Vanessa Ramos
Los Angeles
Summary
Healthcare professional with extensive experience in medical authorizations and insurance verification, including Medical, Medicare, HMO, and private insurances. Demonstrated ability to manage high-volume workloads while maintaining accuracy and compliance in patient care. Recognized for leadership in training staff and enhancing workflow efficiency. Tech-savvy and detail-oriented, committed to exceeding performance goals and supporting departmental success.
Overview
1
1
Certification
21
21
years of professional experience
Work History
Lead Authorization Dept
De La Pena Eye Clinic
Montebello, CA
06.2023 - 06.2026
- Ensuring the team consistently meets daily goals through effective guidance.
- Training team members on the authorization submission process to enhance efficiency.
- Identifying errors and proposing solutions to improve accuracy.
- Provide support to other departments as needed.
- Monitoring workloads and organizing schedules to prioritize tasks and meet deadlines.
- Assist in interviewing.
- Review systems and flow, for a more optimum workflow.
- Roll out communication to the team by holding team huddles, emails, or via teams.
- Work closely with management to maintain proper communication, workflow, and compliance.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
Authorizations Specialist
De La Peña Eye Group
Montebello, CA
07.2010 - 06.2023
- Managed authorizations for various eye care surgery procedures and injections.
- Processed patient authorization requests efficiently and accurately for Ophthalmology, Optometry, Cornea and Retina Specialist.
- Monitor authorization status, follow up proactively to prevent delays in patient care.
- Verified eligibility with insurance plans, PPO, Medicare, and Medi-Cal daily to support accurate and complete authorizations for medical HMO groups.
- Submit urgent and/or Retro authorizations within established timelines to support same-day service needs.
- Generate and submit 60–85 authorizations daily through IPA portals, consistently meeting productivity.
- Prepare and generate paper authorizations for fax submission to IPA and PCP offices when required.
- Update monthly coverages to maintain accurate patient demographics and insurance coverage information in DNA/Modmed system.
- Provide onboarding and hands-on training to new Authorization Department employees, ensuring adherence to workflow standards.
- Step into expanded roles during staffing shortages, covering multiple responsibilities while maintaining daily productivity goals and workflow efficiency.
- Monitor incoming phone calls and provide customer service by directing them to appropriate department.
Front Desk
Star Optometry
Huntington Park, CA
10.2005 - 06.2010
- Conducted pretest for patients prior to physician consultations.
- Managed sales of eyeglasses and oversight of contact lens orders.
- Processed insurance billing for various providers, including HMO/PPO plans.
- Verified insurance coverage and collected patient co-pays.
- Trained patients for proper usage of contact lenses and eyewear.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
Education
Associate of Arts -
Cerritos Community College
Cerritos, CAHigh School Diploma - undefined
Huntington Park High School
Huntington Park, CASkills
- Knowledge in ICD-10, ICD-9, and CPT coding
- Ability to work independently and manage multiple priorities in a fast-paced, deadline-driven environment
- Excellent group facilitation skills
- Proficient in PC-based software programs
- Bilingual(English/Spanish)
- Experience in workflow planning, staff cost management, and business development
- Experience in conducting performance reviews and facilitating hiring and onboarding
- Knowledge of Medical, Medicare, HMO's, Vision Plans, and PPO's
Certification
HIPAA Compliance Training
Timeline
Lead Authorization Dept
De La Pena Eye Clinic
06.2023 - 06.2026
Authorizations Specialist
De La Peña Eye Group
07.2010 - 06.2023
Front Desk
Star Optometry
10.2005 - 06.2010
High School Diploma - undefined
Huntington Park High School
Associate of Arts -
Cerritos Community College