LUZ LEPE
Optum
Las Vegas,NV
15
years of professional experience
Experienced Remote Medical Authorization Specialist with 5+ years managing benefits verification, prior authorizations, and care coordination across outpatient, inpatient, home health, DME, infusion, medication management, radiology, surgery, and OT/PT/ST therapy services. Proficient in payer policy interpretation, authorizing timely services, documenting clinical justification, and communicating with providers, patients, and case managers to reduce denials and expedite care. Strong EMR/EHR, telehealth, and authorization platform skills; HIPAA-compliant, detail-oriented, and committed to improving throughput and patient outcomes.
Work History
Authorization Coordinator
1 Year 11 Months- Obtain prior authorizations for tests, procedures, and medications, using payer guidelines and clinical information.
- Verify patient insurance benefits and eligibility, ensuring compliance with plan requirements.
- Review and document authorization details, reimbursement information, and insurance verification in practice management or EMR/EHR systems.
- Communicate authorization status to clinical staff, scheduling teams, and providers to coordinate care.
- Interact with medical providers and insurers to clarify requirements and resolve authorization challenges.
- Accurately complete verifications for same day or walk-in patients by contacting the provided insurance via phone, fax, or online portal.
Authorization and Benefits Coordinator
2 Years- Verify insurance benefit information monthly via multiple methods such as online tools, calling payors or processing test claims.
- Contact prescriber’s office to obtain information that is required to complete ongoing re-authorization and verification of benefits.
- Places outbound calls to patients or prescriber’s offices to notify of any delays due to more information needed to process or due to a prior authorization.
- Document insurance coverage of medications, administration supplies, and related infusion services including prior authorization requirements and coordination of benefits.
- Maintains up to date prior authorization report.
- Use correct billing codes to support clean claim submission.
- Check benefits to determine deductible, coinsurance, and copayment amounts due.
- Assisted Claims Department as needed.
Medical Assistant Team Leader
10 Years 11 Months- Supervised and provided daily guidance to a team of Medical Assistants to ensure efficient clinic operations and quality patient care.
- Coordinated staff schedules, assignments, and workflow to maintain optimal patient flow and productivity.
- Trained, onboarded, and mentored new Medical Assistants on clinical procedures, electronic medical records (EMR), and office protocols.
- Assisted providers with patient examinations, procedures, and treatments while ensuring adherence to clinical standards.
- Performed patient intake, including obtaining vital signs, medical histories, medication reconciliation, and documenting information in the EMR.
- Ensured compliance with HIPAA, OSHA, infection control, and organizational policies and procedures.
- Managed clinical supply inventory, ordered medical supplies, and maintained exam room readiness.
- Served as a liaison between providers, staff, and patients to resolve concerns and improve communication.
- Monitored quality assurance initiatives and implemented process improvements to enhance patient satisfaction and clinic efficiency.
- Coordinated referrals, prior authorizations, and follow-up care to ensure continuity of patient treatment.
- Assisted with surgery scheduling, surgery authorization and patients payment reasonability .
Medical Administration Assistant
4 Years 9 Months- Enforced safety standards in accordance with OSHA regulations and HIPAA guidelines.
- Provided leadership and supervision to a medical assistant team of 5 ensuring that all tasks were completed in a timely manner.
- Cleaned treatment rooms and medical instruments, complying with infection control standards.
- Administered injections per physician orders while adhering to safety guidelines set forth by the facility's policy manual.
- Compiled patient histories by interviewing them regarding their medical history, family history, current medications or treatments they are undergoing.
- Collaborated with surgeons and anesthesiologists to ensure proper coordination of resources needed for each procedure.
- Responded promptly to inquiries from patients regarding their upcoming surgery dates and times.
- Coordinated pre-operative assessments for surgical candidates, including lab work and imaging tests.
- Scheduled surgeries for clinic patients in a timely manner, prioritizing urgent procedures.
Education
Social Work Associate Degree
Medical Assistant Diploma
High School Diploma
Skills
CPT & HCPS Codes
ICD-10
EMR / EHR Systems
Medical Terminology
Insurance Verification
Insurance Eligibility
Time Management
Excel / Microsoft / Word / Outlook
Remote Communication
HIPAA Compliance
Problem Resolution
Timeline
Authorization Coordinator
Optum
05.2024 - 04.2026Read More
Authorization and Benefits Coordinator
TELADOC
01.2022 - 01.2024Read More
Medical Assistant Team Leader
DELEE MD OB-GYN & FERTILITY CENTER
01.2013 - 12.2023Read More
Medical Administration Assistant
HAMON MEDICAL CENTER
03.2011 - 12.2015Read More
Las Vegas High School
High School Diploma
Read More
College of Southern Nevada
Medical Assistant Diploma
Read More
US Career Institute
Social Work Associate Degree
Read More