Business Analyst Resume Profile

SUMMARY:

Senior level analyst with sixteen years experience in trend analysis, medical management reporting and analysis, health care data and analytical tools.

EXPERIENCE:

Confidential

Support the Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis and data tools
Develop, refresh and provide national data tools designed to facilitate 936
Support Unit Cost Trend tracking and reporting
Work with contracting teams and management to identify savings opportunities
Serve as a key resource on complex and/or critical issues
Perform complex conceptual analyses
Provide explanations and information to others on the most complex issues
Motivate and inspire other team members

Confidential

Develop ad hoc reports and analysis using knowledge of SQL query language to query data warehouse
Develop and produce reports for the Medical Management department and senior management

Develop and update medical Budget-to-Actual analyses

Leverage staff from within and outside the department to successfully complete projects

Make recommendations to senior management to solve business issues related to contract requirements and utilization trends
Develop and enhance reporting tools for the behavioral health department in order to meet internal and external contractual requirements

Confidential

Review, analyze and evaluate business systems and user needs
Develop written specifications of user needs, program functions, and steps required to develop or modify computer programs
Formulate report design to parallel overall business strategies
Develop ad hoc reports and analysis
Test data prior to report implementation

Confidential
Developed and maintained weekly and monthly utilization management statistics.
Gathered information, created spreadsheets, reported information both accurately and timely.

Prepared monthly claims lag and IBNR analysis. Developed historical comparative analysis of authorized versus claims paid data for all levels of care and monitored monthly.

Confidential

Assisted in the development of annual medical budgets. Compiled historical data in order to analyze utilization trends.

Assisted in annual contract re-negotiations by evaluating impact of proposed adjustments to PMPMs.

Developed ad-hoc reports from data warehouse to be used as business decision-making tools by clinical and financial business owners.

Acted as liaison between Finance and Information Technology Department.

Confidential

Generated weekly and monthly utilization management statistics.
Coordinated report submission to internal and external stakeholders to comply with contractual obligations.
Generated desktop reports from a data warehouse using IQ/Object and Crystal Reports.
Team leader and facilitator of several performance standard teams.

Confidential

Marketing Representative

Confidential

Marketing/Client Service Representative

Confidential

Territory Manager

Confidential

Credit and Collection Correspondent

TECHNICAL SKILLS:

Hardware: PC's Operating Systems: DOS
Software: SAS, MS Query Analyzer, Sybase SQL, COGNOS Business Intelligence Tools OLAP , Microsoft Excel, Pivot Table Reports, Palisades Risk, MHS

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