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Kelli Rivera_April 2016

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Kellie Rivera has over 15 years of experience in client advocacy and healthcare coordination. She has excelled in roles managing large caseloads and ensuring compliance with regulations. Most recently, she has worked on annual HEDIS projects for UnitedHealthcare abstracting medical records and creating reports to measure health plan performance.

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KELLI RIVERA 2236 W Heatherbrae Drive #3, Phoenix , AZ 85015 | H: 602-552-3319 | C: 602-303-6412 | kelrey7492@outlook.com Professional Background Experienced professional with excellent client and project management skills. Action-oriented with strong ability to communicate effectively with technology, peers, and managerial audiences. Skill Highlights Client Advocate Accomplishments Delivered compassionate care that exceeded department and agency requirements. While maintaining a large caseload and daily new application, achieved employee of the quarter as well as broke agency case completion records Ensured accuracy of workload by having zero quality control errors per Disability Quality Branch (DQB)reports. Professional Experience Clinical Quality Coordinator - HEDIS Project United Health Care 01/2015 to 05/2015 Phoenix , Arizona In the New Mexico and Texas Markets (Commercial) Working closely with Clinical Quality Managers (CQM), Hedis Program Managers (HPM) as well as other admin temporary employees to abstract and file needed medical records to review compliance for specific member measures assigned. Participated in unit based Quality Assurance Program. Contact providers and Medical records departments to ensure abstraction of any and all records needed. Recorded and filed patient data and medical records. Strictly followed all federal and state guidelines for release of information. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Created and maintained spreadsheets using advanced Excel functions and calculations to develop reports and lists. Clinical Quality Coordinator - HEDIS Project United Healthcare This is an annual contract lasting five months. 01/2016 to 05/2016 Phoenix , Arizona Working closely with Clinical Quality Managers (CQM), Hedis Program Managers (HPM) as well as other admin temporary employees to abstract and file needed medical records to review compliance for specific member measures assigned. Participated in unit based Quality Assurance Program.

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Contact providers and Medical records departments to ensure abstraction of any and all records needed. Recorded and filed patient data and medical records. Strictly followed all federal and state guidelines for release of information. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Created and maintained spreadsheets using advanced Excel functions and calculations to develop reports and lists. Program Service Evaluator, Team Supervisor, Assistant Local Office Manager and Disability Examiner 02/2004 to 06/2014 State of Arizona Phoenix , Arizona Managed caseload with a first in and first out policy unless a quick or expedited determination was needed due to severity of illness. Interviewed clients individually and with families to determine what services would best address their needs.

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Assessed patient and delivered comprehensive case management services. Presented case history material for review and discussion with other staff members. Maintained thorough case history records and wrote detailed reports. Maintained a caseload of 100+ clients working under strict deadlines. Educated residents and their families regarding other community resources. Performed various administrative duties, including data entry and document preparation. Education and Training Nursing Grand Canyon University Phoenix , Arizona , United States Attended two years at the College of Science and Nursing until a quad accident in 2010 forced a break from courses, will resume when time permits Human Services Assistant : Human Services Rio Solado Community College 2006 Tempe , Arizona , United States Coursework in Human Resources, Coursework in Public Health, Coursework in Community and Public Health Coursework in Health Service Policy and Analysis State Government Employee Management : Supervisor Academy 2007 Arizona Government Univsersity Phoenix , Arizona , United States Attended Supervisor Academy after a promotion into management while working for the Department of Economic Security (DES) Disability Examiner : Disability Claims Disability Determination Services Administration (DDSA) 2011 Phoenix , Arizona , United States 14 week training course assessing five domains of childhood development and federal and state guidelines regarding application and claim processing Leadership Essentials Certificate Employee of the Quarter Human Services Situational Leadership HIPPA Annual Certification Annual Exams for the following HEDIS Measures: Certifications

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Controlled Blood Pressure (CBP), Controlled Diabetic Care CDC), Pregnancy and Post Partum Care (PPC), Childhood Immunization Schedule (CIS) Well Child Check up (WCC), Colorectal Screening (COL) Affiliations Mother's In Sympathy and Support (MISS Foundation) July 2002 to Current - Support Group Facilitator/Parental Bereavement Advisor Board Dog Vacay - Host and Dog Care Provider

