Derek Doherty Email & Phone Number

United States

- More to come- Worked with my partner and Manager as the "RAR Team".- The RAR Team was created to overhaul and completely document the complex process of submitting Retroactive Adjustment Requests (RARs) to Medicare for review.- This involves finding plan errors, member errors, Medicare/Social Security errors and having plan systems and the Medicare Database (MARx) updated. The process further entails gathering of supporting documentation, coordination of potential member… Show more - More to come- Worked with my partner and Manager as the "RAR Team".- The RAR Team was created to overhaul and completely document the complex process of submitting Retroactive Adjustment Requests (RARs) to Medicare for review.- This involves finding plan errors, member errors, Medicare/Social Security errors and having plan systems and the Medicare Database (MARx) updated. The process further entails gathering of supporting documentation, coordination of potential member outreach, and creating narratives.- The RAR Team is required to have a deep understanding of the Medicare guidance related to enrollments, disenrollments, reinstatement, plan changes, election periods, letter timeliness requirements, and systemic processes to update member records internally.- The RAR Team is also responsible for the proper application, and the creation of, of internal policies which are often more strict than the Medicare guidelines. - Primarily responsible for the accurate and timely creation, submission, and tracking of RARs narratives. These are detailed bullet point "stories" that explain why we are requesting that Medicare allow us to make a change to a record that normally would not be changed.- Responsible for discovering, reporting, correcting, and documenting plan errors (human and system errors) and trends in order to submit RARs and re-educations. This includes identifying gaps in, and assisting in creating workflows for, process documentation across multiple departments.- Effectively led multiple training sessions across multiple departments to inform and advise how they play a role in the prevention of RARs. - Assisted in the creation of a re-education form that has standardized the way we report plan errors and request either system changes or employee re-education.- Continued to serve as both a resource and a role model or Enrollment staff. Often able to assist Enrollment staff in order to facilitate successful transactions and avoid possible RARs. Show less

Watertown, Massachusetts

- Worked with my partner and Manager as the "RAR Team".- The RAR Team was created to overhaul and completely document the complex process of submitting Retroactive Adjustment Requests (RARs) to Medicare for review.- This involves finding plan errors, member errors, Medicare/Social Security errors and having plan systems and the Medicare Database (MARx) updated. The process further entails gathering of supporting documentation, coordination of potential member outreach, and creating… Show more - Worked with my partner and Manager as the "RAR Team".- The RAR Team was created to overhaul and completely document the complex process of submitting Retroactive Adjustment Requests (RARs) to Medicare for review.- This involves finding plan errors, member errors, Medicare/Social Security errors and having plan systems and the Medicare Database (MARx) updated. The process further entails gathering of supporting documentation, coordination of potential member outreach, and creating narratives.- The RAR Team is required to have a deep understanding of the Medicare guidance related to enrollments, disenrollments, reinstatement, plan changes, election periods, letter timeliness requirements, and systemic processes to update member records internally.- The RAR Team is also responsible for the proper application, and the creation of, of internal policies which are often more strict than the Medicare guidelines. - Primarily responsible for the accurate and timely creation, submission, and tracking of RARs narratives. These are detailed bullet point "stories" that explain why we are requesting that Medicare allow us to make a change to a record that normally would not be changed.- Responsible for discovering, reporting, correcting, and documenting plan errors (human and system errors) and trends in order to submit RARs and re-educations. This includes identifying gaps in, and assisting in creating workflows for, process documentation across multiple departments.- Effectively led multiple training sessions across multiple departments to inform and advise how they play a role in the prevention of RARs. - Assisted in the creation of a re-education form that has standardized the way we report plan errors and request either system changes or employee re-education.- Continued to serve as both a resource and a role model or Enrollment staff. Often able to assist Enrollment staff in order to facilitate successful transactions and avoid possible RARs. Show less

Watertown, Massachusetts

- Research and resolve multiple types of rejections on the Daily Transaction Reply Report received from CMS (Centers for Medicare and Medicaid Services). This requires knowledge of both Medicare and Medicaid guidelines as well as internal system requirements and restrictions.- Primary processor responsible for researching and creating narratives for submission of Retroactive Adjustment Requests (RARs) to CMS. These can be complicated and require a great deal of patience and attention to… Show more - Research and resolve multiple types of rejections on the Daily Transaction Reply Report received from CMS (Centers for Medicare and Medicaid Services). This requires knowledge of both Medicare and Medicaid guidelines as well as internal system requirements and restrictions.- Primary processor responsible for researching and creating narratives for submission of Retroactive Adjustment Requests (RARs) to CMS. These can be complicated and require a great deal of patience and attention to detail.- Primary processor of the Late Enrollment Penalty (LEP) process. Ensuring that only members that should be assessed this penalty and that the proper amount is charged. Also trained the next Enrollment Analyst to take over this role as I transitioned into the RAR process.- Served as a resource and role model for other teammates by; creating a positive working environment, making myself available to assist with questions and to help familiarize them with the office environment and daily operations. - Assisted in the creation of documentation of various Enrollment processes into our resource called Support Point. This is similar to a dictionary and encyclopedia in one. It contains all the various workflows required for daily activity within the department. Show less

Watertown, Massachusetts

- Met face to face with members when they came to our Watertown office. Properly documented and performed follow up as needed.- Attended member meetings and gave presentations during Open Enrollment. Also led "break away" tables where members could have all of their questions answered in small groups.- Served as backup to both the Help Desk and Escalation lines. The Help Desk assisted other Customer Sevice Representatives in finding more complicated solutions. The Escalation Line is… Show more - Met face to face with members when they came to our Watertown office. Properly documented and performed follow up as needed.- Attended member meetings and gave presentations during Open Enrollment. Also led "break away" tables where members could have all of their questions answered in small groups.- Served as backup to both the Help Desk and Escalation lines. The Help Desk assisted other Customer Sevice Representatives in finding more complicated solutions. The Escalation Line is set up for members that request to speak with a supervisor.- Served as interim Team Lead for one of our Customer Service teams when their Team Lead was out for a little over a month. Was responsible for coaching and giving feedback along with attending various meetings.- Was part of a video for the THPMP.ORG website about the company and the role we play in our community. Show less

Watertown, Massachusetts

- Professionally respond to and document inbound member calls, striving to ensure first call resolution.- Consistently exceeded company standards for quality on call scores.- Worked to de-escalate calls by conveying empathy and understanding to enhance the member experience.- Understanding that some situations require additional assistance, set proper expectations, and getting members connected to the correct next contact point.- Observed and took notes for other representatives… Show more - Professionally respond to and document inbound member calls, striving to ensure first call resolution.- Consistently exceeded company standards for quality on call scores.- Worked to de-escalate calls by conveying empathy and understanding to enhance the member experience.- Understanding that some situations require additional assistance, set proper expectations, and getting members connected to the correct next contact point.- Observed and took notes for other representatives with the goal of helping them improve their own call scores. - Served successfully as floor support for multiple new hire classes. This involved both assistance with both material and procedural questions. Show less

Franklin, Massachusetts