Maritza Rivera

adukyu@r.postjobfree.com 469-***-**** linkedin.com/in/maritza-rivera-2b12a3a/

Managed Healthcare Program Coordinator II C- Level Executive Assistant Passionate leader with 5+ years experience in customer service, medical research, billing and claims (EPBD). Enthusiastic about accurately handling time sensitive tasks, minimizing wait times and errors. Exited to collaborate with Centene Corp/Superior Health Plan, Next Health business units to provide a world class customer experience throughout the Medicaid Medicare health systems, laboratory and pharmacy health systems.

Key Strengths

Fluent in Spanish Microsoft Office Suite Hedburg Peachtree AdvancedMD Zirmed InstaMed HC1

Pharmacy CRX TruCare Amysis Decision Tree

Experience

Superior Health Plan, Dallas Texas April 2016 – March 2021 Program Coordinator

Trained new Program Coordinators on system and usage. Guided staff regarding benefits, authorization requirements, work process and policy and procedure. Initiated authorization requests for output & input services and researched claims inquiry specific to the department. Screened for eligibility and benefits. Identify members without a PCP and refer to Member Services.

● Received, documented, and resolved member and provider inquiries by using established best practices thru Trucare and Amysis. Assessed and monitored inpatient census, Screen for eligibility and benefits thru Amysis.

● Produced and mailed routine CM letters and program educational material. Data enter assessments and authorizations into the Trucare system.

● Monitored department email inbox promptly responding to a high-volume of correspondence from customers, suppliers, and project teams.

● Coordinated services with community-based organizations. Provided outreach meetings as directed to represent the plan.

Next-Health, Dallas, TX November 2014 – February 2016 Administrative Billing Specialist

Acted as Inbound & Outbound Customer Service Representative an advocate to a network of 20 toxicology screening labs, using AdvanceMd and a network of 100+ pharmacies using pharmacy’s CRX.

● Resolved all Physician billing concerns and served as patient advocate to members, Managed Patient Assistant Program (PAP) inquiries, concerns and charges.

● Consistently tracked PAP charges, posted PAP charges to patient account, Toxicology Write off tracker for posting.

● Accountable for balance statements to patients or lawyers as requested, Processed, and posted approximately 800+ virtual payments or refunds thru ZirMed, InstaMed proprietary pay portals.

● Accountable for pre- and post-insurance verifications, Expedited results to insurance and patients, mailed lab and pharmacy balance letters.

● Processed 600+ Allied patient medical claims per month, prepared medical file, scanned to India, medical file data spreadsheet reconciliation for Digital filing. Nerium International, Addison, TX July 2012 – September 2014 Project Coordinator

Handled inbound and outbound sales calls as needed, established, and maintained high quality customer relationships.

● Assessed customer with their need and responding to the same effectively and tactfully, resolved product & service issues by clarifying the customer inquiries and complaints. Recommended potential products or services to management by collecting customer information and analyzing customer needs. Maritza Rivera adukyu@r.postjobfree.com Page Two Electra Commercial Cleaning Contractors, New York, NY January 2009 – May 2010 Executive Assistant

Executive Assistant to president CEO, VP Sales, VP Labor Production with all administrative duties, assisted with the overall day to day business activities.

● Coordinated between departments in resolving day-to-day administrative operational happenings.

● Managed assignments and projects and coordinated/verified service specifications and cost/billing when handling customer inquiries and complaints.

● Prepared reports of statistical data pertaining to labor, labor costs issues.

● Initialized extensive research into past records, gathering necessary data and completing the analysis, data entry, filing, extensive file and CRM management.

● Drafted project-specific documentation, streamlined day to day office operations and support, all administrative functions to the executive office,

Empire Office, New York, NY April 2006 - January 2008 Account Specialist & Sales Assistant

Accountable for the complete sales process of corporate furniture and service needs. This function, as well as overseeing all the business processes relating to quote to order processing, ensuring the accuracy of data needed for robust sales reporting, order and billing processing, and client management.

● Supported the Account Manager with activities and tasks associated with tracking and completing all order-related client day-to-day activities, statewide, including ensuring orders were entered, contracted, validated, and implemented, timely and accurately. mpertained to the quote to order process.

● Obtained vendor information, competitor & prospect information, samples, pricing, web searches.

● Oversaw the complete business processes relating to quote to order processing, ensured the accuracy of data needed for robust sales reporting, order and bill management. Additional Relevant Experience

3P Delivery - Staten Island, NY

Administrative Assistant Manager

Maintained customer database, order entry, heavy customer service, client billing, processed customer credits, scheduled, confirmed all deliveries and installation, service calls, Payroll specialist, interpreted complex contractor agreements to produce accurate timekeeping and proper pay rates,

● Answered multiple phone lines, typed letters, memos, tracked expenses, and processed liability claims.

● Assisted with delivery and installation of product and/or- service, managed contractor, store, and customer situations.

● Supervised 5 customer service coordinators and up to 50 truck drivers, assigned and dispatched routes for delivery operators daily, Extensive Administrative & customer service support, accountable for weekly contractor payroll, Daily truck route optimization and delivery planning. The Corbett Healthcare Group, Chicago, IL

Executive Assistant

Assisted the EVP/COO, two EVP in their day-to-day administrative support, calendar management in Outlook, Answered/screened phone calls, typed letters, tailored PP presentations and proposals, business letters, Extensive travel, hotel, entertainment, and meeting coordination, performed personal requests, shipping, and receiving reports.

Education InterAmerican School of Business Associate’s Degree in Business Administration

Contact this candidate