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Healthcare Analyst Resume Samples
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0-5 years of experience
Developed and managed systems to track and trend core metrics in partnership with the Bureau of Medicine and Military Health Systems (MHS) business planning and Access to Care (ATC) directives.
- Recovered over 1Mil in workload using Lean Six Sigma methodologies
- Prepared and presented trend reports to the Board of Directors on target metrics including financials, productivity, utilization rates and demand studies; identified problematic data quality issues and/or ineffective practices
- Partnered with Directors to streamline & strengthen the quality and efficiency of programs
- Awarded “Best Practice” by Navy Medicine West for development of the TRICARE Referral Database
- Acquisitioned, processed and ensured the completion and coding compliance of 38,000 annual outpatient Emergency Room and Same Day Surgery visits.
- Developed and implemented tracking databases to monitor and measure command compliance and clinic processes.
- Completed two Lean Six Sigma projects that resulted in enhanced clinic effectiveness and recouped over $600K over a six month period.
- Managed one subordinate employee
10+ years of experience
Determined utilization, cost, and quality of health care services received under the funds’ benefit plans.
- Provided effective research and analysis to the Assistant Director of Patient Care with data support.
- Conducted and performed population needs assessments.
- Supported the planning and evaluation of new provider networks.
- Responded and attended to ad hoc reports requests.
0-5 years of experience
Participating in rotation program among 4 departments which aims to overview the company operations
- Preformed sub-acute medical billing on timely basis for MCARE, MCAL and managed care departments
- Fastened the revenue cycle by filtering the problem claims in MCARE department for re-billing
- Developed excel macro to decrease the usage of man power on billing process
0-5 years of experience
Generated and distributed standard reports weekly, monthly, and quarterly.
- Documented reporting processes and procedures.
- Created and maintained comprehensive workflows for the production and distribution of assigned reports.
- Established and maintained timelines for reports and projects.
- Identified and completed report enhancements and fixes.
- Assisted and supported with completion of special projects as requested by various internal departments.
- Supported and attended requests from regulatory agencies, contracting agencies and other external organizations.
- Developed and prepared various ad-hoc reports.
- EHR/Practice management implementation.
10+ years of experience
- Gathered and created functional requirements, and performed Quality Assurance testing
- Served as Project Manager for foreign programmers
- Implemented SQL scripts and triggers for various database operations
- Responsible for implementing and on-site training of 72 practices on the use of Practice Management Software (MedStar and DrWorks) and Electronic Health Records (iPatientCare) applications throughout the United States
- Maintained relationships with third party vendors for integration testing
- Provided technical support to 268 clients which included software updates, troubleshooting software, hardware, EDI, HL7, SQL and Windows related issues
- Responsible for the design of Practice Management Software (DrWorks)
- Provided consulting to practices on matters which entailed business operations, financial reporting and Meaningful Use
0-5 years of experience
- Undertook opportunity analysis on various disease conditions to identify long and short term cost savings
- Evaluated the effectiveness of different physician and member facing programs
- Developed analytics for Physician Group Incentive Programs (PGIP)
- Worked on ad-hoc reporting as and when required
- Prepared Dashboard reports for the various initiatives implemented by the organization
- Developed analytical plan, sourced data and undertook analysis for various program evaluation
0-5 years of experience
Analyze UB and 1500 claims to make sure they are paid correctly to the set Medicare Guidelines.
- Correct CPT and Revenue Codes on UB and 1500 clam forms.
- Receive and process any adjustments on commercial billing claims.
- Follow up on claims to make sure payments are processed and posted correctly to the patients account.
0-5 years of experience
Support healthcare providers increase revenue, productivity, and clinic performance through integrating technology into clinical settings.
- Manage quality assurance and testing for cloud-based medical technology.
- Research public health industry by conducting interviews, presentations, and webinars.
- Generate and maintain agreement contracts, consulting frameworks, and reports for all clients.
- Coordinate medical coding and systems analysis to improve process of claims management.
- Gained extensive knowledge of contracting and credentialing for commercial and government insurances.
- Initiate and execute special projects on as needed basis for immunizations, claims management.
6-10 years of experience
Provide support to clients during the implementation of electronic medical records.
- Participate in go-live sessions and provide elbow support to clinicians and end users.
