Sahar Galbert
Las Vegas,USA
Summary
Dynamic professional with 5+ years in healthcare patient and member care coordination. Skilled in telephonic outreach, EMR systems, and HIPAA compliance, ensuring efficient appointment scheduling and patient support. I collaborate with interdisciplinary teams to drive continuous care improvements.
I have extensive experience in patient advocacy, crisis intervention, and compliance auditing. I demonstrate strong abilities in telephonic outreach and care coordination, effectively managing high-volume interactions to ensure optimal patient support. Skilled in collaborating with teams to foster continuous improvements in healthcare delivery. Skilled in handling complex insurance claims and policy processing with experience in navigating through various insurance software systems. Demonstrates strong analytical skills, adept at interpreting policies and efficiently resolving claims to the satisfaction of all parties involved. Known for maintaining high accuracy levels in document processing and data entry, contributing to streamlined operations and improved customer service outcomes. Continuously seeks ways to optimize workflows and enhance team productivity, leading to more efficient claim resolution processes.
Overview
9
9
years of professional experience
Work History
Care Coordinator
Humana
Las Vegas, Nv
10.2025 - Current
- Educated patients on available resources and health management options to empower self-care and enhance health outcomes.
- Identified and addressed members' gaps in care to enhance health outcomes. in care and facilitated transfers to Care managers for additional support.
- Efficiently coordinated and scheduled appointments to streamline members' access to healthcare services. appointments for members to ensure timely access to necessary care, improving patient satisfaction and continuity of services.
- Delivered crisis intervention services to support patients during critical situations.
- Investigated and reported issues relating to patient care and conditions which might hinder patient well-being.
- Documented care coordination activities in an electronic health records system.
- Assessed safety risks associated with living environments or activities of daily living.
- Operated phone systems as a Certified Medical Script Administrator (CMSA) to ensure script accuracy.
Remote Pharmacy Care Support & Member Services Rep
Elevance Health
Las Vegas, NV
06.2024 - 10.2025
- Managed high-volume patient correspondence via inbound and outbound calls, live chats, and emails, built rapport and provided excellent customer service.
- Processed and troubleshot patient prescription requests in strict adherence to HIPAA guidelines, efficiently entering refill orders and resolving data entry exceptions.
- Resolved third party rejects by gathering plan-specific information, correcting claims data, and securing override approvals from insurance providers, which ensured patient access to medications.
- Collaborated with internal pharmacists and escalated clinical or system issues to senior staff to ensure timely resolution and compliance.
- Connected patients to essential resources through case management support, facilitating healthcare appointment scheduling and access to local community services.
- Coordinated with external partners, including social workers and community organizations, to facilitate continuity of care for patients.
- Assisted customers with Medicare inquiries and benefit explanations.
- Communicated with insurance providers to obtain relevant details regarding patient benefits and coverage. to ascertain pertinent information regarding policies and payment benefits for patients.
- Determined client eligibility for Medicaid benefits, ensuring compliance with program requirements. for Medicaid programs and benefits.
- Drafted appeal letters and resolution notices for members and providers, streamlining communication and improving resolution processes.
- Documented appeal findings, correspondence, and case notes in tracking systems.
- Escalated complex grievances to appropriate departments for further review.
- Applied appropriate corrective actions when necessary after reviewing evidence from grievance hearings or investigations.
- Coordinated with adjusters, providers, and internal claims team.
- Processed a high volume of claims efficiently while maintaining quality standards.
- Handled customer inquiries regarding insurance policy coverage details and payment status updates.
- Provided quality customer service to assigned, insured and claimants throughout the claims process to deliver timely service to customers.
- Adhered to strict guidelines pertaining to confidentiality while handling sensitive personal information.
- Collaborated with other departments to resolve billing disputes or address customer concerns quickly.
- Resolved complex discrepancies in policyholder files to facilitate accurate claim processing.
- Assisted customers with selecting and purchasing medications.
- Verified delivery details against pharmacy orders and patient addresses.
- Responded quickly to customer inquiries about order status or estimated arrival times.
Remote HEDIS Compliance Specialist
Elevance Health
Remote
02.2024 - 06.2024
- Coordinated HEDIS processes and results updates for management, maintaining action plans that enhanced compliance and improved member outcomes.
