Healthcare Economic Consultant Resume Samples
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Healthcare Economic Consultant Resume Samples
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MW
M Wintheiser
Mattie
Wintheiser
84131 Elisabeth Locks
Houston
TX
+1 (555) 463 1802
84131 Elisabeth Locks
Houston
TX
Phone
p
+1 (555) 463 1802
Experience
Experience
San Francisco, CA
Healthcare Economic Consultant
San Francisco, CA
Jast-Rolfson
San Francisco, CA
Healthcare Economic Consultant
- Assist leadership staff in developing and maintaining specific work procedures, policies and process improvement projects
- Weekly management reports outlining work completed and issues encountered
- Lead special projects with little to no manager supervision or assistance
- Assist management and sales with product assessments for new business
- Perform vendor analysis and present findings to management teams
- Works with relatively complex raw healthcare notifications and claims data, and recognizes data patterns and potential issues and makes recommendations
- Reviews work of others and provides feedback
New York, NY
Healthcare Economic Consultant / Developer
New York, NY
Prosacco-Beatty
New York, NY
Healthcare Economic Consultant / Developer
- Provide management with statistical findings and conclusions
- Optimizing SQL query performance
- Direct customer (Medical, Technology, Finance) interaction and relationship management
- Identify potential areas for medical cost improvements and alternative pricing strategies
- Provide data in support of actuarial, financial and utilization analyses
- Data management/reconciliation, technical maintenance/deployment of existing data, processes, and reports
- Green field development of ETL Processes, data visualizations, and reports
present
Detroit, MI
Senior Healthcare Economic Consultant
Detroit, MI
Lowe and Sons
present
Detroit, MI
Senior Healthcare Economic Consultant
present
- Develop and improve quantitative data analytics and set performance targets
- Work closely with development to create analytic results
- Working with healthcare data (member, provider, claims, pharmacy, labs)
- Develop, collect and analyze metrics and data to formulate fact-based decisions and proactively implement process improvements
- Responsible for working in conjunction with data analysts to identify new trends, develop, test and implement new production audit opportunities
- Develop and manage to business plans that include both clinical and financial objectives
- Provides management with statistical findings and conclusions
Education
Education
Bachelor’s Degree in Health Care
Bachelor’s Degree in Health Care
University of Arizona
Bachelor’s Degree in Health Care
Skills
Skills
- Working knowledge of relational databases, database structures and the ability to write queries and combine data from multiple datasets for reporting purposes
- Deliver accurate reporting and data related deliverables in a timely manner
- Good understanding of medical claim terminology for example; CPT-4, DRG, Diagnosis codes, etc
- Provide claims, provider, and membership data in support of affordability, trend, and utilization analyses
- Excellent communication, time/project management, problem solving, and analytical skills
- Research data quality questions; present findings; and suggest solutions as necessary
- Provide explanations and information to others on data availability, content and interpretation
- Excellent communication skills in partnership with our client
- Provides data in support of affordability, trend, and utilization analyses
- Solve moderately complex problems and/or conduct moderately complex analyses
3 Healthcare Economic Consultant resume templates
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1
Healthcare Economic Consultant Resume Examples & Samples
- Develop and improve quantitative data analytics
- SAS programming
- Provides data in support of affordability, trend, and utilization analyses
- Functional SME
- Broad business approach
- Resource to senior leadership
- Develops pioneering approaches to emerging industry trends
- At least an intermediate level of proficiency with SQL, SAS and / or other statistical programs
2
Senior Healthcare Economic Consultant Resume Examples & Samples
- Responsible for working in conjunction with data analysts to identify new trends, develop, test and implement new production audit opportunities
- Strong healthcare analysis skills and knowledge of statistical calculation and interpretation
- Project Management experience required (Agile Methodology experience preferred, ITIL, SCRUM, etc.)
