Provider Data Analyst Resume Sample
Robyn Pacocha
277 Shanahan Parks,
Chicago,
IL
+1 (555) 773 3165
Work Experience
Senior Provider Data Analyst
08/2016
-
PRESENT
Detroit, MI
- Demonstrates advanced knowledge of databases technology behind all applications needed to extract, report and present data in a manner that is meaningful to make sound business decisions
- Make recommendations and assist with refining provider data management systems, tools, and processes
- Shift priorities comfortably based upon direction from management
- Manage projects individually or through cross-functional work groups
- Analyze and verify accuracy of provider data received from external sources and link to a provider record in naviHealth’s system
- Work with our clinical teams to identify post-acute providers and update naviHealth’s system
- Review data for deficiencies or errors, correct any incompatibilities, and check output
- Work with analytics staff to correct duplicate provider records
Provider Data Analyst
10/2009
-
06/2016
Phoenix, AZ
- Develop provider matching logic to ensure a provider record maps appropriately in naviHealth systems
- Develop analytical tools/models related to evaluating provider patient outcomes, health care network dependencies, and utilization of publicly available provider-based data and metrics
- Coordinate and lead User Acceptance Testing
- Work cross functionally to drive results
- Work collaboratively with stakeholders to understand business problems and identify
- Provide support for questions and issues raised by staff and provide answers as quickly as possible - supporting the timeliness of the review or outreach
- Conduct provider outreach via outbound calls for demographic validation
Temporary Provider Data Analyst
11/2006
-
08/2009
Philadelphia, PA
- Report on adherence to policy requirements on a regular basis by monitoring and auditing volume, production, and accuracy of team’s work
- Validation of data extracts to ensure accuracy of directories and HSD Tables
- Responsible for batching, reviewing and loading Provider Data in multiple provider systems (CPF/PWB/Facets/Proclaim/ETQS)
- Review and load all requests thru completion from the Inventory Manager (formerly the IBM HCP Intake Portal/Tool)
- Conducts/reviews/responds to outreaches for missing/verification of information from Providers/Matrix partner/Vendors to ensure data integrity
- Loads provider data in CPF/PWB/Facets/Proclaim
- Adheres to production and quality standards
Education
University of Phoenix - Burlington Learning Center
2001 - 2006
Bachelor's Degree in Computer Science
Professional Skills
- Exceptional skills in manipulating data, attention to detail, strong organizational skills
- Excellent communication skills, both written and oral, including ability to communicate effectively with various levels of leadership
- Strong verbal, interpersonal and customer service skills to effectively relate to a wide variety of personalities and professional levels
- Demonstrated research skills in identifying problems, developing and implementing both short and long-term solutions
- Excellent written and verbal communication skills, including ability to communicate at all levels including senior leadership
- An analytical mindset with problem-solving and strong organizational skills
- Demonstrated exceptional active listening and communications skills
How to write Provider Data Analyst Resume
Provider Data Analyst role is responsible for research, analytical, leadership, excel, microsoft, auditing, training, integration, database, inventory.
To write great resume for provider data analyst job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Provider Data Analyst Resume
The section contact information is important in your provider data 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
- Telephone number
Work Experience in Your Provider Data Analyst Resume
The section work experience is an essential part of your provider data 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 provider data 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 provider data analyst position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Provider Data Analyst resume experience can include:
- Research claims utilizing investigation and research skills on complex cases
- Demonstrated ability to organize and prioritize work and adapt to shifting workloads
- Proficient in MS Office (Excel, Access, Word etc.), including intermediate Excel skills
- Navigation skills in Inventory Manager (formerly IBM HCP Intake Tool)
- Two years experience in claims processing, customer service, provider setting or general office work involving data entry or accounting
- Strong knowledge of business processes that impact facility/ancillary/ medical group contracting, claim processing, contract loading, or contract auditing
Education on a Provider Data Analyst Resume
Make sure to make education a priority on your provider data analyst resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your provider data 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 Provider Data Analyst Resume
When listing skills on your provider data 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 provider data analyst skills:
- Strong investigative and decision-making skills
- Excellent verbal communication skills - ability to report to management in a clear and concise manner
- Strong technical & analytical skills to include proficiency with Microsoft office products and databases
