Vanessa Rivera Maldonado
Littleton,CO
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
13
13
years of professional experience
Work History
Associate Clinical Admin Coordinator
UHG
11.2022 - Current
- Medical Records Management
- Revenue Cycle Management
- Maintained complete documentation for permanent records and auditing purposes.
- Maintained high-level knowledge of federal and State regulations on patient privacy.
- Complied with HIPPA relating to patient data storage and transmission methods.
- Demonstrated creativity and resourcefulness through development of innovative solutions.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Applied effective time management techniques to meet tight deadlines.
Customer Service Specialist
Internal Revenue Service, W&I, TPP
11.2021 - 09.2022
- Completes contacts with both English and Spanish speaking customers, i.e., conducts personal or telephone interviews with wide range of individuals who have varying degrees of understanding, or with third party representatives, e.g., CPAs, practitioners, attorneys, who possess professional understanding.
- Provides full explanations to specific inquiries initiated by individual, generated by notices, or internally generated assignments.
- Assist with translations of Policies and Procedures
- (Special project assigned by supervisor)
- Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
- Complied with company policies and procedures by encouraging positive and effective work environment among all peers.
- Assist, educate and help customers within the Taxpayer Protection Program
Appeals and Grievances Analyst
MMM Holdings
03.2021 - 08.2021
- Investigate and gather all information related to complains and log into the systems.
- Make follow up calls or written notifications, as applicable, to obtain necessary documentation from member such as but not limited to Authorization of Representative and Release of Medical Records forms, or from providers such as but not limited to Appeals Request form and Waiver of Liability
- Documents the resolution of all cases in the A&G application, department’s system, and PAU/Pharmacy system.
Member Services Supervisor, Financial Services Supervisor
United Health Group
06.2019 - 01.2021
- Provide daily feedback and best practices education to improve and keep established metrics and overall Performance.
- Effectively establish performance goals and measurements for Customer Service Advocates with proven improvement
- Daily Root Cause Analysis from prior and same day team performance and Improvements Plan process to effectively accomplish high standards of service levels.
- Weekly and monthly meetings with Rx MS client and stakeholders
- Monitor and analyze daily quality to determine gaps and work on process improvements.
- Led team of representatives servicing Medicaid/Medicare Dual Eligibility customers.
Community Health Worker (Member Navigator)
United Healthcare Group
10.2017 - 06.2019
- Completes telephonic outreach to DSNP members utilizing outbound dialing to schedule home visit with members
- Educates member on gaps in care and assists with scheduling provider appointments
- Assists members with social determinants of health and links to community resources
- Identifies gaps in care and assists in closure of gaps (tests, procedures, medications, yearly visits)
- Targeted specific community groups with wellness and disease management information.
- Helped vulnerable individuals navigate complex healthcare system.
- Explained required eligibility applications to patients and helped complete applications for services.
- Worked directly with patient treatment teams and participated in care coordination procedures.
- Provided complex counseling and identified alternative resources for patient care.
- Managed enrollment, transportation and paperwork for individuals to take advantage of community resources.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Carried out day-day-day duties accurately and efficiently.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Organized and detail-oriented with a strong work ethic.
- Identified issues, analyzed information and provided solutions to problems.
Member Services Representative
MolinaHealthCare
01.2017 - 09.2017
- Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints
- Resolves member inquiries and complaints fairly and effectively
- Provides product and service information to members and identifies opportunities to maintain and increase member relationships
- Recommends and implements programs to support member needs.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Introduced clients to available online resources and services to increase convenience.
Contact Center Supervisor
Maximus Inc
08.2010 - 11.2015
- Supervise call center operations and all related contact center activities for all Customer Service Representatives
- Educate callers about Affordable Care Act, eligibility screening, application, inquiry, complaints, claims, exemptions, appeals and enrollment procedures, including Medicaid Program and Child Health Plus
- Effectively establish performance goals and measurements for Customer Service Representatives
- Work closely with Workforce Management team and Managers to always ensure agents readiness.
- Directed, guided, coached and mentored team of 21 agents and surpassed individual and corporate goals.
- Supervised and tracked phone using various contact center applications and software tools.
- Managed daily activities that impacted targeted service levels and tracked adherence to schedules and average handle times.
- Demonstrated professional and polished demeanor with positive, upbeat and friendly personality and supported calling work during times of peak contact volume.
- Supervised site investigations, reported issues and escalated those that required further assistance.
- Communicated best practices among on-site and external personnel to align efforts and goals.
- Supervised and tracked phone and email activity using various contact center applications and software tools.
- Developed and executed contact strategies and improved end-to-end processes and client satisfaction ratings.
Education
High School Diploma -
Western International University, Universidad Interamericana, Margarita Janer Palacios
05.1991
Skills
- Staff Training and Supervision Call Center Operations
- Active Listener Critical Thinker Self Learner Team Collaborator Problem Solver Root Cause Analysis
- Mail Management Report Generation HIPAA Compliance Case Evaluations Policy Implementation
- Continuous Improvement Process Case Management
- Patient Services Management Administrative Management Clinical Data Collection Patient Education Clinical Quality Improvement Employee Performance Evaluations Medicare Compliance Corrective Actions Operational Efficiency
- Medical Database Expertise Medical Records Management
Languages
Spanish
Native or Bilingual
Timeline
Associate Clinical Admin Coordinator
UHG
11.2022 - Current
Customer Service Specialist
Internal Revenue Service, W&I, TPP
11.2021 - 09.2022
Appeals and Grievances Analyst
MMM Holdings
03.2021 - 08.2021
Member Services Supervisor, Financial Services Supervisor
United Health Group
06.2019 - 01.2021
Community Health Worker (Member Navigator)
United Healthcare Group
10.2017 - 06.2019
Member Services Representative
MolinaHealthCare
01.2017 - 09.2017
Contact Center Supervisor
Maximus Inc
08.2010 - 11.2015
High School Diploma -
Western International University, Universidad Interamericana, Margarita Janer Palacios
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