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.
Headline : To obtain a Provider Data Analyst position that allows for the maximum utilization of my oral, written, and team-building skills in a multi-faceted environment that encourages both professional and personal growth and development.
Skills : Microsoft Office, SQL, Project Management, Visio.
Description :
Provided data processing support to the Provider Data Manager for Veteran & Military Tri-care LOB.
Performed various tasks such as query, extract and validate data in order to fulfill providers' requests.
Imported, cleaned, transformed, validated providers' data used to pay government claims.
Created Microsoft Access reports to identify errors and ensure data was current, complete and accurate in the provider and facilities information network database.
Maintained detailed documentation and adhered to standard operating procedures.
Performed data management and cross mapping of SAP's classification codes to the Data Enrichment and Classification (DEC) HUB using Business Objects Reporting, ACCESS and SQL queries.
Participated on solution planning teams for all third-party applications owned and managed by Strategic Procurement; in addition worked collaboratively with IT teams to deliver business results for on-premise technology solutions.
Experience
5-7 Years
Level
Junior
Education
Master Of Science
Provider Data Analyst Resume
Summary : Highly qualified Provider Data Analyst with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and I would excel in the collaborative environment on which your company prides itself.
Skills : Customer Service (10+ years), Computer Skills.
Description :
Generated Disruption reports, (Geo Access occasionally) and analyses and maps ranging from basic/routine to complex/custom.
Interpreted specifications and determine project feasibility relative to program capabilities, workload and unit parameters.
Managed special requests.
Customised Geo Access program as necessary to address specific project needs.
Handled large data files from various internal and external sources (BCBSA, clients/brokers, etc.
Prepared or participated in preparation of provider and service area files for use in Geo Access, Disruption and other provider analyses; as well as for dissemination to brokers/consultants, BCBSA, internal requests and the proposal network analysis team.
Worked with Legal, Information Management, BCBSA, Client Reporting and other areas of the company to research provider data issues and make recommendations for resolution.
Experience
7-10 Years
Level
Management
Education
B.S. In Business Law
Provider Data Analyst Resume
Headline : Provider Data Analyst is responsible for Managing health plan product offerings to maintain compliance, Developing strategies to increase revenue from existing products or establish new products or services, Conducting market research on new ideas for service offerings.
Skills : MS Office, Medical Terminology, Account Management, Adobe, PowerPoint, Access, IDX, Outlook, Accounts Receivable, Accounting.
Description :
Conducted and managed on-going reviews of contract installations.
Partnered with quality management in identifying, analyzing and reporting on trends.
Provided on-going business and technical direction relative to provider data structures that are national or regional in scope in support of claim adjudication and directory production.
Maintained and aligned contracted provider demographic data and negotiated reimbursement arrangements across provider systems.
Reviewed new and existing contract reimbursement arrangements and determines most appropriate system input methodology that facilitates accurate and consistent claim adjudication.
Worked collaboratively with internal/external constituents.
Conducted and managed system audits of PDS systems and user applications.
Experience
5-7 Years
Level
Executive
Education
GED
Provider Data Analyst Resume
Objective : Detail oriented Provider Data Analyst professional with over seven years of medical administrative experience in data management, medical billing/collections, and medical insurance credentialing. Able to manage multiple priorities and tasks while meeting rigid deadlines and maintaining quality of work.
Skills : Customer Service , Multi-task, internet.
Description :
Collected, analysed and interpreted provider data as requested and required for department regulatory reporting.
Performed geo access reporting as required for state-wide analysis.
Established schedules to collect and interpret data.
Provided ad hoc reporting as requested by department staff and health plan executives, querying data from Med/MC and creating usable reports.
Produced, set up, and distribute provider blast fax communications and monitors for correctness, reporting and resending information that may fail.
Developed new reports and processes, identifies opportunities to streamline processes; use advance spreadsheet and database skills; provide recommendations on ways to make the provider data more efficient.
Identified opportunities to correct and update provider data and brings method of correction to management.
Experience
2-5 Years
Level
Executive
Education
MS
Provider Data Analyst Resume
Objective : A high energy, result-oriented Provider Data Analyst professional offering data analytical experience that is looking for a leadership role with an organisation whose mission is based on customer-driven satisfaction.
Skills : Knowledge Of MS Office, Windows, Word, Excel & PowerPoint, Access, Internet Explorer, Visio, Facets, Macess, Citrix, EXP, VPN, Adobe, ADP, IMAX, Customer Service Administration, Medicaid Experience, Data Analysis Reporting, Project Management, Data Entry.
Description :
Conducted analysis, identified root causes, and initiate necessary actions to resolve conflicts within Facets and the encounter data files and provide summary report to management, when applicable.
Developed processes to maintain and monitor the non-participating provider set-up by working in collaboration with the Plan's third party administrator.
Translated and produced daily file conversions to guarantee data from Kentucky Department for Medicaid Services (DMS) was accurately loaded into the Health Plan's Facets system.
Assisted the Data Reporting department with the creation and updates to cross- functional departmental databases.
Facilitated and analyzed processes to assist third party administrator with investigation and resolution of encounters rejected weekly by the Kentucky Department for Medicaid Services (DMS) for discrepancies between Facets and Ika systems.
Developed tracking and reporting tools to monitor activities and identify opportunities for improvement.
Developed reference material and conduct training for departments related to provider data including setup, maintenance, termination, and data interpretation.
