Healthcare Economic Consultant Resume Sample
Velva Hickle
253 Leonie Mills,
Houston,
TX
+1 (555) 125 7564
Work Experience
Senior Healthcare Economic Consultant
04/2017
-
PRESENT
Phoenix, AZ
- Breakdown complex problems into individual root causes
- Interpret and analyze claims, capitation and membership data in support of Underwriting, Actuarial and utilization analyses
- Lead projects to completion by contributing to database creation, statistical modeling and Network reports
- Work closely with ETL team mapping and validating client data
- Develops comprehensive understanding of clinical programs being measured and improve quantitative data analytics
- Works with variety of team to identify potential areas for medical cost improvements and alternative pricing strategies to drive clinical and financial performance of programs
- Lead projects to completion by contributing to data mapping and transformation, statistical modeling and financial reports
- Performs statistical and trend analyses to determine effectiveness of clinical programs (e.g. pre-post analysis, clinical trial results)
- Collects, analyzes and performs quality assurance on analytic initiatives that consume data from multiple sources
Healthcare Economic Consultant
02/2012
-
10/2016
San Francisco, CA
- Identify and implements consistent and sustainable analytic processes in order to track and measure program effectiveness
- Provides consistent and timely communications on projects, outcome and recommendation from analyses
- Partners with business leaders to develop effective clinical strategies
- Interpret and analyze Commercial, Medicare and Medicaid claims in support of Coordination of Benefits savings initiatives
- Write business requirement documents for new algorithms and update existing documents as the algorithm logic is developed or changes over time
- Prepare accurate reports to detect and identify fraud trends, analysis of those trends and risk mitigation recommendation
- Lead large scale projects to achieve key business objectives
Healthcare Economic Consultant / Developer
09/2008
-
11/2011
Philadelphia, PA
- Breakdown complex and unique problems into individual root causes; reporting mitigation and go forward plans to senior leadership
- Provide continuous process improvement recommendations
- Participates in the development of new or enhanced business strategies
- Develop and manage project plans to achieve key objectives
- Research potential overpayment scenarios through the use of client policies and provider contracts
- Present to and consult with physician leadership, clinical review teams, auditing teams, and payment integrity teams
- Identify payment errors regardless of claim system by reviewing data and possessing claims
Education
University of Medicine and Dentistry of New Jersey - Piscataway / New Brunswick Campus
2004 - 2008
Bachelor's Degree in Epidemiology
Professional Skills
- Strong computer skills: MS Excel, Word, Access, PowerPoint
- Crystal Report skills and SQL Server experience
- Utilize excellent communication and presentation skills
- Demonstrable analytic experience working with Coordination of Benefits (COB) - Medicare experience
- Professional presentation and consulting skills
- Intermediate skills in performing data analytics
- Experience in healthcare (preferably billing, coding, auditing claims, pricing)
How to write Healthcare Economic Consultant Resume
Healthcare Economic Consultant role is responsible for sql, auditing, finance, training, database, reporting, design, consulting, research, modeling.
To write great resume for healthcare economic consultant job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Healthcare Economic Consultant Resume
The section contact information is important in your healthcare economic consultant resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Healthcare Economic Consultant Resume
The section work experience is an essential part of your healthcare economic consultant resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous healthcare economic consultant responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular healthcare economic consultant position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Healthcare Economic Consultant resume experience can include:
- Strong computer skills: MS Excel, Access
- Use operational analytical skills to design/develop, program, maintain and publish reports
- R, Python, Tableau, Hadoop, and Big Data skills
- Experience auditing, billing, and/or coding claims
- Healthcare experience working directly with claims data and medical codes, and abstracting medical records
- Experience working with large data sets, proficiency in performing data analytics
Education on a Healthcare Economic Consultant Resume
Make sure to make education a priority on your healthcare economic consultant resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your healthcare economic consultant experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Healthcare Economic Consultant Resume
When listing skills on your healthcare economic consultant resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical healthcare economic consultant skills:
- Validate, measure and track key leading indicators and lagging indicators to determine the effectiveness of the clinical management
- Exceptional time management and organizational skills to manage concurrent deliverables in a fast-paced environment
- Health care experience working with claims data and medical codes – Proficiency in performing data analytics
- Certification in Medical coding or at least 1 years of extensive coding experience
- Work experience in a corporate setting working in a quantitative and/or analytical capacity
- Experience working healthcare claims lifecycle (i.e.: submission, processing, adjudication, and payment)
List of Typical Experience For a Healthcare Economic Consultant Resume
