Healthcare Economics Analyst Resume Samples

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C Beatty

Cloyd

Beatty

2520 Arlie Freeway

Phoenix

+1 (555) 391 5161

2520 Arlie Freeway

Phoenix

Phone

p +1 (555) 391 5161

Experience Experience

Boston, MA

Healthcare Economics Analyst

Boston, MA

Weber LLC

Boston, MA

Healthcare Economics Analyst

Analyze benchmarking data, reports, processes and measurements for key managed care indicators
May analyze client and prospect claim files, with development of value based savings models
Provide claims, premium, capitation and membership data in support of underwriting, Actuarial and utilization analyses
Focus on creation and implementation of process improvement opportunities for Healthcare Economics
May create geographic and disruptive analyses intended to aid the sale of new business
Forecast costs, utilization trends and create financial models using claims and other healthcare data
Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance

Philadelphia, PA

Healthcare Economics Analyst

Philadelphia, PA

Anderson Group

Philadelphia, PA

Healthcare Economics Analyst

Provide analytical support for the Claims, Ancillary, Medical Management and Provider Network departments
Prioritizes individual project workflow while providing necessary updates to senior management
May develop and distribute client-facing operational volume and performance reporting
Working with healthcare data (member, provider, claims, pharmacy, labs)
May develop internal operational volume and performance reporting on the business
Create financial models to evaluate the impact of provider reimbursement changes
May analyze internal operational processes and create incremental revenue opportunity stories based on process improvements

present

Boston, MA

Senior Healthcare Economics Analyst

Boston, MA

Mante, Waelchi and Reichert

present

Boston, MA

Senior Healthcare Economics Analyst

present

Support medical management by performing population analytics to improve overall health outcomes and financial performance
Provide management weekly reports outlining work completed and issues encountered
Maintenance existing production algorithms to maximize performance while working directly with the programmers to test and implement changes
Work with Shared Services Teams to improve data assets
Lead special projects with little to no manager supervision or assistance
Perform data analysis and ad hoc reporting using claims, provider data, and membership data
Producing standard reports for clients using proprietary reporting applications, including Health Plan Manager

Education Education

Bachelor’s Degree in Mathematics

DePaul University

Bachelor’s Degree in Mathematics

Skills Skills

Interpret and analyze claims, premium, capitation and membership data in support of Risk Adjustment activities
Participate in projects to completion by contributing to data base creation and reports
Analyze reporting tools utilized by the internal customer groups
Working with healthcare data (member, provider, claims, pharmacy, labs)
Supporting other business units with reporting and data
Building the infrastructure, processes, algorithms, and reports
Review claims, premium, capitation and membership data in support of underwriting, Actuarial and utilization analyses
Create and update automated processes
Analyze reporting tools utilized by the internal customer
Produce and review reports

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Senior Healthcare Economics Analyst Resume Examples & Samples

Identify potential areas for medical cost improvements and alternative pricing strategies
Intermediate level of proficiency working with MS Excel including formulas, calculations, charts, graphs, etc
2+ years of health care experience

Healthcare Economics Analyst Resume Examples & Samples

Interpret and analyze claims, premium, capitation and membership data in support of Risk Adjustment activities
Participate in projects to completion by contributing to data base creation and reports
Working with healthcare data (member, provider, claims, pharmacy, labs)
Supporting other business units with reporting and data
3+ years of experience performing significant data analysis and report development
Solid experience or knowledge in SAS programming
Intermediate level of programming knowledge (reporting code) and of relational databases, database structures and design, systems design, data management, data warehouse
Intermediate level of proficiency in Microsoft Excel, Access and PowerPoint
Bachelor’s degree in Mathematics, Statistics, MIS, Computer Science or a related field
Experience with SQL (or other statistical programs)
Experience with process improvement, workflow, and evaluation of business processes
1+ years of health care experience working with claims data and medical codes

Healthcare Economics Analyst Resume Examples & Samples

Research, retrieve, design and deliver organized analytics and reporting of medical claims
Analyze benchmarking data, reports, processes and measurements for key managed care indicators
Contract analysis
Develop/document business, analysis and reporting requirements
Assist in making decisions of considerable impact and consequence involving healthcare expense trends
Bachelor’s degree in Business, Accounting, Finance, Economics, Mathematics, Healthcare Administration or Statistics (4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a degree)
1-2 years of professional experience in a data analysis, finance, or accounting role
Advanced level of proficiency with MS Excel, Intermediate MS Access
Desire to make an impact, manage multiple tasks, and shift priorities quickly
Solid interpersonal skills and the ability to influence others
Proficient query writing skills
Beginning to intermediate proficiency using SQL

Senior Healthcare Economics Analyst Resume Examples & Samples

Research potential overpayment scenarios through the use of client policies and provider contracts, seeking to identify overpaid claims used to build recurring algorithms
Identify and refine criteria to successfully build and enhance new and existing algorithm logic ensuring correct claim payment
Research and quickly Identify patterns of claim payment abnormalities through big data analysis
Associate Degree or equivalent experience
1+ years of experience working healthcare claims lifecycle (ie: submission, processing, adjudication, and payment)
Ability to detect data anomalies through the use of large data sets

