close
  • Dashboard
  • Resumes
  • Cover Letters
  • Resumes
    • Resumes
    • Resume Builder
    • Resume Examples
      • Resume Examples
      • Nursing
      • Customer Service
      • Education
      • Sales
      • Manager
      • View All
    • Resume Search
    • Resume Templates
      • Resume Templates
      • Microsoft Word
      • Professional
      • Modern
      • Traditional
      • Creative
      • View All
    • Resume Services
    • Resume Formats
      • Resume Formats
      • Chronological
      • Functional
      • Combination
    • Resume Review
    • How to Write a Resume
      • How to Write a Resume
      • Summary
      • Experience
      • Education
      • Skills
        • Skills
        • Hard Skills
        • Soft Skills
    • Resume Objectives
  • CV
    • CV
    • CV Examples
    • CV Formats
    • CV Templates
    • How to Write a CV
  • Cover Letters
    • Cover Letters
    • Cover Letter Builder
    • Cover Letter Examples
      • Cover Letter Examples
      • Customer Service
      • Marketing
      • Sales
      • Education
      • Accounting
      • View All
    • Cover Letter Services
    • Cover Letter Templates
    • Cover Letter Formats
    • How to Write a Cover Letter
  • Questions
  • Resources
  • About
    • About
    • Reviews
  • Contact
  • jane
    • Settings
    • Help & Support
    • Sign Out
  • Sign In
Member Login
  • LiveCareer
  • Resume Search
  • Analyst auditor
Please provide a type of job or location to search!
SEARCH

Analyst auditor Resume Example

Love this resume?Build Your Own Now
ANALYST AUDITOR
Experience
Analyst auditor
  • Create and review CDAG (Medicare Coverage Determination) Compliance call reports and provide audit analysis to Customer Service Leadership, Training and Quality team to identify continuous improvement activities, compliance adherence and specialist performance within customer service Create, review and maintain FCR (First Call Resolution) Grievance report.
  • Conduct a thorough investigation of grievance report for complete and accurate grievance resolution, member satisfaction, categorization, and documented procedural adherence.
  • Determine operational impact and need action analysis; elevate immediate issues, report trends, and areas for improvement and opportunities to management through report analyst and maintenance.
  • Create and review compliance and operational data reporting and analysis along with managing ad hoc projects and other reports Document and communicate audit findings through written documents, models and quality huddle notes creation for grievance error specific trends.
  • Maintain, analyze and schedule departmental statistical reports and surveys in a timely manner to include recommendations for continuous process improvements initiatives as needed.
  • Assist in updating Grievance training materials along with Policy and Procedures for both Medicare and Commercial product lines for Customer Service and Appeals & Grievance Analyst.
  • Assist with external vendor management initiatives Created and reviewed financial reports; recouped several thousand dollars in lost revenue due to incorrect billing, death, and termination of benefits as well as processed reimbursement claims Grievance analyst Conduct investigations and root cause analyst to drive issue to the resolution of the member's grievance.
  • Accurately, completely and consistently, research and analyze member's issues and collected data in accordance with developed processes, policies and procedures and standards.
  • Review grievances sent to the member grievance workbasket and process via telephone or letter.
  • Provide thorough investigative skills to resolve complaints received directly from the Health Insurance Marketplace.
  • Review the electronic files that are sent from the Marketplace.
  • Processed and resolved state complaints, grievances, CTM complaints, LEP complaints, denials and appeals, email and social media complaints.
  • Participated in level 2 appeals telephone conferences and CMS audit.
  • Pharmacy analyst Lead technician on the implementation of PBM change and oversight.
  • Assisted with formulary updating, criteria formation, plan changes and minutes for P&T Committee Identified and reported FWA to the State of Michigan, resolved grievances and appeals from pharmacy and State of Michigan, Lead technician in medication drug review including high-dollar drugs, coordinated care of chemotherapy drugs with providers to maintain drug cost.
  • Assisted pharmacies in the proper billing of medications and supplies Assisted in Medicare enrollment, LEP determination, COB determination, and entry, created and reviewed reports, trained new employees, created training materials.
  • Accounts receivable liaison.
  • Assisted in guideline formation, formulary management including authorization criteria and medication pricing (AWP, FUL, WAC, MAC), network development, new program formation and testing.
  • skills and abilities High-Quality Auditor and Subject Matter Expert (SME) on multiple lines of businesses to include HMO/PPO/POS/ Federal Employee Health Plan and traditional health care delivery systems, benefits and riders, eligibility and Direct Pay programs and rates.
Analyst
August 2016 to Current
Transwestern
  • An Audit analyst who has worked in multiple positions to include Medicare Sales, Correspondence, and Grievances that create and review compliance reports, data analytics, trends, report maintenance and assist in policy and training updates.
Grievance analyst
April 2016 to October 2016
Cvs Health
  • A grievance analyst who reviewed and completed Marketplace complaints (HICS) and participated in training new employees and grievance entry.
Pharmacy grievance analyst | Meridian rx
June 2013 to October 2015
  • A pharmacy technician who processed grievances resolved escalated phone calls and prior authorization request.
  • Also participated in training new employees, troubleshooting liaison, phone queueand project management.
  • pharmacy analyst | total health care | april 2011 - march 2013.
  • A lead pharmacy analyst who participated in reporting, prior authorization review, CSHCS adherence, compliance reviewer, FWA auditor, overutilization reviewer, member and pharmacy locks, and revenue recoup analyst.
Education
Bachelor of Science : Health Administration, 2019Eastern Michigan UniversityHealth Administration MACRAO & MTA transfer agreements associate of science | may 2016 | henry ford college pharmacy technician license
Certified Pharmacy Technician and fully licensed in the State of Michigan 3
Summary
An analyst seeking an opportunity to apply my vast knowledge and expertise in an environment where I can utilize my analytic skills efficiently and effectively while continuously learning and growing in the healthcare industry. Project Management skills through review and analyzing reports, addressing systematic issues with developers and IT to resolve, proposal writing, and policy updating. Leadership skills through organizing and conducting meetings, training, and teaching. Proficient in all Microsoft products to include Excel, Word, and OneNote Customer Service-driven through flexibility and by providing good judgment and logic Workforce management (WFM) background through call queue management Ability to work in any environment, strong problem-solving and investigating skills. Excellent written and verbal communication skills. Accounting background through finance classes and through purchase order creation and completion
Skills
Accounts receivable, ad, Analyst, benefits, billing, chemotherapy, CMS, compliance reports, conferences, continuous improvement, Customer Service, delivery, email, financial reports, Insurance, Leadership, notes, MAC, managing, network, Pharmacy Technician, policies, POS, pricing, processes, project management, Quality, reporting, research, Sales, surveys, technician, telephone, phone, training materials, troubleshooting, vendor management, written
Build Your Own Now

