Simone Rivera Email & Phone Number

• Researched claims due to a provider inquiry
• Create and update existing workflows for teams
• Facilitate training sessions for onboarding staff and vendors
• Lead weekly vendor conference calls
• Troubleshoot system issues for vendors
• Point of contact for any cross-departmental issues

• Analyzed and researched various types of claims for Medical Director Review
• Executed Directors’ determinations on claims
• In charge of running daily reports for audit teams
• Responsible for appropriately distributing work to the physician outlier vendor, certified professional coders, utilization analysts, and managed care coordinators

• Provided excellent customer service to members inquiring about mental health benefits, authorizations, and claims information
• Assisted in the creating, updating, and processing of mental health and chemical dependency authorizations thru UNITY systems
• Coordinated with clinicians and care managers for the pre-certification of higher level of care admissions for members
• Analyzed and transfers all crisis members to clinicians for risk assessments
• Assisted members in the referral process thru a database of nationwide providers for mental health and substance abuse related issues
• Updated providers and members with current provider status and specialties

Human Resources Management, Human Resources Management/Personnel Administration, General, 3.86

Associate Of Science - As, Business Administration And Management, General