- Develop curriculum and train users in an adult education environment.
- Configure SMART tools (SmartText, SmartLink, SmartSets and SmartPhrase) for physician documentation.
- Assist users on hyperspace navigation, home screen customization, manage in-basket, document encounters, and order entry.
- Design clinical workflows and translate business requirements into functional requirements for developers.
- Provide leadership and support to teams by utilizing my skills in change management, problem resolution and conflict management.
0-5 years of experience
Leading the team of terminology mappers. Performing laboratory, radiology and textual report mapping of codes to LOINC through Regenstrief dictionary, using Distributed Terminology System (DTS) tool.
- Submission of new lab tests as needed to LOINC through Regenstrief Institute.
- Monitoring of unit of measure exceptions that come across multiple data feeds and providing resolution of the errors in a timely manner.
- Validation of the display of patients’ test results in Indiana Network for Patient Care (INPC) in collaboration with Indiana Health Information Exchange (IHIE).
- Took responsibility for and led new initiatives including ways for increasing work efficiency and level of effort assessment.
- Identified problems, planned and executed a resolution to improve processes in place.
- Managing team work load while meeting time constraints and expectations.
- Developed and implemented mapping procedures and guidelines for the team.
- Creating monthly reports for management.
- Interviewed candidates for the clinical terminologist position.
- Used SQL statements to generate reports.
0-5 years of experience
- Maintained monthly and quarterly financial models
- Performed IBNR calculations
- Reviewed individual and small group health insurance rate filings
- Maintained a database of key statistics regarding the individual, Arizona marketplace
- Assisted in the preparations of claim data for analyzing healthcare claim cost patterns and trends
- Assisted in the preparations of Requests for Proposals (RFPs)
- Assisted in the preparations of Annual Part D Attestations for the Retiree Drug Subsidy
0-5 years of experience
Responsible for developing reports for upper-level management to help them in their business decision making process with accuracy and in a timely fashion.
- Responsible for design and development of analysis and reporting of claim, providers, authorization, members, financials, and clinical data using SQL server tools, statistics, and analytical techniques to fully understanding and trend the efficacy of the report.
- Prepare monthly status reports, aid in corporate projects that deal with health care, compare medical budgeting to their prior analysis, and assist in customer service issues
- Carefully reviewing report requests to get clear understanding of what is requested, gathering additional information as needed
- Analyzing query results and clearly present findings both qualitatively and quantitatively to the requestor, strategically providing additional information that the end-user may need
- Utilizing a robust QA process to present client with a finished product.
- Interact with the business clients for report and ad-hoc data analysis requirement for the client’s request.
0-5 years of experience
- Provided highly confidential data analysis of large pools of information for CEO and CFO ensuring strict adherence to federal HIPAA laws while identifying business opportunities
- Prepared, recorded, maintained and organized confidential physical and electronic records using a variety of query tools, systems, and software
- Worked with highly confidential information, removing confidential components to create non-technical, unrestricted reports in Excel using Pivot tables which provided an understanding of patterns, unforeseen trends and practices to support hospital CEO’s and CFO’s research on expansion or development, and in human resource decisions
- Coordinated, trained and supervised intermittent staff to use new software for adhoc reports to determine demand and potential sales
0-5 years of experience
- Track and report sales production for 6 lines of business.
- Produce monthly Competitive Analysis report for Healthfirst and competitors.
- Report monthly PSHP recertification and retention Rates.
- Provide membership data for internal and external audits.
- Create, enhance and maintain SAS programs and methodologies for reporting processes.
0-5 years of experience
- Analyze research, discuss and resolve technical inquiries, issues and upcoming EDI changes.
- Performs troubleshooting and support via inbound and outbound contact
- Implement new Payers (Setup Communication types, and payer testing)
- Identify problems and interface with appropriate internal resources to ensure timely resolution
- Work with the following transaction sets: claims (837P, 837I, 837W), Encounter Data, ERA (835), Claim Status (276,277), Eligibility (270, 271), Acknowledgment (997,999, 277CA)
0-5 years of experience
Provide analytical support to Finance Analysis, Hospital Reporting department
- Create monthly reports using SAS and Excel to show hospital performance including cost, revenue, risk score trends, and identify causes behind emerging trends; share these reports with the senior management
- Produce metrics that demonstrate utilization of inpatient stays, ER visits, and specialist services for providers
- Pull medical data including claims from data warehouse using SAS; perform drilldowns to identify patterns and outliers.
