Dan Petersen has over 15 years of experience in government programs compliance at Blue Cross Blue Shield of Minnesota. He currently serves as a Senior Business Analyst ensuring Medicaid and Medicare appeals meet regulatory standards through daily audits. Previously he was a Consumer/Provider Liaison reviewing appeals concerning benefits and claims adjudication. He also has customer service experience handling inquiries about benefits, claims, and eligibility. Petersen holds a Bachelor's degree in History from Winona State University.

1. DAN PETERSEN
10301 Devonshire Road Apt 201 | Bloomington, MN 55431 | 612-386-0543 |
daniel.petersen@bluecrossmn.com
OBJECTIVE
My career objectiveisto seekachallengingand rewarding job that will allowmeto workin ateam environment and usemy
skillsin government and compliancerelated insurancefields, aswell asallow metheopportunity to grow professionally.
SKILLS PROFILE
- Experienced in Centersfor Medicare&Medicaid ServicesforMedicareAdvantageand Part Dplans
- Experienced in Stateof MinnesotaMedicaidplanbenefits, appealsand grievances
- Chaired projectsand committeesto identify and facilitateprocessimprovements
- Proficient insystemsknowledgeincludingMicrosoft Office, Excel, Visio,Power Point andAdobe
EMPLOYMENT HISTORY
BlueCrossBlueShieldof Minnesota
Consumer ServiceCenter (CSC)
Senior BusinessAnalyst –Government Programs
6/1/2013 — Present
Eagan, MN
 EnsureMedicaid and Medicareappealsand grievancesmeet all regulatory and compliancestandardsthrough daily
audit review or retrospectiveaudit.
 Accountableforauditing allcasesfor Medicare, Medicaidand Federal EmployeePlan (FEP) notificationsand files
to ensurecomplianceincludingbenefit determinations, medicalnecessity reviewsand claimsprocessingissues,
etc.
 Develop and generatereportsfor operational andregulatory agencieswhilealso providing andimplementing
solutions.
 Conduct in-depth research and analysison dataand processesto identify trendsand emergingissues, and
recommend best practicesformaximum performance
 Participateand facilitateworkgroupsand committeessuch as Pay asMedicareand Medicaid Programs,
Government ProgramsGrievancesreview, andMinnesotaDepartment of Human ServicesManaged Care
Organization Workgroup wherethereisdirect impact to theCSC.
 Review, interpret and analyzechangesin regulations, health plan operationsand benefit design, implement
changesasnecessary for CSCto remain compliant.
 Participatein internal andexternalauditsand quality assuranceprocess.
 Responsible for establishing and updating appeal and grievancetrainingmaterials, processflows, andquality
assuranceprocedures to ensurecompliancewith stateand federalregulations.
 Assist updating marketingmaterialsforMedicareand Medicaid clientsto ensureallregulatory requirementsare
satisfied.
 Responsiblefor monthly, quarterly and annual reportingto stateand Federal regulators, aswell asinternal
reporting fordataanalysisand processimprovement.
 Responsiblefor researching andresponding to stateand federal regulatory agencies (MinnesotaDepartment of
Health, MinnesotaDepartment of Commerce, theMinnesotaAttorney General’sOffice, and theMinnesota
Department of Human Services) and theircaseinquiries, complaints, and customer concerns.
 Assist in creating and maintainingnew aswell asconducting annual review of all current government programs
departmental policies and procedures.
 Lead for annual Centersfor Medicare & MedicaidServicesdatavalidation audits, including responding to, and
representing thehealth plan in explaining caseuniverserequests, sourcedocuments, and referencematerials.
 Participatein thepreparation, casepresentation, andfollow upworkrequired to completeNCQAaudits,
MinnesotaDepartment of Health Audits, and internalCMS mockaudits.

2. BlueCrossBlueShieldof Minnesota
Consumer/ Provider SeniorLiaison – Government Programs
5/1/2006 — 6/1/2013
Eagan, MN
 Researched and reviewed member and provider appealsconcerning benefitsand claim adjudication forMedicaid,
Medicare, and FEP linesof business
 Reviewed and responded to incomingcomplaints, appealsand grievances from membersand providers within
regulatory timeframes
 Responded to requests to coordinateresearch, when necessary, withbenefit and medical specialistsin order to
offer completeand accuratedeterminations
 Reviewed all outcome notifications governmentprogramsteam members prior to being released to members to
confirm accuracy and compliancewithbusinesspracticesand regulators
 Trained and mentored new liaisonsin theappeal review processesaswell asconducted daily questions meetings
to ensureappropriatestepswerefollowed
BlueCrossBlueShieldof Minnesota
Customer Service
8/21/2001 — 5/1/2006
Eagan, MN
 Responded to customer phoneinquiriesinvolving productinformation, benefits, claimsresolution, eligibility
and billing questions
 Provided information and education tocustomers, asappropriate, regarding avariety of health, financial and
self serviceprograms
 Served as acustomer advocateby identifying underlying customer needsand guidingto appropriate resources
 Delivered accurateinformation tocustomersin accordancewith performancegoalsand objectives
 Provided information tomembersand providersto supportthem intheirhealthcaredecisions
 Maintained astrict standardof confidentiality to ensure PHI wassecure
EDUCATION
BACHELORS DEGREE GRADUATED 6/1999
- Graduated with aBachelorofArtsdegreein History
- Graduated Cum Laudewith a3.22GPA
- Current member of thePhi AlphaThetanational historicalhonor society
- Received theDistinguished ServiceAward in 1999 by WinonaStateUniversity, andtheCommunity ServiceAward by
WinonaCounty HRA
- Minored in Women'sStudiesand wasvoted 1999 Women'sStudiesStudent oftheYear
REFERENCES AVAILABLE UPON REQUEST