Seeking to build my knowledge within UnitedHealthcare as I branch into new challenging areas. Self-motivated Data Analyst offering 10 years of leadership experience across various industries. Methodical with significant experience in data mining and statistical analysis. Excellent problem-solver with history automating processes and driving operational enhancements. Logical Data Analyst skilled in requirement analysis, software development and database management. Self-directed and proactive professional with 5 years of vast experience collecting, cleaning and interpreting data sets. Natural problem-solver possessing strong cross-functional understanding of information technology and business processes.
Skills
Data quality
Business management
Microsoft Access
Administrative oversight
Project management
Data gathering
Failure analysis
Experience
Senior Provider Data Analyst, Project team, 12/2016 to Current United Healthcare – City, STATE,
Works with Network Management team to ensure providers are loaded correctly within the major systems by reviewing and completing cases submitted by Network team in Impact
Review contractual and demographic data currently loaded within NDB, FACETS, Nice, and Cosmos
Run various reports to assist with review of groups, i.e
Danner Tool, NDAR, NPPES, AMAARDI, etc
Audit provider contracts to review correct contracts are loaded for reimbursement via Emptoris/CLM and NDB to complete cases submitted by NAM
Completes Direct Loads for updates/corrections that can be manually completed
Submits automated requests through Titan making needed provider updates within various systems, COSMOS, NDB, etc
Submit PhyCon PR’s and RESCU (for Urgent cases) for requests that need an in-depth review or correction
Complete Audits of work to ensure request was completed correctly
Respond timely to clarifications for the loading team to complete their process
Assist team members when and where able to – questions or completion of tasks when assistance is needed
Complete Audit review of Rosters for provider group to ensure providers are loaded to all contracts as well as locations
Work in unison with provider and/or Network to obtain data needed to complete audit as well as submit case for group correction
Back up for “Quarterback Position” which entails managing new Project cases that are assigned to our Project queue, reviewing that all pertinent information is attached, working with Network to gather additional information, and assigning cases to team members to complete
Special project with completing NPN provider updates.
Prior Authorization Supervisor, 12/2011 to 12/2016 United Healthcare – City, STATE,
Recruits, screens, and selects applicants for Coordinator positions
Ducates all staff on revised job processes
Nsures proper training of new staff by utilizing the resources available within the team, i.e
SOP’s, Job Aids, DES, etc
Assign work to staff
Anages mentors and supports staff on a daily basis
Evelops and mentors SME’s
Ssists on M&R line of business
Evelops clear goals and objectives for performance management and effectively communicate accountability as well as setting and achieving goals such as Quality and Metrics
Reates a culture and atmosphere that will lead to team's overall job satisfaction, identifying and addressing possible work barriers
Mplements and evaluates strategies to improve performance including work improvement plans and making final determination on terminations of employment
Tilizes management reports for the department to assess performance of entire team, identifying areas of improvement and putting action plan in place
Analyze and identify trends with inventory, adjust gaps and allocate staff where needed to ensure inventory is properly covered
Review daily inventory and provide case volume to business partners on morning call
Acilitate weekly huddle with team to review new processes, patterns of issues or address any questions
Complete Monthly 1:1’s to review Audits and Metrics as well as any case issues found
Attend various Business Partner calls, i.e
Annual Grid review, meetings with the plan to discuss changes/transitions, implementations of new business, manager Weekly meeting, etc
Work with RN Staff daily to ensure cases are managed in a timely manner
Et up and review employee Annual performance reviews, and goals for the coming year
Ork cross-functionally with Management to promote the Coordinator function within the Company
Assisted with the Military and Veterans project
Financial Counselor Supervisor, 12/2009 to 12/2011 Ironwood Cancer & Research Center – City, STATE,
Responsible for supervising 16 employees between the Gilbert, Chandler and Mesa offices
Oversee productivity with the Financial Counselors which include meeting with patients to review their estimated cost for treatment, reviewing other options of funding such as assistance programs and drug replacement assistance
Acquire benefits and authorization for various insurance plans, including Commercial Insurance (E&I), Medicaid (C&S) and Medicare (M&R)
Reviewing claims processing and ensuring that claims have processed according to patients benefits and reviewing with patient 1:1
Monitoring that employee’s complete log for each date of service in a timely manner
Completing regular audits of each employee to make sure they are following proper Policy and Procedure
Developing and adjusting Policy and Procedures and implementing changes with staff due to business changes
Completing probationary period reviews as well as yearly reviews and offering additional training and mentoring where needed
Reviewing and submitting disciplinary write ups
Review with Business Office Manager regarding hiring and firing employees
Oversee training for all employees as well as conduct training for Business Office employees to ensure proper procedures are being followed
Assist in various positions when needed.
Network Relations/Provider Relations Manager, 12/2003 to 12/2009 Foundation Administrative Services – City, STATE,
Oversaw network relations
General oversight and interaction with its 15 affiliated organizations
Maintenance and management of provider contracts
Auditing claims processing by clients
Liaison between provider and client to ensure claims are processed according to contract in place
Auditing and maintenance of the statewide provider database
Development of local foundation website
Project manager for development of the claims system
Project manager for development of the provider maintenance system
Development and implementation of Policy and Procedure guidelines for systems
Development and implementation of trainings on new systems for affiliated organizations and clients of the PPO network
Education and Training
M.H.A: , Expected in Bellevue University - Bellevue, NE GPA: GPA: 3.5
B.S: Criminal Justice, Expected in Florida Metropolitan University - Tampa, FL. GPA: GPA: 4.0, Summa Cum Laude
Activities and Honors
Member, National Criminal Justice Association, January 2009 to present
Accomplishments
Assist CEO with developing proposals and marketing opportunities
Development of provider contracting and relations
Marketing of PPO Network to potential clients as well as key contact person for current clients
Implementation of new client business as well as development of products to disburse to employees of new client
Completed all training required for access and review of database, provider search, etc
To various clients and sister Foundations, Time Management, Independence Blue Cross, Philadelphia, PA, March 1997
Olunteer Experience:
Ay 2007 to December 2007, Trauma Intervention Program, Corona, CA
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