Medical Analyst Resume Samples

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P Greenholt

Pierce

Greenholt

9933 Ray Point

Boston

+1 (555) 398 3343

9933 Ray Point

Boston

Phone

p +1 (555) 398 3343

Experience Experience

Phoenix, AZ

Medical Policy Analyst

Phoenix, AZ

Ruecker Group

Phoenix, AZ

Medical Policy Analyst

Assist with research and development of medical policy materials
Reviews and analyzes client inquiries via CIRTS and provide a clear, precise, and complete client friendly response
General knowledge of regulatory aspects of health insurance or managed care
Completes/participate in special projects as assigned IE PR scrubs, audit assistance
Perform special project assignments for the Senior Medical Director of Medical Policy as requested
Capacity to work on multiple projects simultaneously, frequently under tight deadlines
Follow established guidelines for turnaround time and quality as defined in the Policy Inquiry Policy and Procedure Manual

New York, NY

Medical Systems Analyst

New York, NY

Jenkins, Hauck and Klein

New York, NY

Medical Systems Analyst

Assists the CBO Billing team and our MSP partners with any systems related rejections issues. Interact with external customers to provide updates to issues
Creates support file documentation and instruction guides for employees regarding system file setup
Analyze and suggest department process improvement
Assists with period (month) and year end system closes
Medical Insurance and managed care knowledge
Work with various clearinghouses on current system issues/changes
Provides technical support during and after implementation for healthcare electronic data interchange applications

present

Dallas, TX

Financial Analyst, Medical Chargebacks

Dallas, TX

Schaden-Bailey

present

Dallas, TX

Financial Analyst, Medical Chargebacks

present

Improves financial status by analyzing results, monitoring variances, identifying trends and recommending actions to management
Applies knowledge to complete own work
Completes work flow by processing simple to complex work
Identifies opportunities to improve efficiency while providing flawless transactions, services and products; manages monetary assets and other resources to optimize cost effectiveness
Applies knowledge to established business rules for systems and transaction processes
Provide timely, relevant, accurate reporting and analysis of the results of assigned suppliers
Incorporate Cardinal Health’s values and goals into own work process

Education Education

Bachelor’s Degree in Public Health

University of Oregon

Bachelor’s Degree in Public Health

Skills Skills

Ability to focus and successfully meet monthly or quarterly goals set by Management
Proficient in Intergy and The Medical Manager Practice Management systems
Proficient in Microsoft Office (Word, Excel, PowerPoint, Outlook, Access)
Pulling-Yes
Previous Medical Manager/Intergy experience
Customer service skills are necessary in this position as this job role supports and interacts with the entire organization
Be aware of tones of written communication; provide clear written feedback to customers in factual, non-offensive manner
Balancing-Yes
Crouching-Yes
Experience solving moderately complex problems and/or conducting moderately complex analyses

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15 Medical Analyst resume templates

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Digital Medical Marketing Analyst Resume Examples & Samples

Relevant experience with external data sources: NetProspex, Data.com, Zoominfo
A dynamic self-starter with the ability to gather information, craft strategy, and deploy tactics
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
Bachelor’s degree in relevant field (Business, Computer Science, Marketing or similar discipline)
Minimum 3 years of work experience in Marketing
Experience in online marketing,including email & nurture marketing
Advanced proficiency in Microsoft Excel
Proficiency in standard database sources: CRM, Marketing Automation (preferably Marketo)

