Karen Lopez
Chandler,AZ
Summary
High motivated health care administrator equipped with top-notch communication and decision-making abilities. Facilitates smooth operations with collaborative and proactive approach. Well-versed in healthcare standards and best practices for fully compliant, safe and successful outcomes. Eager to bring talent and expertise to growing department.
Overview
4
4
years of professional experience
Work History
Sr. Clinical Administrative Coordinator
Optum
11.2021 - Current
- Manage referral process, processing incoming referrals for nursing and case manager teams
- Work with hospitals/SNF/Vendors/Providers to facilitate referrals and other services appropriate for patients
- Develop collaborative partnership relationships with healthcare providers in order to provide patients with expeditious delivery of service
- Serve as liaison between patients, providers, and internal staff
- Perform thorough assessment/review of internal/ external referrals and patient's chart to determine eligibility of services
- Work with clinical teams to manage requests for services for patient
- Develop collaborative partnership relationships with health care providers and support staff through frequent communication and interaction
- Provide appropriate triage of queue notifications for clinical/non-clinical assessment/intervention
- Act as Subject Matter Expert for other team members
- Demonstrate good judgment and ability to effectively handle large amounts of information in detailed and timely manner, including confidential patient information.
Clinical Administrative Coordinator
Optum
07.2020 - 11.2021
- Outreach calls to members post facility discharge, verify member using HIPAA
- Navigate EMR systems to review patient health information
- Maintain accurate and timely documentation
- Collaborating with PCP Network, physician offices and hospital facilities
- Support members with coordinating healthcare services
- Arranging post-discharge appointments, transportation, and transition of patient across continuum of care
- Assisted patients in adhering to prescribed care models via phone and email communications.
- Assist with referrals/calls received, and complete outreach calls and documentation
- Reviewed cases to determine need for escalation.
- Maintained high-level knowledge of federal and state regulations on patient privacy.
- Performed patient census operations, collecting data to generate comprehensive profile of practice's performance.
Call Center Specialist
Resilient Behavioral Health
09.2019 - 06.2020
- Handle high volume of inbound/outbound calls
- Work closely with providers to verify eligibility of services
- Assisted customers by answering questions and responding to inquiries.
- Maintain accurate and timely documentation
- Maintain relationships with providers through frequent communication
- Use HIPAA to verify new patient information and health insurance
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
Education
Bachelor of Science - Behavioral Health Science
Grand Canyon University
Phoenix, Arizona12.2019
High School Diploma -
Independence High School
Glendale, Arizona05.2016
Skills
- Conflict Management
- Collaboration
- Resourceful
- Problem Resolution
- Enrollment Management
- Health Plan Operations
- Decision-Making
- Critical Thinking
- Leadership
- Attention to Detail
- Time Management
- Adaptability
Languages
Spanish
Full Professional
Timeline
Sr. Clinical Administrative Coordinator
Optum
11.2021 - Current
Clinical Administrative Coordinator
Optum
07.2020 - 11.2021
Call Center Specialist
Resilient Behavioral Health
09.2019 - 06.2020
Bachelor of Science - Behavioral Health Science
Grand Canyon University
High School Diploma -
Independence High School
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