Nickole Pena
Pocono Summit,PA
Summary
Motivated and well-rounded Medical Office Manager with over 17 years’ experience in Health operations management, billing, coding, eligibility, and benefits as well as Health Information management. Highly skilled in analyzing and validating patient information, diagnoses, and billing. data. Demonstrated leadership skills that enable the processing of high volumes of patient information. to achieve revenue generation goals. looking for a Remote position. Authorized to work in the US for any employer.
Overview
13
13
years of professional experience
Work History
Billing Specialist
HEART OF GOLD HOME CARE
10.2020 - Current
- Oversee daily Billing Department functions for over 200 participants, including medical coding, charge entry, claims, payment posting, and reimbursement management for Home Health and Medical Services
- Overseeing EVV and Billing review daily
- Accurately input EVV and Timesheets into billing software to generate invoices
- Used electronic charge capture practices such as billing and account receivables (BAR) system and medical billing clearinghouse accounts to submit codes and invoices on time
- Follow up on past due invoices and delinquent accounts to reduce number of unpaid and outstanding balances
- Document patient data and medical records and perform routine medical record audits to comply with insurance company requirements
- Uphold and reinforce compliance with hospital policies and federal regulations such as HIPAA.
- Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
- Used data entry skills to accurately document and input statements.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Monitored customer accounts to identify and rectify billing issues.
- Prepared and submitted monthly billing reports to management for financial overview.
- Processed vendor and supplier payments on weekly basis.
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
- Developed and maintained billing procedures to make timely payments.
- Identified payment trends and adjusted billing processes accordingly to retain customers.
- Processed and verified invoices to secure accuracy of billing information.
- Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.
- Handled account payments and provided information regarding outstanding balances.
- Generated accounts payable reports for management review to aid in financial and business decision making.
- Generated monthly billing and posting reports for management review.
- Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
- Collaborated with customers to resolve disputes.
- Maintained accurate records of customer payments.
- Audited and corrected billing and posting documents for accuracy.
- Responded to customer concerns and questions on daily basis.
- Created improved filing system to maintain secure client data.
- Reconciled accounts receivable to general ledger.
- Provided excellent customer service, developing and maintaining client relationships.
- Monitored outstanding invoices and performed collections duties.
- Generated and submitted invoices based upon established accounts receivable schedules and terms.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Generated monthly invoices for customers in multiple formats to provide transparency.
- Utilized various software programs to process customer payments.
- Worked with multiple departments to check proper billing information.
- Researched and resolved billing discrepancies to enable accurate billing.
- Verified accuracy of accounts payable payments, resulting in 98% reduction in payment errors and check reissues.
HR Manager
Charter Home Health
05.2020 - 11.2020
- Processing weekly payroll for over 200 + employees
- Ensuring employees follow all policies and procedures
- Assessing reports provided by the HR team, team leaders and operations managers to determine employee performance and training needs
- Suggesting changes in policies and procedures based on employee and company needs
- Researching compensation standards set by industry and governing bodies to create salary structures and administer employee benefits
- Creating recruitment plans, interview schedules and evaluation standards in accordance with HR methodologies and labor laws
- Supervising all HR activities, communications, reports, requests, and documents created and received by the team
- Attending interdepartmental meetings with other managers
- Overseeing exit interviews and procedures
- Coordinated employee grievances and disputes in timely and professional manner by finding constructive solutions.
- Maintained human resources regulatory compliance with local, state and federal laws.
- Maintained company compliance with local, state, and federal laws, in addition to established organizational standards.
- Reviewed business goals to recommend new HR approaches, policies and procedures for continual improvements focused on meeting business objectives and enhancing productivity.
- Developed focused training programs, leadership pipeline and succession plans.
- Motivated employees through special events, incentive programs, and constructive feedback.
- Supervised and mentored direct reports and developed talented HR teams.
- Advised executives on best practices for employee growth and productivity goals, consistently helping companies improve retention.
- Organized and led staff orientation programs and training to promote collaboration.
- Facilitated onboarding sessions and on-the-job training for new hires, bolstering employee job position knowledge and skillset.
- Motivated employees through special events and incentive programs.
- Oversaw legal compliance with federal, state and local laws and regulations in addition to compliance with company policies and procedures.
- Guided leaders and employees on company policies, programs, benefits and salary administration.
- Processed employee claims involving performance issues and harassment.
- Implemented performance reviews and motivational strategies to elevate HR team results.
