Penela O. SAMON
Middletown,DE
Summary
Self-motivated professional offering a strong work ethic and determination to lead responsibilities and complete tasks in a timely manner. Accurate and result-oriented with extensive Cybersecurity, Chart Validation (CCV), Project Management, Human Resources Management, and Sigma Beta Delta member.
Motivated customer service Specialist with over 9 years of retail experience in a fast-paced, team-based environment. Assertive, enthusiastic with extensive knowledge of process optimization and fraud prevention; always looking for new challenges. Team Leader, quick learner, Critical thinker, and several times best awards winner. I am excellent at programming languages, initiating and planning projects, budgeting and scheduling projects, as well as managing project risks and changes.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Claims Production Analyst II
Cotiviti
09.2019 - Current
- Reprice claims for multiple clients such as Aetna, Cigna, UHC, Wellcare, and BCBSKC.
- Streamline audit processes through the implementation of advanced software tools, reducing time spent on manual tasks.
- Reduce claims processing time by implementing efficient analytical techniques and strategies.
- Enhance customer satisfaction by resolving complex claims issues in a timely manner.
- Proof claim information – Provide higher level proofing support on claims submitting to ensure accuracy of totals, verbiage, calculations or other key variables prior to client submission.
Senior Audit Support Assistant
Cotiviti
10.2016 - 09.2019
- Processed medical record invoices with expected department productivity and accuracy.
- Prepared monthly accrual to send it to Accounts Payable.
- Processed bulk invoices for IOD and CIOX.
- Performed QA to ensure accuracy in medical record packages sent to clients.
- Responded to general inquiries.
- Trained and assisted new employees.
- Enhanced audit accuracy by meticulously reviewing financial statements and records for compliance with regulatory requirements.
- Streamlined audit processes through the implementation of advanced software tools, reducing time spent on manual tasks.
Fraud Analyst II
Bank of America
08.2015 - 10.2015
- Reduced fraud losses by implementing effective fraud prevention strategies and monitoring systems.
- Enhanced detection capabilities for potential fraudulent activities through regular review of account transactions and patterns.
Bilingual Patient Support Specialist
EPharmaSolutions
01.2014 - 05.2014
- Responded to patients’ inquiries via telephone or online to educate and screen them for specific clinical trials.
- Enhanced patient satisfaction by providing exceptional support and addressing concerns promptly.
Assistant Manager / Manager
Green Soul
05.2011 - 12.2013
- Accomplished department objectives by managing staff, planning and evaluating department activities.
- Improved customer satisfaction by addressing and resolving complaints promptly.
- Streamlined store operations for increased efficiency, implementing new processes and procedures.
- Performed administrative responsibilities such as scheduling, budgeting, and payroll.
- Led the procurement of good and services.
Education
Cybersecurity Certificate -
Google
Remote02.2024
Certified Associate in Project Management (CAPM) -
Temple University
Philadelphia, PA12.2017
MSB - Human Resources Management
Lincoln University
Philadelphia, PA08.2017
BS - Computer Network and Security
Wilmington University
New Castle, DE01.2012
AS - Computer Information Systems
Camden County College
Blackwood, NJ06.2010
Skills
- Network Security
- Programming (SQL, Python)
- Linux-line command
- Security frameworks, controls, design principles
- Claims Repricing
- Claims Appeals
- HR Management
- Microsoft Office (Word, Excel, PowerPoint)
- Medical Record Invoice (MRI) Tool and Clinical Chart Validation (CCV)
- Budgeting and Scheduling Projects
- Special Projects
- Claims Review
Certification
- 02/2024 Google Cybersecurity Certificate
- Foundations of Cybersecurity
- Manage Security Risks
- Networks Security
- Linux and SQL
- Assets, Threats, and Vulnerabilities
- Detection and Response
- Automate Cybersecurity Tasks with Python
- 12/2017 Certified Associate in Project Management (CAPM)
Languages
English
Native or Bilingual
French
Native or Bilingual
Timeline
Claims Production Analyst II
Cotiviti
09.2019 - Current
Senior Audit Support Assistant
Cotiviti
10.2016 - 09.2019
Fraud Analyst II
Bank of America
08.2015 - 10.2015
Bilingual Patient Support Specialist
EPharmaSolutions
01.2014 - 05.2014
Assistant Manager / Manager
Green Soul
05.2011 - 12.2013
Cybersecurity Certificate -
Google
Certified Associate in Project Management (CAPM) -
Temple University
MSB - Human Resources Management
Lincoln University
BS - Computer Network and Security
Wilmington University
AS - Computer Information Systems
Camden County College
- 02/2024 Google Cybersecurity Certificate
- Foundations of Cybersecurity
- Manage Security Risks
- Networks Security
- Linux and SQL
- Assets, Threats, and Vulnerabilities
- Detection and Response
- Automate Cybersecurity Tasks with Python
- 12/2017 Certified Associate in Project Management (CAPM)