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Work Background
Loree Tamayo Consulting & ManagementHealthcare Consultant and UR Specialist
Jun. 2022Assess and improve case management workflows to ensure timely patient care transitions, discharge planning, and coordination across the continuum of care.
Analyze case management metrics (e.g., length of stay, readmission rates) to identify inefficiencies and recommend improvements.
Support training and implementation of evidence-based practices in case coordination and interdisciplinary communication.
Facilitate compliance with CMS Conditions of Participation and accreditation standards
Conduct audits and reviews to evaluate appropriateness of care, medical necessity, and adherence to payer criteria (e.g., InterQual, MCG).
Develop or enhance UR programs to improve accuracy, reduce denials, and ensure timely reviews and documentation.
Provide guidance on appeals and peer review processes in collaboration with medical staff and legal teams.
Stay current with regulatory updates and payer policies affecting utilization management.
Perform gap analyses and readiness assessments for healthcare organizations seeking to improve their case management and utilization review systems.
Lead client meetings, presentations, and reporting to communicate findings, progress, and strategic recommendations.
Collaborate with interdisciplinary teams including physicians, nurses, care managers, and financial services staff.
Deliver tailored solutions, education, and tools to improve compliance, patient outcomes, and operational efficiency.
Perform and educate prior authorization processes for hospital admissions Initiate healthy client communications with payor sources
Pain Specialists of AmericaFront Office MA/ FOM
Feb. 2020 - Jan. 2022Handling inquiries, complaints, and requests from clients or customers.
Providing support via phone, email, or in-person.
Maintaining a positive and professional relationship with clients. Greeting clients or visitors.
Answering phone calls and directing them to appropriate departments. Managing appointment schedules and event coordination.
Handling incoming payments and invoicing.
Assisting with client billing and financial documentation.
Maintain accurate financial records and ensure compliance with regulations.
Coordinate office supplies and equipment.
Ensure the office environment is conducive to productivity.
Oversee office maintenance and safety procedures.
Address customer or client inquiries and issues, typically in a back-office capacity.
Ensure service-level agreements (SLAs) are met.
Work with other departments to improve customer service.
Organize meetings, take minutes, and coordinate schedules.
Handle correspondence, including emails and phone calls
Provide training and ensure that all staff follow company policies.
Manage appointments and meeting room reservations.
Manage cash, credit card transactions, or billing for services rendered, generate superbills
Rocky Mountain GastroenterologyFront Office Coordinator and Endoscopy Technician
Jan. 2018 - May. 2019Oversee visitor check-in and check-out processes.
Greet and assist clients or customers in person.
Provide information on company products, services, and policies.
Coordinate office supplies and equipment.
Coordinate patient financial obligations with Insurances and collect payments due at time of service.
Ensuring all endoscopic instruments (e.g., scopes, biopsy forceps) are properly cleaned and disinfected before and after use. This includes following strict infection control protocols.
Preparing the endoscopy room by arranging necessary instruments, ensuring the equipment is functioning, and setting up the monitors and lighting needed for the procedure.
Verifying that the endoscope and related tools are in working order, performing pre-procedure tests, and ensuring the safety of equipment.
Helping to position patients on the procedure table appropriately to ensure a safe and comfortable procedure.
Assisting the physician by passing the endoscope and related instruments during the procedure. This requires good understanding of the equipment and the procedure being performed.
Observing patients for signs of distress, providing reassurance, and assisting with sedation monitoring under the direction of the healthcare team.
Recording patient information, including procedure details and any findings (e.g., biopsy results, abnormalities).
Assisting patients with recovery, monitoring for any immediate post-procedure complications, and ensuring the patient is stable before discharge.
Assisting the physician in collecting tissue or fluid samples for biopsy, and ensuring proper labeling and handling of specimens for pathology.
Keeping track of medical supplies, ensuring that all necessary equipment is available, and managing the ordering and restocking of supplies. Accurately documenting patient records, equipment usage, and any issues that occurred during the procedure.
Colorado Pain SpecialistsFront and Back office Medical Assistant
May. 2011 - Jun. 2017Answering phone calls and scheduling patient appointments.
Managing appointment calendars and confirming appointments.
Handling cancellations and rescheduling.
Greeting patients as they arrive at the clinic or office.
Verifying patient information and updating medical records.
Collecting and processing co-pays, deductibles, and insurance information.
Providing patients with necessary forms to complete, such as medical history or consent forms.
Verifying patient insurance coverage and eligibility.
Communicating with insurance companies to obtain authorizations for procedures or medications.
Organizing and maintaining patient files, ensuring they are up to date and accurate.
Relaying messages between patients and medical staff.
Ordering office supplies and keeping inventory.
Assisting with general administrative duties like faxing, emailing, and copying.
Taking vital signs, such as blood pressure, heart rate, temperature, and weight.
Recording patient medical histories, symptoms, and medications.
Assisting the physician during patient exams, surgeries, or minor procedures.
Explaining post-procedure care instructions and follow-up appointments.
Documenting patient notes in electronic health records (EHR) or paper charts.
COLORADO PAIN MANAGEMENT &Front and Back office Medical Assistant
Jan. 2009 - Feb. 2011Answering phone calls and scheduling patient appointments.
Managing appointment calendars and confirming appointments.
Handling cancellations and rescheduling.
Greeting patients as they arrive at the clinic or office.
Verifying patient information and updating medical records.
Collecting and processing co-pays, deductibles, and insurance information.
Providing patients with necessary forms to complete, such as medical history or consent forms.
Verifying patient insurance coverage and eligibility.
Communicating with insurance companies to obtain authorizations for procedures or medications.
Organizing and maintaining patient files, ensuring they are up to date and accurate.
Relaying messages between patients and medical staff.
Ordering office supplies and keeping inventory.
Assisting with general administrative duties like faxing, emailing, and copying.
Taking vital signs, such as blood pressure, heart rate, temperature, and weight.
Recording patient medical histories, symptoms, and medications.
Assisting the physician during patient exams, surgeries, or minor procedures.
Explaining post-procedure care instructions and follow-up appointments.
Documenting patient notes in electronic health records (EHR) or paper charts
ROCKY MOUNTAIN PAIN MANAGEMENT LLCFront and Back office Medical Assistant
Sep. 2007 - Dec. 2008Answering phone calls and scheduling patient appointments.
Managing appointment calendars and confirming appointments.
Handling cancellations and rescheduling.
Greeting patients as they arrive at the clinic or office.
Verifying patient information and updating medical records.
Collecting and processing co-pays, deductibles, and insurance information.
Providing patients with necessary forms to complete, such as medical history or consent forms.
Verifying patient insurance coverage and eligibility.
Communicating with insurance companies to obtain authorizations for procedures or medications.
Organizing and maintaining patient files, ensuring they are up to date and accurate.
Relaying messages between patients and medical staff.
Ordering office supplies and keeping inventory.
Assisting with general administrative duties like faxing, emailing, and copying.
Taking vital signs, such as blood pressure, heart rate, temperature, and weight.
Recording patient medical histories, symptoms, and medications.
Assisting the physician during patient exams, surgeries, or minor procedures.
Explaining post-procedure care instructions and follow-up appointments.
Documenting patient notes in electronic health records (EHR) or paper charts.
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