- Advised decision-makers on complex and confidential matters ranging from performance management to employee relations issues.
- Maintained payroll and benefits for employees in various locations, minimizing financial discrepancies through detailed program management.
- Managed employee disputes by employing conflict resolution techniques.
- Implemented standardized programs and policies, driving smooth operations, employee retention and engagement.
- Led decision-making and implementation of HR policies, procedures, programs and functions.
- Used technologically relevant digital systems to manage payroll and benefits programs.
- Facilitated onboarding sessions and on-the-job training for new hires bolstering position knowledge and skillset.
- Coordinated immigration process for visa and green card applications to support mobility requests for domestic and international long and short-term assignments.
- Monitored and handled employee claims involving performance-based and harassment incidents.
- Evaluated employee onboarding programs and presented strategic improvement recommendations to upper management.
- Maintained payroll and benefits for employees in various locations and diminished financial discrepancies through expert program management.
- Recommended, initiated and finalized HR actions regarding faculty and staff position management, compensation and employment postings, hiring proposals and new hire onboarding.
- Created vision and goals for HR team and motivated staff to achieve excellence in customer support and core HR processes.
On Call Manager
THE ROYAL CARE INC
10.2017 - 08.2020
- Provided training, coaching, mentoring to staff as appropriate and provided development opportunities to meet the organization’s future needs
- Designed, implemented, and managed necessary operational workflows; met internal and external
- SLA’s (Service Level Agreements)
- Supported and administered various departmental and corporate policies consistent with the company’s core values and philosophies
- Directly managed the Call Center Data Analyst platform for Call outs
- Partnered with the Site Operations Manager for referrals
- Fostered close, cooperative relationships with peer leaders, channel management, as well as internal and external partners
- Controlled resources and assets for department activities to comply with industry standards and government regulations.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Developed quality employees within call center to take over leadership positions.
- Trained personnel in equipment maintenance and enforced participation in exercises focused on developing key skills.
- Determined quality assurance benchmarks and set standards for improvement.
- Leveraged data and analytics to make informed decisions and drive business improvements.
- Resolved escalated customer issues promptly and professionally to maintain satisfaction.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
- Conducted performance reviews for staff members to reduce resolution times and improve customer satisfaction ratings.
- Defined clear targets and objectives and communicated to other team members.
- Improved staffing during busy periods by creating employee schedules and monitoring call-outs.
- Scheduled call center staff to meet operational needs whilst remaining under budget.
- Opened and closed location and monitored shift changes to uphold successful operations strategies and maximize business success.
- Evaluated data to identify trends and determine customer service needs.
- Analyzed customer feedback to identify improvement opportunities and develop action plans.
- Recruited, trained and onboarded new agents, maintaining exceptional service standards.
- Set aggressive targets for employees to drive company success and strengthen motivation.
- Established and oversaw performance targets for call center associates.
Prior Authorization Representative
Phoenix Medcom
01.2018 - 03.2020
- Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements
- Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services
- Request, follow up and secure prior-authorizations prior to services being performed
- Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
- Communicate any insurance changes or trends among team
- Maintains a level of productivity suitable for the department
- Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
- Other duties as assigned
- Prior Authorization/Ancillary services Biller/AR
- Maintained patient confidentiality and safeguarded medical records to avoid information breaches.
- Processed new medication and refill requests for authorization.
- Tracked referral submission during facilitation of prior authorization issuance.
- Contacted insurance companies to obtain prior authorization for medical procedures and medications.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Communicated pertinent information to client's prescribing provider to facilitate quality service.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Developed and maintained productive working relationships with healthcare providers.
- Created and maintained spreadsheets detailing medical procedures and insurance denials and approvals.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Collected and processed patient liability statements prior to service.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Processed patients lacking coverage for planned procedures.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Authorized surgical requests in accordance with applicable plan guidelines.
- Verified eligibility and compliance with authorization requirements for service providers.
- Resolved patient billing inquiries and other issues efficiently.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
Weill Cornell Imaging at NYPH
08.2015 - 10.2017
- Receive and verify requests for prior authorizations and ensure that they are administered properly
- Consult with presiding doctors or nurse managers to obtain clearance for the necessity of treatment
- Look through insurance plans in a detailed manner and process required referrals
- Sort medical records and submit them to the carrier in a bid to expedite the authorization process
- Keep medical staff in the loop about any delays or problems in obtaining authorizations
- Apply billing and coding principles in sync with government policies and standards
- Ensure that insurance carriers’ documentation requirements are completed and that all copies are placed in patients’ medical records files
- Verify patients’ benefits and ensure that proper prior authorization and re-authorization is obtained for additional treatment
- Key achievements:
- Medical billing team posted and submitted claims within 24 hours of receipt
- Supervised a 10-member team and assisted with training new hires.
