Provider Data Analyst Resume Samples
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Provider Data Analyst Resume Samples
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CH
C Hansen
Chelsie
Hansen
31434 Eloy Road
Detroit
MI
+1 (555) 293 9194
31434 Eloy Road
Detroit
MI
Phone
p
+1 (555) 293 9194
Experience
Experience
Houston, TX
Provider Data Analyst
Houston, TX
Farrell-West
Houston, TX
Provider Data Analyst
- Review work performed by others and provide recommendations for improvement
- Establish 'Ask a Question' dialogue with GL 23 Provider Data Specialists and the GL 24 Sr. Provider Data Specialists
- Provide one-on-one training to individuals to drive performance and quality improvement
- Act as a resource to GL 23 Provider Data Specialists and the GL 24 Sr. Provider Data Specialists, including auditing work
- Develop Acceptance Criteria to Support Provider Configuration User Stories
- Provides feedback to reduce errors and improve processes
- Data maintenance, reporting, and analysis for providers, locations, networks, fees, and payees
Dallas, TX
Temporary Provider Data Analyst
Dallas, TX
Wolff-Will
Dallas, TX
Temporary Provider Data Analyst
- Manage data integrity within multiple databases (e.g. PIMS, QNXT) in accordance with established quality standards
- Manage “In-box” and respond timely to provider enrollment requests and to validate member eligibility and claim status
- Assist with evaluation and testing processes related to system enhancements
- Maintain data specialty dictionary related to provider data by updating and revising definitions
- Validate, coordinate, collect and communicate provider data for use by internal customers in a timely manner, and in accordance with established reporting standards and departmental guidelines
- Identify and accurately analyze data file components to complete record set-up of practitioners and facilities; which may include credentials documents such as contracts, fee schedules, and other highly sensitive information. Interpret and escalate data to ensure timely and accurate record set up
- Actively anticipate and report potential areas of concern within data and in consideration of downstream processes (e.g. claims, utilization management, enrollment, and provider network) for potential network inadequacies
present
Philadelphia, PA
Senior Provider Data Analyst
Philadelphia, PA
Kerluke and Sons
present
Philadelphia, PA
Senior Provider Data Analyst
present
- Works in conjunction with managers to develop best practices
- Improve relationships with providers through researching, resolving roster management issues
- Improved relationships with providers through researching, resolving roster management issues
- Work in conjunction with managers to develop best practices
- Performs regular (at least annual) Contract analysis for Tier 1 and other high-profile provider groups
- Performs regular (at least annual) Contract analysis for Tier 1 and other high - profile provider groups
- Perform regular (at least annual) Contract analysis for Tier 1 and other high-profile provider groups
Education
Education
Undergraduate Degree in Health Services
Undergraduate Degree in Health Services
University of Virginia
Undergraduate Degree in Health Services
Skills
Skills
- Excellent written and verbal skills
- Ability to prioritize effectively and work independently
- Attention to detail
- Strong analytical experience
- Strong organizational, interpersonal skills, and presentation skills
- Strong interpersonal and oral communication skills including telephone and email etiquette
- Able to research and solve complex problems
- Strong Analytical skills
- Strong team building skills
- Critical thinking skills
12 Provider Data Analyst resume templates
Read our complete resume writing guides
1
Senior Provider Data Analyst Resume Examples & Samples
- Solve moderately complex problems and/or conducts moderately complex analyses
- 3+ years data analysis and/or audit experience within the healthcare industry
- 3+ years of customer response/customer service experience
- Intermediate level proficiency in MS Excel, Access and PowerPoint
- PCDM provider contract loading background
- Preferred contract loading/auditing/fee schedule experience with the following provider data systems: NDB, Emptoris, NICE, COSMOS, TOPS, PULSE, CSP FACETS, or RV FACETS