- Stay informed on latest Medicaid/Medicare developments such as population mandates and benefit carve-ins, and follow their impact on financial performance
- Work with hospitals and providers to support Medicare risk adjustment efforts to ascertain reimbursement is appropriately based upon member’s overall health.
- Model out reimbursement changes such as capitation to fee-for-service payment to assess financial impact
6-10 years of experience
Senior Healthcare Analyst, Mental Health Department
- Produce essential utilization and cost information that furthers the performance of critical business functions related to network performance and cost management for Mental Health Service
- Support financial and corporate decision making at all levels related to Mental Health Service
- Perform all the analytical and technical tasks involving project conceptualization, methodological design, and data integration
- Consultation & liaison with the other departments on issues related to Mental Health Service
0-5 years of experience
Created and analyzed areas of impact for coming ICD-10 conversion.
- Document project issues/follow-up items and find resolutions.
- Consult with directors and managers to determine requirements for data analysis and metric development.
- Retrieves data from integrated reporting repository using SQL to develop reports on cases such as invalid diagnosis, CPT and ICD-9 trends, member enrollment, provider network status, and medical claims reports for use of economic forecasting and planning.
- Review, analyze, and evaluate business processes and associated IT application requirements.
- Support and lead the process of screening, framing and modeling ideas for process improvements or cost savings.
- Developed business, user, functional, and implementation requirements to deliver on time and under budget an extranet web site for 2200 hospitals in fifty states creating an ecommerce ordering platform using ten project resources
- Develop policies/procedures related to the project implementation process.Design and support information technology procedures with respect to functional and technical requirements.
- Implement and use software and systems to support the department’s goals
- Create Unit and System Integration Testing Plan for team of 11 analysts
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
0-5 years of experience
Replaced the old HEDIS extract SAS programs which were essential for CMS reporting of our $1.4 billion Medicare and Exchange products with processes and quality control checks that were 12 times faster to run and had near perfect file inter-reliability.
- Advised on best practices for SAS Administration, setup, and company-wide learning of the system including leading the internal SAS User Group and its presentations
- Built macros that everyone in the company could use, including exporting of data, keeping passwords and system access private on a UNIX batch system, SAS library lists, and user lists
- Affable attitude, strong work ethic, and perspective thinking allow concurrent handling of multiple complex projects (administration, exploratory analyses, production analyses, ETL) and team management
0-5 years of experience
Create algorithms in SAS to identify members to contact for health improvement programs
- Conduct economic analysis of health improvement programs and present results to management
- Prepare ad hoc reports using various statistical tools to analyze trends in healthcare data
- Work across departments to produce accurate reporting of health improvement programs
0-5 years of experience
Model facility and physician utilization data to find dollar impact on contract proposals
- Work with network management to analyze fee schedules and structure of proposed contracts
- Heavily involved in synergy analyses for Coventry and [company name] integration to determine which contract provides
- Extract claims data from data warehouses, analyze, and summarize findings to upper management
6-10 years of experience
- Develop and execute programs for routine and ad hoc reports and analytics via SAS, MS SQL Server, and Python
- Conduct analytics with claims-based data and data of other origin
- Create standards for data cleaning and mapping for business unit utilization
- Provide guidance to behavioral health business leaders through construction of metrics and analyses including program evaluations
6-10 years of experience
[company name] is an acute care hospital system comprised of Massachusetts Genera Hospital, Brigham and Women’s Hospital, BWH Faulkner Hospital, North Shore Hospital, Newton-Wellesley Hospital, Martha’s Vineyard Hospital, Nantucket Hospital, Spaulding Rehabilitation Hospital, Partners Continuing Care, Mass General Physicians Organization, Brigham and Women’s Physician organization, et al.
- Builds databases, models and reporting tools to address new and previously unaddressed analytical needs.
- Maintains reimbursement / contracting system to ensure reimbursement terms and methodologies are consistent with contractual arrangements
- Develops and disseminated rate assumptions used to produce the annual budget and the multi-year forecast
- Develops quantitative analyses, custom models and ad hoc reports to monitor performance, trends, and opportunities
- Builds models to forecast revenue streams and develop what-if scenarios
- Responsible for project deliverables by developing project and communication plans, risk analysis, schedules along with other project management deliverables while consistently reporting status to management.
