A Provider Data Analyst provides decision making crucial data and information to the management by collecting, analysing, and reporting provider data. The job duties are listed on the Provider Data Analyst Resume as – collecting and interpreting provider data as required, performing geo access reporting, establishing schedules to collect and interpret data, providing ad hoc reporting as needed by the department staff, producing and distributing provider blast fax communications, collecting data for provider directly, and provider website for publication; developing new reports and processes, identifying opportunities to streamline processes; and identifying opportunities to correct and update provider data.
Employers typically seek applicants with the following skills – knowledge of Medicaid and Medicare programs, strong presentation and oral communication skills, knowledge of ETL framework, knowledge of EDW and data management systems; and a good understanding of healthcare procedures. A high school diploma or GED is needed.
Objective : Dynamic Provider Data Analyst with two years of hands-on experience in healthcare data management and analysis. Skilled in transforming complex datasets into actionable insights, I thrive in collaborative environments that prioritize innovation and efficiency. Eager to contribute analytical expertise to optimize provider data processes and enhance operational performance.
Skills : Data Analysis Tools, Database Management, Cross-functional Collaboration, Data Analysis
Description :
Analyzed provider data to ensure accuracy and compliance with regulatory standards.
Executed queries, extracts, and validations to fulfill provider requests efficiently.
Imported, cleaned, and transformed provider data to ensure accuracy for government claims processing.
Generated Access reports to identify errors and maintain current, complete, and accurate provider information.
Documented processes meticulously, adhering to established standard operating procedures.
Managed data cross-mapping of SAP classification codes to enhance data classification accuracy.
Collaborated with IT teams to deliver effective solutions for third-party applications in Strategic Procurement.
Experience
0-2 Years
Level
Entry Level
Education
BSHIM
Junior Provider Data Analyst Resume
Objective : Analytical and detail-oriented Junior Provider Data Analyst with two years of experience in healthcare data management. Proven ability to analyze provider data and enhance operational efficiency through data-driven insights. Committed to improving data accuracy and supporting decision-making processes in a collaborative environment.
Skills : Provider Data Management, Data Integration, Provider Networks, Data Mining, Trend Analysis
Description :
Generated disruption reports and geo-access analyses, transforming complex data into actionable insights.
Evaluated project feasibility based on specifications and workload parameters.
Managed and prioritized special data requests from internal stakeholders.
Customized geo-access programs to meet specific project requirements.
Handled large datasets from various sources, ensuring data accuracy and integrity.
Prepared provider and service area files for analysis and dissemination to relevant teams.
Collaborated with legal and information management teams to resolve provider data issues.
Experience
0-2 Years
Level
Junior
Education
B.S. Health Informatics
Provider Data Analyst Resume
Headline : Accomplished Provider Data Analyst with over seven years of experience in healthcare data management and provider analytics. Expertise in leveraging data to drive strategic decisions, improve compliance, and enhance operational efficiency. Passionate about utilizing analytical skills to optimize provider data processes and contribute to organizational success.
Skills : Software Proficiency, Healthcare Data Standards, Provider Network Management, Data Visualization Software, Presentation Design, Claims Processing Systems
Description :
Conducted comprehensive audits to ensure accuracy of provider data, resulting in enhanced claim processing efficiency.
Collaborated with quality management to analyze trends and implement data-driven improvements.
Provided strategic direction for national and regional provider data structures to support streamlined claim adjudication.
Maintained accurate provider demographic data and managed reimbursement negotiations across multiple systems.
Reviewed and optimized contract reimbursement methodologies for consistent claim adjudication.
Worked effectively with internal and external stakeholders to achieve data alignment.
Executed system audits of provider data systems to ensure compliance and reliability.
Experience
5-7 Years
Level
Senior
Education
BSHIM
Senior Provider Data Analyst Resume
Headline : Accomplished Senior Provider Data Analyst with over seven years of extensive experience in healthcare data management and analytics. Proficient in utilizing data-driven insights to enhance provider operations, compliance, and reporting accuracy. Committed to fostering collaborative environments that drive continuous improvement and optimize provider data processes.
Skills : Data Management, Data Quality Assurance, Statistical Analysis, Excel, Data Visualization, Healthcare Analytics
Description :
Collected, analyzed, and interpreted provider data for regulatory reporting, ensuring compliance with state and federal guidelines.
Performed geo-access reporting to support statewide analysis and improve network adequacy.
Established data collection schedules and methodologies to enhance reporting accuracy.
Generated ad hoc reports for department staff and executives, leveraging MedMC data to create actionable insights.
Produced and disseminated provider communication materials, ensuring accuracy and timely delivery.
Developed innovative reporting processes that streamlined data management operations.
Identified and proposed solutions for correcting provider data discrepancies, enhancing overall data integrity.
Experience
5-7 Years
Level
Senior
Education
M.S. H.I.
Provider Data Analyst Resume
Summary : Experienced Provider Data Analyst with 10 years in healthcare data management and analytics. Adept at synthesizing complex datasets to drive strategic decisions and optimize provider data processes. Committed to enhancing operational efficiency and data integrity through innovative solutions and collaborative efforts.
Skills : Proficient In Ms Office Suite, Customer Service Management, Root Cause Analysis, Process Improvement, Business Intelligence, Data Modeling
Description :
Analyzed provider data discrepancies to identify root causes and implemented corrective actions, significantly improving data integrity.
