Sandra Carbajal

Dripping Springs, TX *****

ad3mhb@r.postjobfree.com

+1-323-***-****

Work Experience

Eligibility Specialist

Central Health - Austin, TX

December 2023 to Present

Interview applicants in a professional and courteous manner to obtain appropriate demographic and household information needed in order to screen clients for appropriate healthcare coverage programs. Accurately enter client data, and collect, verify and scan appropriate documents into the eligibility database according to Eligibility Policies and Procedures. Accurately apply the Eligibility Policies and Procedures to determine client eligibility and enroll eligible clients into the appropriate local and grant programs and assist clients with submitting applications for state and federal health-coverage programs.

Administrative and clerical procedures and systems such as word processing and data base systems, and other office orders or logical operations.

Access Service Representative

Baylor Scott & White Health - Buda, TX

February 2023 to December 2023

Responsible for obtaining current and accurate demographics and insurance information in order to register patient, verification of insurance benefits, negotiates and collects patient financial responsibilities. Passionately cross-trains and works in all areas as assigned. Serves as a mentor and or trainer for peers.

Customer Service Representative

Ascension - Austin, TX

April 2022 to February 2023

Responsible for the registration and pre-registration of patients. Obtains correct and complete demographic information including emergency contacts and insurance information. Utilizes systems like Athena and Compass for tracking, information gathering, troubleshooting, and scheduling patients and includes communicating with doctors and monitoring doctor’s schedules. Triages provided diagnoses and information to determine urgency for the patient to be accurately seen based off their diagnosis or symptoms.

ER Registration/Patient Account Specialist

Antelope Valley Medical Center - Lancaster, CA

October 2017 to February 2022

Responsible for registration and pre-registration for pre- admissions. Obtained correct and complete demographic information, emergency contacts, and insurance information. Collected all co-pays, deductibles or co-insurances as due at time of registration or pre-registration. Expertly explained all consents and forms necessary for ER registration or pre- admission, including Medicare questionnaires and rights. Additional responsibilities included insurance authorizations and coordination with both Primary Care Physicians, Admitting MD and Attending MD. Investigate and resolve complex payment denials inclusive of correcting errors and supplying additional required information to facilitate collection of reimbursement / additional reimbursement. Demonstrates a good understanding and has the ability to interact with the payer to verify coverage, submit claims, follow up on appeals, underpayments, short pays or payment disputes for resolution.

School Bus Driver

Los Angeles Unified School District - Los Angeles, CA August 2008 to May 2019

Responsible for the daily safe commute to and from the school/home for 65+ students. Maintained order on the bus during all routes and followed all safety protocols for passengers. Additional responsibilities included minor office work like filing, faxing, emailing and answering phones. Eligibility Specialist

Cap Management Systems - Encino, CA

August 1998 to July 2000

Responsible for verifying eligibility information, benefits options, Primary Care Physician assignments and more. Updated, added, edited, and terminated members of the medical group as assigned. Handled inquiries from health care providers and members associated with medical groups managed by CMS. Filed monthly EOB’s of PCP capitation payments and matched invoices with correct bills and mailing checks. Education

Associate's degree in Health Information Management Los Angeles Mission College - Sylmar, CA

June 2012 to August 2014

High school diploma

Palmdale High School - Palmdale, CA

August 1994 to June 1998

Skills

• Employee Orientation

• Microsoft Powerpoint

• Insurance Verification

• Phone Etiquette

• Medical Office Experience

• ICD-10

• Medical Records

• Transcription

• Negotiation

• HIPAA

• Bilingual

• Epic

• Medical Billing

• Athenahealth

• Medical Scheduling

• Hospital Experience

• Auditing

• Medical Coding

• Quality Assurance

• ICD-9

• Medical Terminology

• CPT Coding

• ICD Coding

• Cerner

• Triage

• Medical terminology

• Front desk

• Hospital experience

• Customer service

• Translation

• Quality assurance

• Medical records

• Computer skills

• Training & development

• Spanish

• Communication skills

• Organizational skills

• Insurance verification

• Mentoring

• Administrative experience

Certifications and Licenses

CPR Certification

March 2021 to October 2026

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