Summary
Overview
Work History
Education
Skills
Timeline
Generic

Debra Kamuda

Akron,OH

Summary

Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Overview

39
39
years of professional experience

Work History

Rural Carrier Associate

United States Postal Service, USPS
Akron, OH
02.2023 - Current
  • Maintained records on customers with mail forwarding and change of address requests.
  • Delivered mail and packages to customers on prescribed route while processing check submissions, money orders, and stamp purchases in field.
  • Signed and received mail with signature requirements upon delivery and loading.
  • Sorted mail according to order of address appearance for easy access in field.

Patient Account Representative II

Cleveland Clinic Home Care
Brecksville, OH
11.2015 - 02.2023
  • Prepared reports detailing billing actions, flags and other key information.
  • Utilized computer programs to create invoices, letters and other documents.
  • Reconciled statements with patient records.
  • Electronically submitted bills according to compliance guidelines.
  • Posted payments and processed refunds.
  • Contacted patients after insurance was calculated to obtain payments.
  • Monitored flags and resolved urgent items with accuracy and efficiency.
  • Worked with outside entities to resolve issues with billing, claims and payments.
  • Researched billing errors and discrepancies to initiate corrective action.
  • Worked with customer to create debt repayment plan based on current financial condition.
  • Established relationships with customers to encourage payment of delinquent accounts.

Hospice Patient Account Representative

Cleveland Clinic Akron General Medical Center
Akron, OH
04.2017 - 12.2019
  • Utilized computer programs to create invoices, letters and other documents.
  • Prepared reports detailing billing actions, flags and other key information.
  • Responded to patient, family and external payer inquiries.
  • Worked with outside entities to resolve issues with billing, claims and payments.
  • Reconciled statements with patient records.
  • Electronically submitted bills according to compliance guidelines.
  • Posted payments and processed refunds.
  • Generated and distributed monthly customer statements.

Home Health Patient Account Representative

Cleveland Clinic Akron General Medical Center
Akron, OH
04.2016 - 04.2017
  • Utilized computer programs to create invoices, letters and other documents.
  • Contacted patients after insurance was calculated to obtain payments.
  • Responded to patient, family and external payer inquiries.
  • Electronically submitted bills according to compliance guidelines.
  • Reconciled statements with patient records.
  • Worked with outside entities to resolve issues with billing, claims and payments.
  • Monitored customer accounts for payment delinquency and initiated collection efforts.

Home Health Patient Account Representative

Visiting Nurse Service
Akron, OH
11.2015 - 03.2016
  • Prepared reports detailing billing actions, flags and other key information.
  • Utilized computer programs to create invoices, letters and other documents.
  • Contacted patients after insurance was calculated to obtain payments.
  • Responded to patient, family and external payer inquiries.

Home Health Patient Account Representative

Aerotek/Visiting Nurse Service
Akron, OH
08.2015 - 11.2015
  • Data entry of patient and equipment details from old software to new software system for conversion.
  • Prepared reports detailing billing actions, flags and other key information.
  • Utilized computer programs to create invoices, letters and other documents.
  • Contacted patients after insurance was calculated to obtain payments.
  • Responded to patient, family and external payer inquiries.

Third Party Reimbursement Representative

Discount Drug Mart/Hastings Professional Medical
Medina, OH
10.2014 - 05.2015
  • Completion of weekly system reports
  • Requested, received, and entered data in BrightTree
  • Order confirmations
  • Data entry of order specifics
  • Verified reimbursements were correct

Temporary Pharmacy Billing Clerk

Envision Rx Options
Twinsburg, OH
04.2014 - 10.2014
  • Verification of pharmacy eligibility.
  • Executed billing tasks and recorded information in company databases.
  • Temporary prescription drug invoice reviewed for accuracy and completion.
  • Temporary prescription drug invoice data entry.
  • Report created for each invoice, printed, and attached to pharmacy backup.


Medicare and Commercial Insurance Patient Acct Rep

Linde/Lincare/Health Care Solutions
Akron, OH
12.2011 - 04.2014
  • Monthly Excel report including quantity and claims totals.
  • Monthly written report with details of claim findings, resolution, and status to date.
  • Managed large volume of medical claims on daily basis.
  • Responded to correspondence from insurance companies.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Reviewed provider coding information to report services and verify correctness.

Practice Representative/Insurance Billing FollowUp

Physicians Practice Mgmt/Matrix Mgmt Solutions
N. Canton, OH
06.2007 - 09.2010
  • Recommended service improvements to minimize recurring patient issues and complaints.
  • Resolved customer complaints using established follow-up procedures.
  • Facilitated communication between patients and various departments and staff.
  • Followed document protocols to safeguard confidentiality of patient records.
  • Provided excellent customer service to patients and medical staff.
  • Verified patient insurance eligibility and entered patient information into system.
  • Compiled and maintained patient medical records to keep information complete and up-to-date.

Temporary Medical Claims Processor/Analyst

AccounTemps-PrimeTime Helath Plan/Aultra Admin Grp
Canton, OH
03.2007 - 06.2007
  • Data entry of medical claims.
  • Claims adjudication.
  • Responded to correspondence from insurance companies.
  • Reviewed provider coding information to report services and verify correctness.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Customer Service.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Assessed medical claims for compliance with regulations and corrected discrepancies.
  • Verified patient insurance coverage and benefits for medical claims.
  • Identified and resolved discrepancies between patient information and claims data.