1
Experience For Senior Healthcare Economic Consultant Resume
- Understanding the EDPS netting logics
- Develops comprehensive understanding of programs being measured
- Leverage and coordinate enterprise wide capabilities to meet business specific reporting needs and solution
- Provide claims, provider, and membership data in support of monthly production, reporting, and data extraction for the clients
- Participate in analytical, experimental, investigative, and other fact-finding work in support of concept development
2
Experience For Occm / Cph-healthcare Economic Consultant Resume
- Industry thought leader and subject matter expert for healthcare pricing initiatives
- Supports efforts to standardize data from multiple sources to make available to key analytic stakeholders and reporting tools
- Provides ongoing communications on project status, results, and conclusions from analyses
- Develop, analyze, and refine existing analytical models and database queries as appropriate
- Interpret and analyze claims, premium, capitation, and membership data in support of underwriting, actuarial, and utilization analyses
- Calculate financial impact through valuation model using current rate, past rate and future rate
3
Experience For Healthcare Economic Consultant / Developer Resume
- Analyze RAF trends, claim lagged analysis, month on plan reporting
- Explore potential trends identified by internal initiatives and matrix business partners
- Triage anomalies observed with production processes and perform proof of concept analyses
- Perform adjust - down analysis on COB claims (review EOBs and Remits)
- Clearly communicate concept to business partners / clients and be able to appropriately respond to question relating to the logic utilized within hypothesis testing, documentation, and the analytic
4
Experience For Healthcare Economic Consultant Resume
- Performing quality checks for claim overpayment hypothesis results
- Maintain / create job aids / help sheets / policies for a quickly growing team
- Maintain / create job curriculum
- Key resource to others
- Interpret and analyze claims, premium, capitation, and membership data in support of underwriting, actuarial, and utilization analyses within Laboratory Services
- Perform data analytics in support of trend identification, clinical initiative or program development
- Works with a variety of teams to identify areas of opportunity in order to drive financial performance of programs
- Provides consistent and timely communication on projects, results and conclusions from analyses
5
Experience For Senior Healthcare Economic Consultant Resume
- Interpret and analyze medical claim, membership, provider, general ledger, clinical encounter, authorization, pharmacy claim, and lab data
- Lead projects to completion by contributing to data source & destination procurement, data mapping, data dictionary, crosswalk mapping, definition and interpretation
- Document processes, intake, break/fix, governance
- Generate functional business requirements used for various processes, analytic development, strategic reporting, and system navigation (SOPs, BRDs, PRDs, HLDs etc.)
- Develop documentation diagramming & UML support
- Triage anomalies observed with production processes and perform proof of concept analyses for remediation
- Research, identify, and document initiatives delivered by SMEs and various Team members
6
Experience For Occm / Cph-healthcare Economic Consultant Resume
- Integrate well with both internal and external IT partners
- Lead concepts/projects from conceptualization to completion
- Extracts, aggregates and QA applicable data from multiple sources and tables for purposes of root cause analysis
- Works with clinical team to identify areas of opportunity to drive financial performance of programs
- Communicate results to relevant audiences and incorporates results into medical forecast
- Develop and improve quantitative/qualitative data analytics and set performance targets
- Interpret and analyze clinical data from various sources and recommend efficient and accurate methods
7
Experience For Healthcare Economic Consultant / Developer Resume
- Provide and summarize claims, provider, lab, pharmacy, and membership data in support of Business Operations, Analytics, and Clients
- Produce and review production reports
- Presentation of quarterly and annual financial performance and other work product to internal and external customers
- Analyze member information to ensure the Risk Adjustment Factor accurately reflects the member health profile, financial and clinical information
- Prepare and review integrated analysis and reports to ensure the accuracy and completeness of the Medicare Risk Adjustment data, and to ensure compliance with all CMS regulations and guidelines
- Identifies trends and patterns within the Risk Adjustment data and medical record coding to segment and identify areas of risk and opportunity for additional medical record review, member and provider intervention
- Provide management with analysis based on an understanding of the financial impacts of decisions pertaining to Medicare Risk Adjustment and revenue
- Assist in development of membership revenue projections, forecast and budget based on member risk adjustment score and monitoring of variances to identify trends
- Complete complex claims repricing, discount, and cost competitiveness analysis for Request for Proposal process
8
Experience For Healthcare Economic Consultant Resume
- Work with internal and external customers to interpret results and provide strategic guidance with delivery and messaging of results
- Utilize data mining tools (i.e., Access, Excel, Cognos) in order to analyze data and complete deliverables
- Assist in preparation and implement of necessary internal controls for related entities consistent with CMS and to support RADV or other regulatory audits