- 2 years of auditing experience
- High degree of proficiency in Excel, Word, Visio, PowerPoint
- Ability to maintain understanding of numerous client processes
- Certification of Medical coding preferred, or 5-7 years of extensive coding experience
3
Healthcare Economic Consultant Resume Examples & Samples
- Works independently to conduct a data analysis of medical claims and behavioral health claims for inpatient and outpatient services
- Applies clinical, coding and processing knowledge to conduct a review of claims data to identify aberrant billing patterns
- Investigates common fraud schemes through data and develops investigative strategies
- Plans and tracks projects working with large data sets and making data-driven analytical decisions; using Microsoft Excel to build reports and charts; to manipulate, sort, and filter data; and create pivot tables
- Provides subject matter expertise for clinical and coding-related information about behavioral health claims to clients and peers
- 3 years of clinical experience
- 1 year experience of plan behavioral health benefit information, insurance industry products or managed care
- 1-3 years of data analyst experience
- Minimum one year SQL or SAS experience
- Strong problem solving skills and decision making skills
- Ability to communicate in a positive / professional manner both orally and written
- Intermediate PC Skills and experience utilizing Microsoft Office, Outlook, Excel and PowerPoint
- Professional licensure for RN, LCSW, LSW, LPC, LMFT, Licensed Psychologist, or related medical coding certification
- Behavioral health claims or claims coding coding experience
- SIU Process / Systems Expertise
- Experience working with a managed care system, behavioral health claims review or behavioral health claims data
- Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE)
- Certified CPC
- In-depth knowledge of claims adjudication and medical terminology
- In-depth knowledge of claims payment methodology
4
Senior Healthcare Economic Consultant Resume Examples & Samples
- Company thought leader
- Functional Subject Matter Expert
- Conversant in data analysis using one or more of the following tools: SSAS, SSRS, MS-SQL Developer, SAS
- Advanced MS Excel skills for data analysis, presentation and reporting
- Demonstrated ability to prioritize and manage multiple tasks
- Previous healthcare delivery and / or health plan experience
- Experience with Medicare risk adjustment and STARS programs
- Experience with healthcare analysis / business intelligence tools: Optum One
5
Healthcare Economic Consultant Resume Examples & Samples
- Bachelor's degree (Mathematics, Statistics, Economics, Computer Science preferred)
- 2+ years of experience with relational databases (SQL Server, MS Access, Oracle, DB2)
- 1+ years of other computer programming experience
- Intermediate level of experience with UNIX or LINUX systems
- Intermediate level of MS Excel including formulas, calculations, pivot tables, charts, graphs, etc
- Must be a self-starter and detail-oriented
- Master's degree in Mathematics, Statistics, Economics, Computer Science, or a related quantitative discipline
- 2+ years of experience in a healthcare setting
6
Healthcare Economic Consultant Resume Examples & Samples
- 2+ years of experience working healthcare claims lifecycle (ie: submission, processing, adjudication, and payment)
- Proficient with excel to include charts, graphs, pivot tables, foundational formulas, etc
- In-depth knowledge of claims processing
- Ability to detect data anomalies through analysis of large data sets
- Medicare or Medicaid claims experience
7
Healthcare Economic Consultant Resume Examples & Samples
- Interpret and analyze claims, premium, capitation and membership data in support of underwriting, actuarial and utilization analyses
- Proficiency in performing data analytics
- At least a beginner level proficiency with SAS and / or other statistical programs
8
Healthcare Economic Consultant Resume Examples & Samples
- At least intermediate level of proficiency performing data analytics
- At least an Intermediate level proficiency with SQL, SAS and / or other statistical programs
- Intermediate to Advanced experience with Access
- Experienced in connecting to multiple databases using ODBC drivers
- Skilled in advance query skills and report development
- Experience with the SDLC process
- Minimum of 2 to 3 years of experience reporting on Medicaid, Medicare or DSNP populations
- Intermediate to Advanced experience with reporting tools i.e crystal reports, Business objects, Tableau and Microstrategy
- 2-3 years development experience with Oracle, SQL server, Mysql, and Tsql
9
Healthcare Economic Consultant Resume Examples & Samples
- Conduct independent research through both internal & external sources and databases