Healthcare Economics Analyst Resume Examples & Samples

Perform data analysis and ad hoc reporting using claims, premium, capitation and membership data in support of underwriting
Run and maintain processes to support Reporting
Understand and document business requirements based on internal customer discussions
Using reporting tools develop reports to be utilized by the internal customer
Intermediate level SQL

Senior Healthcare Economics Analyst Resume Examples & Samples

Responsible for utilizing all data mining tools (i.e. SAS, SQL, Excel) in order to analyze data to support of their hypothesis
An understanding of healthcare payment methodologies and policies as well as coding is recommended
2+ years of experience with claims processing or adjudication systems (Such as UNET, COSMOS, Facets, Diamond, etc. or provider billing / coding knowledge on Professional and Facility claims)
Intermediate MS Excel and PowerPoint Expertise
Knowledge of Medicare, Medicaid and / or Commercial health plan and payment methodology

Healthcare Economics Analyst Resume Examples & Samples

Create and update automated processes
Ability to write SQL queries
Previous experience with Avaya Proactive Contact 5.1 auto dialer software
Experience with Oracle/Sybase relational databases

Senior Healthcare Economics Analyst Resume Examples & Samples

Intermediate level of MS Excel including pivot tables, calculated fields, vlookups, macros / VBA
Ability to be flexible and adaptable in a fast-paced environment
Bachelor's degree in Mathematics, Statistics, Economics, Computer Science

Healthcare Economics Analyst Resume Examples & Samples

Analyze reporting tools utilized by the internal customer
Produce and review reports
Experience working in a corporate setting
1+ years of working with large data sets
At least a beginner level of proficiency working with MS Excel (create, edit and save)
At least a beginner level of proficiency with SQL

Senior Healthcare Economics Analyst Resume Examples & Samples

Prototype new and complex reporting for hand-off to IT using knowledge of healthcare administrative claims data
Participate in various committees innovating and validating new data-driven performance measures and goals
Ad-hoc reporting and analysis to answer customer business questions and provide recommendations
Experience working with large data sets using SQL (preferably Microsoft’s T-SQL)
At least an intermediate proficiency in SQL, Microsoft Excel and Microsoft Access
At least an intermediate proficiency in performing data analytics
Previous work experience in a corporate setting

Senior Healthcare Economics Analyst Resume Examples & Samples

Report to Market and Regional leaders on an on-going basis including quarterly holistic trend reviews and monthly dives into identified areas of concern
Partner with Affordability teams to identify, size and drive affordability opportunities
Collaborate with Pricing teams on rate advocacy support

Healthcare Economics Analyst Resume Examples & Samples

Researching and developing potential claim overpayment hypotheses
An understanding of healthcare payment methodologies and policies as well as coding
2+ years of experience in healthcare (billing, coding, auditing claims)
2+ years of experience with claims processing or adjudication systems
Maintains working knowledge of Medicare rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC and DRGs)
BA / BS degree or equivalent experience
Coding Certification through AAPC or AHIMA
Ability to breakdown a complex problem into individual root causes
Proficiency with SAS and SQL

Healthcare Economics Analyst Resume Examples & Samples

Interpret and analyze claims and membership data in support of utilization trends and clinical performance
2+ years relevant work experience working with large data sets turning data into actionable information
At least an intermediate proficiency in Microsoft Excel
Work experience in a healthcare or managed care environment
Previous experience working in a SQL or SAS environment

Senior Healthcare Economics Analyst Resume Examples & Samples

Perform data analysis and ad hoc reporting using claims, provider data, and membership data
Research, analyze, review, and trend complex data for monthly production
Using reporting tools to develop reports to be utilized by the internal customer
Support short and long term operational/strategic business solutions through analysis
Develop and implement effective/strategic business solutions through research and analysis of data and business processes
Intermediate level of proficiency with SAS/SQL
Understanding of Medicare Advantage Risk Adjustment
Intermediate level of proficiency with Access

Healthcare Economics Analyst Resume Examples & Samples

1+ years of SAS experience (Base SAS, Macros, Proc SQL, SAS EG)
1+ years of experience with relational databases (SQL Server, MS Access, Oracle, DB2)
Intermediate level of MS Excel including pivot tables, calculated fields, vlookups, macros/VBA
Ability to work with large, unstructured data
Beginner level of experience with UNIX or LINUX systems

