Medical Analyst Resume Sample

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Rickey Block
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Work Experience


National Competitive Medical Cost Senior Analyst
02/2016 - PRESENT
Dallas, TX
  • Collaborates to use business intelligence, statistical, and/or data science techniques to analyze clinical data to guide risk adjustment & gaps-in-care activities.Identifies issues to be investigated and leads or works collaboratively to define and implement a solution
  • Reports status on medical information system implementation and identifies needs and opportunities for improvement
  • Experience and/or current certification in Epic or equivalent Electronic Medical Record systems
  • Excellent written and verbal communication skills and with an ability to interpret and communicate information to both individuals and groups in a clear and concise manner
  • Able to play a leadership role in creating process documentation and interfacing with other team members to obtain this information
  • Experience in relational database software and queries (SQL), applied statistics (SAS, R, etc.)
  • Possess an understanding of medical information systems and how data is collected, stored, reported, and used in clinical workflows
  • Evaluate effectiveness of company medical, administrative, and reimbursement policies; serve as internal and external contact for inquiries related to policies. Work closely with medical staff to review existing policies and develop recommendations for new policies
  • Direct internal areas in the development and implementation of policies. Provide education to staff regarding policy administration
Medical Systems Analyst
11/2009 - 09/2015
Phoenix, AZ
  • Participate in department initiatives and projects. Serve as department representative and participate on projects related to company medical, administrative, and reimbursement policies
  • Maintain provider manuals and internal training materials; ensure materials are consistent with policies and state and federal guidelines
  • Establish criteria for the financial impact analysis of policies; collaborate with internal areas to obtain financial data. Participate in the testing and creation of business requirements for the system request process. Monitor status reports to ensure timely implementation and communication (internal and external) of system changes
  • Reviews and abstracts reports of patients for Radiology services in any setting - Inpatient AmbSurg or ER
  • Confirms that all required procedures are documented. Identifies primary and secondary diagnoses complicating events, treatment rendered. Assigns appropriate ICD9 and CPT 4 codes appropriately
  • Ensures that data is complete and supported
  • Sequences all coded diagnoses and procedures
  • Assist in activities related to complete documentation
Medical Informatic Analyst
09/2005 - 09/2009
Chicago, IL
  • Enters all information using coding system EPIC,
  • Determines and applies appropriate billing mechanisms
  • Work with front end to ensure adequate clinical services
  • Trains and provides orientation for new employees
  • Performs data analysis, ad hoc reporting, data mining, pattern and trend analysis to complete research and analysis projects using healthcare data
  • Conducts data audit, data quality assurance and quality review procedures datasets/databases, as needed, and reviews quality reports from ORIEN Members or Pharma clients
  • Merges and transforms disparate data sets into useable formats for M2Gen or external data consumers, using custom and industry standard ontologies and variable sets as necessary

Education


Emory University
2001 - 2005
Bachelor's Degree

Professional Skills


  • Excellent verbal and written communication skills. Skilled at organizing and facilitating problem-solving discussions
  • Displays Basic Business Analyst skills and related experience (e.g. requirements gathering, system documentation, test plan creation,
  • Strong interpersonal, networking and negotiation skills
  • Digitally savvy; excellent verbal, written, organizational and time-management skills; and extremely detail oriented, thorough and accurate
  • Maintains strong analytical ability including a demonstrated ability to develop, present and monitor analytical business cases and project plans
  • Solid communication skills including the ability to communicate with business and technical users at all levels, internally and externally
  • Claim processing experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently

How to write Medical Analyst Resume

Medical Analyst role is responsible for software, database, health, reporting, finance, training, integration, compensation, design, research.
To write great resume for medical analyst job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Medical Analyst Resume

The section contact information is important in your medical analyst resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Medical Analyst Resume

The section work experience is an essential part of your medical analyst resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous medical analyst responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular medical analyst position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Medical Analyst resume experience can include:

  • Collaborates with members of M2Gen Medical Informatics, M2Gen IT, Business Development & Alliance Management, and ORIEN Member Relations to complete complex data integration requests and for quality control issues
  • Demonstrates a customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others
  • Applies knowledge of statistical analyses and database management skills to assist in M2Gen Medical Informatics support functions
  • Experience in Health Care (managed care, academic, or gov't payer) or equivalent combination of education and experience
  • Intermediate SAS programming skills
  • Analyzing clinical and performance data collected at MGH: Studying data dependencies, patterns, outliers, inaccuracies and validity

Education on a Medical Analyst Resume

Make sure to make education a priority on your medical analyst resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your medical analyst experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school

These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Medical Analyst Resume

When listing skills on your medical analyst resume, remember always to be honest about your level of ability. Include the Skills section after experience.

