ERIKA PENA
Cypress
Summary
Dynamic Senior Account Receivable Management professional with Texas Children’s Hospital, adept at relationship building and financial analysis. Proven track record in resolving complex issues and enhancing patient satisfaction. Skilled in Excel and leading cross-functional teams to drive efficiency and achieve organizational goals. Committed to delivering customized solutions that meet diverse needs.
Overview
21
21
years of professional experience
Work History
Senior Account Receivable Management
Texas Children Hospital
Houston
03.2023 - Current
- Collaborated with cross-functional teams to create customized solutions for providers and our facility.
- Developed and managed relationships with insurance providers to communicate and resolve issues.
- Prepared and analyzed government report data to identify trends in payment, refund, coding, and updates.
- Educated colleagues on trends, how-to, and services that can address their specific challenges.
- Maintained accurate and complete records on past-due accounts and collection actions.
Senior Patient Account Receivable
Texas Children’s Hospital
Houston
03.2015 - 03.2023
- Resolved customer inquiries and complaints requiring management-level escalation.
- Created personalized onboarding experiences for new patients, including assigning appropriate resources, setting up MyChart communication, and providing best practices advice.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Monitored quality scores, proactively addressing concerns to prevent misinformation, and ensuring patient satisfaction.
- Partnered with other departments to resolve customer complaints quickly and efficiently.
EDI Coordinator/Team Leader-Account Specialist/Provider Relations Spec.
eCardio Diagnostics
Houston
11.2010 - 03.2015
- Serve as the lead for all communications between internal users, external trading partners, and external communications network providers.
- Responsible for setting up and troubleshooting new and existing trading partners to solve communication issues. Issues include setting up new trading partners, testing new or existing trading partners' data maps, and monitoring communication system status.
- Responsible for growing the EDI volume throughout the business, while managing all EDI-related activities.
- Coordinate meetings with billing staff to identify errors found in EDI submissions, as well as train and coach individuals on a one-on-one basis.
- Handled all contracting nationwide for the Health and Human Services (Medicaid) states.
- Follow up on the patient account with ALL Health Insurance to ensure the correct allowed payment. Including, but not limited to, filing reconsiderations, appeals, as well as patient appeals.
Lead Account Representative
Patient Account Service
Houston
08.2008 - 11.2010
- Answer inbound calls from patients, physicians, case workers, attorneys, workers' compensation, crime victims, and additional health care providers regarding patient billing, coverage, and coding.
- Responsibilities include account research, claim adjustment, proper account resolution, and educating patients/callers on after-the-fact billing.
- Appropriate follow-up to ensure the account is resolved in a timely and professional manner.
Team Leader for Patient Advocate Reps.
Cardon Healthcare Network
Houston
01.2007 - 06.2009
- Assisted in-house and outpatient by screening patients for eligibility for possible Medicaid, Social Security, and additional government programs to cover hospital bills for patients with no health insurance.
- Worked in a fast-paced hospital setting while completing insurance verification, authorizations, pre-certifications on all new admissions assigned by the hospital, and ensuring that all assigned inpatient/outpatient visits contain complete and accurate demographic and financial information.
- Managed a team of eight account representatives, providing training, program knowledge, and addressing questions, while overseeing all job duties.
- Communicated with physicians, assistants, resident doctors, and discussed the patient condition and proper release forms for different programs.
- Obtained medical records and health and human service forms for medical, social security, and additional programs using safeguards.
Team Supervisor
Adaptive Marketing LLC.
Houston
02.2004 - 01.2008
- Provide leadership and oversee the daily activities of a large contact call center.
- Participate in quality initiatives, and performance management.
- Coach, train, and develop in the direction of achieving maximum sales goals and performance for each sales representative.
- Maintain expert knowledge on all products, computer systems, and communicate updates within the company.
- Data entry on action plans, as well as coordinates, and attending team meetings to discuss potential expansion with our clients.
- Coordinating team and individual meetings to discuss and reiterate updated, as well as current, company policies and procedures, following standard operating procedures.
Education
Graduate -
All American High School
Houston, TX01.2010
Certificate - Medical Assistant Program/Billing and Coding
National Institute of Technology
Houston, TX01.2004
Skills
- Financial literacy
- Analytical skills
- Account Management
- Report skills
- Excel/Microsoft Office
- Communication Skills
- Relationship building
- Additivity/Leadership Skills
References
References available upon request.
Timeline
Senior Account Receivable Management
Texas Children Hospital
03.2023 - Current
Senior Patient Account Receivable
Texas Children’s Hospital
03.2015 - 03.2023
EDI Coordinator/Team Leader-Account Specialist/Provider Relations Spec.
eCardio Diagnostics
11.2010 - 03.2015
Lead Account Representative
Patient Account Service
08.2008 - 11.2010
Team Leader for Patient Advocate Reps.
Cardon Healthcare Network
01.2007 - 06.2009
Team Supervisor
Adaptive Marketing LLC.
02.2004 - 01.2008
Graduate -
All American High School
Certificate - Medical Assistant Program/Billing and Coding
National Institute of Technology
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