Medical Claim Analyst Resume Examples & Samples

Processes "M" Case claims (medical only) within area of payment authority up to, but not exceeding, $3,500
Processes claims, other than “M” cases, where all issues (indemnity, legal, etc.) have been settled and the claim is only open for payment of medical benefits (i.e. maintenance claims not requiring actuarial reserves)
Contacts, by telephone, insureds, claimants, and medical providers for additional information or medical verifications to verify and report the status of claims
May verify coverage on claims by following normal coverage confirmation procedures, as requested. Alerts Team Manager of any errors or discrepancies
Reviews and updates data into a computerized system
Approves payments of medical bills on lost time disability claims (W, N, X, and Z Cases), within payment authority, after compensability has been determined by the Team Manager or claim technician/handler
Informs Team Manager of all Workers Compensation "M" Case claims to be removed from the "M" Case classification per Claim Best Practice guidelines
Answers routine questions, orally and in writing, from agents, claimants, insureds, or other interested parties
Keeps Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Team Manager for direction
Consults with other departments and business units
Documents receipt and contents of medical reports. Reviews and handles other correspondence within authority including material from the team member, customer, or State
Processes claims, other than “M” cases, where all medical issues have been settled and the claim is only open for payment of long term Indemnity benefits
Identifies files that no longer meet the administrative criteria along with recommendation to team manager for reassignment
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
Performs other related duties as required or requested

Medical Investigations Analyst Resume Examples & Samples

Experience with medical record retrieval and review preferred
Claims research and review experience preferred
Knowledge of ICD10 codes a plus
Excellent verbal communication skills and a professional demeanor, with the ability to talk on the phone to physician offices for extended periods of time
Must be self-directed, organized, with attention to detail
Computer/technical skills: MS office (Word, Outlook, Excel), Sharepoint, RightFax, computer based billing and claims systems

Medical Informatic Analyst Resume Examples & Samples

Take leadership role to manage the customer's business needs and translate them to analytic approaches, specifications, reports, and result analyses. Develop business knowledge and business relationships with customers and vendors to articulate business requirements for efficient implementation
Develop innovative analyses and reports using understanding of the business need for information. Independently develop new programs to modify or prepare new complex reports and analyses
Lead special projects as requested by various internal departments or in support of requests from regulatory agencies, contracting or vendor agencies and other external organizations
Participate as key contributor in cross-functional teams to develop new or enhanced systems/processes/ policies/ or programs to support business needs
Research and analyze report results identifying opportunities and trends. Summarize results for easy interpretation. Communicate analytical results in presentations, abstracts, graphs or summaries for high level review
Develop analytical methods so that they may be subsequently delegated for production to Informaticists at lower levels
Facilitate promotion of developed reports into production with established analytics such as inpatient and outpatient medical cost management reports. Cross-train and collaborate with lower level staff
Lead and technically manage complex projects. Lead and train lower level analysts
Conduct technical and business research to improve data accuracy and data structure efficiency and supporting documentation
Make recommendations to enhance department's datamart
Conduct research on data issues, healthcare literature and requirements, technical solutions, and analytic approaches
Verifies and ensures the accuracy of all assigned tasks, including the documentation and validation of code
Attends and participates in team, project, staff, and training meetings. Makes presentations and communicates project results
Participate in special projects, including automation, data governance, and other efforts, to streamline and improve reporting and evaluation processes. For example, validates data load processes and the quality of the data loaded into repositories
May participate in or lead business intelligence solution development
May provide statistical methods guidance and apply methods such as logistic regression as needed to provide compelling analyses to management
May serve as member of team working to remediate reports and tools to accommodate implementation of ICD 10 coding methodology
Proficient in data management and evaluating a wide array of data types, including medical and prescription drug claims, and eligibility data
Very strong problem-solving ability
Advanced level of programming is required
Strong ability to communicate issues, solutions, analytic results. Ability to consult with colleagues across the enterprise and reconcile approaches
Ability to manage time efficiently and produce accurate timely analysis
Ability to be flexible due to dynamic environment with changing work priorities
Ability to work independently effectively and provide required information on time and with a high degree of quality and transparency
Ability to use Microsoft Office, Word and PowerPoint and advanced Excel use
Ability to efficiently use data cubes to extract data and reports from Medlnsight or other BI software
Strong verbal and excellent written communication skills

Medical Agreements & Administration Analyst Resume Examples & Samples

Tracks and maintains our existing agreements as well as notify the owners with any updates, renewals, and expirations
Professional skills with an understanding of industry practices and company policies and procedures
Very good ability to multi-task
Developing proficiency with tools, systems, and procedures
Excellent planning/organizational skills and techniques
Excellent analysis and problem solving skills
Good decision making skills
Direction from manager/director is needed on some issues
Capacity to work under pressure
Ability to oversee small projects
Ability to identify and recommend continuous improvement
Knowledge of key terms in RFP’s and legal agreements
Experience with Microsoft Excel, Word and Adobe
Basic business math
Analytical and organizational skills
Ability to effectively and proactively communicate with sales force and upper management