Present the most important skills in your resume, there's a list of typical medical analyst skills:

  • Maintains strong interpersonal, influencing and communication skills and ability to interact at all levels of the organization
  • Validating, testing, and documenting analytical processes
  • Effective working knowledge of coding
  • Demonstrated understanding of business processes, as well as the ability to translate information into reporting specifications
  • Experience working in customer-focused environment
  • Experience working with diverse group of people

List of Typical Experience For a Medical Analyst Resume

1

Experience For Medical Systems Analyst Resume

  • Demonstrates a thorough working knowledge of claim processing and claim policies and procedures
  • Experience in MS Word, Adobe Professional and PowerPoint
  • Maintaining and modifying programs and scripts designed by others to incorporate new functionality
  • Implementing requirements received from business users
  • Presenting detailed results in a clear, professional, manner understandable to non-technical staff
  • Provide ongoing feedback and instruction to team members, including participation in formal training
  • Familiarity with health insurance data, including claims, eligibility, provider and benefit data
  • Creates summary reports based on pilot data and requests from Medical Informatics leadership
  • Excellent written and verbal communication skills with experience in data management, review and data quality procedures and implementation of data control processes
2

Experience For Medical Policy Analyst Resume

  • Two (2) or more years of experience as a Claim Clerk or the equivalent, demonstrating a thorough knowledge of computer entry and operations
  • Creates summary reports based on pilot data and requests from M2Gen leadership
  • Execute all web, SEO/SEM, email campaigns
  • Coordinate the lead management process
  • With the team managers guidance, provides input on the completion of status reports, initiate’s activity checks and/or widow’s statement of dependency forms
  • Meets daily and monthly production and quality targets; maintaining an exemplary level of accuracy in all work; ensuring completion of assigned projects are QA’d per policy and corrections are made if needed
  • Designing and evaluating optimal data-defined metrics (such as physician/facility performance criteria, bottleneck metrics, productivity limits, processing delay/error reports, etc.)
3

Experience For Medical Informatic Analyst Resume

  • Developing data-driven applications to be used in our clinical environment
  • Working with MGH patients, physicians, staff, management, vendors on a regular basis, looking for the best ways to create optimal, functional and productive environment
  • Healthcare data experience: Demonstrated background in using healthcare data in a project setting. Relevant data types include insurance claims data (diagnoses, procedures, physician/hospital data) or electronic health records (free-text analysis, lab results)
  • Processes "M" Case claims (medical only) within area of payment authority up to, but not exceeding $3,500
  • Approves payments of medical bills on lost time disability claims, within payment authority, after compensability has been determined by the Team Manager or claim technician/handler
  • Two or more years of experience as a Claim Clerk or the equivalent, demonstrating a thorough knowledge of computer entry and operations
  • Responsible for satisfactory completion of QTC Medical Quality Assurance Training Program
  • Able to work with a high sense of urgency and follow through while maintaining professional composure
  • Responsible for the timely reporting, escalation and resolution of day-to-day operational problems
4

Experience For Medical Data Analyst Resume

  • Evaluate, critically appraise and concisely summarize published research for incorporation into shared decision making tools
  • Provide quality assurance for general medical and specialty examination reports
  • Responsible for the timeliness and quality of medical reports
  • Interface with physicians and healthcare extenders and provide case specific feedback as necessary
  • Meet personal productivity and quality goals
  • Work independently and with team members at all levels of the organization
  • Develops and recommends quantitative measures and performance metrics
  • Incorporate feedback from multiple stakeholders and actively iterate with other members of the editorial team
  • Convert highly clinical language to patient-friendly language
5

