Carmen Peniche-Castro
Manassas,VA
Summary
Dedicated, multi-talented and tenacious. I provide superior attention to detail with a high level of energy and enthusiasm. Organized, efficient, adept with planning, and multi-tasking in high-stress, high-volume environments while always delivering in the clutch. Bi-Lingual with proficiency in English and Spanish communications. Superior communicator and “go-to” person.
Tech-savvy innovator with hands-on experience in emerging technologies and passion for continuous improvement. Skilled in identifying opportunities for technological enhancements and implementing effective solutions. Adept at leveraging new tools and methods to solve problems and enhance productivity. Excels in adapting to fast-paced environments and driving technological advancements.
Overview
29
29
years of professional experience
Work History
Billing Specialist
Northern Virginia Electric Cooperative
06.2017 - Current
- Review, research, and correct customer accounts due to current diversion, lost paperwork, meter exchanges, switch meters, high bill complaints, and misapplied payments.
- Issuing service orders to field staff for reading verification, estimating meter readings, and changing or approving readings on accounts before service charges are calculated and bills are generated.
- Processing and performing quality review of meter-related service orders to identify account discrepancies and ensure accuracy and completeness of registration information to update the billing system.
- Providing excellent service to customers if they need verification or additional clarification after an adjustment to their account.
- Supporting operational tasks as a member of a cohesive team or supporting assigned special projects, such as the current effort to update our existing consumption-based billing structure.
- Perform tasks assigned to include email task assignments, billing assignments, creating spreadsheets and letters, document scanning, etc.
- Perform other essential functions such as training new employees, implementing corporate or regulatory programs, and processing returned Capital Credit checks.
- Review and assist in policy and procedure development to comply with corporate and regulatory requirements.
- A bilingual Spanish representative assisted with small projects for different departments, including my own and public relations.
- Self-motivated, with a strong sense of personal responsibility.
- Processed billing inquiries and resolved discrepancies to enhance customer satisfaction.
- Collaborated with cross-functional teams to streamline billing procedures and improve efficiency.
- Mentored junior staff, fostering professional development and promoting best practices in billing operations.
- Researched and resolved billing discrepancies to enable accurate billing.
- Worked with multiple departments to check proper billing information.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
- Maintained detailed records of each account's payment history, providing easy access to information for audit and analysis purposes.
- Contributed to improved financial reporting by reconciling discrepancies between invoiced amounts and actual payments received.
Financial Quality Coordinator
Inova Mount Vernon Hospital
12.2015 - 04.2020
- Full time from 12/17-06/17 and from 06/17 to 04/20 part time on Saturday
- Explains insurance benefits and patient liability using appropriate communication methods/style.
- Checks for understanding and answers any questions.
- Conducts post-submission follow up on alternative funding applications.
- Requests/secures balance due payments from patients in accordance with established policies and procedures.
- Educates and assists patients with the completion/submission of applications for alternative sources of payment for healthcare services, including medical assistance programs, loans and grants.
- Maintains current financial counseling reference manual.
- Reviews documented insurance benefits and patient liability in appropriate system(s) to prepare for patient counseling session.
- Insurance Verification
- Identifies and communicates payer authorization and referral requirements.
- Completes and documents in appropriate computer system.
- Maintains updated authorization/referral requirements information and communicates to team members.
- Applies knowledge of online payer verification systems to obtain and validate insurance information on a timely and accurate basis.
- Determines patient financial responsibility and notifies patient and/or guardian as necessary.
- Provides patients with forms required for medical care and secure complete, signed forms.
- Coordinated quality assurance processes to ensure compliance with healthcare regulations and standards.
Reimbursement Analyst
Parexel International
02.2011 - 12.2015
- Conduct insurance reimbursement and/or payer research.
- Read medical chart and assign the correct diagnosis (ICD-9), procedure (CPT), and HCPCS
- Utilize CPR+ program to test pharmacy claims.
- Consult with CMS regarding LCD for proper coding and billing
- Obtain prior authorizations and claim appeals, as needed.
- Work with insurance companies and providers to obtain coverage of medications.
- Assist patients in understanding their coverage details and provide additional resource information when possible.
- Inform patients of foundations and programs when financial assistance is necessary.
- Execute high volume of call center communications, I took over 100 calls in a day with a 99.9 accuracy resolving various customer service issues
- Accurately enter information into various company databases
- Establish and maintain resource files on program metrics
- Prepare information packets for faxing/mailing
- Retrieve voicemail messages and return calls within strict deadlines
- Execute daily Quality Check data analysis for 100 percent accuracy and compliance
- Process appropriate program and project material ensuring proper delivery.
- (Pharmaceutical)
Tier I
CSC Customer Service Representative
11.2009 - 09.2012
- Provided information and procedures to thousands of callers regarding immigration inquiries, including & provided excellent service while staying within legal and contract means.