- Coordinated and reported progress on annual HEDIS/Quality chart abstraction process, ensuring timely completion and compliance.
- Applied structured auditing criteria to medical records for HEDIS and Quality standards, demonstrating expertise in mandated performance measures.
- Collaborated with providers and internal departments on rate investigations and validation activities, maintaining comprehensive documentation to support accuracy.
- Collaborated with providers and internal departments on rate investigation, validation activities, and maintaining all evidence and documentation.
- Researched discrepancies by reviewing medical records and other relevant information, identifying trends and documenting errors.
- Supported quality improvement initiatives through accurate data reporting, facilitating adherence to evolving guidelines and healthcare regulations.
Patient Intake & Case Coordinator Lead
Icarus Behavioral Health
Las Vegas, NV
11.2023 - 02.2024
- Managed client intake, referrals, and eligibility screening for behavioral health care.
- Cultivated relationships with discharge planners, case managers, and physicians to enhance placement referrals and facilitate seamless care transitions.
- Processed and screened patient referrals promptly, maintaining communication with leadership regarding patient status.
- Completed admission packets and assisted residents in determining healthcare decisions, ensuring compliance with facility policies.
- Monitored service delivery and adherence to treatment plans, updating plans as objectives changed or were met.
- Tracked client adherence to treatment plans for optimal care outcomes, discharge needs, and aftercare support for clients.
- Coordinated scheduling of client assessments to ensure timely evaluations, appointments, and follow-up visits for Icarus clients.
- Maintained communication with court personnel, tracking court appearances and evaluation appointments to ensure patient compliance with legal requirements.
- Coordinated with court personnel to ensure accurate tracking of patient court appearances and evaluation appointments.
- Documented court activities and case management processes accurately and timely in electronic systems to support effective case tracking and compliance.
- Coordinated communication among families, clinicians, and community agencies to ensure effective care management.
- Participated in weekly team meetings to share updates about current cases.
- Ensured confidentiality of all sensitive information associated with cases being managed.
- Advised clients on how best to manage their finances while meeting their basic needs.
- Monitored case progress using data analysis tools, ensuring accurate tracking of client statuses and treatment outcomes.
- Provided guidance and counseling services to clients in crisis situations.
- Developed and implemented case plans to meet the needs of clients.
- Assisted clients in navigating complex legal systems by providing resources and referrals.
Behavioral Health Coordinator
Icarus Behavioral Health
Las Vegas, NV
09.2022 - 12.2023
- Conducted recovery-focused group sessions, mentoring participants and promoting healthy coping and communication skills.
- Established rapport with patients and clinical teams to foster a supportive treatment environment.
- Monitored patient well-being during treatment, promptly reporting concerning behaviors and vital signs to medical staff to ensure timely interventions.
- Facilitated patient intakes, orientations, and daily treatment routines, improving clinical workflow and patient engagement.
- Recorded and tracked self-administered medications for each patient to ensure compliance with treatment plans., recording and tracking individual vitals in patient charts.
- Instructed clients on effective social skills training techniques to enhance their interpersonal interactions. in social skills training techniques such as positive reinforcement, prompting, and shaping behaviors.
- Demonstrated calm behavior during challenging situations to provide support and stability for clients. to provide support during challenging situations, fostering a positive environment., patient support during challenging behaviors and transitions.
- Monitored clients during structured and unstructured activities to assess their social and emotional skill development. to identify areas for improvement in their social and emotional skills. during both structured and unstructured activities to identify potential areas for improvement or reinforcement.
- Administered crisis management support by implementing de-escalation techniques to maintain client safety. by utilizing de-escalation techniques to ensure client safety. when needed by utilizing de-escalation techniques such as redirection or calming strategies.
Health Information Specialist II
Ciox Health
Remote
04.2021 - 09.2022
- Reviewed patient charts for completeness, flagged inaccuracies or missing data, and ensured updated medical records for compliance and continuity of care.
- Logged and tracked requests for medical information, ensuring accuracy and timely responses that complied with HIPAA.
- Resolved complex coding problems by interpreting clinical documentation from physicians' orders, nurses’ notes, and test results, ensuring accurate coding and billing.