- Experience with Market Standard Pricing Schedules
2
Senior Provider Data Analyst of Provider Data Quality Resume Examples & Samples
- Analyze and investigate provider and claims data to result in recovery opportunities
- Provide leadership with suggestions for possible recovery opportunities
- Provide feedback on findings
- Oversee assigned projects to completion
- Creative thinking that allows for the formulation of defect scenarios and/or trends based on past professional experience, trends in contract and/or claims data, audit data, etc
- Manage multiple recovery projects concurrently, while maintaining a high level of quality and commitment to project timeframes (gathering of requirements to execution)
- Analyze provider and claims data to identify trends and issues related to provider loading
- Coordinate work activities with other departments
- Assist to develop plans to meet project objectives
- Identify and resolve operational issues
- Maintain status reports and communicate project status weekly/as needed
- 2+ years of experience in Contract Loading, Contract Auditing, Claims Processing, Claims Adjusting, Claims Recoveries, or Reimbursement Analytics
- Experience performing comprehensive research and identifying provider contract load issues, erroneous billing or reimbursement issues, and/or irregularities or trends that depict claim monetary overpayments to the providers
- Facility provider contract loading/claims/auditing knowledge
- Experience in contract interpretation and industry standard reimbursement guidelines
- Knowledge of the following platforms/applications: COSMOS, NDB
- Intermediate level of proficiency in MS Excel and Word
- Ability to multi-task, shifting back and forth effectively between two or more activities or sources of information
- Ability to make decisions and work independently
- Demonstrated proficiency in requesting reports, claims data and other metrics
- Medicare and Retirement experience
- Project management experience, managing cross functional projects and making presentations
- Data analysis and/or audit experience within the healthcare industry
- Intermediate level of proficiency in MS Access and MS PowerPoint
- Knowledge of the following platforms/applications: Emptoris and Navigator
3
Senior Provider Data Analyst Resume Examples & Samples
- 4+ years of data analysis and / or audit experience within the healthcare industry
- 3+ years of customer response / customer service experience
- NDB and Emptoris experience
4
Provider Data Analyst Resume Examples & Samples
- Develop Acceptance Criteria to Support Provider Configuration User Stories
- Test plan, test case and test script creation aligned to complex business requirements
- Test case execution
- User Acceptance Testing progress reporting, defect management, tracking and resolution using Defect tracking tools
- Support best practices established for User Acceptance Testing
- Support User Acceptance Testing test lead in all testing activities
- Support and mentor other User Acceptance Testing team members
- 2+ years of experience supporting Provider Configuration User Acceptance Testing (i.e. Pre-auth, Reciprocity/Network Schedule, Referral, Penalty)
- 2+ years of experience supporting Network/Contract Configuration (i.e. Service area, network access, auth/notification rules, PCP assignment/reassignment)
- 1+ years working with ALM11 or other defect resolution/tracking tool
- Strong interpersonal and oral communication skills including telephone and email etiquette
- Strong team building skills
- Novice proficiency in Microsoft Excel
- 2+ years working with Agile Methodology
- Oxford / Pulse experience with Provider Contract Data
- Experience with CA Agile
5
Senior Provider Data Analyst Resume Examples & Samples
- Solve moderately complex problems and / or conducts moderately complex analyses
- Apply data analytics to reporting to deliver more than just the data
- 4+ years data analysis and / or audit experience within the healthcare industry
- Microsoft SQL – (Read, Write, Code, Run, Troubleshoot)
- Intermediate proficiency in MS Word and PowerPoint
- Excel Skills - Advanced, (advanced formulas, pivot tables, macros, lists, statistical functions, VLOOKUP, etc.)
