Healthcare Economics Consultant Resume Sample
Aurelia Homenick
303 Modesto Stravenue,
Boston,
MA
+1 (555) 903 6991
Work Experience
Senior Healthcare Economics Consultant
07/2015
-
PRESENT
Houston, TX
- Provides financial support in the analysis of medical expenses, medical expense trend, membership, revenue, medical loss ratio and drill downs
- Provides analysis of revenue and medical costs on a restated basis and/or paid basis to facilitate identification of actionable trend drivers and cost of care initiative
- Provides analysis of Clinical data to support process improvements leading to Cost of Care savings
- Independently develops sound applications and models necessary to efficiently measure, understand, monitor and explain the plan’s medical cost structure and restated financial results
- Proactively identifies medical expense trend opportunities and risks throughout the plan such as trend anomalies, outliers, behaviors etc
- Utilizes all available tools and applications to facilitate the development of actionable information to create performance improvement
- Completes the most diverse and complicated projects and performs complex analytical studies
- Present medical cost trends to a wide audience on a regular basis
Healthcare Economics Consultant
02/2012
-
04/2015
Chicago, IL
- Consults with Plan leadership, including P&L, Segment, Provider Contracting, Clinical, Claims Processing and Finance on analyses and recommendations regarding appropriate courses of actions
- Write business requirement documents for new algorithms and update existing documents as the algorithm logic is developed or changes over time
- Breakdown complex problems into individual root causes
- Design, automate, and maintain Monarch HealthCare’s evolving key performance indicator (KPI) reporting
- Work with Monarch’s departmental leadership to set meaningful data-driven measurements and goals as represented in the KPI
- Support Monarch’s provider overpayment unit with customized tools to capture performance data, create efficiency with automation, and management insight with reporting
- Provide ad hoc analysis and reporting for leadership leveraging Monarch’s robust data warehouses
- Create experience tracking reports at various levels of detail, including rate-cell/regional reporting consistent with revenue reimbursement for all C&S products
- Develop, monitor, and evolve the payment incentive model
Education
Trinity University
2006 - 2011
Bachelor's Degree in Economics
Professional Skills
- Strong project management approach with excellent critical thinking and problem-solving skills
- Excellent written and verbal communication skills, with the ability to communicate effectively with leaders across the organization and external customers
- Experience using advanced data visualization skills using BI tools like Tableau
- Experience using advanced data visualization skills using BI tools like Tableau - I think this was the only difference
- Strong problem - solving and analytical skills
- Experience using SQL; Intermediate to advanced level skills
- Strong verbal and written communication skills, including the ability to present ideas and concepts effective
How to write Healthcare Economics Consultant Resume
Healthcare Economics Consultant role is responsible for advanced, intermediate, code, extract, write, visualization, software, organization, excel, sql.
To write great resume for healthcare economics consultant job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Healthcare Economics Consultant Resume
The section contact information is important in your healthcare economics 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 Economics Consultant Resume
The section work experience is an essential part of your healthcare economics 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 economics 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 economics consultant position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Healthcare Economics Consultant resume experience can include:
- Experience using SQL, intermediate to advanced level skills nice to have (able to write code and to extract data from various sources)
- SQL and Advanced Excel skills
- Collaborate with internal subject matter experts to effectively expand team capabilities and advance projects more quickly
- Effectively engage with internal clients (employees and leaders within other areas of the business)
- Able to effectively engage with internal clients (employees and leaders within other areas of the business)
- Healthcare Analytics experience or Financial experience in the Healthcare industry
Education on a Healthcare Economics Consultant Resume
Make sure to make education a priority on your healthcare economics 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 economics 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 Economics Consultant Resume
When listing skills on your healthcare economics 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 economics consultant skills:
- Experience identifying and effectively communicating trends in highly complex healthcare data
- Experience using SQL, intermediate to advanced level skills
- Experience using SQL, intermediate to advanced level skills nice to have (able to write code and to extract data from various sources)
- Strong computer skills; Access, Excel, Visio, PowerPoint
- Experience with problem-solving, including balancing multiple priorities and researching conflicting and/or inaccurate data
- Advanced Excel skills, including formulas, calculations, pivots, charts, graphs, etc
List of Typical Experience For a Healthcare Economics Consultant Resume
1
Experience For Senior Healthcare Economics Consultant Resume
- Work closely with ETL team mapping and validating client data Perform detailed quality assurance on analytic results
- Recent experience in a position focusing on data reporting and analysis to include root cause analysis
- Demonstrable analytic experience working with Coordination of Benefits (COB) - Medicare
- Experience in health care analytics and working with large data sets to include healthcare claims and member data
- Work experience in a matrixed / corporate setting
- Experience working with claims
- Performs complex data validation and conceptual analyses
2
Experience For Healthcare Economics Consultant Resume
- Performs statistical and trend analyses to determine effectiveness of clinical programs (e.g. pre - post analysis, clinical trial results)
- Performs statistical and trend analyses to determine effectiveness of clinical programs (e.g., pre-post analysis, clinical trial results)
- Performs analyses to determine effectiveness and ways to improve clinical programs
- Performs data analytics in support of trend identification, initiative, program development and validation
- Create dashboards and/or other tools to monitor experience
- Performs data analytics in support of trend identification, initiative, program development, and validation
- Performs statistical analyses to determine effectiveness of clinical programs (e.g. pre - post analysis, clinical trial results)
