Health Operations Resume Samples

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L Wilkinson

Leann

Wilkinson

14352 Maggio Alley

Detroit

+1 (555) 227 2582

14352 Maggio Alley

Detroit

Phone

p +1 (555) 227 2582

Experience Experience

Dallas, TX

Electronic Health Records Operations Analyst

Dallas, TX

Ratke-Grimes

Dallas, TX

Electronic Health Records Operations Analyst

Works with legal, compliance, HIM, medical management and other disciplines to develop guidelines to support eRecord and operations processes
Works with eRecord team ISD staff, clients and/or vendors to evaluate technology solutions including both packaged system solutions and custom development application and component development options
Develops with the EHR Director's assistance and guidance, training for EHR providers and staff to ensure adoption of the EHR initiatives
Manages Project Request for System Enhancements and Changes by working closely with the IT team
Provide service according to the expectations of eRecord team policies/procedures and standards developed around the eRecord for client departments
Assist IT eRecord Team with design and testing of eRecord Application
Work with ISD staff, clients and/or vendor staff to deploy eRecord production applications

Detroit, MI

Operations Team Manager, ADT Health

Detroit, MI

Hoppe, Barrows and Howell

Detroit, MI

Operations Team Manager, ADT Health

Provide every team member with weekly statistical reports to review opportunities for improvement and performance feedback
Work closely with all team members and peer team managers to ensure open communication and consistency of work flow
Provide corrective actions and performance reviews, as necessary
Participate in the recruitment and selection of additional team members, by partnering with Human Resources and other managers
Support the management of daily transaction time and fulfillment goals
Verify payroll information
Provide coaching, mentoring and performance feedback to team members as opportunities arise to improve handling of customer transactions, escalations, provisioning, shipping, intercompany relations, or other situations as they develop

present

Boston, MA

Operations Leader, Mercer Services, Health

Boston, MA

Schamberger-Haag

present

Boston, MA

Operations Leader, Mercer Services, Health

present

Works with business, functions and others to execute work at the tactical level, oversees operational work streams
Facilitates execution of plans against target deadlines and business objectives and applies project and change management best practices,
Identify opportunities to increase efficiency and improve quality, quantify impact, prioritize initiatives, and develop execution plans
Develop and maintain business relationship to ensure full and consistent alignment of strategy and standards
Adapts to changing strategic direction and/or resource allocations
Reviews, understands and translates global/regional initiatives and strategic plans into execution programs
Proactively monitor and assess industry, competitor, macro-economic, and regulatory trends to ensure operational capabilities optimally position the Firm to compete and respond to change

Education Education

Bachelor’s Degree in Epidemiology

Columbia University

Bachelor’s Degree in Epidemiology

Skills Skills

Strong knowledge of managed care approaches across multiple functional areas
Ability to develop strong and collaborative relationships
Ability to work effectively with multifunctional team of health care professionals
Highly developed business and enterprise management skills
Strong organizational skills in project management and leadership
Ability to develop an organizational concept into an operational company with high standards of performance
Excellent communication, organization, and interpersonal skills as well as aptitude for conflict resolution, problem-solving, and staff development
Understanding of financial activities including billing, accounting, and budget management

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15 Health Operations resume templates

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Health Systems Operations Consultant Resume Examples & Samples

3-Brand Teams across BioMeds (IHP, Alzheimer’s, Cardio, Osteo, Diabetes, and Oncology
4-MHS cross-functional teammates
3+ years of relevant Healthcare and/or Operations experience
Leadership: Ability to lead strategy, vision, and tactical projects from inception to completion
Communication: Excellent verbal and written communication skills across multiple levels of the company from Sales to VP
Analytical Skills: Ability to think broadly while managing very complex data and analytical business questions
Customer Centricity: Ability to deliver exceptional customer experiences to Internal (Lilly) and External customers
Cross-Functional Teamwork: Ability to influence without authority across multiple stakeholders regardless of level from Associate to VP
Comfort with Ambiguity: Ability to create from a blank sheet of paper or innovate with limited direction
Ability to Multi-task: Position requires managing multiple priorities simultaneously
Sales Experience
Operations Experience
Payer or Account Experience
Green Belt Training

