Jamella Oree
Pittsburgh,PA
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
11
11
years of professional experience
Work History
Reimbursement Lead/Specialist
RareMed Solutions
Pittsburgh, PA
10.2023 - Current
- Provided training to new staff on the proper submission process for reimbursement requests.
- Resolved discrepancies between provider documentation and insurance plan requirements.
- Serve as point person for escalations and exceptions when Supervisors not available
- Support training, coaching, and feedback for team
- Support Supervisors compliance and quality activities including, call and documentation team monitoring, document updates, call quality monitoring, audit/inquiry support, and data QA/validation
- Strong compliance mindset, demonstrating clear understanding of patient privacy laws
- Active participation in building and maintaining respectful, collaborative internal/external team relationships, exercising, and encouraging positivity
- Supervise/Coach direct report team of 9 or more RS agents
- Provide RS Leadership by overseeing more than 100 RS agnts addressing reimbursement processess to include esculations.
- Developed and implemented process improvement initiatives to increase efficiency of Lead Specialist role.
- Provided guidance and support to other Lead Specialists in the organization.
- Monitored daily performance of each individual Lead Specialist against established goals.
- Identified areas of improvement in lead management processes and developed solutions to address them.
SCREENING PROGRAM
Allegheny Health Network
Pittsburgh, PA
08.2021 - 10.2023
- Schedules Lung Screen tests, procedures, Free Lung Screenings, and office visits; obtain authorizations from insurance carriers
- Collaborated with radiologists and other medical staff to determine appropriate testing schedules and protocols.
- Explained the purpose of each test to patients to ensure understanding prior to procedure.
- Counseled clients on strategies for managing their conditions or chronic illnesses.
- Organized training sessions on proper scheduling techniques for new hires.
New Hire Training Lead
Allegheny Health Network
Pittsburgh, PA
03.2020 - 08.2021
- Demonstrates leadership by communicating effectively, developing others, building, and maintaining relationships, and guiding effective teams and work groups
- Conducted performance appraisals for team members, providing feedback and identifying areas of improvement.
- Identified opportunities for process improvements, implementing changes when required.
- Participated in weekly meetings with the leadership team to discuss quality assurance initiatives.
- Provided coaching and guidance to call center representatives as needed.
- Monitored customer conversations for quality assurance purposes, ensuring that all policies were followed.
- Created onboarding materials such as handbooks and manuals for new hires.
- Mentored and coached newly hired employees in their roles and responsibilities.
ELITE CARE CONNECT REPRESENTATIVE
Allegheny Health Network
Pittsburgh, PA
11.2018 - 03.2020
- Answering incoming patient and provider calls, scheduling patient appointments received into the centralized call center for medical service lines within Allegheny Health Network: Oncology, Psychiatric, Primary Care, Women's Health, Mammograms, outpatient testing, Dermatology, Physical therapy, Occupational therapy, Digestive Health, Ear, Nose and Throat, COVID and Ancillary
APPEALS COORDINATOR
ZOLL Services, LLC
Pittsburgh, PA
04.2016 - 10.2018
- Work directly with Medicare/Medicaid, BlueCross Blue Shield, Highmark, Humana, Aetna, Cigna, veterans Affairs and Misc Insurances for payment of services /products rendered.
- Resolved appeals through negotiations with insurance companies, attorneys, and other parties.
- Collaborated with physicians, nurses, insurance plans, and Medical Directors to resolve issues quickly and efficiently.
- Mentored and coached newly hired employees in their roles and responsibilities.
MEDICAL INSURANCE COLLECTIONS SPECIALIST
ZOLL Services, LLC
Pittsburgh, PA
10.2014 - 04.2015
- Communicate with the Territory Managers and Account Coordinators relating to Purchase Orders and contract issues with facility leases or the Veteran's Administration
- Developed relationships with debtors to encourage timely payments while providing excellent customer service.
- Provided financial advice to customers on budgeting techniques and money management skills to help them stay current on their obligations.
- Analyzed account histories, monitored payments, reconciled discrepancies and updated customer information in the database.
- Reviewed delinquent accounts and contacted customers via phone, email or mail to negotiate repayment terms and payment arrangements.
- Assisted customers with financial hardship by offering alternative payment plans or other solutions that would benefit both parties.
MEDICAL COLLECTIONS SPECIALIST
ZOLL Services, LLC
Pittsburgh, PA
11.2013 - 10.2014
- Re-billing of denied claims to the primary and secondary insurance carrier for payment
- Assisted in the resolution of credit balances due to overpayment or incorrect coding issues.
- Performed data entry tasks related to patient account information updates.
- Ensured compliance with applicable laws governing debt collection practices.
- Maintained accurate records of all patient account activity within the system database.
- Reviewed and processed patient accounts for collections purposes.
- Negotiated payment plans with patients based on their financial abilities.
Education
BACHELOR OF SCIENCE DEGREE IN HEALTHCARE MANAGEMENT -
Anthem College
01.2012
ASSOCIATE OF SCIENCE DEGREE IN MEDICAL BILLING & CODING -
Anthem College
01.2009
DIPLOMA IN MEDICAL ASSISTANT -
Western School of Health & Business
01.1994
Skills
- Hire, train, and onboard staff necessary to support program operations
- Manage staff scheduling to maintain and support day-to-day operations
- Innovation management
- Documentation Management
- Coach and completing evaluations of direct reports
- Monitor team member calls and provide feedbackManagement collaboration
- Medicaid individual, and commercial insurance plans
References
References available upon request
Timeline
Reimbursement Lead/Specialist
RareMed Solutions
10.2023 - Current
SCREENING PROGRAM
Allegheny Health Network
08.2021 - 10.2023
New Hire Training Lead
Allegheny Health Network
03.2020 - 08.2021
ELITE CARE CONNECT REPRESENTATIVE
Allegheny Health Network
11.2018 - 03.2020
APPEALS COORDINATOR
ZOLL Services, LLC
04.2016 - 10.2018
MEDICAL INSURANCE COLLECTIONS SPECIALIST
ZOLL Services, LLC
10.2014 - 04.2015
MEDICAL COLLECTIONS SPECIALIST
ZOLL Services, LLC
11.2013 - 10.2014
BACHELOR OF SCIENCE DEGREE IN HEALTHCARE MANAGEMENT -
Anthem College
ASSOCIATE OF SCIENCE DEGREE IN MEDICAL BILLING & CODING -
Anthem College
DIPLOMA IN MEDICAL ASSISTANT -
Western School of Health & Business