ELVA GARIBAY ***** Arrow Blvd Apt **

Phone 714-***-**** Fontana, CA 92335

OBJECTIVE

To obtain a challenging position that will utilize my strong background

in billing/collections, customer service skills, administrative assistant, my education, capabilities and devotion to hard work, while offering the opportunity for professional growth.

WORK HISTORY

Collector Specialist/Loma Linda Univ Medical Center 05/2019 - Present

Perform Billing and Collections depth knowledge of the billing rules and regulations for Commercial Managed Care, HMO, PPO, WC & Auto. Obtain all information needed for claim submissions. Perform telephone and written inquiries with insurance carriers and third party payers to promote resolution or closure to all accounts. Have the ability to analyze, audit and resolve issues relating to all different insurance carriers accounts. Complete adjustments within the stipulated timeframe on all Commercial insurance payors entities require. These services are provided for LLUMC hospital accounts. Performs other duties as needed.

Hospital A/R Collector Rep/ Conifer Health Solutions, Inc 10/2015 – 11/2018

Responsible to collect total payment on unpaid, under paid & denied ER hospital claims for Medicaid, Non-Contracted & Contracted Commercial insurance plans. Investigate reason claims are not paid, contact payer’s on unresolved balances, request to fix & resolve issue on claim, request rebill insurance for payment or additional payment. Set up wright offs on small balances, request appeals & adjustments necessary.

Self Pay Collector/Biller Specialist, K-Force, Inc/St. Joseph Heritage 03/2015 - 09/2015

Responsible to contact patient on outstanding self –pay low and high dollar accounts in outbound department. Verify if have insurance coverage, set up for billing, updated account to process for payment. No insurance provided, collect payment in full, set up monthly payment arrangements or have patient apply for Medi-Cal benefits. Billed secondary insurance, Worker’s Comp, Medicare Part A&B and all types of primary insurance companies HMO’s, PPO’s or Manage Care providers. Emailed or mailed out copy of itemized statements of acct to patient as requested, worked 40 – 60+ accounts per day.

Sales Representative/ Part time, California Cafe, Inc 10/2014 – 01/2015

Responsible to sell company product Coconut Coffee, Coconut Green tea & Coconut Coco. Began in Walmart at different locations then I sold at Costco’s and Sam’s stores. Traveled to location, set up table with samples for customers to try coffee, sent picture of coffee display in store and display of my table set up beginning of shift & end of shift. Explained the benefits of drinking our product, answered customer questions & did my best to sell large volume to earn top pay.

Reimbursement Specialist, Kelly Services, Inc /Walgreens Company 11/2013 – 5/2014

Collector position to collect on unpaid claims for Walgreens Company. Leading provider in Home Infusion Therapy. Responsible for Commercial claims Aetna, Blue Shield, Health Net and Cal-Optima on patients that received medicine, nutrients or specific fluid prescribed by their doctor and administered by a nurse at their home by IV or needle injection. Worked 30+ accounts per day, required to calculate formula on medication used on patient by grams, vials and/or packages per day/visit & verified collected amount due from insurance provider. Appealed under paid claims, provided medical records if necessary & faxed/mailed out documents depending on provider. Dealt with daily correspondence, insurance EOB’s, searched for paid copied checks in system and via phone customer service.

Administrative Assistant, Medical Professionals/North America Med Management 02/2013 - 9/2013

Assigned to provide confidential administrative support for NAMM by answering telephone, taking messages, routing callers to appropriate department/network staff, coordinate daily appointment calendar and scheduling for AVP & Executive Director, as needed. Open & route incoming mail for department and prepare outgoing mail, coordinate & facilitate conferences, events and meetings, as directed, type & prepare a variety of documents by compiling information, draft letters & type routine correspondence, preparation of monthly physician capitation packages & other ad hoc physician mailings. Maintain accurate records of network information for reference, use high level of diplomacy when communicating with other healthcare professionals, both verbally and in writing, maintain organized filing system for department and network documents and monitor utilization of resources for department by coordinating ordering of all supplies.

Medical Biller, Medix Staffing Solutions/Loma Linda Med Center 05/2012- 2/2013

Biller position in the Patient Financial Services department assigned at Loma Linda Medical Center/Hospital. Commercial, HMO, PPO, W/Comp hospital billing for all insurance companies. Responsible for effective recovery of balances, resolving insurance inquiries, worked/reviewed 70+ claims per day, documentation of collection activity, request billing/coding corrections on UB04 claims, special projects and review/handle insurance EOB’s for secondary/tertiary billing.

Provider Network Developer/Recruiter, QTC Medical Management Services 02/2008 - 10/2011

Work in the Railroad Retirement Board Retirees (RRB) Dept. Receive daily cases for RRB claimant's that applied for disability benefits and require medical evaluations or diagnostic services depending each individual case. Identify & create a database of potential providers within assigned QTC market from all available resources. Responsible for contracting providers of all specialties within established pricing parameters to support expansion and network maintenance. Monitor providers from initial contact through the execution of the provider contract. Establish and maintain positive working relationships with all providers with assigned network to ensure provider retention. Provide accurate first line orientations to prospective providers of the QTC Business Model and the Value proposition. Assist Operations Managers and billing dept with contract negotiations and responsible for the documentation of all activities into PITS.

EDUCATION

Associate Liberal Arts Degree, Santa Ana Jr. College 1988 - 1993

Diploma-General Education, Santiago High School 1984 - 1988

SKILLS

25+ years outstanding billing/collections medical field/healthcare industry, skills, type 65+ wpm, 10 key by touch, Direct Sales, self -motivated, detail oriented & multi-task, strong phone communication & listening skills, all Administrative clerical tasks, Data Entry, Computer Literate: MS Word, Windows, Outlook and Excel, familiar with medical terminology, claims processing, customer service in person/via telephone, cashier, total team player & bilingual: speak, read and write Spanish.