Collaborated with third-party administrators to establish and maintain non-participating provider setups, enhancing compliance.
Executed daily file conversions to ensure accurate integration of data from Kentucky Department for Medicaid Services into the Facets system.
Supported the Data Reporting department by creating and updating functional databases for cross-departmental use.
Investigated and resolved weekly encounter rejections from the Kentucky Department for Medicaid Services, ensuring accuracy between Facets and Ika systems.
Designed tracking and reporting tools to monitor data trends and identify areas for operational improvement.
Created reference materials and conducted training for internal teams on provider data processes, fostering better data management practices.
Experience
7-10 Years
Level
Management
Education
BS HIM
Management Provider Data Analyst Resume
Summary : Dedicated Management Provider Data Analyst with 10 years of extensive experience in healthcare data analytics and provider performance optimization. Expert in transforming complex datasets into strategic insights that drive operational efficiency and compliance. Passionate about leveraging data to enhance provider networks and improve decision-making processes.
Skills : Data Leadership, Data Project Management, Data Organization Skills, Reporting Skills
Description :
Coordinated cross-departmental communication to enhance database improvements, facilitating seamless training sessions.
Ensured continuous database integrity through rigorous quality assurance protocols, enabling accurate data reporting and analysis.
Maintained and updated provider data to uphold network quality, promptly addressing queries and issues.
Identified and resolved data-related challenges to enhance operational efficiency.
Conducted audits that provided actionable feedback, minimizing errors in provider data.
Investigated and addressed non-standard requests, ensuring compliance with organizational standards.
Effectively prioritized tasks to meet project deadlines while maintaining high-quality standards.
Experience
7-10 Years
Level
Management
Education
M.S. HI
Provider Data Analyst Resume
Summary : Seasoned Provider Data Analyst with a decade of expertise in healthcare data management and analytics. Proficient in interpreting complex datasets to drive strategic improvements and enhance provider data accuracy. Driven by a commitment to optimizing operational processes and delivering actionable insights that support organizational goals.
Skills : Time Management, Knowledge Of Hcpcs Codes, Familiarity With Red Book Pricing, Project Management, Communication Skills, Team Collaboration
Description :
Utilized SQL to extract and manipulate large datasets for analysis.
Processed provider discounts efficiently across various healthcare client databases.
Designed and implemented robust audit procedures to ensure data integrity.
Provided training and mentorship to staff, enhancing team performance and knowledge.
Utilized macros to automate data updates, significantly improving accuracy and timeliness.
Conducted client updates, ensuring outstanding service through timely responses and relationship building.
Managed provider termination and demographic update requests across multiple markets.
Experience
10+ Years
Level
Executive
Education
BSHIM
Executive Provider Data Analyst Resume
Summary : Strategic Executive Provider Data Analyst with a decade of expertise in healthcare data management and analytics. Proficient in deriving actionable insights from complex datasets to drive operational excellence and enhance provider performance. Committed to leveraging analytical skills to optimize data processes and contribute to organizational success.
Skills : Etl Processes, Data Interpretation, Market Research, Trend Forecasting, Data Reporting, Analytical Thinking
Description :
Collaborated with IT to optimize data management systems.
Reviewed and validated new contract documents and amendments for accurate entry into claims systems.
Collaborated with Provider Advocates to ensure precise contractual entries and maintain data integrity in divisional databases.
Processed 100-200 updates monthly, serving as the primary resource for Health Plan Provider Representatives.
Monitored high-volume databases for State Health Plans, recommending efficient methods for contractual and payment updates.
Led interdepartmental teams to navigate state regulations, ensuring compliance and operational effectiveness.
Facilitated initiatives to close care gaps, enhancing quality ratings across provider networks.
Experience
10+ Years
Level
Executive
Education
M.S. Health Informatics
Provider Data Analyst Resume
Objective : Proficient Provider Data Analyst with five years of experience in healthcare data management and analysis. Adept at analyzing complex datasets to derive actionable insights that enhance provider operations and improve data accuracy. Committed to leveraging analytical expertise to optimize provider data processes and drive operational excellence in dynamic team environments.
Skills : Data Analysis Software, Data Visualization Tools, Technical Writing, Communication Systems, Client Relations, Provider Support
Description :
Conducted comprehensive audits to improve data quality and reduce discrepancies, ensuring the accuracy of provider information.
Served as the primary liaison for Cigna, managing daily communications with provider representatives and administrators.
Investigated and resolved billing and claims issues, enhancing provider satisfaction through effective problem-solving.
Processed claims for EPO and PPO lines of business, ensuring compliance with industry standards.
Assisted in managing provider add queues to streamline onboarding processes.
Analyzed high deductible health plans as part of the Accumulator team, contributing to strategic decision-making.
Facilitated the completion of provider contracts, expanding the network for Presence Health Partners.
Experience
2-5 Years
Level
Consultant
Education
BSHIM
Provider Data Analyst Resume
Objective : Detail-oriented Provider Data Analyst with over 5 years of experience in healthcare data management. Proficient in analyzing provider networks, ensuring data accuracy, and optimizing workflows. Skilled in SQL, Excel, and data visualization tools. Committed to enhancing provider data integrity and supporting strategic initiatives to improve patient care and operational efficiency.
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