Samantha Silva
Houston
Summary
Detail-oriented healthcare support professional with over 3.5 years of experience in benefits verification, customer service, and administrative support. I excel in problem-solving and communication, ensuring compliance and enhancing patient satisfaction. Skilled in communicating with patients, providers, pharmacies, and insurance companies while maintaining accurate documentation and managing multiple priorities. Experienced in remote work environments and committed to providing exceptional customer service, case coordination, and administrative support.
Overview
13
13
years of professional experience
Work History
Benefits Verification Specialist
Everise
Remote
07.2022 - Current
- Validated medical and pharmacy insurance benefits for specialty medications and treatment programs.
- Collaborate with physician offices, specialty pharmacies, insurance carriers, and patients to facilitate access to prescribed therapies.
- Review prior authorization requirements and communicate coverage criteria, benefit limitations, and approval requirements.
- Investigate insurance coverage issues and identify solutions to support patient access to medication.
- Document patient interactions and case updates accurately while maintaining HIPAA compliance.
- Manage high-volume inbound and outbound calls with patients, providers, pharmacies, and insurance representatives.
- Utilize multiple healthcare systems and databases while maintaining productivity and quality standards.
- Educate patients regarding insurance coverage, copay assistance programs, and next steps in the treatment process.
- Work independently in a remote environment while meeting performance metrics and service expectations.
- Conducted benefits verification processes for diverse healthcare plans.
- Collaborated with healthcare providers to ensure accurate patient eligibility.
- Documented and tracked benefit verification outcomes in internal systems.
- Resolved discrepancies in patient information through detailed research.
- Maintained up-to-date knowledge on industry regulations, ensuring compliance throughout all benefit verification processes.
- Coordinate follow-up activities with provider offices, pharmacies, and insurance carriers to ensure timely case resolution.
Front Desk Receptionist
Ymca Of Greater Houston
Houston Texas
03.2013 - 06.2015
- Assisted prospective members with membership enrollment and account setup.
- Managed high-volume phone calls and directed inquiries appropriately.
- Maintained accurate records and provided administrative support.
- Processed registrations, payments, and account updates.
- Assisted with daily front desk operations in a fast-paced environment.
- Addressed member concerns and provided exceptional customer service.
Education
High School Diploma -
Spring Woods High School
Houston Texas 05.2015
Skills
- Patient Communication
- Insurance Verification
- Prior Authorization Support
- Provider Office Coordination
- Documentation & Record Management
- HIPAA Compliance
- Customer Service
- Phone & Email Communication
- Data Entry
- Microsoft Office
- Outlook
- Multitasking
- Remote Work
- Problem-solving
- Attention to detail
- Excellent communication skills
- Organizational skills
- Decision-making
- Knowledge of call center operations
- Adaptability and flexibility
- Time management
- Administrative support
- Reliability
Timeline
Benefits Verification Specialist
Everise
07.2022 - Current
Front Desk Receptionist
Ymca Of Greater Houston
03.2013 - 06.2015
High School Diploma -
Spring Woods High School