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Sr. Health Industry Analyst RN Resume Example

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SR. HEALTH INDUSTRY ANALYST RN
Professional Summary

Professional Registered Nurse versed in research and analysis. Seeking a leadership position to develop and implement new and innovative health care improvement processes and admission procedures. Extensive knowledge of Medicare Rules and Regulations for government payers. Data analysis and utilization experience demonstrated through reduction in CERT error rates for the Medicare Administrative Contractor JN jurisdiction. Utilizing data and provider input, I was able to create a task force and reduce sepsis mortality rate as the performance improvement coordinator.

Licenses

Registered Nurse - RN9248489


Certified Professional Coder

Skill Highlights
  • Health and wellness expertise
  • Skilled in conducting physical examinations
  • Compassionate STD care and counselor
  • Broad medical terminology knowledge
  • Committed to compliance reporting
  • Effective policy and program development
  • Culturally sensitive
  • Strong medical ethic
  • Computerized charting specialist
  • Familiarity with disease management programs
  • Medical clinical procedures comprehension
  • Medicare Rules and Regulations
  • Data analysis
  • Healthcare Utilization
  • Familiar with ICD 10
  • Outpatient Coding
Professional Experience
First Coast Service Options, Inc. Jacksonville, FL Sr. Health Industry Analyst RN 01/2013
  • Validates data analysis results and analytically identifies potential fraud, waste and or abuse situations in violation of Medicare laws, guidelines, policies and regulations Utilize data analysis techniques to detect aberrancy in Medicare claims data and proactively seeks out and develop output for cases received from a variety of sources including CMS, OIG and ZPIC.
  • Completed my Capstone project regarding a cost analysis of teleworking vs. housing employees on site.
  • Published articles for Medicare Provider Education in Part B claims for First Coast Service Options website.
  • Create, review and deliver formal presentations to the Program Safeguard Communication Group (PSCG).
Orange Park Medical Center Orange Park, FL Performance Improvement Coordinator RN 01/2012 to 01/2013
  • Developed Focused Professional Practice Evaluations (FPPE) for mid-level providers, following Joint Commission and Centers for Medicaid and Medicare (CMS) Standards Maintaining and improving flow for all FPPE's/OPPE's for physicians to meet TJC standards.
  • Facilitating with CPC to optimize the accuracy of credentialing functions for the Cactus database to be used by the Medical Staff Office.
  • Analyzes Risk management incidents and triages queries for further review with Medical Department Chief and/or Committee Review Provides administrative support and quality reviews for the departments of, Orthopedics, Cardiology, and Internal Medicine, Surgery and Anesthesia i.e. facilitating agendas, minutes/metrics and follow up.
  • Tracking and trending physicians for appropriate quality care through Crimson based on metrics to provide quality driven outcomes Extremely versed in Crimson software
  • Actively worked on Clinical Excellence initiatives targeting sepsis mortality and AMI LOS
  • Abstracts all outpatient data; CORE measures i.e. ED arrival to discharge, Pain management, and Outpatient surgery.
  • Helped Develop Outpatient SCIP process to help streamline and monitor Outpatient SCIP antibiotic selection and re-educate physicians and nursing when needed.
  • Abstracts inpatient CORE measure VTE, key person to implement a massive education on the measure to all of nursing and restructure Meditech screens to optimize best patient care.
  • Abstract Emergency Department measures, SCIP CORE measure.
Trace Regional Medical Center Houston , MS Emergency Department RN 01/2008 to 01/2012
  • Assist in various procedures: Intubation, Chest Tube Insertion, Internal Jugular lines, central lines, incision and drainage of large abscesses, etc.
  • Documented and assessed patients for CORE measure metrics Team lead for Code Blue Team in the ED Handling inmates from local prisons for care Appropriately and effectively triaged patients based on acuity Administered medications and treatments as prescribed by the physician.
  • Coordinating transfers for more critically ill patients Maintain barrier nursing techniques and prevent cross contamination.
  • Provide psychological support to the patient and relatives.
Hematology Associates of North Mississippi Tupelo, MS Registered Nurse 01/2008 to 01/2009
  • Administered Chemotherapy agents to clients on daily basis Monitored clients for reactions or adverse effects of therapeutic drugs
  • Accessed VAD's with aseptic technique
  • Accessed Peripheral lines via aseptic technique Initiated intravenous lines on clients for the administration of chemotherapeutic agents
  • Provided education to clients regarding chemotherapy agents they were receiving.
Volusia County Deparmtent of Health Daytona Beach, FL Senior Registered Nurse 01/2006 to 01/2008
  • Total accountability of management for the Federal Title X program for Daytona Beach.
  • Duties include but not limited to Patient Assessment, injections, maintenance of medication supply, assist practitioners with exams and follow up.
  • Intake of client phone calls, handling questions and concerns with appropriate management and documentation, while maintaining confidentiality at all times.
  • Record pertinent data on client records along with appropriate follow-up management, triage and referrals to community resources and providers; completes and submits encounter forms, billing forms, lab slips and screening documents.
  • Selected as Lead nurse for Emergency Shelter.
  • Responsible for infection control, treatment, and reporting i.e.
  • STDs, Rabies, and Tuberculosis.
Education and Training
Masters of Science: Nursing 2015 Western Governors University, Salt Lake City, UT

Leadership & Management
Bachelors of Science: Nursing 2014 Western Governors University, Salt Lake City, UT
Associate of Science: Nursing 2006 Lake-Sumter State College, Leesburg, FL
Professional Affiliations

American Academy of Professional Coders

Florida Nurse Association

Skills

Medicare; Healthcare; Microsoft Office Suite; SAS; Computerized Charting; Quality: Quality Metrics; Managed Care; Advanced Problem Solving; Great Organizational Skills; Data Analysis

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Resume Overview

Companies Worked For:

  • First Coast Service Options, Inc.
  • Orange Park Medical Center
  • Trace Regional Medical Center
  • Hematology Associates of North Mississippi
  • Volusia County Deparmtent of Health

School Attended

  • Western Governors University
  • Lake-Sumter State College

Job Titles Held:

  • Sr. Health Industry Analyst RN
  • Performance Improvement Coordinator RN
  • Emergency Department RN
  • Registered Nurse
  • Senior Registered Nurse

Degrees

  • Masters of Science : Nursing 2015
    Bachelors of Science : Nursing 2014
    Associate of Science : Nursing 2006

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