Clinical Operations Leader, Health Nucleus Resume Examples & Samples

Staff leadership and development and operations, including oversight of client experience and administrative duties
Monitor and evaluate development and performance reporting systems
Participate in design, implementation, validation, and continuous improvement of the Health Nucleus as it relates to client experience and commercialization
Continously monitor testing modalities and implement new technology when appropriate
Maintain and edit ongoing policies and procedures
Develop and coordinate highly synergistic relationships with the Nucleus team as well as other physican groups and health systems referring clients to the Health Nucleus
Outstanding representation of the Health Nucleus with internal and external stakeholders, investors, and clients
Participate in national and global expansion of HLI’s Health Nucleus network, as needed
Strategic planning and business development experience with demonstrated history of relationship building and collaboration in complex systems
Team-oriented with highly developed interpersonal skills capable of high level function across diverse disciplines and environments
Clear communication and presentation skills
Interest in or relevant genomic and/or genetic sciences training and/or experience (e.g., clinical, academia, or industry) and innovative medical care models
Ability to support and drive internal and external organizational/cultural change
Experience working in direct pay or concierge medical settings
Background in biotechnology, genomics, medical device and/or wireless health experience preferred

Health Advisory Payer Operations Manager Resume Examples & Samples

Building solid and collaborative relationships with team members, foster a productive teamwork environment, leverage diverse views to encourage innovation and help develop and grow team members throughout the course of every engagement by providing timely meaningful written and verbal feedback
Delivering significant business results that reflects strategic and creative thinking, problem solving, individual initiative and the following abilities
Identifying and addressing client needs: build, maintain, and utilize networks of client relationships
Managing resource requirements, project workflow, budgets and status updates
Communicating effectively in written and oral formats to various situations and audiences
Managing and conducting quantitative and qualitative benchmarking and primary and secondary analyses of large and complex data

Health Plan Operations Manager Resume Examples & Samples

Understand and educate C&S Functional Leaders and UHC Shared Services Partners (matrix partners) on State Contractual / Market / Member Benefit Requirements in partnership with Compliance to assure understanding and accountability
Build strong relationships with our matrix partners (including Claims, Member / Provider Call, Provider Operations, Appeals & Grievances, Enrollment / Eligibility, Encounters, IT, Provider / Member Experience, Clinical, Quality) by fostering and leveraging an account team structure that is involved in key Health Plan strategic initiatives, goals and activities
Ensure matrix partner processes meet State / Market requirements by assuring that we are working within UHG and State guardrails / requirements. When necessary, you will facilitate resolution of concerns with established guardrails / requirements trying to ensure a win for both UHG and the State
Analyze metrics and trends to ensure contractual / market requirements are met, and working with matrix partners to improve performance when not met
Be a trusted resource for the local Health Plan and assure that every State requirement, process, project and service has an owner within the matrix that will be most effective in execution
Identify opportunities for innovation, productivity improvement and savings
5+ years demonstrated experience working in a highly matrixed environment
3+ years demonstrated experience managing and driving team performance
3+ years in-depth managed care health plan operations experience to include, but not limited to claims, member / provider call center, enrollment and / or eligibility, and provider operations
3+ years’ experience managing multiple projects / tasks to meet contractual deadlines or other time sensitive commitments
MS Excel, MS Project, PowerPoint and Visio skills at an intermediate to advanced level
Experience with SharePoint and / or Six Sigma
Proven ability to influence course of action when others are directly accountable for outcomes
Demonstrated experience to drive Performance Excellence and Accountability change level projects from the start to finish
Demonstrated ability to anticipate and tie operational issues to financial outcomes in order to minimize unexpected hits to Health Plan’s bottom line

