Lameka Pless
Summary
A position where my skills and experience in customer service, quality control, and management will be utilized in a positive environment where there is opportunity for growth and advancement
Experienced with patient interaction, providing comprehensive support and information to ensure patient satisfaction. Utilizes effective communication and organizational skills to manage patient records and coordinate with healthcare teams. Knowledge of healthcare protocols and patient care standards ensures high-quality service delivery.
Healthcare professional with solid foundation in patient support services, offering valuable experience in addressing patient needs and improving service efficiency. Known for fostering collaborative environment and achieving positive outcomes through adaptable approaches. Proven skills in patient communication, record management, and issue resolution.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Patient Support Specialist
LiveOps, US
08.2017 - 06.2025
- Provide remote support by taking inbound calls and working to provide a solution to the callers' questions
- Assist patients enroll in discount programs to help reduce the cost of the prescription, send patients containers for safe disposal of their syringes, or offer to enroll the patient into an ongoing program where the patient is assigned an Ambassador
- Consistently build rapport and provide exceptional customer service
- Access information in the client's system and several online applications to help resolve the patient's needs
- Worked closely with Cancer patients charts performing follow ups to help determine if the treatment worked accurately for the patient.
- Provided compassionate support to patients, addressing inquiries and resolving issues efficiently.
Patient Account Representative/Collections
Fresenius Medical Care, Fayetteville
04.2012 - 06.2017
- MSP adjustments, Coordination of Benefits Specialist, Appeals & Grievances (All insurance types), EOB specialist
- Demonstrated knowledge and ability to assign ICD-10CM codes to the highest specificity ensuring that diagnostic codes and documentation accurately reflect and support the visit encounter
- Maintained a 97% or above accuracy rate
- Maintained consistent daily production of greater than 40-60 reviews per day
- Ability to identify ICD-10CM codes
- Confirms patient insurance eligibility and/or benefits
- Patient payment posting to include cash corrections/adjustments
- Work closely and very effective with insurance carriers
- Answer phone calls/Perform prescriptive conference calls
- Provides customer service to patients inquiring about their patient statements
- Determines required deposits, and follows up to make sure payments were made in accordance to Center's policy
- Audit charts for correct income verification process
- Adjust bad patient checks off and enter notes in practice management system
- Discuss and educate family members on various services offered by the Center and methods of payment for those services including but not limited to Medicare, Medicaid, Insurance and Private Pay
- Makes appropriate adjustments to patient accounts in accordance with Center's policies
- Assist with the implementation of a new billing system
- Work with eligible patients to apply for applicable assistance programs.
Medical Claims Processor
Fresenius Medical Care, Fayetteville, US
05.2012 - 01.2014
- Process 75 HCFA per day/UBs depend on the level of issues average 30 (per day)
- Adjudicates claims in accordance with the most current policy benefits, limitations or exclusions through an automated claims processing system
- Resolves system suspended claims through an automated claims work queue
- Requests claim correspondence
- Denies inappropriate claims following policy guidelines
- Monitors claim reversals and corrections
- Prepares claims that must be routed to other departments for further review
- Reviews difficult claims with guidance from the Leader Worker or Claims Manager
- Performs claims adjustments and reconciliations of questionable claims
- Processes investigation and collection of potential coordination and subrogation of benefits
- Monitors daily production log of claims paid denied and suspended
- Identifies billing errors and possible fraudulent claims submissions
- Verifies recipient eligibility and other health insurance
Unit Secretary
Cape Fear Valley Medical Center, Fayetteville
09.2011 - 12.2011
- Eyes and ears for team leader in the zone
- Review Emstat orders and enter orders in SMS
- Place copy of lab/EKG orders in zone holding rack
- Notify team leader/nurse when specimen recollect is needed
- Monitor timers for delays (new orders, results, review)-notify team leader
- Scan Fax admit orders to pharmacy and bed placement
- Assist physician with work flow place and admit orders and progress notes from form fast.