- Preferred Systems Knowledge (NDB, COSMOS, CSP, NICE, PULSE, EMPTORIS, PHYCON, GALAXY)
6
Senior Provider Data Analyst Resume Examples & Samples
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
- Analyze and investigate
- 2+ years of data analysis and/or audit experience
- 2+ years of provider quality review experience
- 1+ years of experience with NDB
- Experience in PhyCon
- At least an Intermediate proficiency in MS Office
- Proficiency in tracking, trending and reporting on metrics
- Customer response/customer service experience
7
Provider Data Analyst Resume Examples & Samples
- Authorize deviations from standards
- Candidate should be comfortable with data analytics
- Candidate should be capable of communicating appropriately with several different teams at all levels within the company
- Work in a team environment as a contributor
- Have flexibility if extra hours are needed during cycles
- 3+ years of Data Analysis and/or Audit experience within the Healthcare Industry
- 3+ years of experience in managing cross functional projects and making presentations
- 3+ years of experience using Microsoft Excel (pivot tables, data sorting and filtering), Word (documentation), and Outlook (sending and receiving emails)
- Experience tracking, trending, and reporting on metrics
- Experience using Microsoft Access
- Knowledge of Medicaid provider contracting and loading processes
- Experience with provider contracting and loading
- Knowledge of claims systems CSP / Facets, NDB
8
Provider Data Analyst Resume Examples & Samples
- Conducts audits and provides feedback to reduce errors and improve processes and performance. Maintains current provider data to ensure the quality of the network
- Demonstrate great depth of knowledge/skills in provider data process
- Provide objective feedback on a defined schedule; feedback provided to GL 23 Provider Data Specialists and the GL 24 Sr. Provider Data Specialists needs to balance positive with negative feedback
- Recommends corrective action to supervisors where employees are not achieving quality standards on the audits
- Establish 'Ask a Question' dialogue with GL 23 Provider Data Specialists and the GL 24 Sr. Provider Data Specialists
- Walk to production floor
- To be change agent
- Act as a resource to GL 23 Provider Data Specialists and the GL 24 Sr. Provider Data Specialists, including auditing work
- Act as a technical resource to team members as needed
- Proactively identify solutions and improvements to processes and systems/applications
- Strong organizational, interpersonal skills, and presentation skills
9
Senior Provider Data Analyst Resume Examples & Samples
- Macro experience preferred. Candidates should be comfortable with Nexus, Bulk and Auto-User automation
- Intermediate level of proficiency with Access and PowerPoint
- 3+ years in a customer service focused role
- Effective interpersonal skills; able to build relationships and communicate effectively - Undergraduate degree
10
Senior Provider Data Analyst Resume Examples & Samples
- Serve as the SME (subject matter expert) on electronic provider data interfaces
- Collaborate with internal and external customers to ensure business requirements are met
- Analyze data feeds in order to match them to the network database
- Solve problems, both routine and complex
- Attend project meetings to identify customer needs and project requirements
- Support the implementation of new processes and on - boarding of new clients or products
- Present project overview and issue resolution options to customers
- Update documentation as needed
- 1+ years experience working with Provider Data in a managed care setting
- 1+ years managing one or more major projects; preferably those that involve multiple business systems or departments
- Facets, COSMOS, NICE, and / or UNET experience
- 1+ years writing experience
- 2+ years of claims experience, preferably on UNET
- Detail oriented with strong analytic skills
- Solid organizational and interpersonal skills
- Self-starter; team player; quality minded; focused; committed; work
11
Provider Data Analyst, NDB Required Resume Examples & Samples
- Work exclusively within a specific knowledge area
- Prioritize and organize own work to meet deadlines
- Coach and provide feedback to help staff maintain / achieve high performance levels
- 1+ years experience working with NDB
- Previous experience as a SME, mentor or supervisor
12
Senior Provider Data Analyst Resume Examples & Samples
- Identify solutions to non - standard requests and problems
- Intermediate to advanced proficiency in MS Excel and PowerPoint
- 3+ years data analysis and / or audit experience
- 3+ years experience in managing cross functional projects and making presentations
- 3+ years customer response / customer service experience
- MS Access experience
13
Provider Data Analyst Resume Examples & Samples
- Monitor results and quality of production based staff
- Record findings using professional and descriptive language
- Provide explanations and details to further communicate findings
- Participate in calibration activities
- Prioritize work to meet deadlines
- 2+ years data analysis and / or audit experience within the healthcare industry
- 1+ years experience making presentations
- At least an intermediate level of proficiency with MS Office, including Excel
- Highly effective communication skills, including the ability to provide constructive feedback in a manner likely to be well received. Approaches feedback with a win - win attitude
