SULLIAM RIVERA

• Coordinated interactions between healthcare providers and internal care navigation teams to streamline access to care services.
• Managed receipt processing for patient accounts, ensuring accurate entry of payments received via email or text.
• Investigated billing discrepancies and claims processing concerns to facilitate timely resolution.
• Managed the documentation process to ensure accurate record-keeping and timely updates.
• Coordinated resolution of provider inquiries related to claim status, maintaining high standards of accuracy and timeliness in responses.
• Facilitated support and assistance for Spanish-speaking members to enhance their experience.
• Managed Spanish line operations, addressing calls and voicemails to enhance customer support.
• Provided translation services to enhance engagement and understanding among Spanish-speaking members.
• Provided technical support to members experiencing difficulties with debit card payments to enhance user experience.
• Ensured timely communication with patients by addressing messages received via email and text.

• Coordinated the prior authorization process by gathering clinical information, requesting medical records, and ensuring all required documentation was submitted accurately and on time.

• Delivered concierge-level support to members enrolled in the Guardianship/Cash-Centric Care program.
• Coordinated appointments with primary care providers, specialists, imaging centers, and hospitals to ensure timely access to necessary healthcare services.
• Managed activation and funding of member healthcare payment cards.
• Collaborated with physician guardians, provider networks, and care teams to coordinate urgent and complex care needs.
• Provided proactive member education regarding benefits, healthcare navigation, and care coordination.
• Resolved billing concerns and prevented balance-billing situations through effective communication with providers, safeguarding member finances.
• Resolved billing concerns and helped prevent balance-billing situations through direct provider communication.
• Educated members on benefits, healthcare navigation, and care coordination, enhancing their understanding and utilization of available resources.

• Researched attributed patients to identify healthcare needs and enrollment barriers, enhancing program outreach effectiveness.
• Outreached to caregivers to facilitate program enrollment and onboarding, ensuring smooth transitions into care.
• Coordinated with healthcare providers, pharmacies, home health agencies, DME providers, and health plans.
• Built strong relationships with healthcare stakeholders to improve participation in care programs.
• Supported care transitions and patient engagement initiatives through ongoing communication, fostering stronger patient-provider relationships.
• Provided guidance to patients navigating complex insurance claims processes, reducing financial stressors associated with medical treatments.

• Identified trends and escalated concerning findings to healthcare providers.
• Coordinated communication between patients, providers, and care teams.
• Collaborated with healthcare team to assess patient conditions and implement care plans effectively.
• Documented patient data accurately in electronic health records, facilitating seamless communication among staff.
• Responded promptly to alarms and alerts, prioritizing critical situations for efficient care delivery.
• Monitored patient vital signs using advanced telemetry systems to ensure safety and timely interventions.

• Coordinated referrals and cardiac clearance requests to ensure timely patient care.
• Performed EKGs and other diagnostic tests, contributing to accurate and timely diagnoses.
• Coordinated with pharmacies to resolve medication-related issues.
• Assisted with patient triage and care coordination activities.
• Scheduled surgeries by making arrangements with surgical centers and prepared charts and consent forms.
• Facilitated communication between patients and healthcare providers to enhance care coordination.
• Assisted healthcare providers in conducting examinations and procedures, enhancing patient care experience.
• Assisted in compiling patient medical histories and updating electronic health records for accuracy.
• Coordinated patient scheduling and managed appointment confirmations to optimize clinic workflow.

• Supervised medical assistants and daily clinic operations, ensuring efficient workflow and high-quality patient care.
• Assisted physicians with examinations and procedures.
• Collected vital signs, patient histories, and clinical information.
• Managed prior authorizations and medication appeals, facilitating timely access to necessary treatments for patients.
• Interpreted medical information for Spanish-speaking patients and their families.
• Coordinated communication among providers, payers, and health plans to streamline patient care processes.
• Updated inventory, expiration and vaccine logs to maintain current tracking documentation.
• Completed EKGs and other tests based on patient presentation in office.
• Oriented and trained new staff on proper procedures and policies.
• Implemented effective inventory management strategies to ensure consistent availability of essential medical supplies for daily clinic operations.
• Monitored office procedures to correct problems and implement proactive improvements for better patient flow.
• Increased clinic efficiency by training and mentoring new medical assistants on clinical procedures and best practices.

• Prepared patients and examination rooms to ensure smooth clinical visits.
• Collected vital signs and medical histories to support accurate diagnosis and treatment.
• Assisted physicians in patient care and treatment coordination to enhance patient outcomes.
• Educated patients on pre-procedure instructions and post-care protocols, improving compliance rates.
• Sanitized, restocked, and organized exam rooms and medical equipment.
• Called and faxed pharmacies to submit prescriptions and refills.
• Coordinated scheduling for patient appointments, optimizing clinic efficiency and patient care.

• Coordinated patient schedules, ensuring timely appointments and efficient workflow.
• Managed electronic health records, maintaining accuracy and compliance with regulations.
• Developed patient education materials, improving understanding of treatment plans and procedures.
• Coordinated with insurance companies for accurate billing and claim processing, reducing errors and financial discrepancies.
• Collaborated with multidisciplinary teams to optimize patient care delivery across departments.
• Facilitated communication between patients and healthcare providers to enhance care quality.

• Handled inbound customer inquiries, ensuring accurate data entry and prompt issue resolution.
• Executed payment processing and maintained documentation accuracy to support financial transactions.
• Supported management in operational projects and daily assignments, contributing to team objectives.
• Supervised day-to-day operations to meet performance, quality and service expectations.
• Optimized customer service processes to enhance team efficiency and response times.
• Established performance metrics to assess team effectiveness, driving continuous improvement initiatives across departments.
• Oversaw scheduling and shift assignments, optimizing staff coverage during peak times for optimal customer support.

• Assisted physicians during examinations and treatments to ensure quality patient care.
• Prepared patients for visits and organized clinical areas to enhance workflow.
• Sterilized surgical instruments using established protocols in clinic. and supported office operations.
• Coordinated appointment scheduling and follow-up communications to enhance patient experience.
• Conducted routine lab tests and processed specimens for accurate diagnostic results.
• Educated patients on skin care regimens and post-operative instructions to promote recovery.

In Progress