- Proven skills in data management accuracy
- Detail oriented with proven accuracy skills
- Apply proper punctuation, spelling, grammar, and proofreading skills
List of Typical Experience For a Provider Data Analyst Resume
1
Experience For Senior Provider Data Analyst Resume
- Identifies opportunities to simplify workstreams and become more efficient from receiving of request to loading of requests into applicable system
- Work independently while managing multiple tasks and meeting deadlines
- Maintains a current working knowledge of processing rules, contractual guidelines, plan policies and operational procedures
- Work with other departments to identify and resolve problems leading to incorrect provider data and issues regarding payment of claims
- Assists in the Identification of process gaps and trends; providing explanations and feedback to staff and management
- Maintain current loading protocols for all provider groups across all products and network strategies
- Analyzes existing systems to recommend enhancements and creates new systems to reduce manual processes and maximize the business efficiencies
- Performs data collection, analysis, reporting
- Manage communication processes with other departments regarding database improvement
2
Experience For Medicare Provider Data Analyst Resume
- Work with minimal guidance; be resourceful in identifying solutions
- Perform basic to intermediate data analysis using standard tools of Access, Excel etc
- Analysis of provider demographics, contract load status, credentialing status, data comparisons across multiple platforms
- Supports provider network integration activities as directed by Manager
- Identifies opportunities for improvement in processes and workflows as well as volume reduction opportunities
- Baseline Network product as well as AIMS (IFP/Surefit) Network product knowledge
- Responds to and resolves provider and health plan claim inquiries
- Contacts providers via outbound calls to resolve if needed
- Identifies key issues with projects and offers solutions
3
Experience For Temporary Provider Data Analyst Resume
- In-depth knowledge of claims payment methodology required
- Apply mathematical concepts and calculations
- Utilize tools to perform regular audits of ACO provider rosters
- Help manage provider data and maintain and improve databases
- Report and extract data for various reports and analyses
- Help develop / maintain standards for database integrity and quality assurance
- Coordinate corrective activities to clean database and retain users
- Assist in audits and data quality improvement initiatives
4
Experience For Provider Data Analyst, Medicaid Accounts Resume
- Work with care providers and medical groups to maintain current rosters, demographics and network status in our systems
- Perform comprehensive data and contract reconciliations across all platforms
- Manage change requests and data corrections through to claim payment and directory depiction
- Ensure new contract provisions are successfully executed across all platforms and processes
- Partner with UHN, the Health Plans and medical groups to sign off on the accuracy of network profiles, and implementing remediation plans for providers with submission / accuracy gaps
- Present analysis and recommendations for operational and business process improvements
- Support short- and long-term operational/strategic business activities through analysis
- Select, configure and implement analytics solutions
- Serve as a liaison between TPA/BPO partner, internal team members and partner organization providing supervisory leadership for provider data enrollment activities; acts as liaison with technology team and business product team members
5
Experience For Provider Data Analyst, NDB Required Resume
- Defines analysis methodology and provides analytic support
- Analyzes data from conceptualization through presentation and requires proficiency with analytical tools, knowledge of data analysis methodology, use of presentation software, and strong communication skills
- Identifies, evaluates, and implements new data-driven strategies and processes for the department
- Recommends enhancements to existing systems in accordance to business needs by creating ad hoc and standard reports as well as information delivery technologies
- Prepare reports in an accurate, concise and timely fashion
- Provide guidance and support to all claims and operations personnel towards resolution of provider data and claims problems with an emphasis on root cause analysis and resolution of problems
- Monitor adherence to the efficiency and service level goals including volume, processing, timeliness, accuracy and other metrics
- Compile, review and analyze management reports and take appropriate action
- Identify and advise Claims, Provider Network Management, Medicare Operations and other operational areas of trends, problems, and issues as well as recommended course of action; ensure timely communication; participate in the development and implementation of solutions
6
Experience For Senior Provider Data Analyst of Provider Data Quality Resume
- Prioritize issues identified by TPA/BPO, internal team members and/or partner representatives and monitors progress in the resolution of the issues
- Develop deep understanding of processing capabilities and limitations of claims and benefits with TPA/BPO systems, tools and resources; provide recommendations to meet plan requirements