- Practice ability to perform requested tasks with minimal direction
- Remain highly organized and able to work well under tight deadlines
- Calculate deletes/adds financial impact for CV and IDV from RAPs submission
9
Experience For Senior Healthcare Economic Consultant Resume
- Maintain valuation model for EDS and RAPs
- Able to read CMS announcement and modify changes to valuation codes
- Pull & analyze sweep projection at program level and net against MOR
- Beginner level of proficiency with SQL, SAS and / or other statistical programs
- Experience with claims processing or adjudication systems (Such as UNET, COSMOS, Facets, Diamond, etc. or provider billing / coding knowledge on Professional and Facility claims)
10
Experience For Occm / Cph-healthcare Economic Consultant Resume
- Basic level of proficiency with MS Access
- Knowledge of the claims process
- Health care experience working with claims data and medical codes - Proficiency in performing data analytics - At least a beginner level proficiency with SQL, SAS and/or other statistical programs
- Experience with data analysis, interpretation, synthesis and presentation for conveying results and recommendations to internal/external customers programs
- Experience with analytics for payment integrity
List of Typical Skills For a Healthcare Economic Consultant Resume
1
Skills For Senior Healthcare Economic Consultant Resume
- Health care clinical experience working with a provider ; claims data and medical codes - Proficiency in performing data analytics
- Experience working in a matrix and highly adaptive environment handling tight deadlines
- Experience in performing data analytics
- Experience communicating with senior level business leaders and stakeholders
- 2+years’ experience analyzing very large datasets
- Experience working with SAS
- Medical Claim Coding experience/certification
2
Skills For Occm / Cph-healthcare Economic Consultant Resume
- Experience optimizing SQL query performance
- Medical Claim Coding experience / certification (i.e. CPC, CSS, etc.)
- Work experience in a corporate setting
- Experience in health care analytics and working with large data sets
- Health care experience working with claims data
- Health care experience working with claims data and medical codes –
- Experience working in a healthcare informatics environment with claims data and medical codes
3
Skills For Healthcare Economic Consultant / Developer Resume
- Health care experience working with notifications or claims data
- Experience analyzing very large data sets
- Experience developing Tableau dashboard
- Training / instructional design experience
- Technical Writing and / or Business Requirement Documentation experience
- Health care clinical experience working with a provider; Claims data and medical codes
- Some experience working with data in a Laboratory Services environment
4
Skills For Healthcare Economic Consultant Resume
- Experience using SQL query techniques to access rational databases
- Health care experience working with medical information systems
- Intermediate experience with Claim Processing Systems (Facets, Xcleys, Galaxy, IKA, EZCap, etc.)
- Experience working with Facility claims
- Experience working in healthcare analytics
- Work experience in a corporate setting, preferably healthcare
5
Skills For Senior Healthcare Economic Consultant Resume
- Experience using MS SQL and various other Microsoft products
- Health care experience working with healthcare data
- ) of health care experience working with claims data and medical codes
- Contractual and provider policy auditing experience
- Experience with data analysis, interpretation, synthesis and presentation for conveying results and recommendations to internal/external customers
- Experience analyzing health risk scores
- Experience in medical coding or risk adjustment
- Health care data analytics experience working with claim data and medical codes
- General healthcare accounting, finance, or operations experience
6
Skills For Occm / Cph-healthcare Economic Consultant Resume
- Experience in a reporting and analytical role
- Experience with CSP Facets, Cosmos
- Intermediate experience with Tableau
- Strong proficiency in SAS, SQL, Structured Database
- Experience in healthcare data analytic
- Healthcare Analytics or Financial experience
- Intermediate experience with CMS Files 837s, 834s, 277s, MAOs, X12, CCLF etc…
7
Skills For Healthcare Economic Consultant / Developer Resume
- ) of Technical Lead experience
- Experience in Medicare, Medicaid, and Commercial reimbursement methodology
- Experience in a healthcare industry
- 5+ experience with SAS or SQL
- Experience with healthcare data
- Managed care or healthcare experience
8
Skills For Healthcare Economic Consultant Resume
- Medicare Risk experience
- Flexibility and ability to handle multiple priorities at the same time
- Identifies and implements consistent and sustainable analytic processes and methodologies in order to track and measure program effectiveness
- Partners with business leaders to develop effective strategies
- Collects and understands historical data, and performs data analytics in support of trend identification, initiative, program development and validation
- Researching policies, coding guidelines, and regulations that would support the hypothesis being developed
9
Skills For Senior Healthcare Economic Consultant Resume
- Managing and leading a team of developers
- Running initial PL SQL queries to ensure hypothesis is worth developing further
- Understanding of Medicare and/or ACA risk adjustments
- Filling out Business Requirement Documentation in a clear, concise, and comprehensive manner
- Working knowledge of Cognos Analytics
10
Skills For Occm / Cph-healthcare Economic Consultant Resume
- Intermediate proficiency working with MS Excel including formulas, calculations, charts, graphs, pivots, etc.
