Sammantha Perfater
Roanoke,VA
Summary
Dynamic Health Guide at Elevance Health with expertise in medical coding and compliance. Proven ability to enhance patient care through effective education and collaboration with interdisciplinary teams. Skilled in claims processing and insurance authorization, demonstrating critical analysis to resolve discrepancies and ensure optimal member support. Committed to delivering high-quality healthcare solutions.
Overview
6
6
years of professional experience
Work History
Referral Specialist III
Carelon Medical Benefits Management - Elevance
Roanoke, VA
01.2026 - Current
- Initiates and manages clinical referrals for pre-authorization.
- Gathers and submits in depth clinical information regarding cases and routes to appropriate clinical staff for review.
- Reviews referrals for completeness and follows up for additional information if necessary.
- Assigns escalated referrals to staff as appropriate.
- Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, etc) Surgical, Cardiology and other departments.
- Responds to inbound calls initiating exam requests following established processes for complex cases
- Enters referrals, documents communications, and actions in the system.
Health Guide
Elevance Health
Roanoke, VA
08.2021 - 12.2025
- Coordinated with interdisciplinary teams to ensure comprehensive member support.
- Educated members on benefits and claims processes clearly and concisely.
- Reviewed patient records for accurate coding and billing compliance.
- Collaborated with healthcare providers to clarify coding discrepancies.
Certified Medical Assistant/Phlebotomist
Sideline Orthopedics and Sports Medicine
Blacksburg, VA
10.2019 - 02.2021
- Maintained accurate patient records in electronic health record systems.
- Educated patients on treatment plans and provided post-operative care instructions.
- Collaborated with healthcare team to enhance patient care delivery processes.
- Administered injections, immunizations, medications, wound dressings and other treatments according to physician instructions.
- Assisted physicians and nurses with patient exams, including taking vital signs, preparing exam rooms, and updating medical records.
- Educated patients about medications, procedures and physician's instructions.
- Prepared specimens for laboratory testing and performed routine laboratory tests.
- Contacted pharmacies to submit and refill patients' prescriptions.
- Obtained insurance authorizations for prescribed medications or treatments for patients in need of financial assistance programs.
Education
High School Diploma -
Florida State College at Jacksonville
Jacksonville, FLPhlebotomy & Certified Medical Assistance program -
Fast Track Healthcare
Roanoke, VARegistered Nursing Program - non-licensed
New River Community College
Dublin, VASkills
- Medical coding and terminology
- Claims adjustment and processing
- Compliance with healthcare regulations
- Patient care strategies
- Insurance authorization processes
- Treatment delivery administration
- Critical analysis skills
Timeline
Referral Specialist III
Carelon Medical Benefits Management - Elevance
01.2026 - Current
Health Guide
Elevance Health
08.2021 - 12.2025
Certified Medical Assistant/Phlebotomist
Sideline Orthopedics and Sports Medicine
10.2019 - 02.2021
High School Diploma -
Florida State College at Jacksonville
Phlebotomy & Certified Medical Assistance program -
Fast Track Healthcare
Registered Nursing Program - non-licensed
New River Community College