Summary
Overview
Work History
Skills
Languages
Timeline
Generic

Audra Pena

Denver ,CO

Summary

A dynamic leader in healthcare management, enhancing patient experience. Skilled in insurance contracting and passionate about patient care advocacy, I excel in creating efficient, patient-centered environments. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

Overview

20
20
years of professional experience

Work History

Enrollment Manager

Concerto Care
11.2023 - Current
  • Facilitated cross-functional collaboration between departments to create seamless experiences for prospective patients throughout the enrollment journey.
  • Developed strategic processing for increased program visibility, resulting in higher enrollment numbers.
  • Maintained detailed and accurate records between multiple databases and programs.
  • Enhanced enrollment efficiency by streamlining the application and registration processes.
  • Assisted clients with completion of applications and paperwork.
  • Implemented data-driven decision-making processes to optimize recruitment strategies and maximize enrollment results.
  • Advised leadership on enrollment projections, providing data-driven insights for strategic planning and resource allocation decisions.

Provider Relations Manager

Dispatch Health
09.2021 - 01.2023
  • Managed Provider Enrollment team, payer enrollment team, Provider credentialing team and Payer enrollment.
  • New Innovative start-up company with no documented processes. Created processes, built teams, to assist and manage all aspects of Provider relations for over 200 providers including MD, DO, PA and NP and RN.
  • Collaborated with contracting teams and RCM teams to optimize clear activation processes and billing processes to maintain accurate revenue stream.
  • Developed strategies to optimize patient base with growth teams in conjunction with clinical teams.
  • Worked with OGC to ensure compliance with all government agencies and commercial insurance contracts, oversaw special projects.
  • Served as a liaison between healthcare providers and internal departments such as claims processing or customer service, facilitating effective resolution of any issues that arose during day-to-day operations.
  • Established strong relationships with key stakeholders in the healthcare industry, positioning the organization as a trusted partner in patient care.
  • Developed standard operating procedures for the provider relations department, leading to increased efficiency and consistency across all functions.
  • Successfully resolved complex disputes involving reimbursement rates or other contractual disagreements between providers and the organization through skilled negotiation tactics.
  • Developed comprehensive reports highlighting trends and performance metrics of providers, enabling informed decision-making at all levels of management.
  • Enhanced provider relations by conducting regular visits and maintaining open communication channels with healthcare providers.
  • Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
  • Established team priorities, maintained schedules and monitored performance.
  • Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
  • Assisted in organizing and overseeing assignments to drive operational excellence.
  • Streamlined and monitored quality programs to alleviate overdue compliance activities.
  • Planned, created, tested and deployed system life cycle methodology to produce high quality systems to meet and exceed customer expectations.

National Enrollment and Credentialing Manager

American Medical Response, AMR
11.2017 - 09.2021
  • Collaborated with department leaders to develop policies and procedures for maintaining accurate provider records.
  • Expedited the resolution of credentialing issues by liaising effectively with providers and external organizations.
  • Maintained up-to-date knowledge of industry regulations, ensuring ongoing adherence to best practices in provider credentialing.
  • Established strong relationships with external agencies, streamlining communication regarding provider credentials and facility statuses.
  • Facilitated smooth communication between departments, fostering collaboration in support of credential management objectives.
  • Managed the onboarding process for new providers, ensuring timely completion of all required documentation.
  • Successfully managed budgets and allocated resources to maximize productivity and profitability.
  • Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.

Senior Financial Analyst/ RCM Manager

Paladina Health
07.2015 - 11.2017
  • Provided valuable insights by leading monthly variance analysis reviews between actual results and budget/forecast expectations.
  • Enabled informed decision-making by presenting key findings from complex data sets in clear, concise formats for senior leadership team members.
  • Trained new analysts on corporate policies and procedures and implemented mentoring program, reducing onboarding time.
  • Reviewed statistical information to determine financial trends for use in investment planning.
  • Played a pivotal role in annual budget planning, collaborating with department heads to allocate resources strategically.
  • Developed financial models to assess potential investments and identify potential risks.
  • Oversaw Patient Access team and scheduling teams to exceed optimal revenue impact for company.