- An understanding of healthcare payment methodologies and policies, as well as coding
- At least an intermediate level of proficiency working with MS Excel / Access including formulas, calculations, charts, graphs, etc
- An understanding of healthcare payment methodologies, policies, and coding are necessary
- Manages complex projects to completion by contributing to data collection, data analysis, statistical modeling and financial reports
- Lead projects to completion by contributing to database creation, statistical modeling and summary reports
- Proficiency in performing solution / result driven data analytics
List of Typical Responsibilities For a Healthcare Economic Consultant Resume
1
Responsibilities For Senior Healthcare Economic Consultant Resume
- Proficiency in performing solution/result driven data analytics
- Proficiency in performing data analytics with large data sets
- Foundational proficiency in SAS Programming
- Foundational proficiency in SQL / SQL Programming
- Working in a SQL environment
- Performing data analytics
- Working with Microsoft Office and associated software
- At least a beginner level of proficiency working with Big Data, Hadoop, and Hive
2
Responsibilities For Occm / Cph-healthcare Economic Consultant Resume
- At least an intermediate level of proficiency working with SSIS
- At least a beginner level of proficiency working with Tableau
- At least an intermediate level of proficiency working with MS TFS
- Proficiency in financial and / or clinical healthcare analytics with an understanding of Medical claims detail
- At least an intermediate level proficiency with SQL, SAS and/or other statistical
- Beginner level SAS or SQL
- Experience in health care analytics and working with large data sets - At least an intermediate level proficiency with SQL, SAS and/or other statistical programs
3
Responsibilities For Healthcare Economic Consultant / Developer Resume
- Healthcare Payer experience / knowledge
- Experience in Medicare reimbursement methodology
- Previous leadership and / or project management experience
- Foundational level proficiency with SQL, SAS, Tableau and/or other BI / statistical programs
- Healthcare knowledge
- Data and analysis knowledge
- SQL, SAS query techniques
4
Responsibilities For Healthcare Economic Consultant Resume
- Intermediate level of proficiency in Excel (formulas, graphs, charts, pivot tables, etc
- AHIMA or AAPC certification
- Intermediate level of proficiency in Excel (formulas, graphs, charts, pivot tables, etc.)
- Foundational proficiency in MS Access
- Healthcare knowledge
- Data and analysis knowledge
- Beginner level proficiency with SQL and/or other statistical programs (able to read and write simple statements)
- Experience in leading, tracking and planning projects; working with large data sets and making data-driven analytical decisions; ability to prioritize and balance multiple priorities and projects
- Oracle / PL SQL experience
5
Responsibilities For Senior Healthcare Economic Consultant Resume
- Experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity
- Creating job aids / documentation / policies
- Proficiency with SQL, SAS EG
- Curriculum design
- Maintains working knowledge of coding standards, billing rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC and DRGs)
6
Responsibilities For Occm / Cph-healthcare Economic Consultant Resume
- Proficiency with SQL coding and ability to run test queries to ensure viability of concepts under review
- Access, Visio, Tableau and PowerPoint
- At least a beginner level of proficiency with SQL, SAS, and/or other statistical programs
- Maintains working knowledge of CMS rules and regulations; Knowledge of procedure and diagnosis codes (CPT, ICD-9/10 coding, HCPCS and DRGs) and related services
- Experience in revenue cycle management and/or a clinical setting
7
Responsibilities For Healthcare Economic Consultant / Developer Resume
- Proficiency with SQL, SAS, and/or other statistical programs
- Proficiency in MS Excel, Access, Word, and PowerPoint
- At least an intermediate level proficiency with SQL, SAS, and/or other statistical programs
- At least an intermediate level proficiency with SAS
- Additional statistical programs such as R, Python and/or SQL
- At least a beginner level of proficiency with process automation and/or report development software
- At least an intermediate level of proficiency with SQL and/or other statistical programs
8
Responsibilities For Healthcare Economic Consultant Resume
- At least an intermediate level of proficiency with MS TFS or other similar platforms
- At least an advanced level of proficiency in MS Excel (advanced formulas, pivot tables, macros, lists, statistical functions, etc.)
- At least an intermediate level of proficiency with SAS or SQL
- Live within the vicinity of TX
- Knowledge of SQL, SAS or other relational database software
- Knowledge of ICD-9/ICD-10 and CPT codes
- Knowledge of UHC systems as well as desktop applications
9
Responsibilities For Senior Healthcare Economic Consultant Resume
- Experience with claims processing or adjudication systems (such as UNET, COSMOS, Facets, Diamond, etc., or provider billing / coding knowledge on Professional and Facility claims)
- Working knowledge of Medicare rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC, and DRGs)
- At least an intermediate level of proficiency with SQL, SAS, and / or other statistical programs
- Knowledge of Medicare/CMS
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