Samantha Salais
Fort Worth,TX
Summary
With over 8 years of solid customer service and patient care experience, a wealth of knowledge and expertise is brought to any role. In addition, there is almost 3 years of leadership and management experience, successfully training and mentoring team members. An administrative background has also resulted in the development of strong organizational and multitasking skills. Eager to continue learning and growing in a career. Known for strong leadership abilities, thriving in high-pressure environments and excelling at working collaboratively with others. Bilingual in Spanish and English, both verbally and written, effectively communicating with a diverse range of individuals. Dealing with high call volumes in the past has equipped me to handle any challenges that may arise. Open to relocation opportunities anywhere and authorized to work in the US for any employer.
Overview
11
11
years of professional experience
Work History
Experienced Patient Care Navigator/ Trainer-Team Lead Assistant
Orb Health Inc.
04.2019 - 12.2019
- My job title consisted of calling qualified, established, chronic pain, patients and assisting in enrolling into a Medicare based Care Management Program
- This program is for patients that are established with their primary Care provider
- The objective of this program is to help patients deal with their chronic conditions
- An assigned nurse from the company calls the patient once a month
- It is my responsibility to make sure all communications with the patient are documented and to make sure medical records are updated
- To make sure patients account is up to date before the nurse contacts the patient
- I was also assigned to assist the nurses in calling patients to complete monthly assessments with patients
- I reviewed and verified insurance and made sure it was up to date
- I made 50-60 outbound calls per day
- I would also be asked to work until midnight on the last day of the month, to make sure the months quota is met
- I received bonuses and recognitions for going above and beyond my job responsibilities
- I also trained new hires and monitored their calls and gave feedback
- I kept track of and sent out emails for everyone's birthdays and company anniversaries
Senior Claims Representative/ Assistant Trainer/ Team Lead
Evolent Health Systems
04.2016 - 02.2019
- Main job title is being responsible for all incoming calls
- Calls from providers and insurance members
- Mainly, for claim status
- I would assist with all aspects of claim status
- Such as; claim payments, EOB-EOP breakdowns, check tracers, reimbursements, recoupments, reprocessing, internal discrepancy reviews, prior-authorizations Etc
- I spoke to mainly providers
- However, members also called for assistance in benefit and accumulation inquiries
- It was my responsibility to handle all escalations and keep up with updates and messages from internal claims dept
- To communicate final decision to provider
- My title also consisted of me assisting with prior authorizations
- To verify cpt and diagnosis codes
- I am trained in Medicare, Medicaid, Commercial and employee policies
- As a special assigned task, I handle all patient and provider grievance escalations and appeals
- This required me to keep up with the responses of the escalations
- I assist with multiple clients and get chosen for special projects
- While, maintaining my main job responsibilities
- This has helped me excel in multitasking
- Management skills- Appointed Team Lead
- Handled Supervisor calls and escalations
- Leader in team meetings and discussions
- I assisted with new- hire training, and monitored calls for QA for new-hires, for the first 6-weeks once out on the floor
Customer care advocate/ Senior Customer Service Agent- Administration
Stericycle
12.2013 - 05.2015
- My main title consisted of member services/ physician referral services
- I assisted with assigning PCPs, finding specialists, and verifying each insurance plan
- I also documented all appointments made
- I assisted with grievances and appeals
- I also assisted with enrollment and scheduling of health screenings, tests, inpatient/ outpatient paperwork
- I took payments for health education classes
- Such as, diabetes classes
- Weight loss/ bariatric classes
- Maternity classes and tours
- Etc
- After my second month with this company, I was assigned to team Baylor Health Care Systems
- My title was promoted to; Senior patient advocate II
- I was assigned administrative work such as; assisted in employee shift scheduling for breaks and lunches
- Answered Helpdesk calls and assisted fellow peers
- Took care of all birthdays, anniversaries, and parties/pot-lucks
Front Desk Receptionist
Estetica "L" estudio (salon)
02.2009 - 01.2012
- Main title ; front desk receptionist
- I handled all appointments, and handled all payments made
- I opened and closed salon
- I made all supply runs, and stocked up the supply room
- I also helped with shampooing and drying clients hair, when the days were busy
Education
High school diploma -
J Jean private school / Bryan Adams
Dallas, TXSkills
- Customer Service
- Call Center
- Bilingual
- Microsoft
- Excel
- Word
- Spreadsheets
- Administration work
- Leadership
Personal Information
- Willing To Relocate: Anywhere
- Authorized To Work: US for any employer
Timeline
Experienced Patient Care Navigator/ Trainer-Team Lead Assistant
Orb Health Inc.
04.2019 - 12.2019
Senior Claims Representative/ Assistant Trainer/ Team Lead
Evolent Health Systems
04.2016 - 02.2019
Customer care advocate/ Senior Customer Service Agent- Administration
Stericycle
12.2013 - 05.2015
Front Desk Receptionist
Estetica "L" estudio (salon)
02.2009 - 01.2012
High school diploma -
J Jean private school / Bryan Adams
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