- Conduct an assessment of incoming lead referrals, and complete related documentation
- Perform data analysis of claims history to substantiate fraud and abuse allegations
- Build analytics for claims analysis
- Interact / coordinates activities with all levels of leadership and clients about course of investigation or analytical development
- Prepare accurate reports to detect and identify fraud trends, analysis of those trends and risk mitigation recommendations
- Presentation of findings to clients
- Use reporting tools to analyze large data sets
- Assist leadership staff in developing and maintaining specific work procedures, policies and process improvement projects
- Reports activities to leadership on a regular basis
- 2+ years working with healthcare data
- 2+ years of data analysis and reporting
- Experience with SQL or SAS
- An intermediate level of MS Excel and Access skills
10
Senior Healthcare Economic Consultant Resume Examples & Samples
- Interpret and analyze claims data from various systems
- Analyze the CMS EDPS related guidance and develop systems requirements to support the guidance
- Ability to perform User acceptance testing on data systems involving claims and related data
- Analyze reporting tools to investigate sources of variations
- BS in Computer - Science (or related field) or Business Administration or other healthcare - related degree
- 5+ years Health Payer Business Administration and Healthcare IT experience
- Experience in Healthcare industry best business practices and Payer Operations
- Understanding of the Encounter Lifecycle Management for Medicare Advantage Organizations Or Managed Care Organization or ACA
- Understanding of Healthcare Payer claims data, HIPAA standard transaction and code set standards
- Well - developed analytical skill set and problem solving skills
- Use case requirements definition experience
- Strong test methodology and testing skills
- Excellent medical terminology and coding experience
- Strong technical orientation
- Ability to create SQL queries and perform data analysis
- Good interpersonal skills and customer presence
- Excellent communication skills (oral and written)
- Strong facilitation and presentation skills
- Familiarity with CMS HCC Risk Adjustment Model
- Knowledge and experience with claims processing lifecycle and Understanding of the entire revenue cycle management domain for government programs like MAO, Medicaid Managed Care and ACA Market place
11
Senior Healthcare Economic Consultant Resume Examples & Samples
- Programming and analysis in SAS
- Will report to a team lead / manager
- Support other business units with reporting and data
- Part of the Commercial / Exchange team in the Optum CPC Risk Adjustment Informatics Department
- Building the infrastructure, processes, algorithms, and reports
- Intermediate level of proficiency with Microsoft Excel required (creating reports, formulas)
- SAS certification
- Bachelor's degree in Computer Science, Statistics, Mathematics, Business, Finance, Health Administration or a related field
- Microsoft Access experience
- Experience with Crystal Reports
12
Healthcare Economic Consultant Resume Examples & Samples
- Provide on - demand analysis and reporting on key business issues in support of company Clinical, Financial, Operational, and Quality performance measurement and operations
- Design and deploy key dashboards and analytic tools for self-service analysis and research
- Maintain and update automated processes within company reporting platforms
- Experience with Oracle and SQL Server
13
Senior Healthcare Economic Consultant Resume Examples & Samples
- Provide claims, premium, capitation and membership data in support of pharmacy, medical cost and utilization analyses
- Create written and oral communication materials that effectively summarize findings, support fact-based recommendations and provide appropriate detail to substantiate conclusions
- Identify potential areas for medical cost improvements
- Bachelor's degree (advanced degree desired)
- 3+ years of SQL / SAS programming and statistical research experience
- Excellent time management, organizational, communication and prioritization skills and ability to balance multiple priorities
- Master’s Degree in biostatistics, health services research, or other related field
- Strong consulting aptitude and experience working multiple projects simultaneously
14
Healthcare Economic Consultant Resume Examples & Samples
- 3+ years of health care experience working with medical, behavioral, and / or pharmacy claims
- 3+ years’ experience in performing data analytics
- At least an Intermediate level of proficiency with SAS and SQL
- Understanding or knowledge of mix case models, specific to Medicaid (CDPS, MRX, CRG, ACG, ETG); experience running the models highly