- 1+ years experience working with provider data
- 1+ years experience working on or managing projects
- Ability to thrive in a high production environment
- Demonstrated experience in work requiring high attention to detail
14
Senior Provider Data Analyst Resume Examples & Samples
- Internally and externally facing - own the contract administration, implementation and maintenance of provider contract terms and data which impacts claims payment or directory depiction
- Streamline communication between UHN and PCDM regarding contract / demographic updates by creating consistent business rules and processes to eliminate handoffs and rework
- Improve relationships with providers through researching, resolving roster management issues
- Handle the most complex and difficult provider groups in the region
- Address top priority (DOI / DOH / CMS / legislative) issues
- Identify recurring / systemic issues
- Create efficiencies in PCDM interactions
- Ensure high quality data submissions for groups / territories
- Conduct research on issues surrounding the accurate and timely loading of contractual and demographic data
- Collaborate with the contractors, advocates, and PCDM to examine larger scale provider issues, determines root causes, and coordinates solutions
- Reduce contract / demographic errors that affect members of gated products: C&S, Exchanges, etc
- Perform audits of contract load requests for assigned groups
- Perform regular (at least annual) Contract analysis for Tier 1 and other high-profile provider groups
- Support BPQM Quality Audit Programs
- Work in conjunction with managers to develop best practices
- Mentor new and junior team members
- 4+ years data analysis and/or audit experience within the healthcare industry
- 1+ year of Phycon
- Knowledge and experience in Emptoris
- Intermmediate proficiency in MS Excel, Access and PowerPoint
- Understanding reports / metrics
15
Senior Provider Data Analyst Resume Examples & Samples
- 3+ years working with provider data
- 2+ years experience with data analysis and reporting
- Advanced proficiency with MS Excel and ACCESS
- 3 years customer response / customer service experience
- Intermediate or stronger level of proficiency in tracking, trending and reporting on metrics
- Audit experience in the healthcare industry
16
Senior Provider Data Analyst Resume Examples & Samples
- Oversight of taxonomy governance process related to mapping of specialties and provider types across UnitedHealth Group core systems, including leading cross functional business discussions on taxonomy related issues / requests, collaborating with governance council to obtain necessary signoffs and implementation of new taxonomy codes for UHG systems
- Lead process improvement initiatives for the taxonomy governance process including development of status / Inventory reports, creation of tools to facilitate the implementation and maintenance of taxonomy codes
- Lead and participate in teleconferences to guide resolution of taxonomy related issues
- Develop, business rules and job aids that define the configuration rules for provider organization and specialty types on NDB, COSMOS, Facets, NICE or other platforms
- Monitor taxonomy related Policy and Procedures through the development and approval process as part of operational implementation
- Working with operational areas on a cross functional basis to provide assistance with the implementation of new initiatives identifying key impacts to operational departments and their processes
- Speak at national calls to present new processes or system changes to internal departments including Network Management, PCDM, PDS, PDO, PCRL or other healthcare operations staff
- Drive a diverse set of special projects to completion, identifying and engaging staff from impacted departments to create and implement solutions to issues
- Troubleshoot provider data issues associated with NDB, NICE, Facets, Pulse, COSMOS or other systems which store provider data
- Review training materials related to your project
- Follow up with the appropriate staff members from across UHC, Optum, Medicare and Retirement or Community and State as well as IT areas on open issues and to gather information
- 2+ years of NDB experience
- 3+ years of experience with healthcare provider data and its business usage including contracting
- 2+ years prior professional writing experience, including writing of Policies and Procedures
- 2+ years of experience in presenting information at national forums or in large project group meetings and in managing cross functional projects
- Strong organizational and interpersonal skills, customer service skills
- Intermediate level proficiency with MS Word, Excel and PowerPoint
- 3+ years of experience with any of the following platforms: UNET, COSMOS, NICE, Pulse or Facets
- 1+ year of prior experience with a Policy and Procedure governance and sign off process
- Basic level of proficiency with MS Access and Visio
- Medical coding experience helpful, certification
- Reimbursement policy experience (iCES)
17
Senior Provider Data Analyst Resume Examples & Samples
- Internally and externally facing - owns the contract administration, implementation and maintenance of provider contract terms and data which impacts claims payment or directory depiction
- Streamlines communication between UHN and Provider Contract Data Management (PCDM) team regarding contract/demographic updates by creating consistent business rules and processes to eliminate handoffs and rework