Medical Policy Analyst Resume Examples & Samples

Process changes associated with approved library and reject decisions using Client Decision Manager (CDM) and Figaro
Documents action taken for assigned project request in the appropriate field of the project request
Generates the PU audit report after switches have been completed to validate accuracy
Communicates effectively and timely with upstream functional areas to resolve issues
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
Maintains medium level knowledge of CDM functionality
This position is part of the Medical Policy Analyst training program at Cotiviti

Medical Policy Analyst Resume Examples & Samples

Reviews and analyzes client inquiries via CIRTS and provide a clear, precise, and complete client friendly response
Follow established guidelines for turnaround time and quality as defined in the Policy Inquiry Policy and Procedure Manual
Expertise in the Policy Inquiry application (JIRA, Lotus Notes, SQUISH), rule configuration application (RMI), rule tracking tool (RMR), Research Request (RR), BRAT, and Testing
Communicate effectively and timely with multiple functional areas to resolve inquiries
Attend all required team meetings
Ability to provide accurate response with minimal assistance
Completes/participate in special projects as assigned IE PR scrubs, audit assistance
Act as a resource to Off Shore PI for questions/ overflow assistance
Complete monthly reports as requested

Medical Policy Analyst Senior Resume Examples & Samples

Typically requires active state RN license
Nursing degree, MPH, RPH or PharmD preferred
Clinical research experience strongly preferred
Working knowledge of coding required
Strong written and verbal communication required
Technical writing experience required

Medical Plan Analyst Resume Examples & Samples

Monitors metrics and ROI benchmarks for medical plan, including health care trend in the US. Able to use Excel for analysis of trends
Coordinates analytics vendors and health care actuaries to develop analytics goals, and programs for employee interface
Formulates opportunities for improvement in medical plan design, including OON pricing, high cost claims management, and chronic condition mitigation
Ensures coordination between data warehouse and employee outreach vendors
Serves as a lead data analyst to all businesses for medical plan metrics
Works with retirement plans group to cross-pollinate financial wellness outreach
Maintains knowledge base on clinical trends and issues
Leads US vendor integration efforts ensuring appropriate metrics, dataflows, contracting and PG’s are in place to implement “bend the trend”
Bachelor’s Degree from an accredited institution required
Minimum 7 years of medical plan experience
Medical Plan experience including data and clinical analysis
Experience in project management and budgeting (including use of project management tools such as MS Project
Communicate effectively with a broad range of employees from factory workers to senior management
Multi-task various simultaneous projects and activities
Effectively managed previous multi-discipline efforts and cross vendor work

Medical Data Analyst Resume Examples & Samples

Works with internal and external customers to fulfill data collection, verification and reporting needs and works closely with customers to achieve desired results
Effectively engages in report writing and data display activities. Responsible for assisting the Plan with data collection and audit activities to ensure internal and external compliance with CMS
Continuously monitors and analyzes data collection processes and helps create action plans to maintain data integrity or resolve data integrity problems. Prepares data and distributes reports internally and externally on a scheduled and adhoc basis
Perform root cause analysis through researching and analyzing data and processes in order to determine analytic capabilities and solutions. Serves as a resources and coach for the use of data integrity concepts and tools. Responsible for submitting work requests to Information Systems for report creation and development for Health Services as needed
High School diploma required. Bachelor's Degree in healthcare administration, information system or equivalent experience
Minimum two years of experience in health care data and analysis
Experience with relational databases, data collection, reporting and query tools; successfully extracts, manipulations and reports data for customer
Technically sophisticated with relational database concepts and applications, analytic data development (statistics) and decision support tools. Knowledge of medical terminology

