Michael Douglas
South Weymouth,MA
Summary
An energetic, goal-focused, and achievement-oriented person with excellent organizational skills, ability to focus under pressure, detail-oriented, and able to work in a fast-paced environment. Works well as an individual contributor and as a team member.
Overview
25
25
years of professional experience
Work History
Accounts Receivable Coordinator III
Tufts Medical Center
08.2017 - Current
- Resolves specific payer/plan claim edits in 10 assigned WQ’s in Epic system and external Clearinghouse Vendor
- Verify and update patient health insurance coverage for billing purposes in Epic system
- Regular interactions with other departments using Epic System tools to resolve accounts, including registration errors, coding issues and charges billed
- Responsible for researching and handling claim rejections, including understanding why claim rejected, how it must be fixed, whether patient is now liable or whether hospital is liable
- Routing rejected claims from clearinghouse to appropriate departments for review/corrections
- Accessing payer websites for claim status, possible online corrections
- Responsible for processing of adjustments due to denials, contractual requirements, and credit balances
- Conducted follow-up of outstanding account balances with assigned payers taken action for resolution
- Identifies trends in workflows and rework, and report outstanding operational issues to management for further research and resolution
- Resolved assigned accounts in timely and accurate manner, which maximizes reimbursement in compliance with assigned payer regulations and department's policy and procedure
- Recommended and performed third party adjustments and write-offs to Team Leader or Supervisor.
Provider Services Professional
Neighborhood Health Plan (Allways Health Partners)
02.2015 - 08.2017
- Verify benefits, eligibility, and enrollment details to providers and third party vendors
- Review claims and advise of options following adjudication
- Facilitate with submission, revision and troubleshooting of prior authorizations and referrals submitted by provider
- Worked with upper management to ensure appropriate changes were made to improve customer satisfaction
- Assist with coverage for supervisor escalation calls when team leads and supervisors are not present
- Handle and resolve customer inquiries and complaints effectively and professionally
- Maintained 90% or better month to month on department scorecard metrics yearly
- Give accurate and appropriate information to answer benefits questions, troubleshoot issues and resolve complaints
- Accurately document accounts detailing reason for calls for reporting purposes
- Responsible for strict adherence of HIPAA compliance
- Facilitated information flow between customer service, claims, enrollment, and clinical departments to guarantee call center objectives were met
- Verify benefits, eligibility, and enrollment details to members
- Updated members Primary Care Physicians.
- Reduced processing time for claims by verifying insurance information and ensuring accurate billing practices.
- Enhanced provider relations by addressing inquiries and resolving issues in a timely manner
Customer Care Service Professional
Neighborhood Health Plan (Allways Health Partners)
06.2014 - 02.2015
- Verify benefits, eligibility, and enrollment details to providers and third party vendors
- Review claims and advise of options following adjudication
- Facilitate with submission, revision and troubleshooting of prior authorizations and referrals submitted by provider
- Worked with upper management to ensure appropriate changes were made to improve customer satisfaction
- Assist with coverage for supervisor escalation calls when team leads and supervisors are not present
- Handle and resolve customer inquiries and complaints effectively and professionally
- Maintained 90% or better month to month on department scorecard metrics yearly
- Give accurate and appropriate information to answer benefits questions, troubleshoot issues and resolve complaints
- Accurately document accounts detailing reason for calls for reporting purposes
- Responsible for strict adherence of HIPAA compliance
- Facilitated information flow between customer service, claims, enrollment, and clinical departments to guarantee call center objectives were met
- Verify benefits, eligibility, and enrollment details to members
- Updated members Primary Care Physicians.
- Increased customer loyalty through personalized attention and genuine care for their needs.