Temporary Claims Processor

Health Designs Plus
Hudson, OH
05.2003 - 06.2003
  • Followed up with customers on unresolved issues.
  • Collaborated with claims department and industry anti-fraud organizations to resolve claims.
  • Evaluated accuracy and quality of data entered into agency management system.
  • Reviewed applications and supporting documents to verify claims eligibility and accuracy.

Provider Relations Data Specialist

SummaCare
Akron, OH
08.2002 - 04.2003
  • Provider eligibility research
  • Verify accuracy of provider information
  • Data entry of provider data in Amisys provider data sub system

Computer Operator

SummaCare
Akron, OH
10.2001 - 08.2002
  • Generated weekly claim runs after ensuring accuracy.
  • Generated reports covering details about data, system operation, and error monitoring.
  • Changed and replaced backup tapes regularly and performed detailed server backups.
  • Report database manipulation to achieve requested user reports.


Subrogation Specialist

Akron City Health System
Akron, OH
04.2000 - 10.2001
  • Utilized appropriate cost containment techniques to reduce overall claim costs.
  • Followed up with customers on unresolved issues.
  • Conducted full claim investigations and reported updates and legal actions.
  • Escalated files with significant indemnity exposure to supervisor for further investigation.
  • Reviewed new files to determine current status of injury claim and to develop plan of action.
  • Examined claims forms and other records to determine insurance coverage.
  • Maintained contact with claimants and attorneys to determine treatment status.

Claims Adjudicator

Akron City Health Systems
Akron, OH
02.1993 - 04.2003
  • Executed claims processing.
  • Investigated high volume of insurance claims to determine validity and coverage eligibility.
  • Prepared and presented claims to other insurance companies and collaborated to gain necessary information to resolve claims.
  • Collaborated with team members and management to meet goals.
  • Optimized organizational efficiency by mentoring personnel on customer service protocols.
  • Used claims systems to program, set up functions and enter data for claims.

Dental Claims Examiner

Benefit Services
Akron, OH
05.1991 - 03.1992
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Verified client information by analyzing existing evidence on file.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.

Dental Claims Processor and Supervisor

Browne And Associates, Insured Plans
Akron, OH
06.1989 - 03.1992
  • Processed new claims.
  • Verified client information by analyzing existing evidence on file.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Set up new monthly Orthodontia files.
  • Processed monthly Orthodontia claims.

Claims Computer Data Specialist

Browne And Associates, Insured Plans
Akron, OH
06.1984 - 02.1992
  • Managed documents by organizing forms, making photocopies, filing records, preparing correspondence, and creating reports.
  • Reviewed and updated client files and database information to maintain accurate records.
  • Validated incoming data against quality standards to eliminate irrelevant or unusable information.
  • Optimized quality of data by developing and continuously improving data collection and automated upload strategies.
  • Created claims invoices for covered groups.
  • Released claim run after receipt of payment transfers.

Education

No Degree - Health Care Administration

University of Phoenix
Independence, OH
05.2001 -

No Degree - Pre-Nursing

Stark State College
Canton, OH
05.2001 -

No Degree - Pre-Nursing

University of Akron
Akron, OH
05.2001 -

Skills

Multitasking Abilities

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Timeline

Rural Carrier Associate

United States Postal Service, USPS
02.2023 - Current

Hospice Patient Account Representative

Cleveland Clinic Akron General Medical Center
04.2017 - 12.2019

Home Health Patient Account Representative

Cleveland Clinic Akron General Medical Center
04.2016 - 04.2017

Patient Account Representative II

Cleveland Clinic Home Care
11.2015 - 02.2023

Home Health Patient Account Representative

Visiting Nurse Service
11.2015 - 03.2016

Home Health Patient Account Representative

Aerotek/Visiting Nurse Service
08.2015 - 11.2015

Third Party Reimbursement Representative

Discount Drug Mart/Hastings Professional Medical
10.2014 - 05.2015

Temporary Pharmacy Billing Clerk

Envision Rx Options
04.2014 - 10.2014

Medicare and Commercial Insurance Patient Acct Rep

Linde/Lincare/Health Care Solutions
12.2011 - 04.2014

Practice Representative/Insurance Billing FollowUp

Physicians Practice Mgmt/Matrix Mgmt Solutions
06.2007 - 09.2010

Temporary Medical Claims Processor/Analyst

AccounTemps-PrimeTime Helath Plan/Aultra Admin Grp
03.2007 - 06.2007

Temporary Claims Processor

Health Designs Plus
05.2003 - 06.2003

Provider Relations Data Specialist

SummaCare
08.2002 - 04.2003

Computer Operator

SummaCare
10.2001 - 08.2002

No Degree - Health Care Administration

University of Phoenix
05.2001 -

No Degree - Pre-Nursing

Stark State College
05.2001 -

No Degree - Pre-Nursing

University of Akron
05.2001 -

Subrogation Specialist

Akron City Health System
04.2000 - 10.2001

Claims Adjudicator

Akron City Health Systems
02.1993 - 04.2003

Dental Claims Examiner

Benefit Services
05.1991 - 03.1992

Dental Claims Processor and Supervisor

Browne And Associates, Insured Plans
06.1989 - 03.1992

Claims Computer Data Specialist

Browne And Associates, Insured Plans
06.1984 - 02.1992
Debra Kamuda