Health Plan Operations Leader Resume Examples & Samples

Responsible for the project management leadership in all instances that involve development of the company provider network for acute, chronic, and longer term care, including educating provider participants at various levels within this network
Directs the development and execution of the strategic plan for our provider based health plan
Responsible for planning, organizing, and directing the operations of the health plan
Assists Leaders with the development and implementation of policies, procedures, and guidelines and with periodic evaluation of operational processes. Assesses relevancy to changing goals and objectives, including charge capture/reconciliation, billing compliance, and revenue management. Coordinates the completion of business plans for new opportunities being considered
Represent, communicate, and advocate the mission to current and/or prospective participants in the network to ensure delivery of quality care
Recognize opportunities (including programmatic methods, techniques, supports, etc.) for the company to add value in its relationship with providers that improve their satisfaction with company affiliation and the effectiveness of the company plan
Design solutions that enable the company and providers to align their efforts to achieve mutually beneficial performance (HEDIS, HOS, CAHPS, Meaningful-Use, etc.) and/or “care-under-management” outcomes
Build and maintain positive working relationships with company’s current and prospective provider community to protect and enhance company’s goodwill
Review, analyze, and recommend further provider network development or adjustment whenever these changes might result in a sustained competitive advantage of the company
Assist with the expansion and diversification of company lines of business within existing and new market areas as such expansion plans are approved by the Board of Directors
Direct the provider network and contracting activities. Lead all aspects of provider network strategy, including access analysis, network operations, and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for the contracting department
Oversee network development staff and external consultants in the development or provider networks across expansion markets
Perform periodic analyses of the provider network from a cost, coverage, and growth perspective. Provide leadership in evaluating opportunities to expand or change the network to meet company goals
Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations
Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall company strategy
Support market expansion and M&A activities by leading provider contract analyses related to due diligence
Assist health plan CEO and/or COO vendors in key provider relations and strategy
MBA or MHA degree preferred
Experience working in a provider owned health plan preferred
Knowledge of Medicaid and/or Medicaid managed care programs preferred
Highly developed business and enterprise management skills
Understanding of financial activities including billing, accounting, and budget management
Strong organizational skills in project management and leadership
Ability to work effectively with multifunctional team of health care professionals
Strong knowledge of managed care approaches across multiple functional areas
Ability to develop an organizational concept into an operational company with high standards of performance
Ability to develop strong and collaborative relationships
Excellent communication, organization, and interpersonal skills as well as aptitude for conflict resolution, problem-solving, and staff development

Health Operations Manager, Senior Resume Examples & Samples

20 years of experience with the Military Health System and the deployed environment for medical services
Knowledge of Joint Strategic Planning System and the Joint Capabilities Integration Development System
Ability to lead large teams and think strategically
Secret clearance
MA or MS degree
Experience with Combatant Commands and Joint Staff
Knowledge of Healthcare Readiness and Readiness of the medical forces

Health Operations Specialist Resume Examples & Samples

Experience in health operations, hospital, and clinic associated processes and process improvement
Experience with change management and performance measurement
Knowledge of health policy
Knowledge of process improvement, patient safety, and quality
Ability to lead administrative and project related teams, manage multiple simultaneous projects, and develop impactful and productive relationships with senior clients
PMP or CMAP Certification a plus

Health Operations Manager, Senior Resume Examples & Samples

10 years of experience with working in a health industry
3 years of experience with data collection, analysis, and presentation
Ability to work effectively independently and on diverse teams
Ability to adapt in a fast–paced and changing environment
Experience in a management consulting or healthcare–related work environment
Experience with presenting on health related topics in larger forums, including public speaking
BA or BS degree in a business or health–related field preferred; MA or MS degree a plus

Health Nucleus Operations Leader Resume Examples & Samples

Manage business functioning and effectively communicate new and updated processes to business leaders
Responsible for development and management of Health Nucleus budget
Establish Health Nucleus goals and maintain regular performance reports
BA Degree in Business Management or related field
Demonstrated leadership role in clinical program development and operations management (5 years preferred) with budget oversight
Strongly motivated to seek results in an efficient and timely manner
Masters in Business or Healthcare Administration

Health Plan Operations Specialist Resume Examples & Samples

Previous successful problem solving experience
Must have clear and persuasive patient communication skills
Prior call center experience a plus
Health insurance experience a plus
Prior medical office experience a plus
Successful short task project management
Familiar with Microsoft Office applications, and computer user interfaces
Must be organized and detail oriented with a strong bias for follow-up and problem resolution

