Healthcare Analyst Resume Samples

Description :

1. Cleveland, OH  Project aimed at gathering requirements for the implementation of Process Reverse Engineering to make the company more efficient and modernize.
2. Incorporated AGILE methodology to establish a business analysis by interacting SMEs and end-users.
3. Completed a Business and Technical Requirement Document (BTRD).
4. Developed Use Case documents using MS Visio of As-Is and To-be business.
5. Designed and developed business flow and workflow diagrams to develop the software.
6. Created Use case diagrams, Activity, Sequence, and Collaboration diagrams using UML.
7. Participated in walkthroughs with the development team and QA team, to help them understand the requirements and help them formulate the test plans and test scripts on EDI 834 benefit enrollment.

Experience

2-5 Years

Level

Executive

Education

GED

Description :

1. Designed Compile clinical data through the use of computer-based applications and use current trends in the healthcare system to make well-informed decisions in healthcare modeling.
2. Worked daily with vendor agencies and hospitals gathering, compiling, modeling, validating, and analyzing data needed by the company.
3. Prepared monthly status reports, aid incorporate projects that deal with health care, compare medical budgeting to their prior analysis and assist in customer service issues.
4. Provided reliable information for their medical staff and patients for the template in Armed Forces Health Longitudinal Technology Application (AHLTA) and Ambulatory Data Module (ADM) based on revisions/deletions to ICD-9 and ICD-10, Current Procedural Terminology (CPT), and Health Care Common Procedural Coding System (HCPCS) codes, changes in coding practices or changes in the clinic scope of practice.
5. Developed initiatives for providing more effective health care to resolve current service issues with DRG.
6. Successfully navigated clients through customized implementation and managed to ensure product enhancement requests along with coordinating open tickets, new reports, and product optimization.
7. Analyzed financial and operational metrics at institution and system levels to improve collections, reduce overhead, and maximize employee efficiency.

Experience

2-5 Years

Level

Junior

Education

G.E.D

Description :

1. Possessed and maintained a comprehensive understanding and knowledge of BCBSM business, Medicare Advantage products, CMS regulations, HEDIS and STARS programs, and basic research principles/methodologies.
2. Assisted in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.
3. Communicated results of the analysis to management and supporting departments via reports/presentations and assist management in implementing programs that provide solutions.
4. Recommended, communicated, and implemented solutions to identified problems/root causes of issues.
5. Provided expertise and guidance to the unit and corporate staff as required.
6. Represented and participated in group or committee discussions.
7. Coached new employees in the onboarding process.

Experience

10+ Years

Level

Senior

Education

Bachelor Of Science

Description :

1. Responsible for developing long-term goals and strategic objectives for a DoD organization.
2. Identified, analyzed, and monitored issues that affected growth and productivity.
3. Recommended financial and nonfinancial strategic alternatives.
4. Developed and maintained operational plans.
5. Conducted assessment interviews, provided ongoing therapy and crisis intervention.
6. Facilitated meetings, conduct interviews, and developed business cases to implement process changes, develop training materials, and instruct clients on new processes and procedures.
7. Collaborated with other community agencies.

Experience

2-5 Years

Level

Executive

Education

GED

Description :

1. Focused on data integrity validation, intensive data mining, utilization, and cost trend analysis.
2. Identified cost drivers through benchmarking of hospital/physician financial performance trends.
3. Developed specific recommendations for improving financial performance through network augmentation or expansion, benefit design changes, new product development, membership retention, and geographic/ethnic marketing strategies.
4. Communicated with senior leadership and hospital partners to design, implement, and validate cost and quality incentive improvements to the existing contracts.
5. Reported Business owner of design and adoption of web-based reporting/analytical tools for internal and external clients.
6. Designed to include performance metrics for providers - primary care, specialists, and hospitals.
7. Responsible for data/reporting accuracy for premium reconciliation, DRG accuracy, inpatient advances, specialist capitation, and quality incentives.