- Improved relationships with providers through researching, resolving roster management issues
- Handles the most complex and difficult provider groups in the region
- Addresses top priority (DOI / DOH / CMS / legislative) issues
- Identifies recurring / systemic issues
- Creates efficiencies in PCDM interactions
- Ensures high quality data submissions for groups/territories
- Conducts research on issues surrounding the accurate and timely loading of contractual and demographic data
- Collaborates with the contractors, advocates, and PCDM to examine larger scale provider issues, determines root causes, and coordinates solutions
- Reduces contract / demographic errors that affect members of gated products: C&S, Exchanges, etc
- Performs audits of contract load requests for assigned groups
- Performs regular (at least annual) Contract analysis for Tier 1 and other high-profile provider groups
- Supports BPQM Quality Audit Programs
- Works in conjunction with managers to develop best practices
- Mentors new and junior team members
- 2+ years of experience in a network management - related role handling complex network providers with accountability for business results
- 2+ years of experience in the health care industry
- 2+ years of experience with provider contracting / provider relations / provider data
- Intermediate (or better) proficiency with Excel, including use of filters, removing duplicates, converting text to columns, and basic formulas, etc
- High attention to details
- Strong organization skills and able to work independently
- Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others, including but not limited to reimbursement policy standards
- Strong interpersonal skills, establishing rapport and working well with others
- Intermediate MS Access proficiency
- Proficiency with all UHC provider data systems (NDB) and claims platforms (UNET, PULSE, CSP Facets, COSMOS, Impact, FICAS) used in the region
- Proficiency with multiple auditing tools, such as Examiner and Danner
- Due to the aggressive national and regional expansion plans of CAT, internal candidates with UnitedHealth Group experience
18
Senior Provider Data Analyst Resume Examples & Samples
- Undergraduate degree or equivalent
- 1+ years of provider quality review experience
- 1+ year experience with NDB
- Experience in managing cross functional projects and making presentations
- Experience with Phycon
19
Provider Data Analyst Resume Examples & Samples
- Analysis of electronic receipt information and manual processing, including input of provider data into supporting systems
- Ensure all required documents are received in order to submit providers to the Network Improvement Committee, Credentialing, PDM, PDV and other areas responsible for establishing a strong provider network
- Utilize, understand and follow all loading instructions, policy and procedure documentation in SharePoint and c Kit and continually identify and escalates process gaps and opportunities for process efficiencies and any contradictions across documentation to avoid negative customer impacts
- Utilization of PCMA, Cactus, Tract Manager, QNXT, SharePoint, Utilization of Central Provider File (CPF), and other HealthCare Professional sites in order to accurately resolve provider selection fallout
- Effectively interface with peers and management to ensure required results
- Participation in peer training and coaching support to obtain required processing knowledge
- May be required to work on reports and special projects that will assist management with trending and other process improvement activities
- Maintaining established quality, production, and team timeliness standards
- Responsible for meeting deadlines and accepting additional tasks and assignments
- Participate in workload balancing when the need arises, supporting numerous work streams and functions
- Ability to work successfully in a team environment while providing solid individual contributions
- High School Graduate or GED equivalent
- Prior experience in the healthcare industry and knowledge of medical terminology a plus
- Prior experience (1-2+ years) with claim payment and data loading strongly desired
- Superior keyboarding skills and proficiency in the Windows environment
- Excellent attention to detail and ability to follow procedural standards
- Ability to clearly and effectively communicate (Verbally and Written)
- Proven ability to accurately analyze data and process data correctly into systems based on provided reference and processing materials
- Ability to adapt to an ever changing environment and quickly adapt to process changes
- Proven ability to function effectively in a production environment with continuous process improvement
- Responsible for meeting deadlines and accepting additional assignments and tasks as assigned
- Self-motivated, detail oriented, decisive, and adaptable to change
- Ability to support multiple forms or types of work daily
20
Senior Provider Data Analyst Resume Examples & Samples
- 5+ years in the Healthcare Insurance Industry
- 3+ year in UHC network contracting or load team experience
- 2+ years data analysis, research, and/or audit experience within the healthcare industry
- Experience in managing cross functional projects and presenting data
- Intermediate proficiency in MS Excel, Access, Outlook, and WebEx
