Nayely Saldana
Sacramento,CA
Summary
Detail-oriented professional with extensive experience in case management and a strong commitment to HIPAA compliance. Known for exceptional organizational skills and the ability to provide exemplary service, ensuring seamless intake processes and effective communication with employees.
Overview
10
10
years of professional experience
1
1
Certification
Work History
HR LOA Intake Specialist
CommonSpirit Health
06.2021 - Current
- Opens the claim; determines eligibility; sends all notifications; validates whether the request is a new claim or an extension of an existing claim; and uses all Case Management features and functionality including notes, new tasks, correction of a personal or employment information if necessary.
- Call Center Operations: Answers incoming calls to set up leaves of absence as part of the Intake team; provides exemplary service in both quality and quantity, to employees and others in the organization starting or inquiring about leaves of absence; and performs outbound call backs as required and on rotation.
- Follow up: reports and follows up on any Case Management issues or problems; and completes the follow up on initial STD intake requests
- CLMS , Certified
- Help Employee's in obtaining eligibility under FMLA, CFRA, Medical Leaves.
Patient Service Representative
Dignity Health
Folsom, CA
09.2020 - 06.2021
- Accessed patient information through variety of office software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
- Scheduled patient appointment and procedures with GECB and CERNER.
- Referred patients to appropriate professionals and services.
- Checked daily doctor schedules and verified insurance.
- Proficiency in using e-mail systems, Internet and MS office software applications
- Taking complete and accurate messages, and scheduling mutually acceptable appointment times utilizing an electronic appointment management system, electronic health record, and contact center system.
Patient Access Representative
Sutter Health
Roseville’s , CA
09.2019 - 06.2020
- Accessed patient information through variety of office software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
- Knowledge of insurances including HMO, PPO, Medicare, Medi-Cal, and other federal and state agency programs
- Provide patients with benefits breakdowns Using Ecare next system.
- Epic Software and Ecare
- Identifying limitations and exclusions
- Work in High call volumes and time limits
- Customer Service attention to detail and keyboarding skills
- Checked insurance benefits, received payments and provided receipts.
- Verified patient information, including demographics, insurance and providing patient estimates for outpatient/inpatient procedures
Patient Care Coordinator
Western Dental & Orthodontics
Roseville, CA
11.2015 - 03.2019
- Provide patient consultations and communicate information about recommend treatment plans.
- Discuss cost of service , insurance coverage and payment options
- Set and achieve personal sale goals while supporting team goals.
- Handling challenging patient and finding quick resolutions .
- Introduce new patients to office and staff .
- Support strategic local marketing initiatives that help drive brand awareness and new patient growth.
- Customer service acknowledgement; smile greet patients upon arrival and dismissal.-
- Handling multiple phone lines, and patients
- HIPPA knowledge
- Scheduling , Answering telephones, and and maintaining appointment book
Buyer
Ebara Technologies Inc.
Sacramento, CA
04.2017 - 10.2017
- Maintains files, logs and records of invoices.
- Handel work orders, and replace or repair order management
- Assist on expediting orders thru Japan and within the US
- Contacting Vendors to obtain prices and schedule deliveries
- Run MRP and analyze ,verify, recommended purchase and place purchase orders to vendors and suppliers.
- Recommended optimal suppliers after qualifying vendors and evaluating proposals.
- Analyzed sales trends to maximize sales potential.
- Complied with federal, state and company policies, procedures and regulations.
- Organized inventory for multiple locations.
- Communicated closely and effectively with all partners, including vendors, merchants and the distribution center, which helped to ensure well-timed product deliveries.
Education
Natomas High School
05-2011
Bachelor Of Business Administration (BBA) - Industrial Organizational Psychology
American River College/ Sacramento State College
Sacramento, CASkills
- Proficient with basic technology (eg, Point of Sale system, Microsoft Office programs, and Apple devices)
- Excellent written and verbal communication
- Strong collaboration and interpersonal skills
- Strong organizational skills to manage multiple tasks
- Ability to react under pressure, use good judgment in ambiguous situations, and be flexible/adaptable
- Case management
- Quality assurance
- HIPAA compliance
- Self-Directed
Certification
- Leave Managment, Commonspirit LOA Dept - 2021
Accomplishments
Employee of the Month of March 2023
Timeline
HR LOA Intake Specialist
CommonSpirit Health
06.2021 - Current
Patient Service Representative
Dignity Health
09.2020 - 06.2021
Patient Access Representative
Sutter Health
09.2019 - 06.2020
Buyer
Ebara Technologies Inc.
04.2017 - 10.2017
Patient Care Coordinator
Western Dental & Orthodontics
11.2015 - 03.2019
Natomas High School
Bachelor Of Business Administration (BBA) - Industrial Organizational Psychology
American River College/ Sacramento State College