Payroll/HR Coordinator
NURSING DEPT, MARY MANNING WALSH
10.2014 - 01.2015
- Assisted Payroll Supervisor in reviewing and analysis of current payroll processes, procedures and controls
- Assisted with the overpayment collection and reporting processes
- Balanced and audited payroll earnings, deductions, taxes, benefits, etc
- Communicated with Payroll Benefits Coordinator (PBC) in the field to resolve problems, answer questions, train, and advise on regulatory issues
- Coordinated and communicated deadlines to staff and Human Resources team
- Coordinated and reconciled bonus and commission activity for the bi-weekly payroll cycle
- Coordinated with Payroll Supervisor any User Acceptance Testing and helped drive adoption of improved processes within the payroll team
- Imported time files and entered data
- Issued off-cycle check and electronic funds transfer payment activity daily
- Managed regular preparation of relevant management reports, including weekly, monthly, quarterly and year-end reports
- Monitored compliance of PBC/field personnel with required deadlines, compliance to company policies, payroll approval paperwork, system clean up, error reports, etc
- Processed payroll for facilities
- Recorded accounting transaction activity to the corporate general ledger
- Researched best practices to recommend, implement and drive change leading to bestpractice operation
- Researched, compiled, and reported required payroll data for other departments, facilities and regulatory agencies
- Reviewed payroll & accounting entries on a month-end and quarter-end basis
- Stayed current on knowledge of company payroll/HR policies and procedures, administration guidelines, and related regulatory issues for federal, state, and local governments
- Tracked facility transmittal status
- Medical Payment Poster/AR
COLUMBIA UNIVERSITY DEPT. OF SURGERY
05.2012 - 10.2014
- Post payment from check batches received from the Finance Department into the practice management system
- Charge adjust PPO discounts and workers comp fee guidelines as necessary
- Understand EOB’s (explanation of benefits) and adjustments
- Post all payments from patients and various insurance companies within a set turnaround time
- Meet monthly closing deadlines as set by the company
- Balance all posted batches by generating a batch summary report and reviewing for variances
- Recommend new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and services performed
- Ensure notes are entered in the patient account, and copies of EOB’s, denials, and other correspondence are provided to the Collector
- Payments and adjustments are accurately recorded in the patient accounting system daily
- Serves as a member of the Cash Posting (Management/Dept/Coding/Data Entry/etc.) Team
- Perform duties necessary to ensure the team’s projects/goals are completed.
Medical Biller/Receptionist
CONCORDE MEDICAL GROUP
03.2010 - 05.2012
- Responsible for processing payments, adjustments, and denials according to established guidelines (Payment Poster)
- Review medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filed
- Ensure accurate entry of work into designated billing systems
- Assist with training materials and training staff members
- Communicates with the Clinics to provide or obtain corrected or additional data
- Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information
- Responsible for working EDI claim rejections in a timely manner
Education
Medical Insurance Coding
AAPC
MA - Health Information Management
CUNY School Of Professional Studies
2019
BA - BUSINESS ADMINISTRATION AND MANAGEMENT
CUNY School Of Professional Studies
2011
AAS - PARALEGAL STUDIES
CUNY LAGUARDIA COMMUNITY COLLEGE
2009
Skills
- Communication
- Billing Reimbursement
- Ability to Work Under Pressure
- Complex Scheduling
- Decision Making
- HR Generalist; Payroll processing, onboarding
- Time Management
- Word, Excel, PowerPoint, Access, Outlook, Office suite
- Self-motivation
- IDX, Centricity, Intergy, Crown, All Scripts and Epic
- Conflict Resolution
- Type: 65 WPM/ Transcription: Express Scribe Pro
