Megan McNicholas
Plymouth,MA
Summary
Dynamic, results-oriented professional committed to continuous growth and development, excelling in both independent and collaborative team settings. Strong organizational skills and meticulous attention to detail ensure high-quality outcomes in fast-paced environments. A reliable and supportive team member committed to achieving results and fostering a positive workplace culture. Proven ability to adapt to change while effectively managing multiple tasks, consistently focused on achieving results.
Overview
16
16
years of professional experience
2
2
Certification
Work History
Member and Provider Service – CORR I Team
Blue Cross Blue Shield of Massachusetts
03.2008 - 05.2017
- Used problem solving skills to analyze claim processing and take action.
- Assisted with training and development of new associates by instilling the training principles that lead to success in their new role.
- Successfully led the facilitation of several training laboratories.
- Successfully led daily review sessions with trainees analyzing difficult inquiries, challenging topics and any questions that arise in the laboratory setting.
- Took on supervisory roles within the team assisting with support hotline inquiries.
- Successfully supported 1500 Claims, UB Claims and Benefits and Eligibility telephone lines by answering approximately 65 to 85 calls daily from all provider types primarily pertaining to pricing, managed care inquiries, and claim adjustments.
- Reviewed and finalized written correspondence for all provider types.
- Supported the Worldwide process by providing benefit information for services that take place outside of the country.
- As a trainee in the UB training class, documented many of the concepts and modules as there is no formal documentation for this subject matter.
- Promoted first contact resolution by accepting responsibility for every telephone call taken until the issue has been resolved.
- Utilized Blue Tool and other resources to increase knowledge and more effectively respond to provider inquiries.
- Successfully managed multiple tasks in a fast-paced environment and able to shift mindset based on business needs.
- Acted as a role model within the team demonstrating strong performance, professionalism, dependability, and flexibility.
Member and Provider Service - LIT Team
Blue Cross Blue Shield of Massachusetts
03.2021 - 06.2024
- Review and finalize written correspondence for local facility and professional claims for all types of inquiries and Blue Card claims for over the timely filing limit inquiries.
- Screen inquiries that are sent to the system analyst to ensure only true system issues need to be researched and provide education when errors are found.
- Respond to inquiries that are submitted on claims processed by a state other than Massachusetts.
- Assist with coverage of phone calls when the service center is busy.
- Respond to live IM questions related to complex claim system issues for the Service Solution Line.
- Effectively lead refresher classes whenever called upon for team members on various subjects.
- Assist the Blue Card claims team by responding to aged open inquiries to help reduce inventory.
- Job shadow and mentor associates to share best practices.
- Continuously look for ways to improve workflows or processes in place.
- Research and respond to inquiries related to claims that were processed through COITIVITI.
- Assisted with the Individual Consideration Appeals Inventory Reduction process.
- Screen appeals that are submitted for Individual Consideration review.
Member and Provider Service – Business Expert I
Blue Cross Blue Shield of Massachusetts
05.2017 - 03.2021
- Coached and motivated over twenty associates to deliver world class service to our providers.
- Supported and mentored associates when they require assistance with an appeal or inquiry via live IM process to ensure first contact resolution.
- Resolved escalated issues in a timely manner to ensure provider satisfaction.
- Monitored IEX to ensure associates are adhering to their schedule and send updates when necessary.
- Reviewed daily login adherence, capture outliers, and advise associates to minimize late occurrences.
- Monitored Medicare Advantage, Vital and worksheet inventory levels to ensure that resources are aligned best based on inventory needs.
- Reviewed work that has been returned from associates to provide necessary education to prevent future mistakes.
- Reviewed workflows and processes to ensure all information is accurate when a new initiative or payment policy goes into effect.
- Participated in the Provider Experience Workgroup to ensure that the providers are getting the best service possible by sharing best practices and process improvements between different departments within BCSBMA.
- Service observed associates to ensure they are working to their maximum potential and provide tips on best practices to improve their performance and increase their efficiencies.
- Triaged appeals to other departments for review (HMM, BHN, Audit & Recoveries) to ensure timely completion.
Education
Bachelor of Arts - Psychology
Curry College
Milton, MA01.2007
Skills
- Dependable and responsible
- Self-Directed
- Friendly, positive attitude
- Adaptive team player
- Punctuality and reliability
- Research
- Task prioritization
- Medical terminology
- Claims processing
- AAPC Certified Professional Biller and Coder
Certification
- AAPC Certified Professional Coder – Apprentice, May 2025
- AAPC Certified Professional Biller, June 2025
Timeline
Member and Provider Service - LIT Team
Blue Cross Blue Shield of Massachusetts
03.2021 - 06.2024
Member and Provider Service – Business Expert I
Blue Cross Blue Shield of Massachusetts
05.2017 - 03.2021
Member and Provider Service – CORR I Team
Blue Cross Blue Shield of Massachusetts
03.2008 - 05.2017
Bachelor of Arts - Psychology
Curry College