- Experience working with ICD - 10, NDC and procedure code
- Experience with Medicaid managed care programs and capitation reimbursement
- Knowledge of risk - adjusted payment methodologies
- Experience with Python and Tableau
15
Healthcare Economic Consultant Resume Examples & Samples
- Utilize all data mining tools (i.e. SAS, Self Service, SQL, Excel, etc.) to complete complex healthcare data queries to identify aberrancies, trends, outliers within claim data
- Develop behavioral health concepts in partnership with our Analytic and Operation partners to identify and research potential claims hypotheses; size Behavioral Health Concepts for potential opportunity and savings; and when confirmed, present the findings for solution approval
- Excellent communication skills in partnership with our client
- Understanding of healthcare payment methodologies and policies as well as coding is recommended
- 3+ years of experience in healthcare with some of this time working with behavioral health claims
- Experience analyzing and manipulating unstructured data sets
- Experience with SQL coding
- Clinical experience and experience related to behavioral health claims
16
Senior Healthcare Economic Consultant Resume Examples & Samples
- Provide claims and membership data in support of affordability and utilization analyses
- Transform data into actionable insights to help meet goals
- 3+ years of experience in (health care preferred) analytics and working with large data sets
17
Healthcare Economic Consultant Resume Examples & Samples
- Works with relatively complex raw healthcare notifications and claims data, and recognizes data patterns and potential issues and makes recommendations
- Performs data extraction, aggregation, and quality checking from multiple sources and tables in support of trend identification, root cause analysis, affordability initiative development, and validation / measurement of medical expense reduction initiatives
- 3+ years data analytics
18
Senior Healthcare Economic Consultant Resume Examples & Samples
- At least an intermediate level proficiency with SQL (inner and outer joins, Temp tables, sub-selects
- 3+ years of experience in an analytics capacity, working with large data sets
- Experience in Business Analysis (requirements gathering, etc.)
- Experience with Data QA
- Experience building schemas
- Fine tuning databases to increase performance
19
Senior Healthcare Economic Consultant Resume Examples & Samples
- Research client payment policy and write detail Business Requirement documents for analytic development
- Work closely with development to create analytic results
- Perform detailed quality assurance on analytic results
- Maintains working knowledge of Medicare rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD-9/10 coding, HCPCS and DRGs)
- Medical Claim Coding experience / certification
- Experience writing analytics for payment integrity
- Basic level of proficiency with SQL
- Basic level of proficiency with Access
20
Healthcare Economic Consultant Resume Examples & Samples
- 3+ 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)
- Proficiency with MS Excel and PowerPoint
- Knowledge in OON (Out of Network) pricing and Durable Medical Equipment (DME) experience
21
Healthcare Economic Consultant Resume Examples & Samples
- Research new medical cost savings opportunities related to drug claims in the medical benefit
- Perform data extraction, interpret and analyze claims for false positives, trends, and opportunity
- Lead and document new data analytic concepts to completion
- Participate and provide status updates to clients and team as needed regarding project status, data criteria, and opportunity
- Produce, assess, and review reports for tracking purposes as needed
- Demonstrate ability to efficiently prioritize and balance multiple projects and deadlines
- 2+ years of experience analyzing large data sets utilizing statistical programs
- Experience with Medical claims overpayment and root cause analysis involving drug HCPCS codes
- Demonstrated experience in presenting and communicating to senior level executives, both in written format and meetings
- 1+ years SAS, SAS EG, SQL and Relational Database experience
22
Healthcare Economic Consultant Resume Examples & Samples
- Interpret and analyze claims and membership data in support of medical utilization analyses
- Lead projects to completion by contributing to database creation, statistical modeling, utilization and financial reports
- Use notifications, claims or/and membership data in support of business operations, and utilization, network and process / program analyses
- 2+ years experience analyzing very large datasets
23
Healthcare Economic Consultant Resume Examples & Samples
