Shiela Ann Salinas
Harlingen,TX
Summary
I am a sincere, loyal and dedicated individual who has a great deal of ambition. Although I have extensive experience in benefit verification, I love to learn, and am always up to a challenge. I get along well with others, while also working efficiently on my own. I am seeking a position where I can develop and excel while giving my best to an employer.
Overview
15
15
years of professional experience
Work History
Insurance Verification Specialist
Compass Consulting Services
07.2023 - Current
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Improved communication between medical staff and patients by explaining insurance benefits and financial responsibilities.
- Collaborated with team members to resolve discrepancies in insurance verification, ensuring proper billing practices.
- Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
- Assisted patients with understanding personalized insurance coverage and benefits.
Benefits Verification Specialist
AmerisourceBergen
11.2021 - 05.2023
- Review all patient insurance information needed to complete the benefit verification process
- Triages cases with missing information to appropriate program
- Verifies patient specific benefits and documents specifics for various payer plans including patient coverage, cost share, and access/provider options
- Identifies any restrictions and details on how to expedite patient access
- Includes documenting and initialing prior authorization process, claims appeals, etc
- Competes quality review of work as part of finalizing product.
Billing Specialist
Doctors Hospital at Renaissance
12.2018 - 11.2021
- Assists patients and carriers with questions and concerns regarding the billing and collections of accounts
- Receives incoming and outgoing calls from patients and informs them of their balance due after insurance has paid
- Download, run and post credit card payments
- Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures.
Account Representative
Hospital Business Services, Inc
10.2017 - 12.2018
- Utilizing many complex and varying regulations, guidelines and systems, analyzes payments received from insurance companies to assure maximum and correct reimbursement of Hospital’s receivables
- Reconciles accounts daily
- Reviews and performs follow-up on all authorizations, and specialty referrals
- Maintains a current knowledge of contract
- Responsible for the handling of incoming and outgoing mail pertaining to the hospital
- Responsible for accurate and timely payment analysis of managed care contracts to determine that appropriate reimbursement is received
- Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct account payment
- Manage and forward underpayments/denials to the appropriate departments for follow-up and further revenue collection as needed.
Customer Service Advocate
UnitedHealthcare Medicare Solutions
07.2014 - 12.2015
- Primary Responsibilities: Respond to and resolve, on the first call, customer service inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence
- Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider
- Contact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance
- Assist customers in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient
- This role is equally challenging and rewarding
- I would get calls to research complex issues pertaining to the caller’s health, status and potential plan options
- To do this, we would need to navigate across multiple databases which requires fluency in computer navigation and toggling while confidently and compassionately engaging with the caller.
Customer Service Rep.
Dish Network(Echostar Communications Corp)
07.2012 - 07.2014
- Payments and Billing - accept payment by credit card, offer self-serve payment solutions, and explain charges on the customer’s bill
- Product features - assist customers with pay-per-view orders, change programming packages, equipment upgrades, and general questions
- Technical Support - troubleshoot a variety of technical issues, from signal loss to remote control use
- Sales - use a consultative approach to educate and offer existing customers additional programming, products and services to enhance their DISH experience.
Administrative Clerk (temporary)
Manpower Inc.
06.2010 - 03.2012
- Interviewed people that walked in the door to see if they were eligible to work for any of the temporary jobs we had available
- Input information on E-Verify and on our database
- Tested and filed away all information
- Used Excel and Word.
Hostess/Waitress
Logan’s Roadhouse
09.2009 - 09.2010
- Greeted guests as they walked through the doors
- Took orders and cashed out guests.
Education
High School Diploma -
Harlingen High School
Harlingen, Texas05.2010
Skills
- Team Orientation
- Communication
- Leadership Skills
- Problem Solving
- Ability to self-manage and self-motivated
- Work Ethic
- Computer Skills
Timeline
Insurance Verification Specialist
Compass Consulting Services
07.2023 - Current
Benefits Verification Specialist
AmerisourceBergen
11.2021 - 05.2023
Billing Specialist
Doctors Hospital at Renaissance
12.2018 - 11.2021
Account Representative
Hospital Business Services, Inc
10.2017 - 12.2018
Customer Service Advocate
UnitedHealthcare Medicare Solutions
07.2014 - 12.2015
Customer Service Rep.
Dish Network(Echostar Communications Corp)
07.2012 - 07.2014
Administrative Clerk (temporary)
Manpower Inc.
06.2010 - 03.2012
Hostess/Waitress
Logan’s Roadhouse
09.2009 - 09.2010
High School Diploma -
Harlingen High School
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