Elva Garibay

Responsible for billing and collections for Commercial Managed Care (HMO/PPO) claims for Blue Shield payor for City of Hope hospital accounts. Conducted telephone and written inquiries with insurance carriers and third-party payers, and analyzed/audited issues to resolve or close accounts within required timeframes.

Collected unpaid claims for Emanate Health hospital across three facilities, focusing on Commercial IPA claims for Caremore, Central Health Plan, and Brand New Day patients treated in the ER and as in-patients. Appealed underpaid claims, provided medical records when needed, and handled daily correspondence and EOBs via phone customer service with payors for claim status.

Ensured reimbursement to PIH Health by determining patient eligibility, benefits, authorization and utilization requirements, and patient liability, and performing upfront collections to secure financial arrangements and avoid bad debt. Also served as an Auth Coordinator for inpatient stays and NICU authorizations, coordinating with insurance payors and case management.

Performed billing and collections for LLUMC hospital accounts, including Commercial Managed Care (HMO/PPO), workers' compensation, and auto-related claims. Conducted telephone and written inquiries with insurance carriers and third-party payers to resolve or close accounts, and completed required adjustments within stipulated timeframes.

Collected unpaid, underpaid, and denied ER hospital claims for Medicaid and commercial insurance plans (contracted and non-contracted). Investigated non-payment reasons, contacted payers to resolve claim issues, requested rebill and additional payment, and submitted adjustments/appeals and write-offs for small balances.

Worked outbound self-pay low and high-dollar account collections for St. Joseph Heritage by verifying insurance coverage, setting up accounts for billing, and arranging monthly payments when needed. Also billed secondary insurance and various primary coverages (including Workers' Comp and Medicare Part A & B), and mailed/emailed itemized statements while managing 40–60+ accounts per day.

Part-time sales representative selling Coconut Coffee, Coconut Green Tea, and Coconut Coco at retail locations including Walmart, Costco, and Sam's. Set up product sampling displays, explained product benefits, answered customer questions, and worked to generate high-volume sales for top pay.

Collected unpaid home-infusion reimbursement claims for Walgreens by working Commercial claims for Aetna, Blue Shield, Health Net, and Cal-Optima. Calculated medication formulas by grams/vials/packages per day/visit, verified amounts due, handled underpaid claim appeals with medical records, and processed daily correspondence including EOBs and check research.

Provided confidential administrative support to NAMM (North America Med Management) by managing incoming calls and messages, routing callers, and coordinating daily appointment scheduling for two executives. Handled mail and correspondence, supported conferences/events and meetings, prepared documents including monthly physician capitation packages, maintained network records, and managed filing a

Earned an Associate Liberal Arts degree. Completed coursework in general liberal arts education.

Completed a general education diploma program. Graduated from high school after completing required studies.