- Reading and following policies and procedures
- Experience using and navigating MyCoach
21
Senior Provider Data Analyst Resume Examples & Samples
- Ensure that data and work processes conform to state and regulatory agency guidelines (i.e., through CMS, NCQA, State DOI, State Medicaid)
- Support reporting or data requests from state or federal agencies (e.g., DOI, network adequacy, provider audit data)
- Gather and maintain compliance-related data from applicable systems/databases for use in reporting/communications to demonstrate compliance with regulatory requirements
- Perform root cause analysis for non-compliance with data
- Develop, query, and submit reports to applicable stakeholders to include leadership, sales, QM/QI
- Lead or participate in applicable projects related to design, entry, and or support of data
- Utilize database systems and tools to enter and/or research provider data
- Review database results to determine the accuracy of keyed data
- Audit credentialing databases to insure accuracy of data extraction
- Demonstrate an understanding of and apply business strategies rules and procedures as appropriate
- Advanced level of experience with MS Word, Excel and Access
- Knowledge of CMS regulatory guidelines
- Experience with Facets
- Effective oral and written communication skills
- Must have the ability to prioritize multiple tasks and perform complex administrative functions with minimal to no supervision
- Must have the ability to work self-directed
22
Senior Provider Data Analyst Resume Examples & Samples
- Analyze contract language to determine the best way to load the content into the Emptoris contract database
- Create logic to link sections of data and ensure contract language is used correctly
- Create and update contract documentation
- Notify market of contract changes
- Create and maintain security specifications to limit contract availability
- Facilitate and lead team meetings
- Ability to work independently and make decisions with minimal guidance
- Intermediate proficiency with MS Excel
- 2+ years experience utilizing MS Word for creating and editing documents
- Strong communication skills; both written and verbal
- Experience with technical writing
- Working knowledge of MS Access and SharePoint
- Experience with contract management databases, preferably Emptoris
- Ability to multi-task and shift priorities
- Adapts easily to change
23
Provider Data Analyst Resume Examples & Samples
- 2+ years of experience supporting Network / Contract Configuration (i.e. Service area, network access, authorization / notification rules, PCP assignment / reassignment)
- 1+ years of data analysis and / or audit experience within the healthcare industry
- 1+ years working with defect resolution and / or a tracking tool
- Novice proficiency in Microsoft Access
- Experience working with Agile Methodology
- Experience supporting Provider Configuration User Acceptance Testing (i.e. Pre-auth, Reciprocity / Network Schedule, Referral, Penalty)
24
Provider Data Analyst Resume Examples & Samples
- 2+ years of experience supporting Provider Demographic or Network / Contract Configuration
- Experience supporting Provider Configuration User Acceptance
- Oxford / Pulse experience with Provider Demographics or Contract Data
- Experience with CA Central
25
Provider Data Analyst Resume Examples & Samples
- Investigate non - standard requests and problems, with some assistance from others
- Experience with Facets or its equivalent
- 2+ years experience in managing cross functional projects and making presentations
- Advanced proficiency Excel, Access and PowerPoint
26
Provider Data Analyst Resume Examples & Samples
- Manage data integrity within multiple databases (e.g. PIMS, QNXT) in accordance with established quality standards
- Review, analyze, and comprehend appropriate fee schedule interpretation for setup and maintenance
- Serve as point of contact within the company for questions related to provider data and set up
- Maintain data specialty dictionary related to provider data by updating and revising definitions
- Other job duties and projects as assigned
- Support compliance with all CMS, Federal and State requirements including but not limited to Chapters 3, 4, 5, 6 and 9 of the Medicare Managed Care Manual
- Two year degree preferred. High School diploma/GED and/or two years of experience or training in healthcare setting
- Experience working with Medicare Advantage/Centers for Medicare and Medicaid Services (CMS) preferred
27
Provider Data Analyst Resume Examples & Samples
- Data maintenance, reporting, and analysis for providers, locations, networks, fees, and payees
- Establish and document standards for database integrity
- Provides feedback to reduce errors and improve processes
- Research request including professional communications with the provider to ensure proper actions are taken to achieve the intended result
- Balances company goals with incoming request to troubleshoot potential conflicts
- Coordinate activities internally to ensure other functional areas are aware and aligned with incoming requests on key groups
- Track all work with actions taken and close the loop upon completion or as indicated on the request
- Participate in process improvement discussions and actively represent functional area
- Document policies and procedures and review / modify as needed
- Other projects and duties as assigned
- 3 years of experience working with vision insurance, healthcare, or provider relations