Healthcare Economics Analyst Resume Examples & Samples

Performs analysis and reporting of medical claims data, utilizing personal experience and knowledge to synthesize information
Analyzes data using various methods to evaluate the effectiveness of company Intervention Programs as well as "slices" the data to produce various management reports
Creates various reports monthly, quarterly and/or annually that track client medical claim utilization, provider billing patterns, and VillageHealth's progress in achieving claim target goals
Supplements standard analytics with statistically and/or quantitatively driven insights to further drive the team’s understanding of the results
Formulates solutions/recommendations as needed for internal and client use, and presents this information to various internal and external groups
Prioritizes individual project workflow while providing necessary updates to senior management
Bachelor's degree in healthcare field, math, statistics, or other quantitative fields strongly preferred
Knowledge of medical claims terminology (such as cost bucketing, CPT, ICD-9, ICD-10, UB-04 and CMS 1500)
Minimum of 2 years experience with analytics and reporting
Knowledge of relational database principles including SQL and MS-Office software
Practical knowledge of statistical and/or quantitative analysis that can be readily applied to work assignments
Understanding of healthcare billing and payment methods

Senior Healthcare Economics Analyst Resume Examples & Samples

Producing standard reports for clients using proprietary reporting applications, including Health Plan Manager
Responding to scheduled and ad hoc requests for data
Accountable for knowing how to obtain the requested data
Within Health Plan Manager, they will be skilled navigators, able to create datasets, select and export views, find and update an existing book, and able to accurately and appropriately apply filters
Following standard guidelines in translating the data into initial drafts of client presentations
Doing the initial quality review and validation of the data including comparison
Actively participate in end-user functional testing of the reporting applications
Adhere to data security and relevant privacy policies, as well as function effectively as a data stewards
Demonstrated proficiency in learning software and working within a windows environment
Demonstrated comfort working with data in some capacity
Demonstrated ability to work independently in a fast-paced environment
Demonstrated ability to attend to details and manage workload through to completion
1+ years in healthcare
1+ years of data analyses or programming experience

Healthcare Economics Analyst Resume Examples & Samples

May develop internal operational volume and performance reporting on the business
May develop and distribute client-facing operational volume and performance reporting
May create geographic and disruptive analyses intended to aid the sale of new business
May analyze client and prospect claim files, with development of value based savings models
May analyze internal operational processes and create incremental revenue opportunity stories based on process improvements
Focus on creation and implementation of process improvement opportunities for Healthcare Economics
Serve as a mentor or manager to less experienced and /or newer Healthcare Economics colleagues
Commit to client service excellence
Demonstrate Company’s Core Competencies and values held within
The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary
Minimum Bachelor’s degree in statistics, accounting, finance, economics or related field; or HS Diploma and 4 years of related experience
Minimum 3 years experience in reporting, analytics, or a similar field, preferably within a healthcare environment
Ability to use software, hardware, and peripherals related to job responsibilities, including MS Office, as well as SQL and/or Oracle
Occasional travel to Newtown Square, PA, office
Knowledge of managed care concepts and principles
Problem solving, analytical, organization, and communication (written, verbal and listening) skills
Ability to work independently on multiple concurrent projects

Healthcare Economics Analyst Resume Examples & Samples

Provide analytical support for the Claims, Ancillary, Medical Management and Provider Network departments
Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management
Create financial models to evaluate the impact of provider reimbursement changes
Gather data and conduct ad-hoc analyses as directed by other Finance Analysis team members and assist with the development and presentation of analytical data reports
Support Financial Analysis projects related to medical cost reduction initiatives
Support Medical Management by assisting with Return on Investment (RoI) analyses for vendors to determine if their financial and clinical performance is achieving desired results
Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance
Bachelor’s degree from an accredited institution
Analytical work experience within the healthcare industry (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
Work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis
Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue
Bachelor's degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, or Healthcare Administration
Experience in modeling financial impact of provider reimbursement changes
Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills
Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms

Senior Healthcare Economics Analyst Resume Examples & Samples

Perform repeatable analytics in support of medical utilization trend identification, root cause analysis
Support medical management by performing population analytics to improve overall health outcomes and financial performance
Lead projects to completion by contributing to database creation, statistical modeling and financial reporting
Build financial models to perform financial analysis to improve health plan competitiveness and support reporting requirements
At least a basic level of proficiency working with SQL and / or SAS programming tools
1+ years of health care experience working with claims data and medical codes is highly preferred
Intermediate skills / knowledge of query tools, database platforms, data mapping / ETL, system platforms and software packages platforms

Senior Healthcare Economics Analyst Resume Examples & Samples

Provide on - demand analysis and reporting in support of business and State data requirements
Analysis in Clinical, Financial, Operational, and Quality metrics
Lead report projects to completion by contributing to reporting requirement gathering, development, and documentation
Design and deploy key dashboards and analytic tools for self - service analysis and research
Maintain and update automated reports on company reporting platforms
Develop and support relationships with our healthplan and State business partners in support of meeting State and Centers for Medicare and Medicaid goals and objectives
Intermediate proficiency in performing data analytics
Beginner level proficiency with Access, SQL, Sybase and / or other statistical programs
Experience with Microsoft Office products including Excel and Access