In-House Collection Agent
Cape Fear Valley Medical Center, Fayetteville
11.2003 - 11.2007
- Uses the on-line work-list and account referrals to review accounts that is in house bad-debt status and pending payment from insurance companies for additional information
- Contact insurance companies or if necessary, patients to expedite payment
- Prepares lists of adjustments and write-offs to accounts according to policy and procedure to assure accurate account balances and statements
- Files insurance claim via electronic or hard copy to satisfy insurance requests
- Communicates effectively, both orally and in writing
- Provides prompt responses to customer's needs
- Demonstrates accuracy and thoroughness in responding to a wide range of customers seeking assistance
- Performs a complete review of records and other documentation for administrative completeness, accuracy and appropriateness
- Performs administrative support by responding to questions, complaints, and situations
- Provides explanation of Department policies and conduct research to provide responses
- Coordinates information with insurance companies to secure necessary information and to resolve discrepancies
- Prepares and maintain records of all actions for the service.
Provider Customer Service Specialist
United Healthcare
11.2022 - 06.2023
- Resolved inquiries regarding provider services, ensuring accurate information delivery.
- Handled complex escalations, collaborating with multidisciplinary teams to reach satisfactory resolutions.
- Analyzed complex grievance cases to ensure compliance with regulatory standards and organizational policies.
- Facilitated communication between patient and internal staff to resolve appeals efficiently and effectively.
- Reviewed documentation for accuracy, ensuring timely processing of appeal requests.
- Led initiatives to streamline grievance resolution processes, minimizing turnaround times for appeals.
- Maintained compliance with regulatory requirements by staying current on industry standards and guidelines.
Data Entry Clerk/Processing Assistant
Spherion/Cumberland County Health Department, Fayetteville
03.2003 - 02.2005
- Input immunizations for Cumberland County School system into computer
- Performed miscellaneous duties for various committees of the facility as assigned by supervisor
- Provided outstanding customer service to individuals and families
- Retrieved patient information thru Vista
- Assisted patients with appointments
- Conducted clerical duties for the service
- Administered the admission and discharge of patients
- Assembled charts for new patient admissions
- Performed clerical duties for business office upholding all phases of secretarial support group.
Dietary Administrator
Rehabilitation@ Village Green, Fayetteville
06.2002 - 09.2002
- Monitored residents meal intake
- Entered data in patient charts and files
- MDS data entry
- Quality assurance of resident meal preparation
- Monitored residents weight loss and gain.
Education
BS - Healthcare Management
Capella University
Accounting
Methodist University
Skills
- Medical Terminology
- Word
- PowerPoint
- Excel
- Access
- Type 55 words per minute
- Outlook
- Advanced EPIC System Knowledge
- CRCR Certifications
- Patient confidentiality
- Follow-up coordination
- Insurance verification
- Medical terminology
Certification
CRCR Certified Revenue Cycle Representative
PMS/Billing Software
NexGen Healthcare
Medisoft
Medical Billing Software
Kareo Billing
NexGen Billing
EPIC
ClearingHouses
Availity
Kareo Clearinghouse
SSI Group
Emdeon (Change Healthcare)
Timeline
Provider Customer Service Specialist
United Healthcare
11.2022 - 06.2023
Patient Support Specialist
LiveOps, US
08.2017 - 06.2025
Medical Claims Processor
Fresenius Medical Care, Fayetteville, US
05.2012 - 01.2014
Patient Account Representative/Collections
Fresenius Medical Care, Fayetteville
04.2012 - 06.2017
Unit Secretary
Cape Fear Valley Medical Center, Fayetteville
09.2011 - 12.2011
In-House Collection Agent
Cape Fear Valley Medical Center, Fayetteville
11.2003 - 11.2007
Data Entry Clerk/Processing Assistant
Spherion/Cumberland County Health Department, Fayetteville
03.2003 - 02.2005
Dietary Administrator
Rehabilitation@ Village Green, Fayetteville
06.2002 - 09.2002
Accounting
Methodist University
BS - Healthcare Management
Capella University
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