Dominique Rivera
San Diego,CA
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet organization goals.
Overview
8
8
years of professional experience
Work History
Referral & Authorizations Coordinator Temp
Neighborhood Healthcare
05.2024 - 08.2024
- Referral Specialist coordinates, processes and documents medical referrals and prior authorizations for a variety of medical services for clinic patients, as requested electronically by clinic providers
- As an integral member of the Health Care Team, the Referral Specialist manages a high volume of referrals and pre-authorizations for multiple Providers and collaborates with other Clinic Referral Specialists, Providers, MA's, Patient Service Representatives and other support staff in multiple clinic locations
- This position requires the use of clinical and administrative judgment and initiative to determine best approach for both urgent and non-urgent patient care needs
- Completes all required documentation accurately, in a timely manner, and thoroughly in accordance with department standards; in addition, documentation complies with patients' insurance requirements
- Meets daily referral modification productivity standards for Referral Specialists, adhering to referral processes and guidelines
- Per referral guidelines, provide appropriate clinical information to specialist
- Performs other duties as assigned
- Prepares and processes all referral and pre-authorization paperwork, including gathering pertinent information as needed via EHR, from incoming phone/email/fax messages, or from clinical team
- Contacts various clinics, facilities, and companies to obtain information to accurately complete referral/pre-authorization requests.
Customer Service Rep
CVS Health Aetna
07.2023 - 12.2023
- Handled high volume of inbound calls for Member and Provider inquiries
- Handled customer inquiries and suggestions courteously and professionally
- Answered constant flow of provider/member calls with minimal wait times
- Be able to answer Member and Provider inquiries and type information into computer systems simultaneously
- Verify members' health insurance
- Proficient with MS Office and ability to navigate multiple platforms
- Delivered prompt service to prioritize customer needs
- Processed medical records requests efficiently, safeguarding patient privacy while ensuring timely information access for healthcare providers
- Followed document protocols to safeguard confidentiality of patient records
- Resolved billing inquiries and disputes in timely fashion
- Demonstrate premier customer service while assisting patients in a fast-paced environment: assess and appropriately respond to patient needs in an efficient and courteous manner
- Review insurance eligibility and educate patients on available programs offered through Neighborhood Healthcare
- Accurately schedule and confirm patient appointments according to established guidelines and reschedule as necessary
- Receive payments for services and records them in computer or ledger
- Verify patient's record is up to date and accurate
- Make appropriate changes in computer system
- Deescalate difficult situations and identify solutions for the patient as necessary
- Monitor Provider schedules for openings to ensure maximum utilization of all available appointments
- Update patient chart in electronic health records upon arrival for appointment.
Patient Service Rep
Neighborhood Healthcare
05.2022 - 07.2023
- EClinical Works
- Handling high volume of inbound calls for Member and Provider inquiries
- Handled customer inquiries and suggestions courteously and professionally
- Answered constant flow of provider/member calls with minimal wait times
- Be able to answer Member and Provider inquiries and type information into computer systems simultaneously
- Verify members' health insurance
- Proficient with MS Office and ability to navigate multiple platforms
- Delivered prompt service to prioritize customer needs
- Processed medical records requests efficiently, safeguarding patient privacy while ensuring timely information access for healthcare providers
- Followed document protocols to safeguard confidentiality of patient records
- Resolved billing inquiries and disputes in timely fashion
- Demonstrate premier customer service while assisting patients in a fast-paced environment: assess and appropriately respond to patient needs in an efficient and courteous manner
- Review insurance eligibility and educate patients on available programs offered through Neighborhood Healthcare
- Accurately schedule and confirm patient appointments according to established guidelines and reschedule as necessary
- Receive payments for services and records them in computer or ledger
- Verify patient's record is up to date and accurate
- Make appropriate changes in computer system
- Deescalate difficult situations and identify solutions for the patient as necessary
- Monitor Provider schedules for openings to ensure maximum utilization of all available appointments
- Update patient chart in electronic health records upon arrival for appointment.
Night Merchandiser/ Inventory Clerk
Costco Wholesale
08.2016 - 05.2022
- Reduced out-of-stock occurrences by monitoring inventory levels closely and replenishing items promptly
- Inspected floor displays, noted missing items, and immediately replenished merchandise
- Maintained neat, organized stockroom free of hazards
- Handled all members' relations issues in a gracious matter, while following company policies
- Welcomes members' with a smile and help locate items in the warehouse
- Educate members' on any new items for the season
- Kept work area clean and organized
- Communicated clear with management and employees
- Help assist on other department needs
- Box and restock merchandise
- Rearrange items for seasonal needs
- Every 6 months did warehouse inventory
- Monitor trucks coming in nightly/check manifest for inventory.
Education
Bachelors of Science in Health Management & Clinical Assistance -
University of Phoenix
San Diego, CA04.2015
Associates of Science in Health Administration -
University of Phoenix
San Diego, CA07.2013
Skills
- Appointment Scheduling
- EMR system: eClinical Works
- Customer Service
- Administrative Support
Timeline
Referral & Authorizations Coordinator Temp
Neighborhood Healthcare
05.2024 - 08.2024
Customer Service Rep
CVS Health Aetna
07.2023 - 12.2023
Patient Service Rep
Neighborhood Healthcare
05.2022 - 07.2023
Night Merchandiser/ Inventory Clerk
Costco Wholesale
08.2016 - 05.2022
Bachelors of Science in Health Management & Clinical Assistance -
University of Phoenix
Associates of Science in Health Administration -
University of Phoenix
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