Michael Kerble Email & Phone Number

Burlington, Massachusetts, United States

Brighton, Ma

Watertown, Massachusetts, United States

Maintained and processed physician and provider credentialing information for new and established health plan practitioners in accordance with Tuft Health Plan’s (THP’s) policies and procedures, as well as state laws and regulatory agencies.• Assessed adequate and accurate information for participation in THP, including provider contract information.• Performed accurate and timely entry of initial and existing credentialing applications into thecredentialing information system (Cactus).• Utilized primary source verification through internal and external websites relative to licensure or other certifications.• Reviewed and reported all adverse information received through National Practitioner Data Bank(NPDB), as well as state and federal sanctions. Forwarded details to compliance team when applicable.• Retrieved missing and/or expired information and documentation required for credentialing.• Acted as resource for physician and provider questions related to certification and/or the credentialing process.• Assisted credentialing supervisor with issues of broader complexity or sensitivity that required further action by a medical director or other outside source.

Watertown, Massachusetts, United States

• Credentialed providers under all product lines associated with commercial, Medicare, and/or ancillary service agreements.• Monitored providers by product line participation and compliance associated with specific product requirements.• Delegated, processed, and monitored turnaround time for completion of initial and re-credentialing files.• Completed all reporting requirements in accordance with federal and state regulations.• Hired, trained, supervised, and evaluated credentialing specialists.

Watertown, Massachusetts, United States

• Utilized comprehensive knowledge of all of the system provider information (PI) supports, including: TAHPMaster, Diamond, Cactus, and Alui.• Maintained various reporting tools and quality metrics for tracking information changes.• Followed up and resolved issues identified through monthly audit reporting.• Disseminated various requests and changes to provider information.• Coordinated all aspects of training for new and existing provider information specialists. Developed, updated, and maintained a provider information training manual and other relevant departmental documents. Conducted audits and monitored termination paperwork.• Communicated and confirmed provider information changes to providers, internal departments, and/or external contacts.• Verified, inputted, and maintained out-of-plan provider data to ensure accuracy for payment. Resolved and documented issues requested via MACESS. Continually followed established internal service agreements and met departmental standards on a daily basis.• In coordination with the provider information supervisor, initiated, coordinated, and executed special projects related to system enhancements. Completed changes associated with provider information to improve the quality of provider data as it related to plan operations.

Watertown, Massachusetts, United States

• Interpreted and verified multiple daily requests received via email, fax, and/or mailed correspondences associated with provider record changes.• Utilized various reporting tools and quality metrics for tracking provider information changes, including: the physician change report and Secure Horizons change report.• Resolved issues identified through monthly audit reports prepared by provider information trainer.• Maintained out-of-plan provider data to ensure accuracy for payment.• In coordination with the provider information supervisor, initiated, coordinated, and executed special projects related to enhancements for system changes and provider information to improve the quality of provider data as it related to plan operations.

Watertown, Massachusetts, United States

• Adjusted claims and explained benefits to providers and members.• Managed direct contacts with providers and members via phone.• Properly logged information of claims and phone conversations on the THP computer system.• Collaborated with supervisory teams and coworkers in a call center environment.• Managed multiple phone queues.• Handled and adjusted auto-related claims (subrogation), private healthcare systems, and preferred provider organizations (PPOs).

Burlington, Massachusetts, United States

• Resolved billing problems, processed collections, and escalated customer cases.• Directed customer contact via phone and email.• Frequently worked with provisioning of long-distance phone services and local phone services.• Assisted in dispatch of emergency telecommunication services.

Boston, Massachusetts, United States

• In charge of logging information into the cytology database.• Responsible for data entry of laboratory information and other office filing.• Open specimen bags, match labels to specimens, and process specimens using proper equipment.

Natick, Massachusetts, United States

• Assisted patients with personal care, such as bathing and dressing.• Assisted client exercise under supervision of a nurse or therapist.• Worked in a home residential setting and occupational setting.