- Confirm that all provider data elements have been set up within the claims payment system and are aligned with the requirements as specified by the plan materials
- Coordinate corrective action plans with partner/client and TPA/BPO operations services administrator to resolve issues
- Support internal plan team members with the resolution of daily issues
- Serve on various committees and attends required meetings
- Extensive knowledge of PCs and related software applications, such as Word, PowerPoint, Excel, Project
- Help develop/maintain standards for database integrity and quality assurance
7
Experience For Provider Data Analyst Resume
- Provide clear explanations and information to others on difficult issue
- Build and maintain repository of C&S operational pain points across markets, match with national improvement initiatives, and develop state, regional, & national reporting to support leadership communications
- Support and contribute to development of leadership presentations, metric scorecards and other reporting, requiring coordination with multiple teams
- Lead or help develop program or project scope statements, in consultation with applicable stakeholders (e.g., program/project charter, Statement of Work, Business Vision Document, cost/benefit analysis)
- Partner with subject matter experts to fully understand initiatives that require capital funding, and champion those projects through the formal capital funding process, including submission, tracking and monitoring, updating, and reporting closure
- Facilitate meetings as needed to bring together UHN, C&S, & UHC Ops teams in support of specific initiatives (i.e. system migrations) and/or strategy discussions
8
Experience For Senior Provider Data Analyst Resume
- Partner with other operational, network, and C&S departments and resources to initiate, leverage and deploy solutions across the enterprise as an individual contributor
- Experience in a Health Plan, MSO and/or an IPA. Epic Experience
- Experience with Emptoris
- Claim payment experience
- In facility/ancillary/medical group contracting, claim processing, contract loading, or contract auditing
- Intermediate level of proficiency in data analytics – data tracking, trending, and reporting
9
Experience For Medicare Provider Data Analyst Resume
- Intermediate level of proficiency in tracking, trending, and reporting on metrics
- Interpret existing contracts in order to identify potential problems or issues needing correction
- Working with large data sets for the purpose of analysis and reporting
- In a role setting up and delivering information via WEBEX
- Professional provider contract loading/claims/auditing knowledge
- Plan and organize work independently while reorganizing the critical aspect of communicating with senior management
- Coordinate work activities with other departments including Network Management, Claims, Recoveries etc
- Interpret and/or verify contract language, information, and intent in order to load pricing information into systems properly
10
Experience For Temporary Provider Data Analyst Resume
- Load contract pricing information or implement updates and amendments (e.g. rate updates, termination, rate corrections)accurately into appropriate systems
- Perform audits of new and/or existing provider contracts and fee schedules in order to ensure accuracy
- Review and/or maintain reports (e.g., metrics, dashboards, spreadsheets) associated with provider contract loading (e.g.,turnaround time, number of contracts loaded, accuracy) in order to assess performance, determine potential issues, and/or prioritize workloads
- Conduct testing of proposed solutions and/or changes made in order to determine their effectiveness and make unnecessary modifications
- Working knowledge of PC software (Word, Excel, Access, Sharepoint, etc.)
- Identify and/or implement potential long-term, permanent solutions to resolve recurring issues and problems (e.g. training, process changes)
- Intermediate level of proficiency in reporting on data / project progress
- Advanced proficiency in MS Excel, including pivot tables
List of Typical Skills For a Provider Data Analyst Resume
1
Skills For Senior Provider Data Analyst Resume
- Experience in tracking, trending and reporting on metrics
- Experience in Contract Loading, Claims Processing/adjusting, Claims Recoveries, and or Reimbursement Analytics
- Experience working with provider data - provider loading, contract installation
- Experience in managing cross-functional projects and making presentations
- Provider data loading and / or audit experience using CSP Facets, OHBS Facets, NDB, or Cosmos
2
Skills For Medicare Provider Data Analyst Resume
- Experience in managing cross-functional projects and making presentations
- Demonstrated proficiency in ad-hoc reporting using standard report tools
- Experience working on or managing projects
- Experience submitting/auditing PhyCon Requests to update or correct provider data
- Experience with Healthcare Contracting and / or Healthcare data loading
- Advanced experience in generating and identifying trends in an effort to develop solutions
- Experience with microsoft excel, including formulas, pivot tables, vlookups, exporting to graphs)
3
Skills For Temporary Provider Data Analyst Resume
- Experience populating and analyzing data from Access or any other relational database (Oracle, SAP, Dynamics, BAAN, etc.)
