Summary
Overview
Work History
Education
Skills
Timeline
Generic

Mirna Rivera

HOUSTON

Summary

Dynamic Utilization Management Coordinator at Village Medical with proven expertise in HIPAA compliance and exceptional multitasking efficiency. Adept at enhancing patient care through meticulous documentation and critical thinking. Bilingual in English and Spanish, skilled in utilizing electronic health systems to streamline processes and improve patient satisfaction.

Overview

25
25
years of professional experience

Work History

Utilization Management Coordinator

Villagemd
02.2021 - Current
  • Assisted in reviewing and processing utilization management requests for accuracy and compliance.
  • Collaborated with healthcare teams to facilitate timely patient care decisions and resource allocation.
  • Supported data entry and documentation within utilization management systems for efficient tracking of cases.
  • Helped gather necessary documentation for audits and quality assurance reviews within the department.
  • Communicated effectively with providers to clarify information and resolve discrepancies in care requests.


  • Use of Medicare and state HMO guidelines to comply with the UM plan in data entry and preparation of letters utilizing standard templates.


  • Provided float coverage utilizing and following established policies and procedures


  • Data entry via EZ cap software,tracking time frames designated to contractual obligations.


  • Knowledge in processing incoming faxed in hylafax software and other clerical duties as deemed necessary to assis with the facilitation of UM functions.


Referral Coordinator

Village Medical
03.2018 - 01.2021
  • Coordinated patient referrals to ensure timely access to specialty care
  • Managed communication between healthcare providers to streamline referral processes
  • Maintained accurate and up-to-date patient records using electronic health systems
  • Evaluated referral requests for completeness and compliance with protocols
  • Demonstrated strong attention to detail and organizational skills in managing a high volume of referrals while maintaining exceptional levels of patient care.
  • Processed referral requests from patients, doctors and other health care professionals.
  • Responded to patient inquiries to offer timely updates regarding referral status.
  • Served as a liaison between primary care physicians, specialists, and patients to ensure timely access to needed services.
  • Provided exceptional customer service, addressing patient concerns and inquiries regarding the referral process.
  • Developed and maintained strong working relationship with referral sources to streamline processing.
  • Enhanced patient satisfaction with timely coordination of referrals and appointments.
  • Improved departmental workflow by assisting colleagues with tasks such as appointment scheduling or insurance verification when needed.
  • Contributed to practice growth by maintaining positive relationships with both patients and referring providers.

Medical Records Clerk

Village Medical
01.2001 - 02.2018
  • Managed electronic health record systems ensuring accurate patient information retrieval and storage.
  • Processed medical records requests in compliance with HIPAA regulations to maintain confidentiality.
  • Trained new staff on medical records management protocols and electronic system navigation.
  • Scanned medical records in digital format for easy retrieval and accessibility.
  • Maintained patient records systems by archiving, scanning and indexing important documents and files.

Education

High School Diploma -

Springwoods
Houston, TX
05-2000

Skills

  • Multitasking efficiency
  • HIPAA compliance awareness
  • Critical thinking
  • Documentation accuracy
  • Bilingual(english/spanish)
  • Proficient in the use of athena,amazon workspace,hylafax,outlook ezcap and basic excel functions

Timeline

Utilization Management Coordinator

Villagemd
02.2021 - Current

Referral Coordinator

Village Medical
03.2018 - 01.2021

Medical Records Clerk

Village Medical
01.2001 - 02.2018

High School Diploma -

Springwoods

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