Provider Relations & Claims Expert

TARA SCOTT

Owings Mills, MD • 667-***-**** • ***************@*****.***

PROFESSIONAL SUMMARY

Provider relations, claims resolution, and Medicare operations professional with 15+ years of experience supporting hospitals, physicians, billing teams, and payer stakeholders. Extensive background working with Medicare Advantage, commercial plans, billing operations, credentialing, enrollment, and revenue cycle management. Proven success serving as a primary liaison to resolve escalated provider issues, educate providers on policies and electronic tools, and ensure compliance with CMS, HIPAA, and payer guidelines. Strong relationship-building, investigation, and documentation skills with the ability to communicate clearly with clinical and administrative leaders. CORE STRENGTHS

Provider Relations • Claims & Billing Resolution • Provider Education & Outreach • Enrollment & Eligibility

Medicare/Medicaid/MA • DSNP • Blue Plans • Issue Research • Dispute Resolution • Policy Interpretation

Credentialing & Enrollment • Managed Care Operations • Revenue Cycle Management • Compliance Provider Portal Navigation • Electronic Tools Training • Communication & Stakeholder Engagement Systems: CareFirst Direct • FACETS • GuidingCare • Availity • NaviNet • CRM Systems • MS Office Suite

PROFESSIONAL EXPERIENCE

Healthcare Service Corporation / HealthSpring / Cigna — Remote Plan Change Agent (Seasonal Contract) Sept 2025 – Present

• Serve as a frontline liaison supporting Medicare Advantage members across 25+ states, ensuring smooth transitions between plans and resolving issues involving eligibility, enrollment, and billing.

• Perform detailed research on provider participation, formularies, network rules, and cost-sharing to ensure members are aligned with compliant and accurate plan choices.

• Educate members on benefits, premiums, and CMS-regulated requirements, ensuring clear understanding of policies and coverage.

• Document all interactions accurately and escalate complex issues to internal teams when needed.

• Maintain strict adherence to CMS, HIPAA, and quality standards while handling high-volume calls. Edwin Ampiah-Addison State Farm Agency — Remote/Hybrid Life & Health Insurance Agent Oct 2024 – Sept 2025

• Provided personalized insurance quotes, benefits education, and policy enrollment guidance across multiple product lines.

• Ensured accuracy in data entry, eligibility verification, and billing updates.

• Served as a knowledgeable point of contact to resolve customer concerns related to billing, claims, coverage changes, and compliance.

TLC Health Advisors — Remote

Licensed Health Benefit Advisor Mar 2020 – Oct 2024

• Assessed coverage needs for Medicare and ACA applicants and guided them through plan selection processes.

• Verified provider participation, reviewed formularies, and ensured accurate plan alignment.

• Maintained billing accuracy and collaborated with payers to resolve discrepancies and ensure proper member enrollment.

Fidel Integrated Medical Solutions — Pikesville/Baltimore, MD Assistant Director of Billing (2003–2010) ® Director of Enrollment, Billing & Credentialing (2010–2020)

• Promoted to oversee full billing, enrollment, and credentialing operations for multi-specialty providers.

• Managed provider enrollment and credentialing with Medicare, Medicaid, commercial payers, and PHOs.

• Resolved escalated provider issues involving denied claims, coding discrepancies, contract interpretation, reimbursement delays, and portal access.

• Led RCM operations including claim submission, payment posting, denials management, appeals, and financial reconciliation.

• Educated providers and clinical staff on billing protocols, documentation requirements, and payer processes.

• Strengthened payer and provider relationships by serving as a reliable liaison between practices and insurance plans.

• Implemented workflow enhancements that reduced denials and increased collection rates by 27%. EDUCATION

MBA, Business Administration (Leadership) — Mount St. Mary’s University Bachelor of Science, Information Technology — University of Phoenix SKILLS

Medicare/Medicaid Billing • CMS/HIPAA Compliance • Provider Relations • Claims & Billing Research • Revenue Cycle • Provider Dispute Resolution • Credentialing & Enrollment • Data Analysis • Reporting • Provider Portal Navigation • Provider Education • Network & Formulary Lookup • MS Office Suite

Contact this candidate