- Perform regular and repeatable data extraction, aggregation, and quality checking from multiple sources and tables in support of trend identification, root cause analysis
- Analyze data or data sources utilized by internal customer groups
- Asses and interpret business requirements and propose technical solutions
- Work with minimal guidance; seek guidance on complex tasks
- Provide explanations and information to others on data availability, content and interpretation
- Research data quality questions; present findings; and suggest solutions as necessary
- Create custom data extracts and aggregation processes in support of one time studies
- Participate in projects by contributing to database creation, maintenance, and enhancement
- Create reporting tools to investigate sources of variations
- 2+ years of experience in healthcare data analytics
- Intermediate level proficiency with SAS
- Experience working with large data sets (100M+ rows, and with multiple data sets concurrently)
- Must be a detail-oriented self-starter, critical thinker, with analytic skills and evidence of creative, proactive problem solving
- Proficiency with SQL
- Advanced SAS skills
- Ability to effectively manage multiple priorities
24
Healthcare Economic Consultant Resume Examples & Samples
- Utilize all data mining tools (i.e. SAS, Self Service, SQL, Excel, etc.) to complete complex healthcare data queries to identify aberrancies, trends and outliers within claim data
- Focus on developing medical necessity concepts in partnership with our Analytic and Operation partners to identify and research potential claims hypotheses
- Size Fraud and Abuse Expansion Concepts for potential opportunity and savings; and when confirmed, present the findings for solution approval
- Clinical experience and experience related to medical necessity determinations
- Bachelor’s degree and/or Master’s degree
25
Healthcare Economic Consultant Resume Examples & Samples
- Identify patterns of claim payment abnormalities that will lead to new rule development through data analysis
- Research new leads for viability
- Populate client test file templates and gather all supporting documentation for trend approval
- Develop metrics to provide forecasting on new rule profitability and FTE needs
- Write Policy and Procedure documents for each new rule and maintenance existing documents as the rule logic changes
- Research production rule revisions for accuracy while working directly with the Data Analyst to test and implement changes
- Facilitate new rule kick off calls with Operations, Centers of Excellence, and the recovery team
- Assist on client calls with the presentation of new rules for client approval
- Monthly analysis of rule performance; forecasted vs. actuals
- Maintenance of existing rules to drive maximum rule performance on output and efficiencies
- Weekly management reports outlining work completed and issues encountered
- Screen scrape and automation ideation as well as providing Data Analyst support for existing automations and scrapes
- Experience working with SQL/SAS and/or other statistical programs
- Coding Certification: CPC, CPC-P, COC, CCS, or CCA, CCS-P
26
Healthcare Economic Consultant Resume Examples & Samples
- Customer funded role that requires high degree of attention to detail and problem solving
- Solid knowledge of Excel and Access
- An Beginner level of proficiency with MS Access
- Experience with UNET or FACETs or any other claims processing systems
- At least a beginner level proficiency with SQL, SAS and/or other statistical programs
27
Healthcare Economic Consultant Resume Examples & Samples
- Research, retrieve, design, troubleshoot, and deliver organized analytics regarding healthcare, capitation, accounts receivable, utilization data, claims data and financial accounting data
- Subject Matter Expert as it relates to healthcare capitation, accounts receivable, utilization, claims, and financial accounting data
- Analyzes and extracts data from the Enterprise Data Warehouse (EDW) to report to internal and external customers
- Serves as a key resource to finance teams by providing data/analytical support, mentoring, guidance and technical expertise
- Designs, develops, tests, documents and maintains database queries for ad hoc reporting used in complex conceptual analyses
- Develops systematic reporting processes and procedures to ensure timely delivery of weekly, monthly, quarterly, annual and ad hoc reporting to management
- Manages reporting and analysis elements on all business initiative projects
- Recommends and implements new or modified reporting methods and procedures to improve report content and completeness of information
- Analyze benchmarking data, reports, processes, and measurements for key managed care indicators to recognize trends and assist in developing forecasts and financial planning