- Provided comprehensive support to clients during the entire service process, from initial inquiry to final resolution
- Resolved customer complaints, ensuring an optimal resolution for both the client and company
Business Class & MDU Account Executive
Comcast Corporation
06.2009 - 05.2014
- Managed high-volume workload taking between 500-800 troubleshooting calls week resolving customer service problems maintaining average of 6%-7% truck roll percentage
- Successfully diffuse volatile customer situations using strategic influencing to come to resolution
- Assisted peers to bring down truck roll percentages with side-by side training techniques
- Meet and exceed sales goals by cross-selling, and/or upgrading products and services all year for 2012
- Receive training as it relates to customer service taking courses in ESS for career advancement
- Display daily retention tactics to retain residential and business class customers that no longer need products and services and by participating in focus groups when offered.
Customer Care Account Executive
Comcast Corporation
10.2006 - 05.2009
- Managed high-volume workload taking between 500-800 troubleshooting calls a week resolving customer service problems maintaining average of 6%-7% truck roll percentage
- Successfully diffuse volatile customer situations using strategic influencing to come to resolution
- Assisted peers to bring down truck roll percentages with side-by side training techniques
- Meet and exceed sales goals by cross-selling, and/or upgrading products and services all year for 2012
- Display daily retention tactics to retain residential and business class customers that no longer need products and services and by participating in focus groups when offered.
Operations- Trade specialist
Brown Brothers Harriman &Co.
02.2001 - 10.2006
- Successfully helped implement new procedures for Right-Fax European lift-outs to process trade investments
- Helped team lead processing of over 2 million trade transactions with low O/E rates
- Responsible for day to day technological operations to control loss productivity
- Contacted outside vendors globally to obtain 30% of workload for department for daily processing of Trades
- Provided consistent quality of service and professionalism working with Client/Vendor Management
- Demonstrated outstanding problem solving and active listening skills with financial business partners
- Managed and recorded all current incoming inventories within department
- Supported leadership to facilitate meetings operating resource tools to provide information clients and internal employees.
Corporate Services
Brown Brothers Harriman &Co.
06.1999 - 02.2001
- Successfully helped implement new procedures for Right-Fax European lift-outs to process trade investments
- Helped team lead processing of over 2 million trade transactions with low O/E rates
- Assisted in training and development of new client service representatives
- Consistently met performance benchmark in all areas of financial services
- Responsible for day to day technological operations to control loss productivity
- Contacted outside vendors globally to obtain 30% of workload for department for daily processing of Trades
- Provided consistent quality of service and professionalism working with Client/Vendor Management
- Consistently met performance benchmarks in all areas of financial reporting
- Demonstrated outstanding problem solving and active listening skills with financial business partners
- Managed and recorded all current incoming inventories within the department
- Supported leadership to facilitate meetings operating resource tools to provide information clients and internal employees.
Education
A.S Business Administration - Accountant
Bunker Hill Community College
Charlestown, MA2024
A.S Business Administration -
North Shore Community College
Danvers, MA01.2014
Skills
- Proficient in evaluating and processing insurance claims
- HIPPA compliance
- Commercial and Medicaid claims
- Epic
- Insurance verification
- Excellent data entry skills
- Accounts Receivable
- Great Interpersonal Skills and ability to function as team member
- Invoice Processing
- Payment tracking
- Microsoft Office
Timeline
Accounts Receivable Coordinator III
Tufts Medical Center
08.2017 - Current
Provider Services Professional
Neighborhood Health Plan (Allways Health Partners)
02.2015 - 08.2017
Customer Care Service Professional
Neighborhood Health Plan (Allways Health Partners)
06.2014 - 02.2015
Business Class & MDU Account Executive
Comcast Corporation
06.2009 - 05.2014
Customer Care Account Executive
Comcast Corporation
10.2006 - 05.2009
Operations- Trade specialist
Brown Brothers Harriman &Co.
02.2001 - 10.2006
Corporate Services
Brown Brothers Harriman &Co.
06.1999 - 02.2001
A.S Business Administration - Accountant
Bunker Hill Community College
A.S Business Administration -
North Shore Community College