Brian Bragg Email & Phone Number

Bridgewater, Ma, Us

Implementing health insurance claims editing solutions. Formerly known as ClaimsXten.

Oversee Service and Operations workgroups for multiple corporate initiatives and projectsFacilitate and participate in cross-functional workgroups to ensure project deliverables are metProvide business knowledge and subject expertise in matters relating to Provider Enrollment and Service workflows, applications, and claims knowledge for Corporate and Divisional projectsWrite and Review Business Requirements, workflows/processes and recommend solutions and alternative workarounds to satisfy business needsDevelop, analyze, and execute User Acceptance Test plans for Provider Enrollment and ServiceCreate logos, visual representations, and presentation materials

Coordinated BlueCore Provider/Pricing Issue and Risk database - including database maintenance, reporting, analysis, customer support, and process improvementProvided business knowledge and subject expertise in matters relating to Provider Service workflows, applications and claims knowledgeDocumented business requirements, workflows/processes and recommend solutions and alternative workarounds to satisfy business needsDeveloped and analyze test plans for Provider/Pricing and Service User Acceptance Testing (UAT)Facilitated and participate in cross-functional workgroups to ensure project deliverables are met

Supported 70 phone associates with complex claims processing and benefit inquiries within Provider Service Call CenterResearched and communicated solutions to complex system and adjustment issuesCoordinated and supported departmental system and workflow issues - communicating with external business areas as neededReduced correspondence inventory aging from 1200 to 25 within 4 month periodImproved aging inventory turnaround from 120 days to 3-5 daysDeveloped, documented and implemented improved workflows/processes - reducing claims processing times and improving associate and provider satisfaction levelsReduced paper usage by 70% Improved ACW ("after-call" work) 25%, increasing occupancy rates by implementing new workflowAssisted in new hire training

Conducted audits on Performance Guarantee Accounts and Par Plans utilizing a 13 step process to ensure claims processing accuraciesPerformed Quality Audits on 35 Data Entry Associates and 25 Claims Processing AssociatesAnalyzed and developed new workflows for high impact errorsProvide ad hoc reports to directors, senior managers, and par plansFacilitated weekly and monthly meetings to update managers, supervisors, and associates on updates and trends in data entry and claims workflows

Responsible for servicing Professional, Institutional, and Mental Health and Ancillary providersResearched, resolved and responded to provider inquiries both telephone and written, regarding eligibility, benefits, claims and billing issuesCoordinated with various departments to assure providers were adhering to BCBSMA contractual provisions and obligationsIdentified common provider issues and offered resolutionsAssisted in new hire training

Managed database consisting of 250 (active/inactive) Clozapine patientsEnsured compliance with federal regulations by updating and maintaining patient recordsCoordinated Drug Utilization Reviews with Medicaid program to ensure reimbursementNegotiated vendor pricing contract with pharmaceutical distributor Analyzed patient blood counts for compliance with FDA mandates