DISCLAIMER

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

How this resume score could be improved?

Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:

56Fair
Resume Strength
  • Completeness
  • Formatting
  • Word choice
  • Measurable results
  • Strong summary
  • Typos

Resume Overview

School Attended

  • Eastern Michigan University

Job Titles Held:

  • Analyst auditor
  • Analyst
  • Grievance analyst
  • Pharmacy grievance analyst | Meridian rx

Degrees

  • Bachelor of Science : Health Administration , 2019
    Certified Pharmacy Technician and fully licensed in the State of Michigan 3

Create a job alert for [job role title] at [location].

×

Advertisement

Similar Resumes

View All
Business-Control-Analyst---Auditor-resume-sample

Business Control Analyst - Auditor

Diebold Corp

Mankato , MN

Quality-Analyst/Lead-Quality-Auditor/Quality-Inspector-resume-sample

Quality Analyst/Lead Quality Auditor/Quality Inspector

Total Wine

Pleasanton , CA

ISO-INTERNAL-AUDITOR-AND-RISK-ANALYST-resume-sample

ISO INTERNAL AUDITOR AND RISK ANALYST

Erm Protect

Coral Gables , FL

  • About Us
  • Privacy Policy
  • Terms of Use
  • Sitemap
  • Work Here
  • Contact Us
  • FAQs
  • Accessibility
  • EN
  • UK
  • ES
  • FR
  • IT
  • DE
  • NL
  • PT
  • PL
customerservice@livecareer.com
800-652-8430 Mon- Fri 8am - 8pm CST
Sat 8am - 5pm CST, Sun 10am - 6pm CST
  • Stay in touch with us
Site jabber winner award

© 2022, Bold Limited. All rights reserved.