- Leadership
- Adaptability
- Vendor Contract negotiations
- Teamwork
- Social Media Savvy:
- Twitter, LinkedIn, Instagram, Facebook
- Creativity
- Faxing, Scanning, Copying, Letter Drafting, Data entry
- Property Management experience
- CRM
- Excel
- Inventory
- Microsoft Office
- Team Building
- Training
- Sales
- Management
- Filing
- Epic
- ADP
- Oracle
- Billing Dispute Resolution
- System Updates
- Audit Procedures
- Month-End Closing Procedures
- Data Imports
- Coding Proficiency
- Accounts Receivable Expertise
- Medical Billing and Collections
- Google Drive
- Diagnostic Codes
- Billing Systems and Software
- Records Organization and Review
- Claim Processing
- Till Counting
- Creating Treatment Plans
- Information Updates
- Collections Quotas
- Invoicing Proficiency
- Records Preparation
- Billing Best Practices
- Customer Contact
- Customer Engagement
- Health Information Policy and Procedure Development
- Collection Practices
- Monthly Reconciliations
- Insurance Confirmation
- Petty Cash Disbursement
- Monthly Billing Management
- Fixed Asset
- Error Revision
- Credit Term Computing
- Account Posting
- Equipment Monitoring and Troubleshooting
- Organizational Management
- Review Documents
- Accounting Functions
- Meeting Support
- Colorectal Surgery
- Machine-Assisted Statement Preparation
- Desktop Publishing
- Manual Processing
- Office Supplies and Inventory
- Billing Document Creation
- Charges and Rates Documentation
- Fee and Charge Computation
- Access Software
- Electronic Health Records Systems
- Maintain Records
- Performance Plans
- Work Coordination
- Sales Tickets
- Bank Machine Operation
- Correct Errors
- Operating Costs and Revenues
- Auditing Proficiency
- Process Payments
- Stop Payments
- Client Rapport-Building
- Protested Check Handling
- Categorizing and Classification
- Electronic Document Management System
- Billing Data Verification
- Process Monitoring
- Sage 50 Accounting Software
- Adding, Calculating and Billing Machines
- 10-Key Data Entry
- Accounting and Financial Management
- Statement Distribution
- Correspondence Writing
- Report Compiling
- Validation of Discrepancies
- Market Value Estimation
- Check Endorsing Machines
- Statement Itemization
- Account and Ledger Reconciliations
- Digital Postal Meters
- Mail Sorting and Correspondence
- Prepare Statements
- Invoice Documentation Management
- Signature Verification
- QuickBooks Expertise
- Benefits Verifications
- Services Rendered Documentation
- Charge Slips
- Database Maintenance
- Breast Surgery
- Discrepancy Reconciliation
- A/P and A/R Expertise
- Rate, Rule and Regulation Updating
- Submitting Insurance Documents
- Verify Data
- Collections
- Research
- Peachtree
Accomplishments
- HHA EXCHANGE
- Marketing
- Marketing
- Receptionist
- Marketing
- Receptionist
- Medical Records
- EMR Systems
- Insurance Verification
- Office Management
- Accounts Receivable
- Medical Billing
- Medical Scheduling
- HIPAA
- ICD-10
- Medical Terminology
- Case Management
- Medical Coding
- Recruiting
- CPT Coding
- Hospital Experience
- Anatomy Knowledge
- Medical Office Experience
- Triage
- Laboratory Experience
- Managed care
- Microsoft Access
- Windows
- Medical Office Management
- Workers' Compensation
- Human Resources Management
- Links http://linkedin.com/Nickole-pena-cpc-cpb-783798120
Languages
Spanish
Native or Bilingual
Timeline
Billing Specialist
HEART OF GOLD HOME CARE
10.2020 - Current
HR Manager
Charter Home Health
05.2020 - 11.2020
Prior Authorization Representative
Phoenix Medcom
01.2018 - 03.2020
On Call Manager
THE ROYAL CARE INC
10.2017 - 08.2020
Weill Cornell Imaging at NYPH
08.2015 - 10.2017
Payroll/HR Coordinator
NURSING DEPT, MARY MANNING WALSH
10.2014 - 01.2015
COLUMBIA UNIVERSITY DEPT. OF SURGERY
05.2012 - 10.2014
Medical Biller/Receptionist
CONCORDE MEDICAL GROUP
03.2010 - 05.2012
Medical Insurance Coding
AAPC
MA - Health Information Management
CUNY School Of Professional Studies
BA - BUSINESS ADMINISTRATION AND MANAGEMENT
CUNY School Of Professional Studies
AAS - PARALEGAL STUDIES
CUNY LAGUARDIA COMMUNITY COLLEGE