- Develops innovative approaches to achieve deliverables and increase efficiencies
- Functions as a team lead, oversees the work of others within designated teams
- Bachelor’s Degree, Finance, Accounting, Business Administration, Healthcare Administration, or related field (4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
- 4+ of general healthcare accounting, finance, or operations experience
- 2+ of experience in a reporting and analytical role
- Proficient in SQL, SQL Reporting Services, MS Access, and MS Excel and/or equivalent data capture/reporting tools
- 2+ years of experience in a managed care environment
- 5+ years of reporting and analytic experience
- Understanding of the complexity of Member healthcare accounting, claims and revenue
28
Healthcare Economic Consultant Resume Examples & Samples
- Creating a clear, compelling assessment of root causes and actionable/non-actionable contributing factors
- Serves as a trusted advisor to internal and external customers on healthcare cost and quality topics
- Travel will be required 25% of the time to go to customer sites
29
Healthcare Economic Consultant Resume Examples & Samples
- Interpret and analyze claims, premium, and capitation and membership data in support of Finance, Operations & Client Services
- Run financial impact valuation models
- Uploading Bids, plan/PBP & rate tables within client databases
- Validate MMR & MOR, analyze RAF trends, Bids rate, and membership
- Produce monthly financial packages for external clients
- Produce RAF by Provider reporting, assist with sweep payment forecasting, Variance analyses & Ad Hoc reporting
- Assist with sweep projection and reconciliation for external clients
- Analyze & report on sweep payment from CMS
- Conduct cost-benefit analysis, calculate cost impact, summarize and present to manager
- At least an Intermediate level of proficiency with SQL
30
Healthcare Economic Consultant Resume Examples & Samples
- Analyze reporting tools utilized by internal work groups and clients
- Project management and facilitation of deliverables for the Price Surveillance program
- Proactively think outside of the box to find solutions for drug cost / trend management
- 3+ years of work experience in a healthcare and/or finance setting
- Pharmacy technician experience
31
Healthcare Economic Consultant Resume Examples & Samples
- 3+ years of work experience in a corporate setting desired
- 1+ years of health care experience (working with claims data and medical codes desired)
- At least a beginner level proficiency with MS Access, SQL, SAS and / or other statistical programs
32
Occm / Cph-healthcare Economic Consultant Resume Examples & Samples
- Reviewing data to identify aberrancies, trends, and outliers in claim data
- Utilizing data mining tools (i.e. SAS, SQL, Access, Excel) in order to analyze data to support of a hypothesis
- Understanding healthcare payment methodologies and policies as well as coding is necessary
- 3+ years of data analysis experience, analyzing and manipulating unstructured data sets
- Experience with claims processing or adjudication systems, specifically COSMOS
- Proficiency with MS Excel, Word, Outlook and PowerPoint
- Knowledge of Medicare, Medicaid and/or Commercial health plan and payment methodology
- Excellent communication (verbal and written) and negotiation skills
- Self - starter with the ability to support multiple concurrent projects and meet delivery timelines
- Knowledge of SNF or Hospice Claims
- Knowledge of Client Reimbursement Policy
- Strong Research Skills
- Experience with claims processing or adjudication systems, (Such as UNET, Facets, Diamond, etc. or provider billing / coding knowledge on Professional and Facility claims)
- Advanced degree in health care or medical field
- Knowledge of statistical methods used in the evaluation of healthcare claims data
33
Healthcare Economic Consultant Resume Examples & Samples
- Lead projects and provide insights to help assess outcomes
- Bachelor’s degree in epidemiology, biostatistics, pharmacoeconomics, health services research, economics, health economics, public health or a related quantitative discipline
- 3+ Programming experience with SAS or SQL
- 3+ years of experience within healthcare industry
- 3+ years of experience with data reporting and analysis
- VBA skills with excel, access
- Masters within epidemiology, biostatistics, pharmacoeconomics, health services research, economics, health economics
- Reporting skills using software like Tableau, Cognos, Futrix
34
Healthcare Economic Consultant Resume Examples & Samples
- Serves as subject matter expert to a health plan or specific critical job function
- Lead other analysts on specific project or job function
- Complete of physician scorecards according to terms of VBC agreements and present to Health Plan
