Peneatha Lane
Benson,NC
Summary
Dynamic Healthcare Arbitration and Revenue Cycle Specialist with over 17 years of expertise in denial management, claims dispute resolution, and complex billing disputes. Proficient in documentation review, appeals preparation, and arbitration case analysis, all aimed at facilitating effective dispute resolution. Holds a Master of Health Services Administration and demonstrates advanced proficiency in Epic, Cerner, and Meditech systems, complemented by a thorough understanding of healthcare financial regulations and payer compliance. Results-driven professional committed to enhancing organizational goals through collaboration, adaptability, and exceptional communication and analytical skills.
Overview
15
15
years of professional experience
Work History
Arbitration Specialist
Provider Resources Inc.
Remote
10.2025 - Current
- Review and analyze all relevant documents, contracts, and evidence presented by the parties
- Serve as a neutral mediator to facilitate discussions between conflicting parties
- Prepare and issue binding arbitration awards and decisions based on findings
- Stay updated on changes in arbitration laws and best practices
- Proven success in negotiation and technical writing
- Knowledge of medical terminology
Patient Account Representative III
Inova Health
Remote
04.2024 - 10.2025
- Prepare appeals process for denied or underpayment claims
- Disclosed payments, adjustments, and write-offs to patient accounts
- Resolve denials and follow up on claims
- Sustain strict confidentiality of all patient and financial records in compliance with HIPAA regulations
Finance Account Representative/Collections Representative
WakeMed
Raleigh, North Carolina
10.2017 - 04.2023
- Ability to work outstanding accounts receivables and process write-offs
- Accounts Reconciliations, researching and reconciling payment discrepancies based on contracted fee schedules
- Processing electronic payments according to contractual agreements and determines payment accuracy
- Monitor collections, aging and write-offs for billing activities.
- Knowledge of CPT/HCPCS revenue codes,Billing edits to ensure all claims accurate before being submitted to the payers.
- Responsible for following up on outstanding claims to seek a timely resolution.
- Ability to work independently and prioritize workflow.
- Able to communicate effectively with colleagues, supervisor, and manager.
- Ensure A/R are greater than 90 days is less than 20% of the overall outstanding A/R.
- Entails the ability to work a high volume of claims, strong organizational skills and attention to details.
- Responsible for attaining knowledge of state and federal grant regulations.
- Verification of insurance eligibility, prior authorizations, and referral authorizations
- Verification of active Medicare, Medicaid, and Commercial Insurance coverage.
- Following up & Resolving on Rejected & Denied Medicare/Medicaid claims.
- Followed up on all third party & self-pay accounts.
- Responded to all third party & patient inquiries (EOB’s, denials, refunds requests, etc..)
- Gathering, researching, and analyzing data/information.
- Responsibility for obtaining financial and demographic information for maximum reimbursement.
Aseptic Filling Technician/Inspector Technician
Xellia Pharmaceutical
Raleigh, North Carolina
06.2015 - 10.2017
- Perform all required manufacturing processes within the SOP’s, Complete FDA documentation requirements, batch records and troubleshoot
- Perform job function in strict accordance to room classification while insuring product quality
- Exemplify the DPT Core Values of Integrity, Dignity, Perseverance and Trust.
- Share operational knowledge with peers, new hires, contingency staff members and newly-appointed operators as needed to maintain efficiencies and compliance
- Carry out inspection of manufacturing bottles
- Check bottles for compliance with relevant regulations and standards
- Identify and report any defects or irregularities
- Assess and record the condition of the bottles
- Reject non conforming bottles
- Ability to inspect bottles for quality control
- Attention to detail
Report Clerk
FirstGroup
Raleigh, North Carolina
02.2011 - 06.2015
- Examine and analyze records to follow-up and determine financial status of accounts
- Gathering, researching, and analyzing data/information.
- Reimbursement bookkeeping, issue invoices, credit balances and process credit card transactions
- Review and reconcile reimbursement logs with report documentation
- Maintain FDA driver log reports in accordance to regulations and upload documentation to the Department of Transportation
- Used SAP for account receivables, managing bookkeeping
- Receive incoming calls to address customer concerns
- File and retrieve records of passenger counts, driving logs, and safety records
Education
Master’s Degree in Business Management - Health Services
Strayer University
Raleigh, NC01-2021
Bachelor of Business Administration - Health Services Administration
Strayer University
Raleigh, NC01-2019
Associate of Business Administration - undefined
Strayer University
Raleigh, NC01-2017
Some College (No Degree) - Medical Coding and Billing
Wake Technical Community College
Raleigh, NC01-2017
Certificate Administrative Medical Assistant - undefined
Wake Tech Community College
Raleigh, NC10-2016
Skills
- Revenue Cycle Management
- Denials & appeals Resolution
- Arbitration & Dispute Management
- Insurance Claims Investigation
- Patient Account Resolution
- Medical Billing Compliance
- Account Reconciliation
- Financial Analysis
- Healthcare Regulations
- Documentation Review
- Revenue Recovery
- Healthcare Financial Systems
Timeline
Arbitration Specialist
Provider Resources Inc.
10.2025 - Current
Patient Account Representative III
Inova Health
04.2024 - 10.2025
Finance Account Representative/Collections Representative
WakeMed
10.2017 - 04.2023
Aseptic Filling Technician/Inspector Technician
Xellia Pharmaceutical
06.2015 - 10.2017
Report Clerk
FirstGroup
02.2011 - 06.2015
Bachelor of Business Administration - Health Services Administration
Strayer University
Associate of Business Administration - undefined
Strayer University
Certificate Administrative Medical Assistant - undefined
Wake Tech Community College
Master’s Degree in Business Management - Health Services
Strayer University
Some College (No Degree) - Medical Coding and Billing
Wake Technical Community College