Summary
Overview
Work History
Education
Skills
Relevant Coursework
Timeline
Generic

SUMMER-LEA RIVITO

Schwenksville

Summary

Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

Overview

28
28
years of professional experience

Work History

Service Advocate, Medicare Service Operations

Aetna Insurance/CVS Caremark
11.2020 - Current
  • Review and analyze medical claims to ensure accuracy and completeness of required information.
  • Research and assign CPT, ICD-10, and HCPCS codes based on provider documentation, industry standards, and payer requirements.
  • Identify and resolve missing or inaccurate diagnosis and procedure codes to support accurate claim submission and reimbursement.
  • Apply knowledge of coding guidelines, medical terminology, and insurance policies to validate claim accuracy.
  • Collaborate with providers, internal departments, and claim processors to obtain clarifying documentation and ensure compliance with regulatory standards.
  • Maintain productivity and quality standards while meeting strict deadlines for claim adjudication.
  • Demonstrate attention to detail in analyzing documentation and coding to minimize denials and improve first-pass claim acceptance rates.
  • Utilized tools such as MS Project, QuickBase, SharePoint, and Tableau to streamline service processes.
  • Mentored colleagues on meeting their metrics
  • Created training modules for new hires within the department
  • Worked on the SharePoint web-design team creating the departments webpage
  • Managed the departments Engagement Team

Deli Manager

The GIANT Company
05.1997 - 10.2020
  • Led a team of 21+ employees, overseeing scheduling, training, and daily operations.
  • Consistently met and exceeded monthly sales and profit goals through strong leadership and product knowledge.
  • Managed departmental budgets and invoices while ensuring high customer satisfaction.
  • Promoted a positive work environment, boosting team morale, and productivity.

Education

Master of Science in Management - Project Management

Colorado Technical University
08.2025

Master of Business Administration - Data Analytics

Colorado Technical University
04.2024

Bachelor of Applied Science - Healthcare Management

Jefferson University
Philadelphia, PA
08.2021

Skills

  • Project Planning & Execution
  • Agile, Waterfall & Hybrid Methodologies
  • Customer Service Excellence
  • Team Leadership & Staff Development
  • Data Analysis & Reporting (Tableau, Excel)
  • MS Project, Word, PowerPoint, Access
  • Budget Management & Scheduling
  • Conflict Resolution & Problem Solving
  • Decision-making skills
  • Customer service background
  • Complaint handling
  • Complex Problem-solving

Relevant Coursework

  • Project Management Fundamentals
  • Project Procurement & Contract Management
  • Agile, Waterfall & Hybrid Methods
  • Operations Management
  • Scheduling & Control
  • Financial Decision Making
  • Organizational Behavior
  • Leadership Theory
  • Cross-Cultural Communication
  • HR & Information Systems Management

Timeline

Service Advocate, Medicare Service Operations

Aetna Insurance/CVS Caremark
11.2020 - Current

Deli Manager

The GIANT Company
05.1997 - 10.2020

Master of Science in Management - Project Management

Colorado Technical University

Master of Business Administration - Data Analytics

Colorado Technical University

Bachelor of Applied Science - Healthcare Management

Jefferson University

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SUMMER-LEA RIVITO