Keith Macdonald Email and Phone Number

► Coordinated vision and validation sessions between Humana and implementation partner KPMG on the Finance Modernization Project to update all Humana finance streams to a cloud-based solution.► Worked with Technology Management and Security & Controls teams to define and track action items needed for vision and validation phase completion.

► Created stories and managed goals for the Claims & Finance Operations team for the Senior Products implementation to HealthRulesPayor claims processing software. Result: Met an aggressive ‘go live’ deadline.► Enhanced Data Analysts’ performance productivity by successfully articulating business requirements into defined stories for Data Analysts to execute.► Frequently collaborated with other teams to accomplish joint goals by coordinating timelines for efficient delivery of work and dependencies. ► Initiated weekly meetings with the business and developers to minimize concerns over lack of communication and ensured coding cross walk and claims processing goals were achieved.

► Updated language and formatting for member and provider letters for new product launch of CarePartners of Connecticut. Result: Met an aggressive ‘go live’ deadline for 1/1/20.► Independently took initiative to successfully revise existing letters for Tufts Health Plan Senior Products with appropriate language and formatting. ► Implemented solution for letter creation process that eliminated existing duplicative work.► Liaison and Quality Control for explanations of benefits (EOBs) for Senior Products, including transition and development work with new vendor.

► Streamlined the provider appeals process by successfully leading a team of Business Analysts on new ownership and trained the entire claims department on appeal requirements and actions.► Made determinations on appeals for technical denials from contracting providers.► Set up appeals for medical necessity denials for review by nurses and medical directors.

► Set up provider and vendor profiles based on specialty and contract specifications.► Ensured proper pay rates by updating procedure codes, modifiers, and contract code profiles.

I hosted live, in-person Stump Trivia and Questionnairey events at various restaurants and bars on various nights over the years with Stump, which was acquired by Buzztime then Sporcle. My most recent regular gig was at Brewer's Coalition in Newton on Tuesdays. Unfortunately, due to the pandemic, hosting trivia wasn't an option anymore so I decided to hang up the mic. It is easily the best side job I ever had thanks to all the managers and coordinators over the years, the excellent restaurant staff I worked with, and of course the incredible people, strangers and regulars, I got to see on a weekly basis.

Ensured all claims billed to insurance were processed correctly and promptly. Appealed incorrect denials, corrected claims, and rebilled claims to insurance as needed. Posted insurance payments and requested refunds on all overpayments. Resolved billing issues with patients, insurance companies, and other facilities. Trained coworkers on each insurance’s online tools and resources. Recognized by supervisors twice through employee recognition program.

• Managed the billing department which handled all insurance, facility and patient billing• Trained employees in each aspect of the billing department and operations center including call taking, ambulance &chair car billing, aging, and payment posting• Reviewed documentation expectations with new EMTs and Paramedics at orientation• Imported and posted payments from insurances, facilities, and patients• Created specialty codes & updated contracted rates for insurances and facilities• Delegated workflow for billing staff and supervised employee performance• Personally handled specialty accounts and all higher level billing issues• Minimized billing time from multiple weeks to next day billing• Minimized recurrent denials through prebilling practices

Coded and billed ambulance and chairvan transportation to insurance and private pay patientsCoordinated booking and payments of towncar & limo reservations for limousine divisionAnswered emergent and nonemergent calls at ambulance dispatch center