- Analyzed complex medical records to identify and correct data inconsistencies or discrepancies.
- Prepared medical records for release to authorized facilities, ensuring proper documentation and confidentiality.
- Developed and maintained structured filing systems, improving recordkeeping efficiency and ensuring audit readiness.
- Developed and maintained structured filing systems to enhance recordkeeping efficiency and ensure audit readiness.
- Supported registry submissions and quality improvement initiatives, including HEDIS and other relevant programs.
- Handled sensitive information with discretion and professionalism, preserving patient trust and confidentiality.
Health Information Management (HIM)
Renown Health
Reno, NV
01.2020 - 04.2021
- Adhered to strict HIPAA regulations to protect patient privacy and confidential medical records.
- Verified insurance, demographic details, and medical history to ensure accuracy in patient files, enhancing quality of patient care.
- Maintained, updated, and organized patient charts and medical records for easy access and compliance.
- Documented referral and patient updates accurately within EHR systems to ensure continuity of care.
- Coordinated with insurance providers and medical offices to facilitate timely referrals to specialists, improving patient access to care.
- Executed audits of medical records to ensure accuracy and completeness, supporting compliance with regulatory standards.
- Collaborated with multiple departments to efficiently coordinate release of information requests from patients, legal representatives, and insurance companies.
- Scheduled patient appointments, coordinated check-ins/check-outs, and processed billing payments.
Department Support Specialist
Private Daycare Home
Houston, TX
08.2017 - 12.2019
- Maintained safe, clean, engaging childcare environment, while enhancing child well-being through proactive behavior management and hygiene practices.
- Implemented behavior management strategies and positive reinforcement techniques.
- Monitored and documented behavioral patterns and triggers, supporting individualized progress toward developmental goals.
- Observed and documented children's behaviors to identify areas of strength and improvement.
- Facilitated structured play, sensory activities, and social interaction to encourage development.
- Designed and implemented daily and monthly activity schedules that balanced instruction, creative play, and rest.
- Communicated with parents, caregivers, and support staff about children's needs and progress, fostering a collaborative support network.
- Communicated regularly with parents, caregivers, and support staff, fostering collaboration to address each child's needs and celebrate achievements.
- Taught children routine habits such as handwashing, toy clean-up, and sharing through consistent modeling and guidance.
- Maintained inventory of supplies and restocked hygiene products to support daily care operations.
- Collaborated with therapists, special educators, and program coordinators to support individualized education plans.
- Modeled empathy, patience, and consistency to promote emotional regulation and trust.
Education
General Studies -
Houston Can Academy Charter School
Houston, TXSkills
- Care coordination
- Crisis management
- Patient assessment
- Care management
- Peer support coordination
- Patient advocacy
- Medication management
- Electronic health records
- EHR management
- Insurance verification
- Medicare verification
- Medicaid
- Insurance claims
- Claims processing
- Prior authorization
- Appeals processing
- Grievance adjudication
- Denied claims identification
- Quality assurance
- Quality metrics
- Data analysis
- Data management
- EHR audit preparation
- Appointment scheduling
- Prescription processing
- Medical terminology
- Mental health support
- Peer support coordination
- Wellness action planning
- Relationship management
- Insurance verification review
- Medical terminology
- Conflict resolution
- Dispute resolution
- Problem-solving
- Active listening
- Multitasking skills
- Adaptability
- Quality assurance
- Insurance policies
- EHR audit preparation
- Data management
- Peer support coordination
- Appeals management
- Insurance policies
- Appointment scheduling
Timeline
Care Coordinator
Humana
10.2025 - Current
Remote Pharmacy Care Support & Member Services Rep
Elevance Health
06.2024 - 10.2025
Remote HEDIS Compliance Specialist
Elevance Health
02.2024 - 06.2024
Patient Intake & Case Coordinator Lead
Icarus Behavioral Health
11.2023 - 02.2024
Behavioral Health Coordinator
Icarus Behavioral Health
09.2022 - 12.2023
Health Information Specialist II
Ciox Health
04.2021 - 09.2022
Health Information Management (HIM)
Renown Health
01.2020 - 04.2021
Department Support Specialist
Private Daycare Home
08.2017 - 12.2019
General Studies -
Houston Can Academy Charter School