Experience For SC Analyst Medical Resume

  • Edit a high volume of content within standardized templates and styles
  • Communicate project status to Program Manager in meetings
  • Maintains proficiency in understanding an Entity Relationship Diagram (ERD) and data dictionary to design complex analytical queries from an Oracle or SQL Server database using SQL or other reporting software as needed
  • Maintains proficiency in HTML, XML, JQuery, scripting and reporting technologies with knowledge of best standards in usability and user-centric design
  • Using appropriate technical, clinical, and financial knowledge to assess the completeness and reliability of data and the validity and accuracy of analytical results
  • Produces new analyses under tight deadlines
6

Experience For Financial Analyst, Medical Chargebacks Resume

  • Work collaboratively with internal teams to prepare promotional materials, including mobile apps, iPad detail aids, print sales aids, websites, videos, emails, speaker decks and other digital media, for medical/regulatory/legal submissions
  • Review references along with primary core promotional materials for accuracy and relevance
  • Ensure accuracy of submissions to client medical/regulatory approval process
  • Create and maintain core claims documents, process documents and department documentation as needed
  • Maintain digital reference library
  • Proactive, independent, and able to perform literature searches as well as understand journal articles/medically related literature
  • Data extraction from BIS data warehouse
  • Process and integrate different sources of data
  • Interpret statistics for both clinical relevancy and for a patient population
7

Experience For Medical Claim Analyst Resume

  • Edit content within standardized templates and styles
  • A thorough understanding of epidemiology, demonstrated by 2 years of experience translating, interpreting and communicating biostatistical and epidemiological research
  • Acquires expert knowledge of the Epic implementation (as needed) to support existing use cases and related initiatives
  • Maintains operational processes and workflows to produce foundational reporting and/or structured clinical data extracts. Supports & develops process improvements to existing data workflows as needed
  • Functions as a data steward and liaison between the Epic implementation and users of data such as extant workflows, stakeholders, leadership, and analytics assets
  • Review relevant medical files and related documentation to provide a narrative and cost project from future treatment related to Workers Compensation and Liability injuries
8

Experience For Europe Medical Cadence Analyst Resume

  • Successfully meet weekly and monthly file goals in a metrics based setting
  • Collaborate with a team of attorneys and medical professionals to identify negotiating and documenting guidelines and cost reductions for future treatment plans
  • Experience in healthcare, medical, or insurance related industries
  • Identify documentation applicable to rated age determinations
  • Utilize ISO Claims Partners technology tools to identify diagnoses, treatment guidelines, and prescription medication pricing; document the case when applicable
  • Provide additional analysis and medical recommendations as needed
  • Principal liaison with vendors, deployment team analysts, IT project managers, support analysts, the business and other Chevron operating companies to complete required tasks, obtain approvals, etc
  • Provides timely reporting on project deliverables to Project Managers, including the identification of risks and mitigations, issues impacting the project schedule, changes in deliverable scope, etc
  • Oversight of Auditing Data to maintain Data Integrity against Global HR Data Systems and within H&M reporting systems
9

Experience For Medical Agreements & Administration Analyst Resume

  • Subject Matter Expert for SAP environments within H&M; maintains proficiency in use of SAP Business Warehouse frontend tools, BI, EPH and other reporting
  • Provides analysis and develops analytical tools to evaluate internal and external trends and support Health and Medical program recommendations
  • Maintains good understanding of customer support requirements, business priorities, processes in order to use expertise to offer continual support and future enhancements
  • Maintains familiarity with H&M Global Medical Database system application software, Oracle database and related tables
  • Provides EMR security and system administration backup
10

Experience For Medical Plan Analyst Resume

  • Creates reports for finance on Provider/Broker incentive payments
  • Reviews medical records for risk adjustment opportunities
  • Facilitates adjustment of claims
  • Knowledge of key terms in RFP’s and legal agreements
  • Travel 25% international and domestic
  • Knowledge of Anthem medical policies and clinical UM guidelines