Supervisor, Health Plan Service Operations Resume Examples & Samples

Oversee teams that support one or more of the Health Plan Service Operations functions: Member/Provider Services, Missed Treatment Surveillance, Care Coordination, or Medical Records/Renal Care
Manage and develop direct reports
Facilitate the development, implementation, and reporting of goals and performance standards, including monitoring productivity, monitoring associate quality and achieving service levels to meet both CMS regulation requirements and FHP goals
Responsible for managing and oversight of training and reference materials including content, work instructions, and tools
Ensure all employees within the assigned team(s) understand and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations; establishing and maintaining effective internal systems and controls to promote compliance
Provide direction to employees, according to established policies, procedures and management guidance
Supervise day-to-day operations of employees. Responsible for hiring, coaching and counseling employees, including performance reviews, disciplinary action and terminations

Health Plan Operations Excellence Manager Resume Examples & Samples

Understand and educate Community & State Functional Leaders and UnitedHealthcare Shared Services Partners (matrix partners) on State Contractual / Market / Member Benefit Requirements in partnership with Compliance to assure understanding and accountability
Build strong relationships with our matrix partners (including Claims, Member/Provider Call, Provider Operations, Appeals & Grievances, Enrollment/Eligibility, Encounters, IT, Provider / Member Experience, Clinical, Quality) by fostering and leveraging an account team structure that is involved in key Health Plan strategic initiatives, goals and activities
Ensure matrix partner processes meet State / Market requirements by assuring that we are working within UnitedHealth Group and State guardrails / requirements. When necessary, you will facilitate resolution of concerns with established guardrails / requirements trying to ensure a win for both UnitedHealth Group and the State
3+ years of documented experience working in a highly matrixed environment
3+ years of demonstrated experience managing and driving team performance
3+ years of in-depth managed care health plan operations experience which could include to claims, member / provider call center, enrollment and / or eligibility, and provider operations
3+ years of experience managing multiple projects / tasks to meet contractual deadlines or other time sensitive commitments
Intermediate experience in MS Office Suite products
Ability to manage multiple tasks and priorities in a matrix environment, strong problem solving skills and attention to detail
Demonstrated experience to drive change level projects from the start to finish
Demonstrated ability to interface and succinctly present to senior management effectively
Demonstrated ability to anticipate and tie operational issues to financial outcomes
Excellent collaboration and drive for results and organizational excellence
Reside within a commutable distance to Southfield, MI
Medicaid, CHIP, long term care and / or government health plan experience

Health Operations, Senior Resume Examples & Samples

3+ years of experience with overseeing research in support of an HRPP
Experience in working with and supporting Institutional Review Board (IRB) functions
Experience with a DoD HRPP
Knowledge of HIPAA as it pertains to research with humans
Knowledge of animal care and use regulations and researching misconduct
Certified IRB Professional (CIP)

Health Operations Resume Examples & Samples

Summary of Assigned Duties (Describe what the incumbent has to do to achieve main objectives; include main achievements expected)
Essential
Use of Language Skills

Behavioral Health Operations Analyst Principal Resume Examples & Samples

Participates in behavioral health program strategic development and implementation planning including process improvements, and operations management
Manages the implementation of critical pieces of the overall behavioral health strategy. Research, document, and resolve business or operational issues to support strategy
Participates in the design and implementation of corporate initiatives dependent upon behavioral health operations
Accountability for Behavioral Health relationships with internal partners such as network, clinical program management, medical UM/CM/DM, claims, customer service, appeals, compliance, intake, vendor management, and quality
Works closely with business partners to identify poor performance and assists to put in place performance improvement plans (PIP) and facilitate the resolution of vendor related issues
Acts as a primary contact on compliance matters related to behavioral health, including initial and subsequent accreditation audits; consults whenever necessary with both internal and external entities to ensure compliance issues are adequately addressed where appropriate
Ensures consistency of specific vendor functions is maintained where feasible, while developing customization to meet unique member and customer needs within both commercial and government lines of business
Ensures clinical design meets regulatory compliance with state and federal agencies, and accrediting bodies for all program development
Provides consultation as a subject matter expert as needed to all stakeholders
Partners closely with clinical program management, health econ, and vendor management to develop and implement comprehensive measurement and refinement of vendor performance
Acts as a liaison between vendors and internal matrix partners (e.g. CCA, HCCU) to ensure behavioral/medical integration occurs
Perform other accountabilities as assigned