Program Implementation Analyst

Department of Defense- Tricare
12.2013 - 01.2015
  • Oversaw Tricare for Life transition to new contract for the dual eligible beneficiaries.
  • Reviewed current contract, processed new policies according to new Federal policies and compliance regulations.
  • Met with contractor awarded contract and trained on implementation and variances in previous contract. Including all auditing of hiring process, and government compliance implementing and reporting to,
  • Created Tricare operations manuel, collaborating with program integrity department to transition all necessary reports to the contract administrator.
  • Leveraged strong analytical skills to assess the impact of implemented solutions on overall business performance over time.
  • Maintained open lines of communication with clients throughout the entire project lifecycle, fostering trust and positive working relationships.
  • Streamlined processes through effective collaboration with cross-functional teams during project execution.
  • Audited all deficit claims and new processes, handled all beneficiary and patient complaints sent to congress as appeals.

Director of Operations

Colorado Orthopedic and Prosthetics
06.2011 - 01.2014
  • Oversaw daily operations across multiple departments, ensuring seamless coordination and efficient execution of tasks.
  • Monitored budget and utilized operational resources.
  • Oversaw day-to-day production activities in accordance with business objectives.
  • Oversaw successful implementation of operational strategies and policies to drive organizational growth and productivity.
  • Conducted regular performance reviews to assess team progress, providing constructive feedback and guidance for continuous improvement.
  • Collaborated with senior management to develop and execute long-term corporate goals and objectives.
  • Mentored and coached team members to foster productive and engaging work environment.
  • Managed budgets and resources, optimizing allocation for maximum impact on business objectives.
  • Defined, implemented, and revised operational policies and guidelines.
  • Established strong partnerships with vendors, suppliers, and key stakeholders to improve collaboration and ensure alignment with business requirements.
  • Negotiated with vendors, suppliers and other stakeholders to acquire mutually beneficial contracts and agreement.
  • Enhanced employee engagement by developing training programs, fostering a collaborative culture, and promoting professional development opportunities.
  • Promoted a culture of safety within the organization by enforcing compliance with established regulations, policies, procedures, as well as conducting regular auditschecks.
  • Drove revenue growth through the identification of new market opportunities and the expansion of existing products/services offerings.
  • Achieved company-wide recognition for leadership excellence, mentoring high-performing team that consistently exceeded operational goals and objectives.
  • Achieved operational excellence by continuously evaluating and refining processes, employing data analytics to inform decision-making and identify areas for improvement.
  • Launched successful initiative to automate repetitive tasks, freeing up staff to focus on strategic projects and value-added activities.
  • Reported issues to higher management with great detail.
  • Tracked trends and suggested enhancements to both challenge and refine company's product offerings.
  • Managed 5 clinics in and around Denver Metro area, direct supervisor for providers and clinical staff
  • Maintained credentials for all facilities and providers
  • Responsible for all month end reporting AR and AP Converted EMR system successfully increasing company profitability.
  • Ensured excellent customer service and quality care for all patients served.

Owner and Office Manager

DRMD
08.2009 - 02.2012
  • Managed day-to-day business operations.
  • Developed and maintained strong relationships with clients, resulting in repeat business and referrals.
  • Oversaw daily operations, ensuring all tasks were completed accurately and efficiently by team members.
  • Increased customer satisfaction by implementing efficient business processes and providing exceptional service.
  • Managed financial aspects of the business, including budgeting, financial reporting, and tax preparation.
  • Hired trained, and managed a high-performing team of employees dedicated to achieving company goals.
  • Implemented marketing strategies to increase brand awareness and attract new customers.
  • Successfully navigated challenging economic conditions by making informed decisions that protected the business''s financial stability.
  • Generated revenues yearly and effectively capitalized on industry growth.
  • Led negotiations for major contracts, securing favorable terms that significantly reduced costs.
  • Managed purchasing, sales, marketing and customer account operations efficiently.
  • Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
  • Facilitated smooth communication between departments, addressing concerns promptly to maintain harmonious work relationships.
  • Reduced overhead costs significantly through negotiation of vendor contracts for office supplies and services.
  • Resolved office disputes swiftly and equitably, maintaining harmonious workplace.
  • Successfully managed budgets and allocated resources to maximize productivity and profitability.