SC Analyst Medical Resume Examples & Samples

Conduct or support internal data gathering processes; such as cross-divisional demand figures
Conduct or support the collection of supplier, market, category and internal business information at both the category and sub-category levels
Run RFI, RFP and RFQ processes in collaboration with line function and/or the Global/Regional Category or Manager
Responsible for understanding stakeholder requirements and incorporating them into projects in support of the category manager
Responsible for negotiating pricing with suppliers on behalf of Novartis stakeholders to leverage spend across Novartis network for given spend thresholds
Negotiation of contract terms below a defined value threshold – working closely with legal, compliance, and finance functions
Produce final contracts, maintain, archive and monitor as needed. This could include Confidentiality Agreements CDAs, Master Supply/Service Agreements (frame agreements), work-orders, scopes of work, equipment maintenance contracts, and material transfer agreements
Monitor and support compliance to global contracts
Support the buying process executed at line-function level, PO review for savings reporting
Participate in initiatives and projects to drive category objectives
Responsible for assisting the consolidation of information and reporting to inform the Procurement Balanced Scorecard and dashboard reports
Responsible for providing project management support to specific projects (if required)
Responsible for assisting the coordination of materials for supplier segmentation processes
Responsible for supporting the category Supplier Performance and Innovation activities
Responsible for supporting the Global Category Lead to track and document risk and issue management for the category
Contribute to vendor audit requests and facilitate corrective action plans
Calculate, project, and report savings across the various Novartis divisions in all available systems
Bachelor’s degree Native German written and verbal skills (or equivalent), business proficiency in English written and verbal
3-5 years’ experience in Procurement
Demonstrated ability of data analysis
Knowledge of clinical trials and associated processes
Solid understanding of contractual legal terms and conditions
Excellent interpersonal skills with a proven record of business partnering Bachelor’s degree Native German written and verbal skills (or equivalent), business proficiency in English written and verbal

Medical Analyst Resume Examples & Samples

International Classification of Diseases - 9th or 10th Volume/Diagnostic Related Groups/Products of Ambulatory Surgery/Current Procedural Terminology
Assist in preparation of answers or other responses to medical malpractice claims and complaints
Assist attorneys in the defense of medical malpractice cases
Draft memorandum that outlines the medical treatment rendered, to determine if appropriate care was rendered
Research medical topics or other literature searches relevant to the possible action
Assist attorneys and others on medical issues and on communication with medical staff and risk managers
Consult with other units in need of nursing expertise for their cases

National Competitive Medical Cost Senior Analyst Resume Examples & Samples

Manage, monitor and prioritize activities related to existing tools (COB, Unit Cost Summary and others)
Identify data elements needed for enhancements to existing tools and reports, and appropriate data sources, and gaps pertaining to business/user needs
Work with teams to review, analyze, determine opportunities and identify solutions to increase analytical processing efficiency and scalability
Build and maintain strong relationships with various stakeholders, including IT, CIMA, Contracting, Pricing and Medical Economics
Maintain a close, productive and collaborative relationship with our IT partners
Support management in the long-term strategy and defining of priorities

Medical Policy Analyst Resume Examples & Samples

Assist with research and development of medical policy materials
Attend internal and external meetings on behalf of the Senior Medical Director regarding aspects of medical policy
Monitor myriad sources for changes/updates/developments on key issues and brief company personnel as directed by Senior Medical Director
Perform special project assignments for the Senior Medical Director of Medical Policy as requested
Where necessary, assist company personnel in understanding, implementing and monitoring relevant operational requirements
Masters degree in Health Care Policy or related field required or currently enrolled in Masters level program with 1 year of experience in Health Care public policy issues
Must demonstrate skill and proficiency in policy-related research
Must demonstrate policy-related analytical skills and problem solving ability
Excellent communication skills, verbal and in writing
General knowledge of regulatory aspects of health insurance or managed care
Capacity to work on multiple projects simultaneously, frequently under tight deadlines
Competency in MS Office applications (e.g., Word, Excel, PowerPoint, Outlook)

