Lucero Nunez
Salt Lake City
Summary
Healthcare Operations & EDI Analyst with over 10 years of experience in eligibility data management, benefits administration, and Medicare compliance. Expertise in EDI file processing, root cause analysis, cross-functional system integrations, and operational workflow optimization. Known for improving process efficiency, mentoring peers, and driving scalable solutions in high-volume healthcare environments.
Overview
11
11
years of professional experience
Work History
Eligibility EDI Analyst
Collective Health
Lehi
07.2025 - Current
- Manage end-to-end ANSI X12 834 eligibility file processing across 11 client accounts in a high-volume production environment.
- Resolve 25+ daily Zendesk and Jira tickets within SLA while maintaining accuracy and timely issue resolution.
- Perform file validation, mapping analysis, and data reconciliation to identify and resolve eligibility discrepancies.
- Partner cross-functionally with Engineering, Product, and Implementation to support integrations, file builds, and client go-lives and Open Enrollment season.
- Lead complex file restructuring efforts during client organizational changes and integration updates.
- Guided peers on ANSI X12 logic, troubleshooting, and workflow best practices, fostering knowledge sharing and team capability.
Care Coordinator
Collective Health
Lehi
10.2021 - 07.2025
- Led training and onboarding for all new Care Coordinators, ensuring they had the knowledge and resources to excel in their roles.
- Conducted interviews for new team members, collaborating with leadership to select top talent.
- Played a key role in team meetings, providing insights, feedback, and process improvement suggestions to enhance care coordination.
- Managed administrative workflows, including scheduling appointments, researching plan benefits, handling claims questions, and coordinating care.
- Provided direct support to a multidisciplinary team of Social Workers, Nurses, Pharmacists, and Dietitians, ensuring seamless patient care.
- Assisted in developing and refining workflows, including participation in a pilot program that improved team efficiency.
DME Medical Sales
Byram Healthcare
Murray
01.2018 - 01.2021
- Managed a pipeline of 150+ Medicare patient referrals for continuous glucose monitors (CGMs) like Dexcom and Abbott FreeStyle Libre.
- Met and exceeded monthly sales goals and quotas, demonstrating strong sales performance and customer engagement.
- Conducted benefit checks to verify Medicare coverage and eligibility, ensuring patients met guidelines before proceeding with sales.
- Performed outbound sales calls, educating patients on CGM options, pricing, and long-term supply costs.
- Collaborated with providers and patients to gather clinical documentation and prescriptions, ensuring timely processing.
- Stayed up to date with Medicare policies and DME guidelines, ensuring compliance with changing regulations.
- Accurately documented all interactions and sales processes in Salesforce, maintaining meticulous records.
Pharmacy Analyst
Medical Review Institute of America
West Valley City
09.2015 - 02.2018
- Utilized healthcare and pharmacy knowledge to navigate multiple software systems for reviewing clinical documentation and criteria policies.
- Summarized and organized case information to prepare comprehensive reviews for physician evaluation.
- Resolved client inquiries and gathered necessary information via email and telephone for successful Rx case reviews.
- Communicated with physicians to coordinate daily administrative tasks and review progress.
- Applied strong time management to ensure timely and seamless case transitions in a fast-paced environment.
- Assigned licensed physicians to cases based on specific requirements and their availability.
- Ensured strict adherence to compliance processes and procedures throughout all review tasks.
Education
Associate of Science - Health Information
Salt Lake Community College
01-2014
Skills
- ANSI X12 834
- File Mapping
- Data Reconciliation
- Eligibility Data Validation
- Root Cause Analysis
- SLA Management
- Ticket Management
- Jira/Zendesk
- Microsoft Excel
- Google Workspace
- Analytical thinking
- Cross-functional Collaboration/Integration Support
- Project Management
- Implementation
- EDI testing procedures
Timeline
Eligibility EDI Analyst
Collective Health
07.2025 - Current
Care Coordinator
Collective Health
10.2021 - 07.2025
DME Medical Sales
Byram Healthcare
01.2018 - 01.2021
Pharmacy Analyst
Medical Review Institute of America
09.2015 - 02.2018
Associate of Science - Health Information
Salt Lake Community College