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
Remote
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
Conshohocken, PA
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
Newark, DE
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
Plymouth Meeting, PA
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
Philadelphia, PA
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)