- Experience working with multiple complex and detailed data systems
- Experience in researching requests and deriving a solution
- Critical thinking skills
- Able to research and solve complex problems
- Ability to prioritize effectively and work independently
- Excellent written and verbal skills
28
Senior Provider Data Analyst Resume Examples & Samples
- Streamlines communication between UHN and Provider Contract Data Management (PCDM) team regarding contract / demographic updates by creating consistent business rules and processes to eliminate handoffs and rework
- Ensures high quality data submissions for groups / territories
- Reduces contract/demographic errors that affect members of gated products: C&S, Exchanges, etc
- Performs regular (at least annual) Contract analysis for Tier 1 and other high - profile provider groups
- 2+ years of experience with provider contracting / provider data
- Proficiency with all UHC provider data systems (NDB) and claims platforms (UNET, PULSE, CSP Facets, COSMOS, Impact, NICE, FICAS) used in the region
- Due to the aggressive national and regional expansion plans of CAT, internal candidates with UnitedHealth Group experience is highly preferred
29
Temporary Provider Data Analyst Resume Examples & Samples
- Identify and accurately analyze data file components to complete record set-up of practitioners and facilities; which may include credentials documents such as contracts, fee schedules, and other highly sensitive information. Interpret and escalate data to ensure timely and accurate record set up
- Validate, coordinate, collect and communicate provider data for use by internal customers in a timely manner, and in accordance with established reporting standards and departmental guidelines
- Perform follow-up actions as necessary for data collection and maintenance
- Extract data and review to interpret and identify any required validation activities and to detect issues and/or trends for further analysis. Conduct system audits and provide results for process improvement activities
- Actively anticipate and report potential areas of concern within data and in consideration of downstream processes (e.g. claims, utilization management, enrollment, and provider network) for potential network inadequacies
- Assist with evaluation and testing processes related to system enhancements
- Manage “In-box” and respond timely to provider enrollment requests and to validate member eligibility and claim status
- Manage timely processing of provider data claims work queues and incoming correspondence scanning queue. Index and file incoming information into appropriate storage files after completion of required response activity
- Experience with Medicare reimbursement methodology preferred
- Experience in credentialing, medical billing, claims processing and/or office administrative health care environment (preferred)
30
Provider Data Analyst Resume Examples & Samples
- Responsible for the loading of Provider data into multiple systems – i.e. claims, directory, HSD Tables
- Act as a SME (subject matter expert) for provider demographic loading into all Cigna-HealthSpring systems
- Provide one-on-one training to individuals to drive performance and quality improvement
- Track issues and opportunities from matrix partners and provide feedback to those respective teams
- Report on adherence to policy requirements on a regular basis by monitoring and auditing volume, production, and accuracy of team’s work
- Act with a sense of urgency to research questions or issues raised by both internal and external customers. Identify the right parties or resources to resolve these issues. Follow up with these parties to drive resolution and provide on-going feedback to individual(s) who raised the question or issue
- Intake provider data from multiple sources. Vet and distribute data to appropriate personnel
- May be responsible for directing other team members’ work distribution of work assignments on a daily and weekly basis, as well as monitoring turnaround times to ensure CMS compliance
- Managing the full risk, delegated IPA relationships unique to the Arizona market
- Providing guidance to the team relative to the delegated (non-full risk) provider groups specific to the Arizona market
- Coordinate with PDM team relative to shared providers to ensure no duplication of work is taking place between the two teams
- Coordinate with National Ancillary & Facility team members to ensure accuracy for their subset of providers
- Strong knowledge of healthcare insurance industry, terminology, provider networks, contracting and credentialing
- Experience with the provider onboarding process, system applications and procedures
- Ability and willingness to share knowledge and coach individuals with varying levels of experience
- Detail oriented, with proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards)
- Excellent communication skills – verbal, written, and presentation
31
Medicare Provider Data Analyst Resume Examples & Samples
- Ongoing analysis of provider data to assure quality and adherence to defined procedures
- Data discrepancy reporting and resolution
- Provider Rosters and Medicare Corporate Provider return mail
- Create and maintain Medicare Provider Contract, Configuration and issue tracking and status reporting
- Translation of CMS Medicare Provider Data requirements into reports of these functions to ensure performance standards meet all CMS Directory, HSD Table, Claims and Audit requirements as well as applicable State and Contractual requirements