List of Typical Skills For a Medical Analyst Resume

1

Skills For Medical Systems Analyst Resume

  • Impeccable interpersonal and project management skills
  • Proven clinical research experience
  • Demonstrated managed care experience
  • Work effectively as a remote team member
  • Editing experience related to science/medical/health content
2

Skills For Medical Policy Analyst Resume

  • Demonstrated technical competency in reporting technologies such as SAP, BI, EPH, or other reporting technologies
  • Experience developing programs and scripts that can be passed on to other analysts to improve their work efficiency
  • Claim processing experience required
  • Demonstrates an understanding of basic medical terminology and appropriate medical tests for claimed conditions
  • Flexible with rapidly shifting priorities and deadlines and flourishes in high-pressure situations
  • Strong healthcare data and financial background
3

Skills For Medical Informatic Analyst Resume

  • Experience with analytical tools/software
  • Clinical research experience required
  • Three to five years of experience in medical policy review, quality management or an analytical discipline
  • Experience in Health Care (managed care, academic, or gov't payer)
  • Proven ability to organize, plan, coordinate and multi-task
  • Investigate, fact find and provide evidence towards case resolution
  • > 2 years of experience
  • Creating and maintaining code for various analyses
4

Skills For Medical Data Analyst Resume

  • Executing report batches using statistical software
  • Diagnosing and reporting data issues
  • Ensuring data files are transferred according to established M2Gen protocols
  • Ensuring data files are transferred according to protocol parameters
  • Integrating data from multiple sources
5

Skills For SC Analyst Medical Resume

  • Coordinating with other analysts and business users to design analyses and reports
  • Maintaining sourcecode to accommodate data changes
  • Based on data analysis, presenting performance-improving recommendations, and working on implementing them at MGH clinical facilities
  • Works closely with Global H&M staff in defining, designing and developing reporting/analytical needs and reports to support H&M Strategy
  • Organizes documentation when referral to underwriting is necessary, applying appropriate underwriting and/or benefit administration guidelines
  • Familiarity with formatting, editing and maintaining reference lists
  • Data uploading and downloading from analytic tools and monitoring the process
  • Performs complex data analysis, ad hoc reporting, data mining, and pattern and trend analysis to complete research and analysis projects using healthcare data
6

Skills For Financial Analyst, Medical Chargebacks Resume

  • Provides analytical expertise to the H&M personnel other Chevron HES groups in addressing health issues/questions and responding to requests for health data
  • Advises on the use of statistical and graphical techniques in analyzing and presenting health data, and performs analyses
  • Participates in new version testing, deployment, and trouble-shooting
  • Knowledge of medical terminology and claims payment policies including applicable coding methodology
  • Assist in the defense of medical malpractice cases, including participating in the discovery process
  • Assist attorneys with trial preparation, including assisting in the preparation of expert medical witnesses for deposition and trial
  • ERA Coding Analytics: Reporting and application support to coders that need access to electronic medical records
7

Skills For Medical Claim Analyst Resume

  • Provider-Focused Analytics: Analytic and reporting support to understand provider performance on gaps in coding and care delivery
  • Continuously improve marketing processes through the use of marketing analytics
  • Leads US vendor integration efforts ensuring appropriate metrics, dataflows, contracting and PG’s are in place to implement “bend the trend”
  • Supports the reporting and analysis of legal expenses in accordance with Hartford Hospital’s legal billing guidelines
  • Data cleansing and QA testing
  • Applies knowledge of project management to manage active and pending data requests along with incorporating timely completion of requests
  • Work ethically and with integrity, including compliance with the company’s ethics policies and procedures
  • Work safely, including compliance with the company’s health, safety and environmental (HSE) policies and procedures
  • Researches and resolves claims and billing discrepancies
8

Skills For Europe Medical Cadence Analyst Resume

  • Identifies errors in ICD 10 coding
  • Maintains records of cases in progress and results of underwriting review
  • Burden of illness scoring
  • List of three (3) references with contact information, including email addresses
  • Develops and maintains high quality system support, technical and programming documentation
  • Can manage multiple and sometimes competing tasks with tight deadlines
  • Knowledge of managed benefits strategies, utilization review techniques, healthcare financing and delivery
9

