
Sanford Brown College
Diploma -
Lakewood High School