Yvette Rivera

Experience

• 

  AGIS

  Jan 2008 - Jan 2012

  Eligibility Specialist

  • Review and process all eligibility requests, maintain billing spreadsheets for large clients, assist in billing reconciliation and payroll functions, administer Cobra for Key Clients • Serve as a primary day-to-day contact to clients and members with benefits, claims and/or billing inquiries• Train new clients on all carrier website billing and reporting • Administratively assist Sales Executives and Account Managers in all functions of new and renewed business• Professionally conduct benefit enrollment presentations to client employees while increasing opportunities to upsell • Review contracts to ensure appropriate benefits are applied• Process renewals with carriers to ensure group policies and members are accurately enrolled for the new plan year • Track service issues and conduct data analysis on individual claims to provide recommendations on benefit selections Show less

• 

  Express Scripts

  Jan 2012 - Jan 2015

  Senior Training Specialist - Learning and Development

  • Successfully designed and developed a Training Certification Program for the Billing and Reimbursement Department which included Knowledge Checks, Training Material, New Hire Process and Onboarding • Defined the scope of the program in collaboration with Senior Leadership and created/executed a detailed work plan to address identified needs or gaps in performance or knowledge with a strong focus on Government Programs• Used clear communication and cross-functional process management skills to ensure timely delivery of effective training courses that added value in business initiatives while maintaining compliance and mitigating risk• Built and maintained effective partnerships with internal clients through needs assessments and discussions to proactively identify issues that impact training needs • Conducted various meetings with project stakeholders to ensure accurate development of Certification Program• Maintained awareness of new developments in training, instructional design and recommend modifications in curriculum and practices• Demonstrated knowledge of human behavior, adult learning program delivery, organization development theory and practice as well as working knowledge of all facets of training assessment, design, delivery, implementation, and enforcement• Prioritized and managed time effectively and kept issues confidential• Turned complex information from multiple sources into simple, understandable material to train the organization• Provided training for staff on processes, operating and market systems, programs, and developments• Pursued innovations in technology and methods of presentation in an effort to continuously upgrade • Evaluated effectiveness of training programs and provided recommendations for improvement as appropriate • Maintained and reported annual budgeting for training needs• Travel to out of state locations to deliver and/or evaluate training needs Show less