- Behavioral health provider data loading and / or audit experience using CSP Facets, OHBS Facets, NDB/UNET, or Cosmos
- Proven ability to maintain positive working relationships and to provide coaching and guidance to other staff members
- Experience in managing projects
- Experience in managing cross functional projects
4
Skills For Provider Data Analyst, Medicaid Accounts Resume
- Experience in managing cross functional projects
- Experience writing policies and procedures and/or work instructions
- Demonstrated competency in driving process improvements
- Experience making presentations
- Experience working with NDB
5
Skills For Provider Data Analyst, NDB Required Resume
- Experience working with provider data
- Experience in network management-related role, such as contracting or provider services
- Experience in managing cross functional projects
- Experience with contract installation/provider data loading
- Behavioral health claim processing experience
- Experience in managing cross-functional projects
6
Skills For Senior Provider Data Analyst of Provider Data Quality Resume
- Experience working with provider data
- Medical coding experience
- Data analysis and business intelligence experience working with BI suites such as Qlikview, SSRS, Tableau or other enterprise class tools
- Review claims to ensure they are properly submitted by the provider, i.e. prior-auth if needed, proper ICD-10 coding
- Data analysis and/or audit experience within the healthcare industry
- Experience with Lexis Nexis and /or Bulk Macros. Comfortable with automation of process
7
Skills For Provider Data Analyst Resume
- Data analysis and/or audit experience within the healthcare industry
- Customer response / customer service experience
- Experience with provider or claims data and installation
- Data analysis experience within the healthcare industry
- Experience with OHBS Facets, CSP Facets, and/or NDB
- Data analysis and / or audit experience within the healthcare industry
- Experience with ACOs
- Experience with Cosmos
- Experience with Examiner
8
Skills For Senior Provider Data Analyst Resume
- Experience with Impact
- Data analysis research and/or audit experience within the healthcare industry
- Subject Matter Expert experience
- Experience with relevant platforms (e.g., NDB, COSMOS, Emptoris, Facets, Nice, Pulse, PIMS)
- Experience in business/finance analysis
- Data analysis and / or audit experience within the healthcare industry
- Experience with NDB, Impact, CSP Facets, Emptoris, and / or Phycon
- Experience in the health care industry
- Experience with NDB
9
Skills For Medicare Provider Data Analyst Resume
- Experience in the healthcare industry
- Experience with internal systems NDB, UNET, FACETS, COMSOM, Emptoris, PhyCon
- Experience with data analysis
- Experience with SharePoint maintenance and development
10
Skills For Temporary Provider Data Analyst Resume
- Claims/data entry experience
- Experience in a managed care environment
- Experience in a data driven support role
- Experience with Medicare Advantage plans
- Demonstrated ability to work well with others and work in a team environment
List of Typical Responsibilities For a Provider Data Analyst Resume
1
Responsibilities For Senior Provider Data Analyst Resume
- Intermediate knowledge of Emptoris or contract loading / provider setup
- Advanced level of proficiency with MS Excel, including functionality to include V look up, pivot tables, Macros
- In pricing configuration
- Critical/Analytical thinking. Ability to problem solve for overall big picture
- Minimal travel up to 15% for training purposes
2
Responsibilities For Medicare Provider Data Analyst Resume
- Ensure the integrity of the provider directories for all corporate products are accurate and timely by performing maintenance of the provider file database
- Knowledge of computer software packages including database management programs as well as Microsoft Windows, Word, Access and Excel
- In network contracting, load or audit teams
- Travel 25% travel to Minnesota for training and meetings
- Advanced proficiency with Excel, including use of filter, remove duplicates, text to columns, and basic formulas, etc
- Collaborate with the various business partners to examine larger scale provider issues, determines root causes, and coordinate solutions
- Identify defect trends and action plans to improve trends.
3
Responsibilities For Temporary Provider Data Analyst Resume
- Proficiency Excel, Access and PowerPoint
- MS Access, PowerPoint proficiency
- Identify and implement process improvements. Be a creative thinker, with an ability to suggest change outside of standard protocols
- Accurately document procedures, business requirements
- Intermediate knowledge of NDB
4
Responsibilities For Provider Data Analyst, Medicaid Accounts Resume
- Proficiency with all UHC provider data systems (NDB) and claims platforms (UNET, PULSE, CSP Facets) used in the region
- Familiarity with UHG systems such as NDB, CSP FACETS, Basic Inquiry functionality
- Learn complex material quickly, allocate time efficiently
- Beginner in MS Office Excel and PowerPoint
- Coordinate, update, and maintain the contracting administration and enrollment processes for all participating professional and institutional provider files to ensure eligibility, demographic, reimbursement and risk sharing requirements are met
- Contribute to the development and maintenance of relations with the provider community on an operational basis
5
Responsibilities For Provider Data Analyst, NDB Required Resume
- Meet deadlines! Requires the ability to provide accurate and timely reports within specific timeframes
- Professionally handle numerous tasks simultaneously and to maintain a high level of detail accuracy for extended periods of time, and at some periods under stressful, or strict time constraints and frequent interruptions
- Claim contract rate interpretation and payment methodology, preferably hospital and ancillary contracts
- Knowledgeable in various payment methodologies
- Intermediate proficiency Word
- Provider Network knowledge
- Basic knowledge of PhyCon
6
Responsibilities For Senior Provider Data Analyst of Provider Data Quality Resume
- In the Health Insurance Industry
- Intermediate proficiency in Access and PowerPoint
- Advanced proficiency in Microsoft in Excel
- Intermediate proficiency with MS Access
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