Medical Data Analyst Resume Examples & Samples

Proactively analyzes system wide risk management and claims data to identify opportunities for increased patient safety and reduction in the number and severity of claims
Gather important medical claims data through the use of computer based applications to understand the current trends across the Hartford Healthcare System
Prepare monthly reports and analysis, aid in corporate projects associated with risk and claims
Work with leaders to track and trend departments safety events to limit exposure to liability
Promptly communicate with Department Director regarding pertinent safety trends affecting Hartford Healthcare
Contribute and assist in the implementation of a wide range if initiatives brought for the by Department Director
Prepares and presents reports to leadership as warranted
Administers the system wide adverse event reporting software application and develops reports as indicated
Supports the reporting and analysis of legal expenses in accordance with Hartford Hospital’s legal billing guidelines
High school education required
Associates in Claims or Legal Principles preferred
Demonstrates understanding of related insurance coverage
Excellent problem-solving and analytical skills
Excellent communication and good judgment

Medical Informatics Analyst Resume Examples & Samples

Strong background in math, computer science and/or business
Hands-on experience with major data analysis/processing algorithms (such as regression, time series, modeling, optimization) and tools (such as Matlab)
Good programming skills: designing, compiling and implementing time-efficient and robust software applications
Good practical knowledge of databases and major database engines (SQL server, Oracle)
Good communication skills; ability to work with different clinical teams as well as independently
Problem-solving mindset
Data analysis (regression, modeling, optimization, forecasting)
Experience with applied data-driven research
Programming in Matab
Programming in C++, C# or .NET
Experience with optimal algorithm design
Experience with MS-level projects in engineering, data analysis, or healthcare

Medical Economic Analyst Senior Resume Examples & Samples

Bachelor's Degree in relevant field required
Minimum of 5+ years of Data Analysis, Reporting, Claims, Managed Care or Healthcare experience required
Demonstrated skills with at least one reporting application as SAS, Crystal Reports, MS Excel, MS Access, SQL

Medical Systems Analyst Resume Examples & Samples

Generate department productivity reports as needed
Produce necessary insurance plan reports
Utilize Automation Anywhere software to streamline current and new processes
Maintain current automation tasks
Analyze and suggest department process improvement
Monitor and review Intergy Tasking for ICD-10 and billing issue tasks
Work with various clearinghouses on current system issues/changes
Provides technical support during and after implementation for healthcare electronic data interchange applications
Responds to inquiries regarding EDI issues with enrollment, claims, payments, and/or clearinghouse activities
Conducts analysis of EDI transactions and is responsible for documentation and reports
This position will be responsible for supporting inbound and outbound EDI submissions of all HIPAA compliant and proprietary transactions
Assists the CBO Billing team and our MSP partners with any systems related rejections issues. Interact with external customers to provide updates to issues
Acts as the subject matter expert for EDI, claims formatting, and Navicure
Ensures maintenance and setup of support files within Medical Manager and Intergy Practice Management , which includes but is not limited to: Insurance, referring physician, fee schedules, service facilities, help files, CPT and ICD-9/ ICD-10 codes
Weekly review of billing hold and credential holds to ensure proper system setup
Creates support file documentation and instruction guides for employees regarding system file setup
Assists with period (month) and year end system closes
Timely completion of enrollment applications and follow up on EDI, EFT, ERA
Responding and processing of Intergy tasks and Service Wise requests
Intergy support file knowledge. Medical Manager Knowledge is preferred
Ability to work independently yet also be part of the 21st Century Oncology Team
Ability to read and understand Explanation of Benefits (EOB)
Ability to communicate clearly and effectively verbally and in writing
Ability to document accounts clearly
Ability to analyze accounts and procedures
Ability to focus and successfully meet monthly or quarterly goals set by Management
Customer service skills are necessary in this position as this job role supports and interacts with the entire organization
Preferred 2 years medical billing or physician office experience
Experience solving moderately complex problems and/or conducting moderately complex analyses
Experience analyzing, translating, and defining business requirements into technical solutions
Proficient in Microsoft Office (Word, Excel, PowerPoint, Outlook, Access)
Proficient in Intergy and The Medical Manager Practice Management systems
Excellent written and verbal skills required
Be aware of tones of written communication; provide clear written feedback to customers in factual, non-offensive manner