- Responsible for government reporting such as monthly US Labor reports used to value Consumer Price Indexes
- Chairperson of the monthly Payer and Contracting Analysts Forum.
0-5 years of experience
Responsible for reducing aging reports for all commercial payers
- Responsible for communicating with site locations in reference to patient accounts
- Responsible for preparing reports for weekly conference calls
- Responsible for performing account adjustments and writing off balances
0-5 years of experience
- Provides consultancy utilizing knowledge and expertise on insurance and healthcare.
- Develops and implements general insurance health policies in accordance with state and federal laws.
- Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions.
- Works in problem solving capacity and communicates solutions to providers/members via telephone interaction.
0-5 years of experience
- Responsible for monitoring risk pool performance, communicating financial results and identifying areas of opportunity for [company name] and hospital senior management
- Produce and manage annual hospital performance review packets, including membership, revenue, and cost analysis for hospitals and overall [company name]
- Monitor costs and revenue trends for hospitals and identify route cause of developing trends
- Respond to requests for analysis and provide analytic support to network management and owner hospitals
0-5 years of experience
- Responsible for conducting research and reporting on emerging trends in the healthcare industry
- Responsible for compilation and entry of data for applicable databases
- Responsible for supporting all other analytical & operational activities
- Responsible for analyzing trending payer and provider data related to managed care and writing monthly white papers on hot topics in the healthcare industry
0-5 years of experience
- Study the prevalence, disease burden, and associated costs of various health conditions at the population level using healthcare claims and employer survey data.
- Analyze health policy and publicly available data to estimate the potential impacts of national and state-level healthcare reform on different populations.
- Produce issue briefs, written reports, and presentations that visually display data analyses and translate findings for various audiences.
- Collaborate with policy and clinical experts to inform findings and develop recommendations for optimizing healthcare delivery, utilization, and expenditures.
- Provide consultative analyses to the UAW Retiree Medical Benefits Trust and Michigan Health & Hospital Association
- Perform brief and comprehensive reviews of peer-reviewed literature to inform analyses and identify
- Develop data requests, manage large data sets, and apply critical thinking to solve issues of data
- Communicate directly with clients to manage large projects, deadlines, and expectations.
0-5 years of experience
- Conduct custom strategic market research projects for high profile pharmaceutical clients.
- Execute project methodology using qualitative, quantitative research techniques.
- Manage Analyst I’s on specific projects to ensure quality of analysis.
- Blend the findings from the various research steps to produce reports containing insightful findings.
- Analyzed and manually scored messages for topic and sentiment, layering manual scoring with other data pulls in order to offer highly accurate market analysis snapshots.
- Interpret findings to provide actionable steps that can make a critical difference in client market position.
- Implement methodology rapidly and in savvy manner to achieve timely completion of projects.
- Make presentations to clients regarding projects and findings.
- Conduct brand tracking of pharmaceutical brands on social media channels; compare clients’ drug with competitors’ product, and describe sentiment (positive, negative, mixed, neutral) towards the clients’ brand.
- Played a critical role on the team to improve the company’s proprietary tool; helped to develop proprietary tool to help organize and store important documents.
6-10 years of experience
Healthcare marketing strategist, with a focus on digital trends
- Areas of expertise include consumer use of mobile, social, video, and other digital resources for health; deep understanding of how consumers connect with pharma and healthcare companies online, including variations by patient audience
- Responsibilities include survey design; extracting actionable marketing insights from large syndicated data sets; writing articles, blog posts, and other thought leadership pieces; and creating reports and presentations for healthcare clients such as Merck, Johnson & Johnson, Google, WebMD, Eli Lilly, and Sanofi
- Quoted as an expert in various marketing publications, including MedAdNews, Medical Marketing and Media, PharmaVOICE, and DTC Perspectives
- Previous role as marketing manager included hand-on experience with search engine marketing, email marketing, web content management, social media, and media relations
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[Healthcare Analyst]
Last edited by: Gabriela Barcenas, CPRW, Content Writer II -
Gabriela Barcenas
CPRW, Content Writer IIGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