- Review Clinical Integration scorecards and present to health plan
- Prepare payment request submissions based on scorecard results
- Prepare target models in support of UHN requests, following contracting guidelines
- Perform more complex Model and Scorecard peer reviews
- Submit monthly accrual estimates to accounting
- Lead for market, major tasks or projects
- Trains lower level analysts
- Reviews work of others and provides feedback
- Bachelor's degree in Finance, Accounting, or Business or a Bachelor's degree in any major with 2+ experience in data analytics
- 4 years minimum work experience
- Ability to anticipate customer needs and proactively develop solutions to meet them
- Solves complex conceptual issues and/or performs complex analyses for ad hoc health plan requests
- Promote UHN contract guidelines and department policies and procedures, making recommendations for changes to address critical business needs
35
Healthcare Economic Consultant Resume Examples & Samples
- Design & deliver data reporting from a variety of sources typically UNET platform in addition to data from other systems
- Deliver accurate reporting and data related deliverables in a timely manner
- Ability to communicate and consult with customers and business partners as needed
- Working knowledge of relational databases, database structures and the ability to write queries and combine data from multiple datasets for reporting purposes
- SQL query design experience, Mainframe SAS and/or SAS EG, JCL
- Good understanding of medical claim terminology for example; CPT-4, DRG, Diagnosis codes, etc
- Identifies and delivers reporting solutions to non-standard requests and problems
- Excellent communication, time/project management, problem solving, and analytical skills
- It will take your considerable analytical ability to meet the challenge of working with large complex data sets and finding the best ways to communicate why the data is meaningful
- 3+ years of work experience in a healthcare environment
- At least a beginner level proficiency SAS EG
36
Senior Healthcare Economic Consultant Resume Examples & Samples
- Performs data extraction, aggregation, and quality checking from multiple sources and tables in support of trend identification, root cause analysis, affordability initiative development, validation/measurement of medical expense reduction initiatives, and regulatory compliance
- Leverages existing and ad-hoc reporting capabilities to identify trends in health plan performance, opportunities for clinical operations improvements as it relates to regulatory compliance monitoring
- Collaborates within and outside the Medical Informatics department, UHC, and UHN to lead the development and continuous improvement of methods, processes, and technologies to enhance healthcare quality, affordability, outcomes, and member/provider experience
- Generally work is self-directed, and serves as a resource and mentor to others
37
Senior Healthcare Economic Consultant Resume Examples & Samples
- PHD preferred within epidemiology, biostatistics, pharmacoeconomics, health services research, economics, health economics, public health or a related, relevant discipline. PhD with applied research focus
- Well-developed understanding of epidemiologic, pharmacoeconomic, and health services research design and methods, including the various methods of economic evaluation -Demonstrable Project Management skills
- Proficient in the application of advanced statistics to evaluate economic, clinical and humanistic outcomes
- 5+ years of experience within healthcare industry
- 5+ years of experience with data reporting and analysis
- Able to present your research and ideas to key leaders and clientele
- Proven track record of translating research findings into actionable information to support business decisions
- Established record of peer-reviewed publication
38
Senior Healthcare Economic Consultant Resume Examples & Samples
- 3+ years of experience in health care analytics and working with large healthcare claims data sets
- Demonstrable proficiency using SAS
- An intermediate level of proficiency working with MS Excel including formulas, calculations, charts, graphs, etc
39
Senior Healthcare Economic Consultant Resume Examples & Samples
- Provide claims, capitation and membership data in support of Underwriting, Actuarial and utilization analyses
- Produce and analyze reports to identify business opportunities
- Experience creating reports or leading report development
- At least an intermediate level proficiency with SQL, SAS and/or other statistical programs –
- Ability to work across teams
40
Healthcare Economic Consultant Resume Examples & Samples
- Perform vendor analysis and present findings to management teams