• 

  UBC

  Jan 2015 - Mar 2022

  Oversee programs to ensure that all managers and supervisors are fully able to provide support to call center associates who assist patients with chronic conditions and the healthcare providers with the utmost customer service Serve as a client and vendor contact with external entities related to the program to establish and maintain excellent client managementTrain leaders on effective performance management and support Learning and Development as an advisor on creation and maintenance of leadership training guidesPartner with Compliance department leaders as an advisor on the task force to maintain and develop company Standard Operating ProceduresIdentify, assess, track, and mitigate issues and risks at multiple levelsDrive effective teamwork, communication, collaboration, and commitment across multiple groupsApply a data-oriented approach to evaluate program success, test new hypotheses, and scale initiatives Provide thought leadership to help identify program enhancements around opportunity areas of increasing revenue, leveraging data analytics skills and financial acumen to identify and prioritize the opportunities.Coordinate projects and programs across multiple business groups to ensure timely delivery of objectives.Effectively communicate program status, risks and issues to Senior Leadership, and present options and recommendations for resolution.Collaborate with Project Manager during project implementation as an Operations Subject Matter Expert to ensure successful and timely launch of programs from end to endCreation of Standard Operating Procedures, project specific procedures, business rules document. Contribute to the development of CRM system, portal designs and other electronic data capture solutions based on client expectationsAssist business development with request for proposal information, call center expertise, budget preparation, review and provide feedback on contract terms and conditions to contribute to an effective program. Show less • Managed multiple programs with clinical and non-clinical staff in a call center environment to support patients with terminal diseases states and their healthcare providers• Establish and maintain excellent client and vendor management • Schedule and monitor staff and day to day workflow• Develop employee’s skills, evaluate performance, and provide feedback• Oversees resolution of employee relations• Conducts hiring, training, and evaluation of staff• Develop, track, and monitor employee’s compliance to quality, service and production standards• Monitor prescription turnaround time so that internal standards and client performance guarantees are met• Manage program accounts receivables/payables• Produce accurate monthly invoicing for client review/approval• Address staff concerns and day to day operational, system, customer service, quality, and professional issues• Produce accurate and timely reporting of program status throughout its life cycle• Analyze program risks and work directly with client to ensure programs continued success• Work directly with regulatory team to ensure that program delivers successful annual audit results while maintaining program/company Standard Operating Procedures • Work in production as needed to support staff and maintain key performance indicators • Support new program implementation and identify process improvement to enhance the level of internal and external service provided• Partnered with Director of Operations to analyze operations and overall efficiencies• Serve as a point of escalation for issues requiring a higher degree of expertise or discretion to resolve• Direct point of contact with manufacturer • Work directly with client and contracting department to effectively maintain Master Service Agreement and Statement of WorkPresent monthly business reviews to client while delivering key successes and solutions to identified opportunities Represents operations in cross-functional meetings and projects Show less • Managed Call Center Case Managers to promote a working team environment and ensure best practices are shared• Work to develop employees’ skills, evaluates performance, and provides feedback• Oversee resolution of employee relations issues• Conduct hiring, training and evaluation of staff• Provides on-going coaching to each associate on their team concerning quality, reliability, accountability, and productivity• Maintain awareness on payer guidelines to ensure compliance is captured• Responsible for achievement of service levels and performance guarantees• Closely work with Senior Manager and Key Client to develop strategic business work plan goals• Handle client requests including eligibility, payer issues, claim review, reporting requests and general inquiries.• Site Champion to support troubleshooting and resolving requests through partnership with operational groups• Run weekly scheduled reporting, analyze, and maintain case data and report distribution for program leaders and external clients• Participate in Monthly/Quarterly Business Reviews with Key Client • Maintain excellent business relationship with Key Client • Successfully contribute to development of program and process improvement to enhance the level of internal and external customer service provided• Serve as point of escalation for issues and calls requiring a higher degree of expertise or direction to resolve customer issues to ensure a timely resolution• Successfully contribute to operations program metrics reaching stretch levels• Successfully lead multiple special projects to enhance program metrics and employee morale Show less • Successfully contributed to the design and development of training material for the Acthar Program • Defined the scope of the program in collaboration with Senior Leadership and created/executed a detailed work plan to address identified needs or gaps in performance or knowledge with a strong focus on client expectations • Use clear communication and cross-functional process management skills to ensure timely delivery of effective training courses that added value in business initiatives while maintaining compliance • Prioritize and manage time effectively and kept issues confidential• Turned complex information from multiple sources into simple, understandable material to train operations staff• Provide training for staff on processes, operating and market systems, programs, and developments• Successfully contributed to the implementation of a new workflow model for the Acthar Program• Collaborated with Leadership and Management to implement a new hire onboarding process• Maintain all required employee documentation• Evaluated effectiveness of training programs and provided recommendations for improvement as appropriate • Travel to out of state locations to deliver and/or evaluate training needs• Site Point of Contact for New Employee Orientation to include verification/completion of I-9 documentation Show less

  • Senior Program Manager – Operations Management

    Apr 2021 - Mar 2022

  • Program Manager – Operations Management

    Apr 2019 - Apr 2021

  • Associate Program Manager – Operations Management

    Jan 2017 - Apr 2019

  • Training Specialist - Learning and Development

    Jan 2015 - Jan 2017
• 

  Bozzuto

  Feb 2024 - Oct 2024

  Director

  As the Director of Resident Experience, I am the first person prospects and residents meet when they come home. I take ownership and pride in creating stellar first impressions and building ongoing positive relationships. My natural ability to strike up a conversation and make people feel “at home” is what enables me to excel. I enjoy personalizing every interaction and being the resource for resident and staff. I lead my Concierge Staff by example and ensure that we provide the best Customer Service in all interactions. Show less

• 

  Mercalis

  Sept 2024 - now

  Senior Manager - Design and Implementation - Hub

  As a Client Solutions and Design Manager, I help eliminate barriers for patients, increase their access to medications, and help them receive lifesaving treatments.The Client Solutions and Design Manager facilitates the detailed design session(s) to collaborate with the client, internal stakeholders and external partners, to successfully design and implement programs.