Kamesha Douglas
Dublin,OH
Summary
Results-driven professional with extensive experience in patient intake and care coordination, dedicated to ensuring seamless and efficient processes. Strong communication skills effectively resolve patient inquiries and billing issues, enhancing overall patient satisfaction. Proficient in healthcare systems and patient management software, contributing to a supportive and organized patient environment. Committed to delivering high-quality care and improving operational workflows within healthcare settings.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Patient Representative
Memorial Hospital
Plain City
02.2026 - Current
- Facilitated patient admissions and discharges, ensuring compliance with hospital policies and procedures.
- Managed appointment scheduling systems to enhance patient access and minimize wait times.
- Provided information on services, assisting patients in navigating hospital resources effectively.
- Resolved patient inquiries and concerns promptly, fostering positive relationships and satisfaction.
- Validates patient insurance coverage(s) via real-time eligibility and various tools.
- Requests payment for determined co-payments and prior balances, manages the cash drawer.
- Collects copies of patient photo id and insurance card(s) and scans to the EMR system.
- Explains patient forms and requests signatures.
Appeal Representative
United Health Group
10.2018 - 11.2022
- Research and resolving written complaints submitted by providers/physicians and members.
- Categorizing complaints correctly and obtaining additional information when needed.
- Reviewing cases to determine if clinical review is needed and rendering nonclinical decisions.
- Analyzed and processed appeals for accuracy and compliance with regulatory standards.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
- Increased customer satisfaction ratings through timely follow-up on appeal status inquiries, providing accurate information and addressing concerns promptly.
- Implemented process improvements that reduced appeal turnaround time and enhanced customer satisfaction.
- Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.
- Conducted comprehensive training sessions for new hires on proper procedures for processing claims denials and managing appeals caseloads.
- Demonstrated exceptional attention to detail when evaluating medical records in order to identify discrepancies or inconsistencies that could impact an appeal's outcome positively or negatively.
Pharmacy Technician
Kroger
01.2020 - 04.2021
- Receiving prescription refill request via phone and fax and online and in person.
- Counting, measuring, preparing, packaging and dispensing medications for customers.
- Ordering products, stocking shelves, and replacing out of date and expired products.
- Processing customer's purchases and offering medication counseling with Pharmacist.
Denial Coordinator
Buckeye Health Care
06.2019 - 12.2019
- Coordinating Medicaid Management denial process including letter printing, tracking and disposition.
- Scanning and date stamping all incoming mail and serving as department liaison for appeal issues.
- Analyzed office performance metrics to identify areas for process improvement and cost reduction.
- Streamlined office operations for improved efficiency, including document organization and workload distribution.
- Increased patient satisfaction through attentive customer service and prompt response to inquiries.
Communications PAC Coordinator
Spectrum Charter
06.2018 - 09.2018
- Resolving cable and internet issues for residential and commercial accounts.
Eligibility Associate
Express Scripts
12.2017 - 05.2018
- Retrieving and verifying patient information to determine eligibility.
- Using Accredo system to identify and resolve patient insurance and claim issues.
Warehouse Associate
Taylor Communications
01.2017 - 12.2017
- Picking and packing orders for shipment, palletizing, and labeling shipments.
Dispatcher
Campus parc
09.2012 - 11.2016
- Answering calls for service on campus and dispatching campus police, safety officers and technicians.
- Responding to requests from students and faculty and communicating via two-way radio.
- Providing information about university, events and parking and giving directions.
Medical Records File Clerk
North Central Mental Health Services
04.2016 - 09.2016
- Answering phones, scheduling appointments, filing, and pulling medical records.
Subrogation Case Reviewer
Health Management Systems
09.2015 - 06.2016
- Preparing correspondence liens, medical claims, and related documents to resolve appeal cases.
- Performing document review, legal research, and case management to ensure case progress.
Call Center Representative Inbound
Affinion Group
10.2012 - 01.2013
- Managed over one hundred calls daily.
- Received inbound calls from Bank of America and Wells Fargo reward members.
- Explained point discrepancies, awards and the overall program which was broken down into a point base increment system.
LSP
Allstate
10.2011 - 12.2011
- Provided great client service by processing payments & reporting claims.
- Scheduled appointments for clients to meet with Principal Agent to discuss needs-based on policy reviews Updated policies and coverage as needed.
Customer Service Representative
State Farm
04.2009 - 03.2011
- Generated new business through leads and referrals.
- Processed payments for clients, and prospect new business through lead and referrals.
Education
EdD Doctor of Education -
Johns Hopkins School of Education
Maryland09-2024
Master's Degree - Healthcare Administration
University of Maryland Global Campus
Maryland01-2024
Bachelor of Arts Degree - Political Science
The Ohio State University
Columbus, OH01-2020
Skills
- Experienced in Microsoft Office Suite applications
- Medical terminology expertise
- Experience as a pharmacy technician
- Data entry proficiency
- Health administration master's degree
- Skilled in utilizing Lexis Nexis resources
- Proficient in Medicare appeals process
- Basic life support certification
- Experience with EPIC and MITS systems
Certification
- UnitedHealth Care M & R Certified, 2022
- Certificate in Computer Office Skills including MSWord and Excel, Ulearn, 2024
Timeline
Patient Representative
Memorial Hospital
02.2026 - Current
Pharmacy Technician
Kroger
01.2020 - 04.2021
Denial Coordinator
Buckeye Health Care
06.2019 - 12.2019
Appeal Representative
United Health Group
10.2018 - 11.2022
Communications PAC Coordinator
Spectrum Charter
06.2018 - 09.2018
Eligibility Associate
Express Scripts
12.2017 - 05.2018
Warehouse Associate
Taylor Communications
01.2017 - 12.2017
Medical Records File Clerk
North Central Mental Health Services
04.2016 - 09.2016
Subrogation Case Reviewer
Health Management Systems
09.2015 - 06.2016
Call Center Representative Inbound
Affinion Group
10.2012 - 01.2013
Dispatcher
Campus parc
09.2012 - 11.2016
LSP
Allstate
10.2011 - 12.2011
Customer Service Representative
State Farm
04.2009 - 03.2011
Bachelor of Arts Degree - Political Science
The Ohio State University
EdD Doctor of Education -
Johns Hopkins School of Education
Master's Degree - Healthcare Administration
University of Maryland Global Campus