Experience

5-7 Years

Level

Executive

Education

High School Diploma

Description :

1. Reviewed payer-related documentation for Medicare/Medicaid for accuracy and make the necessary corrections as needed.
2. Verified insurance information and computer data entry for accuracy and completeness and resolves discrepancies as needed.
3. Obtained clinical information needed to support payer medical necessity requirements and to support the billing process.
4. Processed information received from intake and branch personnel.
5. Organized and cataloged incoming documentation for the department.
6. Facilitated communication between the branch personnel and departments. Prepares reports using MS Excel and PowerPoint.
7. Prepared client-ready service documents as required by the Policies and Procedures Manual.

Experience

5-7 Years

Level

Executive

Education

High School Diploma

Description :

1. Guided community members to adhere to the phases outlined by the S&I Framework and to develop various outputs and artifacts for each phase.
2. Managed team to develop documents outlining pilot metrics for the Office of the National Coordinator PDMP Initiative.
3. Collected and analyzed data for the Li-Fraumeni Exploration (LiFE) Research Consortium.
4. Developed use case materials for the Office of the Chief Privacy Officer (OCPO) Patient Choice Initiative to document policies for HIE and Consent systems in order to enable the execution of client initiatives.
5. Performed data analysis between the NCI Cancer Data Standards Registry and Repository (caDSR) and the NLM Common Data Elements (CDE) Repository.
6. Enhanced strategic models and presented recommendations to improve the NLM repository- this led to significant enhancements and a 70% increase in user satisfaction.
7. Served as liaison between Quality Utilization Management, Risk Management, and Legal Affairs Department Scheduled and Prepared for pre-trial meetings.

Experience

2-5 Years

Level

Junior

Education

Bachelor Of Science

Description :

1. Provided epidemiologic input into development strategic plans and submissions.
2. Provided expertise in clinical research, project monitoring, evaluation, medicine, public health issues, public health epidemiology, public health surveillance coordination, health research coordination, and analysis.
3. HIV / AIDS, TB, Family planned, and maternal health Data analysis and reporting.
4. Experienced Inpatient coding MS-DRG, APR-DRG, Risk of Mortality (ROM).
5. Applied ICD-9 and/or ICD-10 inpatient codes for diagnoses and procedures (Diagnostic Related Group is automatically assigned by the grouper software) for inpatient stays.
6. Prepared and developed reports by researching and synthesizing data from various research studies, health reports, drafts, and recommendations Data manipulation skills using database and spreadsheet applications.
7. Worked knowledge of database applications, including extraction and querying skills.

Experience

2-5 Years

Level

Junior

Education

Master In Public Health

Description :

1. Provided comprehensive management services to Independent Physician Practices and Healthcare Networks.
2. Assembled and reviewed Utilization Management and Claims data and analyze healthcare costs to assist physician groups effectively manage their practice by improving their profitability.
3. Led special projects and targeted assignments for the senior Finance leadership team.
4. Performed mapping and harmonization of data elements and standards between the NCI cancer Data Standards Registry and Repository (caDSR) and the Meaningful Use Common Clinical Data Sets (CCDS)- results led to updates to the NCI registry and development of a white paper for ONC.
5. Involved in verifying EDI 834 raw data from different portals such as fax, websites, or email.
6. Managed multiple projects, as well as meet time constraints and expectations.
7. Supported government customers in a variety of tasks, utilizing critical thinking and analysis skills.

Experience

2-5 Years

Level

Executive

Education

Bachelors of Science

Description :

1. Worked as an analyst with a focus on healthcare process improvement.
2. Traveled to client sites weekly to analyze healthcare processes and develop procedural improvements, with the objective of reducing client spending and maximizing revenue.
3. Focused on the revenue cycle to ensure that client business processes are functioning efficiently.
4. Analyzed all the procedures involved and restructuring to ensure the client is meeting national standards.
5. Worked with a team of Huron consultants, as well as with client counterparts, to achieve process improvement goals.
6. Led internal and client meetings as needed to accomplish the necessary steps within a specified timeframe.
7. Manipulated, cleansed, and processed internal health plan data using Excel, Access, and SQL.

Experience

2-5 Years

Level

Junior

Education

GED