- Naturalization
- Adjustment of Status
- Employment Authorizations
- Temporary Protected Status
- Fiancé petitions
- Performed 100 percent accurate data entry for thousands of clients to various Service Centers
- Achieved quality scores of 99% on all monitored calls.
- (U.S. Citizenship & Immigration Services)
- Skilled at working independently and collaboratively in a team environment.
- Worked effectively in fast-paced environments.
Administrative Assistant
Small Business Administration
01.2007 - 05.2009
- Performed file audits and travel authorizations.
- Reviewed Accounts Payable records.
- Screen visitors and locate the appropriate person or department for appointments or consultations.
- Examined Vouchers for payment processing for 7 different centers and for over a Million dollars.
- Maintained Central Billing Accounts for reconciliation. Credit Card refunds and cancellation logs.
- Provided Daily and Weekly reports to (Management and Reservists team).
- Active listener and conduct of relevant parties, ensuring the best decisions executed for business
- Networked with centers of influence developing new businesses including accountants, attorneys, and other referral sources.
- Coordinated office operations, ensuring efficient workflow and communication among team members.
- Developed and maintained filing systems, enhancing information retrieval and document organization.
- Implemented process improvements that streamlined administrative tasks, increasing overall productivity.
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
- Ensured accurate record-keeping with diligent data entry and database management for vital company information.
- Improved document organization with thorough file maintenance, archiving outdated records as necessary for efficient retrieval when needed.
- Supported executive staff through scheduling meetings, coordinating travel arrangements for management and reservist team.
- Collaborated on special projects as assigned by leadership, contributing research findings or coordinating event logistics as needed for success.
Receptionist/Information Specialist
Oberthur, Inc.
07.2006 - 01.2007
- Provided superior welcome experience for thousands of visitors and sales callers
- Performed administrative duties: accurate data entry, filing, faxing, copying, mailing and bi-lingual translations (Spanish)
- Maintained accurate records of visitor logs and correspondence for tracking purposes.
- Developed customer service protocols to enhance client interactions and satisfaction levels.
- Answered phone promptly and directed incoming calls to correct offices.
- Kept reception area clean and neat to give visitors positive first impression.
- Resolved customer problems and complaints.
- Streamlined front desk operations for increased efficiency by effectively managing phone calls, emails, and walk-in clients.
Purchasing Manager Assistant Inventory Management Supervisor
Accu-assembly, Inc.
08.1996 - 12.2005
- Supervised, managed and trained staff by 10 personnel.
- Demonstrated ability to identify errors and communicate needed corrections.
- Demonstrated ability to lead people and get results through others. Ability to develop and motivate a team. Ability to organize and manage multiple priorities.
- Provided superior support in sales, procurement, accounting, payroll and billing.
- Provided superior customer service to callers and visitors.
- Assisted in quality control and inventory.
- Reviewed customer and vendor files.
- Assemble and test electronic circuit board assemblies, ability to understand schematic diagrams, bills of material and specifications to determine established assembly method, material needed and subassembly to be processed.
- Pulled parts listed in a job order kit prior to running the board assembly.
- Placed SMT & through hole components manually on prototype PCBs.
- Re-stock unused parts from various production cell runs
- Performed other duties as assigned.
- Developed and implemented procurement strategies to optimize supply chain efficiency.
- Negotiated contracts with vendors to secure favorable terms and pricing.
Education
Associate of Applied Science - Cybersecurity
NVCC
Manassas, VA05.2025
Associate degree - Executive Secretary
Josefa Ortiz De Domínguez
Merida, Yucatan, Mexico06.1992
Associate degree - Computer Programmer Analyst
CETEC
Mérida, Yucatan, Mexico06.1992
Skills
- Payments cybersecurity fundamentals
- Insurance verification
- Invoice processing
- Claims processing
- HIPAA compliance
- Billing systems and software
- Account reconciliation
- Invoice generation
- Claim submission
- Payment posting
- Medical billing expertise
- Patient account management
- Accounts receivable management
Clearance
Inactive Public Trust - U.S. and Immigration Services Citizenship
Languages
Spanish
Native or Bilingual
Timeline
Billing Specialist
Northern Virginia Electric Cooperative
06.2017 - Current
Financial Quality Coordinator
Inova Mount Vernon Hospital
12.2015 - 04.2020
Reimbursement Analyst
Parexel International
02.2011 - 12.2015
Tier I
CSC Customer Service Representative
11.2009 - 09.2012
Administrative Assistant
Small Business Administration
01.2007 - 05.2009
Receptionist/Information Specialist
Oberthur, Inc.
07.2006 - 01.2007
Purchasing Manager Assistant Inventory Management Supervisor
Accu-assembly, Inc.
08.1996 - 12.2005
Associate of Applied Science - Cybersecurity
NVCC
Associate degree - Executive Secretary
Josefa Ortiz De Domínguez
Associate degree - Computer Programmer Analyst
CETEC