Ashley Rivera Robles

Reduce medical costs by identifying waste and error by determining the accuracy of the bill submitted by the provider to United Health Group and comparing it to medical records submitted for the date of service being reviewed.

• Perform clinical judgement/decision making on complex payment decisions that directly impacts the provider and UnitedHealthcare/Client by following state and government compliance guidelines and the policies set forth by the department.
• Navigate claims application (Facets), and internal systems to research and work independently on making decisions.
• Analyze and interpret data and medical records/documentation on a daily basis to understand historical claims activity, determine validity, and demonstrate their ability to provide written or verbal communication to senior leadership on root cause identification.

• Monitored over 140+ patients monthly and reported changes in patient condition to physician in accordance with policies and procedures of medical facility.
• Developed and modified patient care plans and identifying client needs and goals to determine priorities of care.
• Updated patient charts with data such as medications and vitals to keep records current and support accurate treatments.
• Educated family members and caregivers on patient care instructions.
• Participated in professional growth programs to support special education improvement efforts.
• Evaluated patient histories, complaints and current symptoms.
• Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
• Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.

• Worked collaboratively with other mental health professionals to provide consistent care and minimize diversion.
• Evaluated patients to identify behavioral concerns and medically relevant symptoms.
• Cross-trained existing employees to maximize team agility and performance.
• Trained and mentored staff to maximize effectiveness.
• Evaluated employees strengths and assigned tasks based upon experience and training.
• Demonstrated new procedures and techniques to employees.
• Documented vitals, behaviors and medications in client medical records.
• Transported patients between rooms and appointments or testing locations.
• Documented resident's behavior in terms of mental status, sleeping and eating patterns in medical record books.
• Helped patients effectively manage routine bathing, grooming and other hygiene needs.
• Participated in fun activities with patients to boost mood, improve overall memory and provide light entertainment.
• Kept patients mentally alert by entertaining, conversing and reading aloud to patients.
• Facilitated activities of daily living, including personal hygiene management, feeding and ambulation.