Experience
2-5 Years
Level
Junior
Education
Bachelor Of Science
Provider Data Analyst Resume
Objective : Highly organized and independent individual; able to effectively coordinate tasks to accomplish projects with timeliness and creativity. Efficient in fast-paced multitasking environments; able to prioritize effectively to accomplish objectives with creativity, enthusiasm and humor.
Managed all internal communication processes with other departments and team leaders in regards to current and upcoming database improvements for all systems through training and informational sessions.
Developed and maintained continuous database integrity and quality assurance of systems and services based on industry and organizational standards, report and extract necessary data for various system analysis, provide explanations and information to managers so that changes and updates can be implemented correctly to ensure constant quality control.
Maintained current provider data to ensure the quality of the network manage questions and concerns and take necessary actions to implement and resolve issues.
Responsible for identifying and solving problems within area of expertise.
Conducted audits within departments and provide feedback to reduce errors in provider database information.
Investigated non-standard requests and problems and take the necessary actions to ensure completion and compliance concerns are met.
Continually prioritised and organised workload to meet commitments and deadlines in a timely manner.
Experience
2-5 Years
Level
Junior
Education
Master Of Science In Management
Provider Data Analyst Resume
Headline : To establish a Provider Data Analyst professional career using the experience, knowledge and skills I have gained over a span of 30 years. I have a high drive to succeed with practicable characteristics such as multi-tasking, ability to learn quickly, time management, conflict resolution and organisation. Successfully managed detail-orientated projects, implemented concepts to bolster team moral resulting in quality production, pride, and profit with award winning results.
Skills : Knowledge Of CPT, HCPC Codes, Red Book, MDDB Drug Rates And HIPPA Compliance. Proficient With Microsoft Excel, Word And PowerPoint.
Description :
Updated demographics on hospital, facility and physician database.
Processed provider discounts on several healthcare client databases.
Designed and managed audit procedures and processes.
Performed expert lead role by training and supervising staff.
Implemented the use of Macro's to effectively update data in a timely and accurate manner.
Conducted client updates ensuring they received outstanding customer service by implementing timely responses and creating friendly business relationships.
Received and processed Provider Termination and Demographic update requests for multiple Markets.
Experience
5-7 Years
Level
Executive
Education
GED
Provider Data Analyst Resume
Summary : Respected and innovative at identifying business needs, applying skills in business analysis, process and continuous improvement, using basic statistical analysis. Possess abilities to properly scope, define and lead Lean Six Sigma projects; evaluating risks, integrating financial initiatives and ensuring precision for corporate strategies.
Skills : SigmaXL, Minitab, SQL, Medicaid.
Description :
Recorded provider contract, demographic and claims reimbursement data into specialized claims payment application.
Investigated new contract documents and amendments prior to insertion into claims payment application.
Compiled meticulous information with Provider Advocates for unique practices, requiring special care of contractual entry, review reports and update divisional databases to ensure data integrity.
Processed 100-200 updates per month and function as the Go to Person for changes in support of the Health Plan Provider Representatives.
Monitored the company's database, a high volume production processing area for various State Health Plans, offer recommendations on major contractual or payment updates for large medical groups; proposing the most time-effective method to make the update(s) and to ensure the medical group's satisfaction is achieved.
Served as Interdepartmental Team Lead for specific line of business through extensive understanding of State regulations, requirements and compliance provisions.
Worked with groups to close the gaps in care to improve their ratings.
Experience
7-10 Years
Level
Management
Education
Master In Business Administration
Provider Data Analyst Resume
Summary : Knowledgeable in Microsoft Word, Excel, Access and Power Point. Excellent customer service skills Excellent telephone etiquette Knowledgeable in Photoshop and Dreamweaver Superior skills in decision making Able to work without supervision or work in a group environment.
Skills : Microsoft Office, Adobe, Adobe, Data Entry, Avaya, Customer Service, Call Center, Windows, Windows.
Description :
Conducted audits and providing feedback to reduce errors and improve processes and performance, maintaining current provider data to ensure the quality of the network, and responsible for representing the provider network area on company IT projects.
Worked as the Cigna Liaison in handling the daily outlook emails from provider reps and Cigna administrators.
Reviewed research and correct issues the providers had with billing and payment of claims.
Experienced in processing claims for the EPO and PPO lines of business.
Assisted in working the provider add queues.
Worked on the Accumulator team as an analyst for high deductible health plans.
Processed and completed provider contracts to become in network Presence Health Partners.
Experience
10+ Years
Level
Senior
Education
GED
Provider Data Analyst Resume
Objective : To utilise my experience and skills to the best of my ability, and to also secure a position with a well established organisation, with a stable environment that will lead to a lasting relationship in the field that is desired. I will also like to obtain a position that will enable me to use my strong organisational skills, educational background, and ability to work well with people.
Skills : General Office Duties, Medical Terminology, Accounts Payable And Receivable, Front Office Operations, Customer Service, Data Entry, Billing, ICD 9 Coding, CPT Coding.
Description :
Used their MD Staff system daily to update provider information and to enter new providers.
Identified and addressed complaints and service issues regarding the providers.
Responded to inquiries through emails or claims error report methods, while ensuring provider processes are accurately set up in database.
Performed quality checks on provider data.
Maintained provider contract files and system information.
Maintained provider records to support health care networks for member health care plans and resolve and trouble shoot any network or data issues.
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