Summary
Overview
Work History
Education
Skills
Certification
Awards and Honors
Volunteer work
Timeline
Generic

Jeannet Rivera

Summary

I am a Master's in Healthcare Administration (MHA) candidate seeking a leadership role in an organization where I can apply my 10+ years of experience in the healthcare industry.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Program Coordinator

Wellcare
11.2020 - Current
  • Assist members and providers with authorization status for our Medicaid Managed Long Term Services and Support (MLTSS) population
  • Escalate pending requests and nurse assessments to the handling department
  • Provide administrative support to the case management team
  • Process incoming authorization requests as outlined in department policies and procedures

Grievance Coordinator

Clover Health
06.2019 - 08.2020
  • Reviewed, researched, and resolved member grievances
  • Inputted data and maintained records in various computer programs and databases
  • Interacted with internal departments, medical providers, and members to collect additional information required for case research
  • Prepared resolution letters following the guidelines and time frames set by the Centers for Medicare & Medicaid Services (CMS)

Senior Customer Service Representative

Clover Health
02.2018 - 06.2019
  • Provided guidance and support to internal staff on company policies and procedures to successfully complete their job
  • Handled escalated-supervisor calls which resolved customer questions, concerns, and complaints
  • Submitted performance feedback forms for Customer Service Representatives
  • Examined and identified ways to improve existing processes and workflows

Customer Service Representative

Clover Health
07.2017 - 02.2018
  • Assisted members with inquiries regarding plan policies, benefits, and claims information
  • Maintained clear and accurate call logs of all customer encounters
  • Scheduled customers for in-home health assessments
  • Connected members with caseworkers, social workers, and medical providers

Administrative Assistant

The Wellness Institute
06.2015 - 07.2017
  • Registered new patients and scheduled appointments in system
  • Handled all filing, records management, and incoming calls
  • Managed co-payments, medical billing, and insurance verification

Home Health Aide

Elite Home Health Care
01.2013 - 06.2015
  • Provided in-home care for disabled, cognitively impaired, and chronically ill patients
  • Accompanied patients on necessary trips outside of the home including doctor's appointments
  • Maintained records of house visits and submitted weekly reports

Education

Master of Health Administration (MHA) -

Rutgers University
New Brunswick, NJ

Bachelor of Arts - Psychology, Business

New Jersey City University
Jersey City, NJ

Skills

  • Process Improvement
  • Office Administration
  • Customer Satisfaction
  • Escalation Problem-Solving
  • Time Management
  • Microsoft Office (Excel, PowerPoint, Outlook, Word)
  • Fluent in English and Spanish

Certification

Lean Six Sigma Green Belt

Awards and Honors

  • New Jersey City University Presidential Scholarship, September 2016-May 2018
  • Hudson County Community College Government Scholarship, September 2015-May 2016

Volunteer work

Liberty State Park Gardening, Jersey City, NJ
• Assisted in cleaning the park by pulling grass weeds and collecting garbage
• Planted flowers in the garden
CUMAC, Paterson, NJ
• Bagged frozen food, meats, and vegetables in plastic bags in preparation for delivery
• Sorted cans of food by category

Timeline

Program Coordinator

Wellcare
11.2020 - Current

Grievance Coordinator

Clover Health
06.2019 - 08.2020

Senior Customer Service Representative

Clover Health
02.2018 - 06.2019

Customer Service Representative

Clover Health
07.2017 - 02.2018

Administrative Assistant

The Wellness Institute
06.2015 - 07.2017

Home Health Aide

Elite Home Health Care
01.2013 - 06.2015

Master of Health Administration (MHA) -

Rutgers University

Bachelor of Arts - Psychology, Business

New Jersey City University

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Jeannet Rivera