Medical Evidence Analyst Resume Examples & Samples

Bachelor’s degree in a relevant field (Advanced degree preferred)
> 2 years of experience applying and communicating epidemiology and biostatistics concepts to the public
> 5 years of writing experience related to medical or scientific content (or 3 years writing experience plus advanced degree in related field)
> 2 years of editing experience related to medical or scientific content
> 2 years of experience with MS Office Suite including Word (with use of track changes) and Excel
Understanding of health literacy concepts
Ability to exercise judgment to make decisions and produce content requiring minimal changes
Ability to self-manage multiple tasks and priorities within deadlines, and report on work produced
Demonstrated leadership qualities, such as initiative and strong work ethic
Demonstrated interpersonal skills such that feedback is effectively and constructively given
Demonstrated ability to manage discrete projects or teams

Medical RWD Analyst Resume Examples & Samples

Apply a mix of quantitative problem-solving skills and qualitative research to solve the questions of the pharmaceutical and medical device industries
Collaborate with both clients and fellow team members to implement solutions
Be an expert in data (insurance claims, electronic health records), method (statistics, data visualization), and domain (healthcare policy, market dynamics)

Europe Medical Cadence Analyst Resume Examples & Samples

Lead and own monthly cadence calls with European country management teams for Sales and Service with the support of the MEAR Cadence Manager
Compile data and add relevant comments to the cadence files to provide up to date sales forecasts and supporting evidence for the 3 vertical businesses – MFAPS, DCS and HCIS
Agree the draft submission with the Regional General Managers and Business Development Managers prior to sending it to the US for incorporation in to the global files
Work closely with regional Sales Operations Managers, Business Development Managers, Service Managers and Business Operations Managers to ensure that data and reporting within the CRM, SalesForce.com, is maintained correctly, accurately and updated in a timely manner by the sales and project management teams
Propose ways of improving existing processes and materials that are currently used to feed the cadence process
Monitor and report the accuracy of sales forecasting by vertical business and region on a monthly basis
Confident and able to demonstrate strong people management in challenging environment
Knowledge of SAP/ SFDC would be highly advantageous
Demonstrable high level of skill in using Excel is essential
Must be comfortable to work with informal reporting and to work within multiple systems and with a variety of software packages
Fluency in English is a prerequisite requirement - other European languages would be advantageous - must be a strong communicator
Requires good interpersonal skills and needs to be comfortable working with very senior management. Will also need to be mature and assertive enough to be able to own and lead country calls and work directly with Global Management team as well as the Regional Sales Managers
Independent as well as good team worker and able to be self-motivating as necessary
Can work well during periods of high activity – able to prioritise with minimal supervision
Needs to be able to seek constant improvement opportunities, de-risk situations/processes and drive out waste
Able to analyse and assess key elements requiring attention within complex situations
Must be able to work with and consolidate complex sets of data and retain a high level of accuracy, often to strict timelines

Financial Analyst, Medical Chargebacks Resume Examples & Samples

Demonstrates basic knowledge of supplier contract or customer master set-up and maintenance process
Demonstrates basic understanding of key metrics around process
Completes work flow by processing simple to complex work
Produces meaningful information
Applies knowledge to complete own work
Develops accurate and complete supplier transactions
Interacts appropriately and independently with supplier or internal business partners to assist in the development of solutions related to contract, research or set-up and maintenance issues
Participates in LSS initiatives as SME over process
Applies knowledge to established business rules for systems and transaction processes
Establish, maintain, and enhance the supplier experience through chargeback administration
Serve as the contact to research and resolve issues for suppliers
Accountable for sound financial decisions regarding payback of chargebacks to supplier, as well as inputs into the financial settlement process
Improves financial status by analyzing results, monitoring variances, identifying trends and recommending actions to management
Reconciles transactions by collecting, comparing and correcting data
Recommends actions by analyzing, interpreting data and making comparative analyses of assigned suppliers
Prioritize and organize work to meet and exceed personal and team goals
Protects operations by keeping financial information confidential
Provide timely, relevant, accurate reporting and analysis of the results of assigned suppliers
Incorporate Cardinal Health’s values and goals into own work process
Bachelor's degree in Finance or Accounting field preferred or equivalent work experience
Excel proficiency a plus