Health Operations Consultant, Mid Resume Examples & Samples

2+ years of experience in a consulting environment
Experience with basic laboratory techniques
Experience with quantitative and qualitative analysis
Experience with strategy planning
Experience in working with Microsoft Access and Excel macros
Experience with lab quality systems, including CLIA, GLP, or QSR
Possession of excellent oral and written communication skills
PhD degree in Molecular Biology, Biochemistry, Genetics, Microbiology, or a related field a plus

Health Plan Operations Clerk Resume Examples & Samples

Extensive work experience within own function
Work is frequently completed without established procedures
Works independently
May act as a resource for others
May coordinate others' activities
Entering and monitoring state defined Health Risk Assessments for our Healthy Michigan Plan. Position is responsible for Entering data, performing mailings, answering questions with internal/external customers
Prepares source data for computer entry by compiling and sorting information; establishing entry priorities
Processes documents by reviewing data for deficiencies; resolving discrepancies by using standard procedures or returning incomplete documents to the providers for resolution
Enters member data by inputting alphabetic and numeric information on keyboard according to screen format
Maintains data entry requirements by following data program techniques and procedures
6+ months professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties
Experience using Microsoft Outlook, Word and Excel
Experience working within the Healthcare Industry
Professional experience in a clerical or administrative support related role
Working Knowledge of Medical Terminology to communicate with members and providers
Experience working with Medicare and / or Medicaid Services

Operations Team Manager, ADT Health Resume Examples & Samples

Provide coaching, mentoring and performance feedback to team members as opportunities arise to improve handling of customer transactions, escalations, provisioning, shipping, intercompany relations, or other situations as they develop
Provide every team member with weekly statistical reports to review opportunities for improvement and performance feedback
Provide every team member with comprehensive written qualitative monthly feedback to include attendance, quality audits, and analysis of productivity levels against goals
Provide corrective actions and performance reviews, as necessary
Supervise floor as appropriate as a visible leader, providing additional support to center as needed
Participate in the recruitment and selection of additional team members, by partnering with Human Resources and other managers
Support the management of daily transaction time and fulfillment goals
Support coordination of process documentation and training programs as needed
Work closely with all team members and peer team managers to ensure open communication and consistency of work flow
Take supervisory calls, including customer problems and take appropriate action to resolve issues
Minimum of 1-2 years’ operations and project management experience is preferred
Basic Associate Management experience is preferred
Basic IT and/or HR Skills is a plus
Customer obsession philosophy
Strong interpersonal skills and coaching and development skills
Ability to perform multi-tasks and to exercise sound, independent judgment
Ability to interpret and analyze data to effectively implement strategic plans

Dir, Enterprise Behavioral Health Operations Resume Examples & Samples

Accountable for the development, integration and implementation of all Behavioral Health (BH) enterprise operational processes for all administrative, clinical and business processes
Responsible for ensuring consistent execution and quality assurance of all BH operational processes
Accountable for the coordination, alignment and oversight of all BH driven (and dependent) project management
Coordination and alignment of all BH special population and initiatives work
Manage BH operational manager and staff, ensuring high employee engagement and development
Assist in strategic and business planning, advocacy and new business development, including developing reports, materials and strategies for stakeholder engagements; contributing to writing and positioning of the alignment of BH operational practices and processes in meaningful value models
Bachelor’s Degree in Health Care, Business or related field, or equivalent years of relevant work experience is required
Minimum of five (5) years of experience in health care or managed care is required
A minimum of five (5) years of analytics, business improvement or process redesign experience is required
Behavioral Health experience is preferred
Proficient in Microsoft Excel, Word, PowerPoint and Excel
Comprehensive knowledge of all areas within the Health Services, including: Behavioral Health, Case Management, Medical Management, Integration, Quality and Pharmacy
Planning, problem identification and resolution skills
Strong oral, written, and interpersonal communication skills
Energetic, enthusiastic, change resilient and politically astute
Negotiation and conflict resolution skills
Knowledge of regulatory reporting and compliance requirements
Demonstrated ability to develop, prioritize and accomplish goals
Ability to work both independently and collaboratively across multi-disciplinary teams