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Kelli Rivera_April 2016

  • 1. KELLI RIVERA 2236 W Heatherbrae Drive #3, Phoenix , AZ 85015 | H: 602-552-3319 | C: 602-303-6412 | kelrey7492@outlook.com Professional Background Experienced professional with excellent client and project management skills. Action-oriented with strong ability to communicate effectively with technology, peers, and managerial audiences. Skill Highlights Client Advocate Accomplishments Delivered compassionate care that exceeded department and agency requirements. While maintaining a large caseload and daily new application, achieved employee of the quarter as well as broke agency case completion records Ensured accuracy of workload by having zero quality control errors per Disability Quality Branch (DQB)reports. Professional Experience Clinical Quality Coordinator - HEDIS Project United Health Care 01/2015 to 05/2015 Phoenix , Arizona In the New Mexico and Texas Markets (Commercial) Working closely with Clinical Quality Managers (CQM), Hedis Program Managers (HPM) as well as other admin temporary employees to abstract and file needed medical records to review compliance for specific member measures assigned. Participated in unit based Quality Assurance Program. Contact providers and Medical records departments to ensure abstraction of any and all records needed. Recorded and filed patient data and medical records. Strictly followed all federal and state guidelines for release of information. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Created and maintained spreadsheets using advanced Excel functions and calculations to develop reports and lists. Clinical Quality Coordinator - HEDIS Project United Healthcare This is an annual contract lasting five months. 01/2016 to 05/2016 Phoenix , Arizona Working closely with Clinical Quality Managers (CQM), Hedis Program Managers (HPM) as well as other admin temporary employees to abstract and file needed medical records to review compliance for specific member measures assigned. Participated in unit based Quality Assurance Program.
  • 2. Contact providers and Medical records departments to ensure abstraction of any and all records needed. Recorded and filed patient data and medical records. Strictly followed all federal and state guidelines for release of information. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Created and maintained spreadsheets using advanced Excel functions and calculations to develop reports and lists. Program Service Evaluator, Team Supervisor, Assistant Local Office Manager and Disability Examiner 02/2004 to 06/2014 State of Arizona Phoenix , Arizona Managed caseload with a first in and first out policy unless a quick or expedited determination was needed due to severity of illness. Interviewed clients individually and with families to determine what services would best address their needs.
  • 3. Assessed patient and delivered comprehensive case management services. Presented case history material for review and discussion with other staff members. Maintained thorough case history records and wrote detailed reports. Maintained a caseload of 100+ clients working under strict deadlines. Educated residents and their families regarding other community resources. Performed various administrative duties, including data entry and document preparation. Education and Training Nursing Grand Canyon University Phoenix , Arizona , United States Attended two years at the College of Science and Nursing until a quad accident in 2010 forced a break from courses, will resume when time permits Human Services Assistant : Human Services Rio Solado Community College 2006 Tempe , Arizona , United States Coursework in Human Resources, Coursework in Public Health, Coursework in Community and Public Health Coursework in Health Service Policy and Analysis State Government Employee Management : Supervisor Academy 2007 Arizona Government Univsersity Phoenix , Arizona , United States Attended Supervisor Academy after a promotion into management while working for the Department of Economic Security (DES) Disability Examiner : Disability Claims Disability Determination Services Administration (DDSA) 2011 Phoenix , Arizona , United States 14 week training course assessing five domains of childhood development and federal and state guidelines regarding application and claim processing Leadership Essentials Certificate Employee of the Quarter Human Services Situational Leadership HIPPA Annual Certification Annual Exams for the following HEDIS Measures: Certifications
  • 4. Controlled Blood Pressure (CBP), Controlled Diabetic Care CDC), Pregnancy and Post Partum Care (PPC), Childhood Immunization Schedule (CIS) Well Child Check up (WCC), Colorectal Screening (COL) Affiliations Mother's In Sympathy and Support (MISS Foundation) July 2002 to Current - Support Group Facilitator/Parental Bereavement Advisor Board Dog Vacay - Host and Dog Care Provider