Medical Credentialing Specialist - Tareen Dermatology
(2025-02)
- Directed end-to-end credentialing operations for a multi-specialty provider network, ensuring compliance with NCQA, CMS and state regulations
- Conducted Primary Source Verifications of education, licensure, board certifications and work history
- Liaised with healthcare providers, insurance companies and regulatory agencies to resolve credentialing discrepancies and expedite approvals
- Established tracking systems for expiring credentials, proactively managing renewals to maintain uninterrupted provider participation
- Coordinate credentialing and recredentialing processes for physicians, physician assistants & nurses
- Ensure confidentiality and adherence to HIPAA regulations in handling sensitive provider information
- Partnered with HR, medical office staff, and payer enrollment teams to align credentialing processes with organizational goals and provider satisfaction
Collections Specialist 2 - Blue Cross and Blue Shield of MN
(2022-05 - 2025-01)
- Managed Optum Credit Balance & Retractions Queue
- Manage Worker's Compensation, Subrogation, and Third-Party Liability claims, addressing discrepancies and coordinating resolutions.
- Maintained strict adherence to HIPAA guidelines while handling sensitive information, documents, and while assigning all incoming correspondence from attorneys, other insurance companies, and members to the analyst assigned to their specific case.
- Collaborated with Accounts Receivable (AR) to ensure settlement checks are applied to the correct claims in each case.
- Utilize HCPCS and CPT codes for accurate billing and collections
- Collaborate with the assigned analyst to apply the recovery fee to the case and close after final review.
Collections Specialist 1 - Blue Cross and Blue Shield of MN
(2019-06 - 2022-05)
- Conducted document reviews for accuracy and compliance
- Managed subrogation and third-party liability claim investigation and case documentation and payment recovery efforts
- Took on numerous additional projects as needed
Subrogation Associate - Blue Cross and Blue Shield of MN
(2018-03 - 2019-06)
- Reviewed and processed incoming correspondence from attorneys and entities
- Compiled necessary information to construct comprehensive cases
- Managed post-payment letter queue with a 30-day turnaround time
- Collaborated with analysts to finalize case setups and ensure accurate handling
Customer Service Representative Associate - Blue Cross and Blue Shield of MN
(2016-01 - 2018-03)
- Handled a high volume of both member and provider calls for the Federal Employee Program (FEP)
- Conducted thorough research and facilitated claims adjustments for both medical and basic dental
- Assisted team members with backlog management for timely processing
Teller and Foreign Currency Exchange Specialist - Wells Fargo
(2015-02 - 2016-01)
- Provided exceptional customer service, advising clients on account management and budgeting
- Managed foreign currency stock and ensured compliance with stocking requirements
- Processed high volumes of financial transactions daily, balancing vaults and teller drawers
- Promoted bank services and products to enhance customer satisfaction and loyalty
Hair Stylist and Product Coordinator - Fantastic Sams
(2010-01 - 2014-12)
- Conducted detailed consultations with clients to meet their hair styling and color needs
- Managed multiple clients simultaneously during complex chemical processes
- Tracked and managed salon product inventory, ensuring optimal stock levels