Avp-behavioral Health Operations Resume Examples & Samples

Masters Degree in behavioral sciences, social work, or healthcare related field or nursing degree a preference
Successful tenure in executive leadership role in a Behavioral Health Facility ( 3 years preferred)
Minimum of 7 years in management position within behavioral health setting (2 years related to med/surg hospital setting preferred)

Operations Leader, Mercer Services, Health Resume Examples & Samples

Leverage proven operational design principles to define the Mercer Services Health operations and technology strategy, optimize location footprint,
Develop and maintain business relationship to ensure full and consistent alignment of strategy and standards
Identify opportunities to increase efficiency and improve quality, quantify impact, prioritize initiatives, and develop execution plans
Develop and implement a measurement system with metrics and KPIs associated with client experience, operational excellence, productivity and operational risk and control
Proactively monitor and assess industry, competitor, macro-economic, and regulatory trends to ensure operational capabilities optimally position the Firm to compete and respond to change
Determine and maximize the use of current systems (HBB and BA2) to enhance efficiency
Reviews, understands and translates global/regional initiatives and strategic plans into execution programs
Works with business, functions and others to execute work at the tactical level, oversees operational work streams
Facilitates execution of plans against target deadlines and business objectives and applies project and change management best practices,
Applies concepts such as Six Sigma, Lean and Customer Experience to simplify and drive greater consistency in business processes
Adapts to changing strategic direction and/or resource allocations
10+ years of years operations and technology experience serving the insurance/ financial services industry
Change management and project delivery track record
Utilization of process improvement and problem solving techniques
Demonstrates strong written, oral and presentation skills to communicate all levels of the organization
Exhibits solid operations management and planning skills
Strong analytical and conceptual skills, broad based project management experience and outstanding client focus
Demonstrates strong management skills required to lead teams in achievement of goals and objectives
General knowledge of core business consulting, processes and methodologies. Proven ability to successfully manage projects of varying complexity
Demonstrates strong project management skills and ability to manage multiple projects
Ability to operate/ navigate in a multi-cultural business environment
Quantitative, fact-based approach to decision making
Demonstrated financial acumen and commercial mindset
Experience developing and implementing operational improvement plans
Experience managing IT solution delivery and complex technology initiatives
Experience working with 3rd party service providers, including contracting, delivery and ongoing support

Optum Behavioral Health Provider Operations Data Consultant Resume Examples & Samples

Authorize deviations from standards
Strong emphasis will include strategic management of national provider data quality initiatives, practical analysis of provider quality data, cross-functional collaboration, project reporting and presentation of data to various levels of management
1+ years of provider or claims data analysis experience
1+ years of experience managing programs or projects across cross functional teams
Intermediate experience with Microsoft Excel, Word, Outlook, and PowerPoint
Knowledge of policy / procedure updates, process improvement, business requirement documentation, compliance
Working knowledge of Cosmos, Facets, and/or NDB

MSU Health Team Operations Administrator Resume Examples & Samples

Establishes standards, procedures and priorities for multiple clinic practice sites. Supports clinic managers and directors through implementation and accountability processes
Interacts with the clinic management to ensure patient safety and quality improvement activities are in compliance with MSU HealthTeam guidelines
Oversees integrated clinic budget process and monitors budget reconciliation
Facilitates strategic planning and implementation for the integrated service lines. Manages and directs service line project development, timelines and execution
Directs and oversees the MSUHT quality improvement, patient safety, clinical competency and training programs for the group practice
Interacts with medical directors, department chairs, and clinic mangers to improve operations of clinical areas
Directs, coaches, and mentors clinic managers
Hires, evaluates and directs the supervisors and support staff of the integrated service units
Plans for future needs of the enterprise:including space utilization, equipment purchases, training programs in order to meet health care delivery objectives and clinic organizational goals
Serves as a member of senior management in order to participate in the development of goals, objectives, policies and procedures for the MSU HealthTeam

