Customer Service Case Manager

SAN ANTONIO, US, ***** • ******.*****@*****.*** • 210-***-****

KRISTI PENNA

Medical Billing and Coding Specialist

PROFESSIONAL SUMMARY

Customer service, call center, Medical Billing and Coding Specialist with over 25 years of extensive expertise in claims processing, insurance verification, and medical coding. Demonstrates strong leadership and critical thinking skills, enhancing team efficiency and patient satisfaction. Committed to maintaining compliance with HIPAA standards while fostering effective communication between healthcare providers and patients. EMPLOYMENT HISTORY

CASE MANAGER / CSR Oct 2024 - Mar 2025

Remx Staffing Agency - McKesson Remote

ER BILLING COORDINATOR SUPERVISOR May 2017 - May 2024 Victoria Emergency Associates Remote

ER BILLING COORDINATOR Jul 2009 - Jul 2017

EMCARE, INC. San Antonio, Texas

Case Manager for the Merck Access program. A department that assists healthcare providers and their patients with providing Cancer assistance and funding, so they may receive a cancer drug to help save their lives. Customer Service call center, outbound/inbound calls, clinical review of all documentation, eligibility and Benefits of Insurance, authorization, follow up on missing information, faxing. Remote position, HIPAA certification.Provided compassionate support to patients navigating cancer treatment options, ensuring they received timely assistance and access to necessary medications.

Provided compassionate support to patients navigating cancer treatment options, ensuring timely access to necessary medications and enhancing patient care.

Managed clinical reviews of documentation, leading to improved eligibility determinations and faster authorization processes for patients.

Conducted thorough follow-ups on missing information, facilitating smoother communication between healthcare providers and patients, resulting in reduced delays.

Lead ER billing for 13 sites, ensuring accurate coding and timely documentation. Collaborate with providers to resolve billing issues, improving efficiency. Produce detailed billing reports for strategic decisions. Manage provider transitions, ensuring compliance and smooth onboarding. Conduct weekly audits of ER charts, maintaining billing readiness. Coordinate ER billing, ensuring accurate record submission and reconciliation. Trained new staff on EmScan, enhancing team efficiency and system proficiency. Managed critical care charges, improving billing accuracy and reducing errors. Maintained organized patient records, supporting high-paced trauma facility operations. Proficient in Microsoft Office and Meditech, facilitating seamless data management. Streamlined billing processes by reconciling emergency department logs with patient records, enhancing accuracy and reducing billing discrepancies.

Analyzed patient charts and billing information, ensuring timely submissions and improving overall billing efficiency across departments.

Implemented a tracking system for critical care charges, leading to noticeable gains in charge capture and revenue integrity. Maintained meticulous records of patient admissions and billing inquiries, ensuring compliance with hospital protocols and improving patient satisfaction.

Streamlined ER billing processes, enhancing accuracy and reducing discrepancies, which supported timely revenue collection. PFS CLAIMS SPECIALIST II Jun 2001 - Jul 2009

Kinetic Concepts Inc. San Antonio, Texas

PBX OPERATOR & RECEPTIONIST Apr 1998 - Aug 2001

Laurel Ridge Psychiatric Hospital San Antonio, Texas EDUCATION

CMA/BILLING AND CODING CERTIFICATE Aug 1998 - Jun 2000 Professional Career Development Institute San Antonio, TX HIGH SCHOOL DIPLOMA Aug 1994 - Jan 1997

East Central HS San Antonio, TX

COURSES

CPC CERTIFICATION Jul 2024 - Present

Coding Clarified

SKILLS

Medical Billing (Experienced), HIPAA (Experienced), Insurance Verification (Experienced), Claims Processing (Skillful), Customer Service (Expert), Microsoft Office (Experienced), Data Entry (Experienced), Medical Coding (Experienced), EMR (Experienced), Problem Solving (Experienced), Critical Thinking (Experienced), Leadership (Experienced), Documentation (Experienced), Healthcare (Experienced), Patient Care (Experienced), Credentialing (Skillful), Case Management (Experienced).

Evaluated and processed orders swiftly, ensuring compliance with payer requirements. Maintained high productivity and received multiple accolades for customer service excellence. Trained new employees and supported supervisors with process improvements. Managed diverse payer sources with extensive knowledge, maintaining professional relationships. Regularly attended meetings to implement effective process enhancements. Trained new employees on claims processes, fostering a collaborative environment that improved team performance and service delivery.

Monitored payer requirements to ensure compliance, leading to marked gains in claims approval rates and reduced processing delays.

Maintained comprehensive documentation of all claims actions, ensuring accuracy and adherence to internal standards while improving operational efficiency.

Cultivated professional relationships with patients and providers, strengthening trust and streamlining communications for better service outcomes.

Streamlined claims processing protocols, leading to noticeable gains in approval rates and significantly reducing turnaround times.

Trained and mentored new team members, fostering a supportive environment that enhanced overall team performance and service quality.

Customer Service Operator, handling internal and external calls efficiently, enhancing communication flow. Coordinated front desk and admissions, ensuring smooth patient intake. Verified insurance benefits and obtained authorizations, reducing delays. Utilized MS Word and 10 Key Punch for accurate data entry. Operated fax and copy machines, supporting administrative tasks. Managed all incoming and outgoing calls efficiently, reducing wait times and enhancing communication flow within the hospital.

Executed meticulous verification of patient eligibility and benefits, ensuring accurate authorizations that streamlined the admissions process.

Coordinated with medical staff to facilitate admissions, improving patient intake efficiency and supporting overall hospital operations.

Utilized MS Office tools to maintain organized records, contributing to improved data accuracy and operational transparency.

Optimized data entry processes using MS Office, enhancing record accuracy and contributing to seamless administrative operations.

ADDITIONAL INFORMATION

CERTIFICATIONS

• Certified Coding Specialist (1999 – 2000)

• Certified Medical Billing Specialist (1999 - 2000)

• Medical Office Admin Certificate (1999 - 2000)

CPC AAPC course completed - waiting to take certification exam

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