MARIA PENA
Richmond,CA
Summary
Dynamic RCM Team Lead at Veradigm with expertise in claims and revenue management. Proven track record in enhancing billing accuracy and resolving denials, ensuring optimal revenue collection. Skilled in insurance verification and adept at fostering team collaboration to achieve financial goals. Committed to delivering exceptional results in a fast-paced healthcare environment.
Overview
26
26
years of professional experience
Work History
RCM Team Lead
Veradigm
Chicago, IL
10.2015 - 06.2025
- Managing patient accounts, ensuring accurate billing and claims processing, and maximizing revenue collection within the healthcare industry.
- Updating patient accounts, verifying insurance coverage, and ensuring accurate patient information.
- Submitting claims, reviewing claims, and working to resolve denied claims or denials.
- Following up on outstanding balances, making collection efforts, and resolving payment discrepancies.
- Answering patient complaints, and providing information about billing and collections.
- Drafting appeal letters, gathering necessary documentation, and submitting appeals to insurance payers.
RCM Cash Poster and Refunds Specialist
Sutter Health
San Francisco, CA
05.1999 - 10.2015
- Accurately recording and reconciling payments from insurance companies, patients, and other third parties.
- Input payments, adjustments, and denials into the billing system.
- Research and resolve unapplied or misapplied payments.
- Keep accurate records of cash posting activities and payment information.
- Work with the AR and billing teams to ensure payment accuracy.
- Investigating and resolving discrepancies in payments.
- Processed and managed refunds by reviewing credit balances, processing refund requests, adjustments, and other corrections.
Education
Bachelors of Education - Education
Centros De Estudios Universitarios
Monterrey, NL Mexico07-1986
Skills
- Claims and revenue management
- Billing accuracy and reconciliation
- Insurance verification and denial resolution
Accomplishments
- I consistency surpassed my job responsibilities and achieved outstanding results. Often going above and beyon what is required.
- My contribution lead to significant improvements, positive outcomes and positive impact on team or organization.
Languages
English
Professional
Spanish
Professional
Experience
- 26 years of RCM experience with excellent professional references.
References
References available upon request.
Timeline
RCM Team Lead
Veradigm
10.2015 - 06.2025
RCM Cash Poster and Refunds Specialist
Sutter Health
05.1999 - 10.2015
Bachelors of Education - Education
Centros De Estudios Universitarios
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