SANDRA RIVERA
Wesley Chapel,FL
Summary
Business professional with over 20 years of experience providing thorough and insightful support to include senior levels of management and sales personnel. Ability to prioritize and complete multiple time sensitive tasks and follow through to achieve company-wide goals. A self-motivated professional with superior research and writing skills; able to grow positive relationships with clients and colleagues at all levels within any organization.
Overview
29
29
years of professional experience
Work History
Business Owner/Operator
Quality Commercial Services Of Tampa
05.2012 - Current
- Improve customer satisfaction by finding creative solutions to problems.
- Verify invoice procedures to validate customer contracts and maintain billing communication.
- Apply payments from customers to proper accounts, checking over all information to verify accuracy.
- Apply billing adjustments to resolve discrepancies in account receivable journals.
- Follow all company procedures to keep data confidential.
- Monitor contracts for customers outside of standard billing cycle.
- Administer queries, resolving reconciled items for unbilled accounts.
- Consult with customers to assess needs and propose optimal solutions.
- Train and motivate employees to perform daily business functions.
- Oversee business budget planning and administration, accounting functions, purchasing, and bi-weekly payroll to handle financial needs.
- Prepare bank deposits and handle business sales and transaction reports.
- Oversee end-to-end business processes to maintain proficiency and profitability.
Practice Administrator
360 Dermatology
07.2023 - Current
- Streamlined office operations by implementing efficient administrative systems and procedures.
- Fostered positive work culture by promoting open communication, teamwork, and professional development opportunities among staff members.
- Completed bi-weekly payroll for 25 employees.
- Supervised team of 25 office personnel.
- Oversaw accounting, budgeting, and financial reporting.
- Addressed and remedied all patient or team member issues.
- Consulted with healthcare professionals on business decisions.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Payables & Accounting
Call Center Manager
360 Dermatology
08.2015 - 07.2023
- Manage eight (8) physician calendars for five (5) locations, including scheduling patient appointments and procedures.
- Updated patient financial information to ensure accuracy.
- Addressed, documented, and responded to incoming and outgoing calls and correspondence.
- Train all new hires in call center and scheduling department
- Coordinated primary staff and physician schedules to guarantee optimum duty coverage.
- Conducted meetings to update management and staff members on progress.
- Navigated insurance company websites to obtain pre-authorizations and referrals to confirm coverage.
- Used EMR system to maintain and update patient database.
- Proactively identified scheduling issues and developed quick solutions to promote efficiency and profitability. Managed daily scheduling conflicts to reduce operational backlogs and support full shift-coverage.
Appeals Coordinator
WellCare Health Plans Inc.
01.2006 - 01.2010
- Provides managed care services exclusively for government-sponsored health care programs, focusing on Medicaid and Medicare as well as prescription drug plans.
- Researched and resolved written complaints and complex or multi-issue appeals submitted by members, physicians/providers and/or representatives by investigating all relevant information and prepare written notification responses within specified time frame to meet compliance to ensure federal regulations are followed.
- Researched and prepared files for clinical review by nurses, medical directors, appeals committee and/or external review committee to meet the requirement of resolution when appeals are elevated to higher level of appeal.
- Participated in the identification and implementation of process improvements, trending and root cause analysis in an effort to reduce volume of preventable overturned cases by CMS.
- Worked with internal departments to resolve appeal cases, including but not limited to claims, enrollment, utilization and outside vendors including Independent Practice Association.
- Tracked laws and regulations that affect the organization's policies and stay current on changes and trends.
- Completed and maintained current with internal compliance education including URAC, HIPPA and Trust, Fraud & Abuse Program.
- Developed appeals functions, policies and procedures and documentation.
Administrative Assistant
Southern Wine And Spirits
11.2001 - 01.2006
- Generated and distributed weekly tracking reports for major grocery chains and independent accounts to all sales personnel.
- Processed product samples for upcoming events; wine tastings, trade shows, charity functions, supplier and sales market audits.
- Provided support to Sales Manager for Central Florida including 3 Territory Area Managers, 11 District Managers and 60 Sales Representatives.
- Created sale documents/portfolios for post market analysis.
- Researched and provided actionable insight surrounding sale issues.
Executive Assistant
Charmer Industries
01.1999 - 07.2001
- Maintained and updated program calendars; including running monthly depletion reports; ongoing update and monthly distribution.
- Released orders from reserve inventory for high key accounts.
- Provided high volume administrative support for vice president and department.
- Handled confidential and sensitive information with discretion and tact.
- Managed executive calendars, scheduling meetings and appointments and coordinating travel arrangements to optimize time.
- Updated spreadsheets and created presentations to support executives and boost team productivity.
- Coordinated product samples for special events including charity events, trade shows and tastings.
Administrative Assistant
Charmer Industries
01.1997 - 01.1999
- Responsible for inputting all orders for allocated items.
- Implemented and generated weekly and monthly sold reports to track sales.
- Provided support to sales department including three (3) Sales Managers, four (4) District Managers and forty (40) Sales Representatives.
- Developed and updated spreadsheets and databases to track, analyze, and report on performance and sales data.
- General office duties.
Office Manager
Cypress Medical Therapeutics
01.1995 - 01.1997
- Medical office providing medical attention to No-Fault and Workers Compensation Patients.
- Managed day to day operations within Chiropractic, Neurological and Physical Therapy office.
- Delegated and supervised responsibilities to front office staff of 8.
- Liaison with attorney's and patient insurance companies on daily basis to reconcile billing issues.
- Billing for no-fault and worker's compensation claims.
- Recorded daily banking transactions in addition to posting payments to patients' accounts.
- Controlled finances to lower costs and keep business operating within budget.
Education
GED -
Middle College High School At Laguardia Community College
Long Island City, NY06.1994
Skills
- MS Office Proficient
- QuickBooks
- Data Entry
- Bookkeeping
- Payroll Administration
- Practice Management
- Schedule Management
- Staff Management
- Administrative Support
- Problem Resolution
- Strong Communication Skills
- Critical Thinking
- Leadership
Languages
English
Spanish
Timeline
Practice Administrator
360 Dermatology
07.2023 - Current
Call Center Manager
360 Dermatology
08.2015 - 07.2023
Business Owner/Operator
Quality Commercial Services Of Tampa
05.2012 - Current
Appeals Coordinator
WellCare Health Plans Inc.
01.2006 - 01.2010
Administrative Assistant
Southern Wine And Spirits
11.2001 - 01.2006
Executive Assistant
Charmer Industries
01.1999 - 07.2001
Administrative Assistant
Charmer Industries
01.1997 - 01.1999
Office Manager
Cypress Medical Therapeutics
01.1995 - 01.1997
GED -
Middle College High School At Laguardia Community College
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