- Quickly identify payment errors regardless of claim system by means of data analysis
- Identify and refine criteria to successfully increase efficiency of rule logic
- Subject matter expert on client processes and policies
- Assist management and sales with product assessments for new business
- Train analysts within and outside of Analytics
- Perform validation steps for new client implementations and file layout changes
41
Senior Healthcare Economic Consultant Resume Examples & Samples
- Provide claims, provider, and membership data in support of affordability, trend, and utilization analyses
- Lead projects to completion by contributing to database creation, quality control and financial reports
- 4+ years of healthcare and/or financial analysis experience
- Previous healthcare delivery and/or health plan experience
- Experience with Value Based Contracting
42
Healthcare Economic Consultant Resume Examples & Samples
- Responsible for utilizing data mining tools (i.e. SQL, Access, Excel) in order to analyze data to support of their hypothesis
- When opportunity is confirmed, the analyst will present the findings for solution approval in a clear and concise manner utilizing data reports and summaries to support their concept
- An understanding of healthcare payment methodologies and policies as well as coding is necessary
- 3+ years of experience in healthcare (billing, coding, auditing claims)
- 3+ 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)
- Strong computer skills: MS Excel, Word, PowerPoint
- Data System expertise in SAS, SQL
- Auditing or trending for outliers experience
- Self-starter with the ability to support multiple concurrent projects and meet delivery timelines
43
Healthcare Economic Consultant Resume Examples & Samples
- Interpret and analyze claims and membership data
- Logical, detail oriented thought process with the ability to breakdown a complex problem into individual root causes
- Ability to identify payment errors regardless of claim system by reviewing data and possessing claims coding experience
- Ability to identify and refine criteria to successfully increase efficiency of algorithm logic
- Generate functional business requirements used for automation of processes, analytic development, strategic reporting, and system navigation (SOPs, P&Ps, BRDs, etc.)
- Develop training documentation diagramming manual processes
- Execution of standalone production processes
- Triage anomalies observed with production processes
- Research, identify, and document potential areas for medical cost improvements and alternative pricing strategies with government and commercial payers
- Intermediate in performing data analytics
- 2 + years of experience in Medicare reimbursement methodology
- At least a beginner level of proficiency with SCRUM process or other Agile methodologies
- At least a beginner level proficiency with SQL and/or other statistical programs (able to read and write simple statements)
44
Healthcare Economic Consultant / Developer Resume Examples & Samples
- Translate real world business needs into technology solutions
- Green field development of ETL Processes, data visualizations, and reports
- Data management / reconciliation, technical maintenance/deployment of existing data, processes, and reports
- Interpret and analyze claims, premium, capitation and membership data in support of Underwriting, Actuarial and utilization analyses
- Lead projects to completion by contributing to requirements gathering, database creation, statistical modeling and financial reports
- Direct customer (Medical, Technology, Finance) interaction and relationship management
- 3+ years of database scripting and/or software development work
- At least a beginner level proficiency in performing data analytics
- At least a beginner level proficiency with process automation and/or report development software
- At least an intermediate level proficiency with SQL, SAS, Access and/or other statistical programs
45
Healthcare Economic Consultant Resume Examples & Samples
- Develop and document business, analysis and reporting requirements
- Required Qualifications
- 2+ years SAS programming experience
- 2+ years solving problems / developing solutions through data analytics
- Advanced proficiency MS Excel and Access
- Experience analyzing and manipulating very large data sets
- Experience delivering verbal and written communications
- Experience in the healthcare industry working with healthcare claim data
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Healthcare Economic Consultant / Developer Resume Examples & Samples
- Optimizing SQL query performance
- Data management/reconciliation, technical maintenance/deployment of existing data, processes, and reports
- 1+ years’ experience optimizing SQL query performance
