WANDA RIVERA

• Direct day-to-day operations by spearheading implementation of short-term and long-term strategies to achieve business plan and profitability goals.
• Manage scheduling, training and inventory control.
• Implement policies and standard operating procedures and managed quality, customer service and logistics.
• Deliver positive customer experiences by implementing effective quality assurance practices.
• Improved morale and management communication by creating employee recognition and rewards practices.
• Recruit, hire and train crew members on application of projects, customer relations and customer service.
• Developed initiatives for process improvement and reviewed and assessed ongoing operations.
• Conducted employee observations and documented findings.
• Guided employees on understanding and meeting changing customer needs and expectations.
• Plan delivery routing, team workflows and promotional initiatives.
• Address customer concerns with suitable solutions.
• Anticipate and tracked operational and tactical risks to provide strategic solutions.

Credentialing Physicians

• Communicate with and gathered feedback from customers about progress updates and worked to resolve specific concerns.
• Perform database queries, compiling information according to requests and logging logistics changes.
• Maintain informational resources, tracking and documenting requests for updates, certification and credentialing.
• Negotiate, reviewed and managed contracts for Providers and Workers Compensation Insurance Companies.
• Create referral Panels for Insurance company and employers
• Recruited IME physicians
• Review proposed contracts against established policies, guidelines and legal requirements to identify critical issues.

• Directly supervise and devise workflows and protocols within the central business office, including a dedicated call center, transcription department, and claims department
• Oversee all aspects of the patient experience as it relates to workers’ compensation claims navigation and related legal requests
• Successfully reduced 24-person call center’s abandonment rate from 8% to 2% through scenario scripting, quality monitoring, and restructuring of ACD call queues
• Recruit, hire, train, and mentor all employees.
• Liaison to all referring nurse case managers, referring physicians, adjusters, patients, and attorneys
• Train physicians to understand and adhere to the process and guidelines of workers' compensation guidelines for patients covered by workers' compensation insurance
• Managed an IME team to meet deadlines for clients, while collecting payments, medical records, prepping charts, and negotiating IME rates
• Assist other areas within the business office on surgical precertification, charge billing, payment posting and tracking of settlement claims, patient responsible,
• Analyze and address patient inquiries and concerns
• Maintain statistics of all incoming new patient referrals
• Analyze claims and receipts to ensure maximum reimbursement.
• Collaborated with staff to maximize customer satisfaction, streamline procedures and improve bottom-line profitability
• Achieved and surpassed production targets through effective staff management, task allocation and materials coordination
• Aligned operational boundaries between processes and production demands
• Collaborated with 42-person management team to improve tracking and improve operational results
• Delivered positive customer experiences by implementing effective quality assurance practices
• Worked collaboratively to enhance processes and implement of a workers compensation team, resulting in 15% increase in profitability