Healthcare Analyst w/10+ yrs exp

Résumé

e-mail: *******@*****.***

phone: ***/**5-4752

Position Sought

Healthcare Analyst

Objective

Provide business analytics to healthcare organizations seeking to improve their financial bottom line

Employment History

Senior Healthcare Analyst: July, 2006 -

Preferred Health Partners, P.C.

• Perform advanced data analysis using MS Access, MS Excel, SAP Crystal Reports, and IBM SPSS, and develop trend, outlier, and variance reports with respect to cost of healthcare services delivery, utilization, claims, provider contracts, membership, etc...

• Participate in the development of annual revenue and expense budgets by aggregating historical data

from multiple sources

• Perform what-if and root-cause analyses to identify and quantify performance barriers and opportunities within corporate operations, services utilization, provider contracts, and revenue cycle activities

• Perform contractual analyses of major payor contracts relative to Medicare/RBRVS and internal benchmarks

• Create and disseminate monthly and quarterly summary and variance reports and profiles with regard to physicians, outpatient hospital facility utilization, provider specialties, lines of business, places of service, CPT-4/ ICD-9/ revenue codes, and RVU's

• Participate in negotiations of provider contracts and medical services agreements by providing supporting data, analysis, and documentation

Managed Care Analyst: August, 2003 – June, 2006

Central Brooklyn Medical Group, P.C.

• Gather data from multiple sources for HEDIS and other QI reports

• Analyze medical claims data, and prepare utilization, variance, and reconciliation reports;

• Develop and maintain provider profiles;

• Monitor compliance with managed care/risk contracts;

• Develop and maintain fee schedules;

• Create and maintain claims data repository;

Claims Manager: November, 1999 – July, 2003

Central Brooklyn Medical Group, P.C.

• Manage workflow related to HCFA/CMS-1500 claims processing

• Monitor compliance with managed care (fee-for-service, capitated, case rate) contracts

• Develop and monitor fee schedules

Education

New York University, Robert F. Wagner Graduate School of Public Service:

• Master of Healthcare Administration - Health Services Management & Finance, May 1995

Long Island University, Richard L. Connolly College:

• Bachelor of Science - Science / Respiratory Therapy, July 1981

Skill Sets & Other Competencies

• Microsoft Office suite of applications

• SAP Crystal reporting

• Sage Mass500 suite of accounting applications

• Microsoft FRX reporting

• Emblem/HIP QCARE and TSO

• Nextgen EMR and EPM applications

References

Provided upon request

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