Electronic Health Records Operations Analyst Resume Examples & Samples

Assist IT eRecord Team with design and testing of eRecord Application
Assists with the design and documentation of business/system functional requirements in formats to facilitate the development of deliverables such as Request for Proposals and/or Information, custom development efforts, project based planning documents such as scope documents and client services communication
Assures quality of information technology solutions through business case and application level testing; validates test results to initial business needs
Develops with the EHR Director's assistance and guidance, training for EHR providers and staff to ensure adoption of the EHR initiatives
Evaluates and documents client needs and all aspects of business processes both operational and financial, including current process analysis; and proposed revisions to optimize business processes
Manages Project Request for System Enhancements and Changes by working closely with the IT team
Protects the integrity and confidentiality of all data and information through physical and electronic measures
Provide ongoing troubleshooting, support and maintenance of eRecord production applications
Provide service according to the expectations of eRecord team policies/procedures and standards developed around the eRecord for client departments
Work with ISD staff, clients and/or vendor staff to deploy eRecord production applications
Work with Information Services staff and the integration team to design, test and deploy appropriate hardware solutions, connectivity requirements and interface solutions, as appropriate
Works as an EHR Operational lead for EHR initiatives such as meaningful use of the EHR, telemedicine projects etc
Works with eRecord team ISD staff, clients and/or vendors to evaluate technology solutions including both packaged system solutions and custom development application and component development options
Works with legal, compliance, HIM, medical management and other disciplines to develop guidelines to support eRecord and operations processes
Bachelor degree in Information Systems/Computer Science, Nursing, Health Information Management, Business, clinical or financial studies or related field
A Masters degree in a related field or an equivalent combination of education and experience would be considered
Minimum of 3 years of health care, business or IT experience required
Good oral and written communication skills are required
Knowledge of clinical workflow and JCAHO and DOH regulations are preferred
Extensive related experience will be considered. 4 years experience in financial and/or medical analysis or successful completion of the FMR Program
Superior computer skills with expert knowledge in Word, Excel and EpicCare/eRecord preferred
Demonstrate a high degree of professionalism, enthusiasm and initiative on a daily basis
Ability to work in a fast-paced environment a must
Ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences
Attention to detail is critical to the success of this position, with demonstrated competency in customer orientation and the ability to deal with ambiguity
Excellent planning, communication, documentation, organizational, analytical, and problem solving abilities
Ability to interpret and summarize results of various analyses in a timely and meaningful way
Ability to effectively approach problem solving
Ability to re-engineer processes to positively impact productivity in terms of timeliness and accuracy
Possess technical knowledge and expertise in understanding patient access, physician template utilization and must possess an understanding of the complex information system solutions and the implementation/support of those solutions in the client community
Ability to analyze financial & clinical results and to comprehend forecasting models
Well-informed and conversant with general business, economic, and clinical matters
Effective analytical skills are required
Must be able to work within an aggressive deliverables based and/or service quality based environment
The ability to continuously interact effectively with all levels of clients is critical
Available to work overtime if required
Travel to practice sites occasionally required

Analyst, Health Plan Operations Resume Examples & Samples

Performs system cause analysis, based on inaccuracy or erroneous Claim payment with respect to the Benefit, Contract, and Fee Schedule
Understand the downstream impact of benefit data, provider contract requirements, and claims processing
Ensures accurate interpretation of benefit requirements and definitions to deliver correct system configuration
Manages special, high urgent and critical assignments/projects to meet rigorous timelines with expected outcome
Understands claims processing system logic and rules, and their impact to system configuration
Conducts preliminary evaluation of contractual agreement prior to execution to determine system configurability and the outcome to improve auto-adjudication of processed claims
Conducts system requirement analysis and evaluation to meet regulatory changes and updates
Tests and audits Pre- and Post-production reports to ensure accurate and valid system configuration
3-5 years System/application Analyst experience
3+ years of healthcare experience
Claims, Benefit, and Contract experience in managed care or healthcare
Managed care, Medicare, Medicaid/Medical
QNXT experience