Patient Accounts Manager

MCPN
10.2006 - 06.2008
  • Reduced outstanding accounts receivable balances by diligently monitoring payment statuses and following up on overdue payments.
  • Led team meetings effectively to address current challenges within the department, discussing potential solutions and encouraging open communication among all members of the team.
  • Analyzed data trends related to delinquent accounts, using this information to develop proactive measures aimed at reducing late payments from patients.
  • Ensured accurate financial record-keeping, conducting regular audits to maintain compliance with industry standards and regulations.
  • Managed a high volume of patient accounts effectively, prioritizing tasks and allocating resources based on the urgency of each case.
  • Strengthened relationships with insurance providers for improved communication and timely resolution of claim disputes.
  • Consistently met or exceeded department goals for collections, maintaining a healthy cash flow for the organization while upholding excellent patient relations throughout the process.
  • Established performance metrics for staff members within the Patient Accounts team, setting clear expectations and monitoring progress toward achieving these targets consistently.
  • Responded to patient, family and external payer inquiries.
  • Monitored flags and resolved urgent items with accuracy and efficiency.
  • Reconciled statements with patient records.
  • Oversaw appointment scheduling and itinerary coordination for both clients and personnel.
  • Kept high average of performance evaluations.
  • Built highly-efficient administrative team through ongoing coaching and professional development opportunities.
  • Conducted ongoing reviews of program financial systems to assess cost control measures.
  • Developed internal requirements and standards to minimize regulatory risks and liability across programs.
  • Delegated tasks to administrative support staff to organize and improve office efficiency.
  • Worked with FQHC programs to serve the underserved community. Worked closely with all government programs to maintain compliance with federal regulations.

Practice Manager

Total Long-Term Care
10.2004 - 10.2006
  • Addressed patient concerns promptly and professionally, demonstrating empathy and excellent problem-solving skills.
  • Managed daily practice operations to optimize appointment scheduling, patient records management and billing functions.
  • Ordered all office supplies and kept check on inventory levels.
  • Facilitated communication between staff members, fostering a collaborative work environment that improved overall team performance.
  • Developed strong relationships with patients, ensuring a high level of care and satisfaction throughout their experience.
  • Developed close working relationships with front office and back office staff.
  • Evaluated practice workflows regularly to identify areas for improvement and implement necessary changes efficiently.
  • Managed office budget, reducing unnecessary expenses and allocating funds for necessary improvements.
  • Provided supervision and management to team of support personnel.
  • Boosted staff morale by offering constructive feedback and specific direction.
  • Assessed processes and procedures, complying with OSHA, and HIPAA regulations.
  • Coordinated with insurance providers to streamline the billing process and minimize any delays in reimbursement.
  • Spearheaded initiatives aimed at improving community relations, including hosting events such as health fairs or seminars on relevant topics in healthcare management.
  • Conducted thorough market analysis to identify trends and opportunities for practice growth.
  • Worked with stakeholders to pilot the PACE program through Medicaid, reviewed all PACE applications and worked with city and government agencies to maintain waive compliance for all patients entering PACE program,


Skills

  • Teamwork and collaboration
  • Customer service
  • Time management
  • Attention to detail
  • Effective communication skills
  • Reliability
  • Excellent communication
  • Organizational skills
  • Decision-making
  • Patient Scheduling
  • Analytical skills
  • Patient Care Advocacy
  • Proficient with Medical terminology and account management
  • Team Building
  • Contract negotiations
  • All aspects of medical billing
  • Leader in Executive team
  • Expertise in Commercial and all government insurance programs, CMS, Medicare and Medicaid and Advantage plans

Languages

Spanish
Native or Bilingual

Timeline

Enrollment Manager

Concerto Care
11.2023 - Current

Provider Relations Manager

Dispatch Health
09.2021 - 01.2023

National Enrollment and Credentialing Manager

American Medical Response, AMR
11.2017 - 09.2021

Senior Financial Analyst/ RCM Manager

Paladina Health
07.2015 - 11.2017

Program Implementation Analyst

Department of Defense- Tricare
12.2013 - 01.2015

Director of Operations

Colorado Orthopedic and Prosthetics
06.2011 - 01.2014

Owner and Office Manager

DRMD
08.2009 - 02.2012

Patient Accounts Manager

MCPN
10.2006 - 06.2008

Practice Manager

Total Long-Term Care
10.2004 - 10.2006

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Audra Pena