Skills For Medical Agreements & Administration Analyst Resume

  • Advanced proficiency with Microsoft PowerPoint and Excel, including chart development and formula development for statistical analysis
  • Draft chronologies outlining the medical treatment received by patients
  • Develop novel computer programs and scripts using Base SAS and PL-SQL
  • STARS and HEDIS Analytics: Operational and reporting support to current and future interventions and pilots that require clinical data elements
  • Acquire new and complete existing customer profile databases
10

Skills For Medical Plan Analyst Resume

  • Generate target customer lists for marketing campaigns
  • Evaluate, critically appraise and concisely summarize published research for incorporation into shared decision-making tools
  • Medical Writing Sample
  • Knowledge of Microsoft Excel, Word, Data Entry, and Access
  • Generates letters to members to request information and relay review determinations
  • Requests medical records from providers and contacts members/providers via telephone for basic information needed for review
  • Presents information to providers regarding the benefits of giving access to their Electronic Medical Records (EHR) and assists in the coordination and implementation of access

List of Typical Responsibilities For a Medical Analyst Resume

1

Responsibilities For Medical Systems Analyst Resume

  • Three (3) years facilitating Electronic Medical Record (EMR) data transfer, analysis, and/or implementation
  • Medical, dental, vision, supplemental plans, and flexible spending accounts
  • Knowledge of MCG guidelines and InterQual guidelines
  • Certified Professional Coder (CPC) Certification
  • Medical policy and benefit knowledge, contract knowledge and knowledge of provider risk arrangements
  • Experience with health data or metrics supporting business strategic focus areas, data integration and analytics - proven experience in delivering advanced analytic solutions and capabilities and working with a wide range of data tools, e.g. SQL, Access/Excel, JQuery, HTML
2

Responsibilities For Medical Policy Analyst Resume

  • Electronic health/medical record system data management expertise and have knowledge of regulatory and legislative requirements related to EHR/EMR including data privacy laws
  • Analyze injuries suffered by the Plaintiff in connection with the lawsuit and analyze plaintiff’s medical history
  • Assist attorneys in the preparation of answers or other responses to medical malpractice claims under state and federal law
  • Communicate with medical staff at correctional facilities and other medical facilities
  • Prepare exhibits for use in court proceedings
3

Responsibilities For Medical Informatic Analyst Resume

  • Health statistics (e.g., epidemiology or health services)
  • Health insurance business principles
  • Use MS Office, esp. Excel and Access, Unix, SAS
  • Vocational training in specific aspects of job functions and/or demonstrated ability to perform assigned tasks, preferably in a medical related area of study (i.e. LVN, LPN, EMT, MA, Military Medic, etc.)
  • Direct healthcare experience in medical case management or quality assurance to include the review of complex multi-focal medical reports for quality, clarity, thoroughness and insightful medical explanation
  • ACAS processing experience required
  • Experience with case management software, electronic medical records and medical databases
4

Responsibilities For Medical Data Analyst Resume

  • Proven ability to gather data, compile and synthesize information, including medical information, claims payment histories and billing, to identify level and types of services utilization
  • Claim processing experience and / or medical necessity call center experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently
  • Claims experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently
  • Three (3) years performing complex data analysis, ad hoc reporting, data mining, pattern and trend analysis to complete research and operational projects using large healthcare data sets
  • General business/finance principles
  • 401 (k) plan with a company match
5

Responsibilities For SC Analyst Medical Resume

  • Generous paid time-off and holidays
  • Experience working with IT and matrix partners to build business requirements for a new tool or application, create the new tool or application, test and make needed enhancements and roll out new tool or application
  • Work productively in a matrix environment across departments and position levels
  • Quickly understand key aspects of data and applications as they relate to business functions and objectives
  • Scientific background in epidemiology, biostatistics, bioinformatics or clinical research
6

Responsibilities For Financial Analyst, Medical Chargebacks Resume

  • Large-scale health databases
  • Quality measurement methods
  • Program evaluation methods
  • Process control statistics
  • Clinical risk adjustment
7

Responsibilities For Medical Claim Analyst Resume

  • Research medical topics
  • Data management methods
  • LRSP systems knowledge

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