- Collaborate with Provider Network Management, Provider Data Management, Provider Data Integrity, Claims and any/all other Departments
- Development of department workflows, policies and procedures as well as training material, recurring and complex ad-hoc reports and data sets
- This position will also demonstrate proficiency with trending and performance analysis, recognizing patterns and possible variables that impact performance
- Identification of operational gaps, risks and issues, opportunities for efficiencies and strategies for process improvement
- Development of short and long term solutions, monitoring plans and mechanisms; implementation and UAT for change management and process improvement
- Ability to develop and understand business process flows and impact to performance results. Elaborate findings, insights and communicate such to management, internal and external customers
- Express status of performance through summaries, including changes in performance and impact to performance standards
- Up to 5 years' Claims processing, configuration and Medicare
- CMS Medicare technical experience and understanding of regulatory requirements
- Microsoft Office, FACETS, SQL, SAS, , Crystal Reports, Data warehouse ad hoc queries
- Must haves Medicare and FACETS experience in order to apply
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Senior Provider Data Analyst Resume Examples & Samples
- Provide clear explanations and information to others on difficult issues
- 4+ years' data analysis and/or audit experience within the healthcare industry
- 3+ years’ experience in managing cross-functional projects and making presentations
- 3+ years' customer response / customer service experience
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Provider Data Analyst, Medicaid Accounts Resume Examples & Samples
- 2+ years experience with NDB
- 2+ years customer response / customer service experience
- Intermediate level of proficiency in tracking, trending and reporting on metrics
- Previous experience with Medicaid
- Experience managing work across functions / departments
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Provider Data Analyst Resume Examples & Samples
- At least an intermediate level of proficiency with MS Excel
- 1+ years experience with CSP Facets
- 1+ years experience with OHBS Facets
- 1+ years experience with Cosmos
- Previous experience with Behavioral Health
- Proficiency with SharePoint
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Provider Data Analyst Resume Examples & Samples
- Use pertinent data and facts to identify and solve a range of problems
- Investigate requests and issues
- Provide explanations and information to others
- 2+ years’ of provider data loading and / or audit experience using CSP Facets, OHBS Facets, NDB, or Cosmos
- 2+ years’ of experience in managing cross functional projects
- 2+ years’ customer response / customer service experience
- Proficiency in tracking, trending and reporting
- Proficiency in Excel
- Strong organizational, presentation, and interpersonal skills
- Working knowledge of applying policies and procedures
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Senior Provider Data Analyst Resume Examples & Samples
- 2+ years' data analysis and/or audit experience within the healthcare industry
- 2+ years’ experience in managing cross-functional projects and making presentations
- 2+ years' customer response / customer service experience
- Advanced proficiency in MS Excel, and PowerPoint
- Intermediate level understanding of UHG provider data, including at least one of the following: NDB, UNET, Facets
- Experience with data entry to NDB
- Advanced proficiency in MS Access
- Experience with Community & State (Medicaid) business
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Provider Data Analyst Resume Examples & Samples
- 2+ years of data analysis and / or audit experience within the healthcare industry
- 2+ years of experience in managing cross functional projects and making presentations
- 2+ years of customer response / customer service experience
- Intermediate proficiency Excel, Access
- NDB Knowledge
- Phycon experience
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Provider Data Analyst Resume Examples & Samples
- Ability to mentor and coach DLAs on errors and loading procedures
- Experience in either leading or participating in quality projects (Six Sigma and etc.)
- Ability to communicate / work with internal PCDM stakeholders
- Lead quality discussion forums on error topics/trends with contract / demo load teams to prevent errors from occurring moving forward
- Intermediate level of proficiency in tracking, trending, data analytics and reporting on metrics
- Intermediate proficiency in Excel and PowerPoint
- Experience and knowledge with NDB, CSP, FACET, Emptoris, PhyCon, NICE and Pulse
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Provider Data Analyst Resume Examples & Samples
- Ensure accuracy of NDB data
- Candidate must possess strong skills in the following areas
- 2+ years working with internal and external business partners or vendors
- Advanced understanding or knowledge in the NDB system
- Advanced proficiency in Excel, Word, Access and PowerPoint
- Working knowledge of provider contracts within the NDB system
- Assisting in writing policies and procedures