3
Experience For Senior Healthcare Economics Consultant Resume
- Analysis prioritization & peer analysis review
- Healthcare industry experience to include healthcare claims and/or member data knowledge
- Intermediate level experience with SQL, SAS and / or other statistical programs
- Tableau development experience (publisher)
- Experience in data analytics
- Reports, scorecard, dashboards development experience data visualization software such as Tableau, MicroStrategy, Wave Analytics or similar
- Data analysis work experience
- Experience in Medicare, Medicaid and Commercial reimbursement methodology
4
Experience For Healthcare Economics Consultant Resume
- Experience with SQL for data extraction and manipulation
- Advanced analytics experience
- Experience with Teradata SQL, SSRS, SSIS, SAS, Tableau, and/or other data visualization tools
- Experience in broad-based analytical, managed care payor or provider environment
- Experience with Teradata SQL, SSRS, SSIS, SAS
- Experience with Medicare Quality programs
- Experience with client management and support
- Professional experience with Tableau and/or other data visualization/BI tools
- Project management experience ideal
5
Experience For Senior Healthcare Economics Consultant Resume
- Professional experience with Tableau and/or other data visualization tools
- Systems analysis experience
- QL/SAS or other relational database experience
- Managing production reports, performing ad hoc investigation and analysis, mentoring junior analysts
- Performing reconciliations to determine if physicians have met contractual obligations
- Updating databases used by downstream customers
- Assists driving projects to completion by contributing to database creation, statistical modeling and financial reports
6
Experience For Healthcare Economics Consultant Resume
- Detail data analysis on utilization, hospital contract modeling, monetization modeling, and inpatient unit cost forecasting
- Provide data analysis, contract auditing, and metrics reporting to management
- Lead projects to completion by contributing to data analysis and financial reporting
- Prepare target models in support of customer requests, following contracting guidelines
- Trend analysis, such as impact of moving schedules, changing terms, etc
- Lead projects to completion by contributing to database creation, statistical modeling and visual representation
7
Experience For Senior Healthcare Economics Consultant Resume
- Serves as a key resource to finance teams by providing data / analytical support, mentoring, guidance and technical expertise
- Manages projects to completion by contributing to database creation statistical modeling and financial reports
- Leads projects to completion by contributing to database creation, statistical modeling, and financial reports
- Assist in leading complex analytic projects leveraging data from multiple sources
- Communicate results to relevant audiences and incorporate results into forecasting process and reporting
8
Experience For Healthcare Economics Consultant Resume
- Create and update automated processes using SAS and Excel VBA to streamline monthly reporting
- Lead projects by contributing to database creation, statistical modeling and financial reports
- At least an intermediate level of proficiency working with MS Excel and PowerPoint including formulas, calculations, charts, graphs, etc
- An advanced level of proficiency working with MS Excel including formulas, calculations, charts, graphs, etc
- Proficient in SQL, SQL Reporting Services, MS Access, and MS Excel and / or equivalent data capture / reporting tools
9
Experience For Senior Healthcare Economics Consultant Resume
- Advanced proficiency working with MS Excel including formulas, calculations, charts, graphs, etc
- Identifies potential areas for medical cost improvements and alternative pricing strategies in collaboration with the
- Develop complex coding and manual workarounds
- Populate client-s test file templates and gather all supporting documentation for trend approval
- Lead projects to completion by contributing complex SQL code, database creation, operational and financial reports
- Serves as subject matter expert to a health plan in support of value based contracting strategy
- Complete physician scorecard reports according to terms of VBC agreements and present to Health Plan
- Works with minimal guidance; seeking guidance on only the most complex tasks
10
Experience For Healthcare Economics Consultant Resume
- Works with minimal guidance, seeking guidance on only the most complex tasks
- Analyzes reporting tools to investigate sources of variations
- Develop, maintain, and enhance inpatient bed day reporting
- Comfortable presenting to various audiences and levels of leadership
- Create excel models to track affordability initiatives and perform standard monthly reporting for medical cost deep dive analysis
List of Typical Skills For a Healthcare Economics Consultant Resume
1
Skills For Senior Healthcare Economics Consultant Resume
- Experience in supporting finance and accounting partners through an analytics focused role, including forecasting techniques
- Experience billing, coding, and auditing claims
- Experience in Payment Integrity or with billing, coding, and auditing claims
- Experience communicating analyses, including trends, opportunities, and recommended actions, to clients and the business in writing and verbally
2
Skills For Healthcare Economics Consultant Resume
- Experience working with a health plan or a risk-bearing physician organization in the capitated / delegated model
- Demonstrable analytic experience working with claim system data and reporting
- Relevant work experience in a healthcare or managed care environment working with large data sets using SQL (preferably Microsoft’s T-SQL)
- Experience working in a matrix and highly adaptive environment handling tight deadlines
- Financial, accounting or auditing experience
- Experience defining and documenting Business Requirements based on Analysis
- Certification of Medical coding / coding experience
3
Skills For Senior Healthcare Economics Consultant Resume
- Certification of Medical coding/coding experience
- Demonstrated capability in driving business results through modeling and segmentation implementation, analysis, and refinement
- Good at analyzing large datasets and working with SAS and relational databases
- Experience analyzing and manipulating health care data
- ) of professional experience in analytics and working with large data sets, preferably working with healthcare data
- NAIC Guidelines knowledge or Coordination of Benefits auditing experience
- Analytical experience in financial analysis, healthcare pricing, network management, healthcare economics, or related discipline
- Experience working directly in Fraud Waste and Abuse analytics
4
Skills For Healthcare Economics Consultant Resume
- Health care experience working with claims data and/or medical codes
- Experience working with SQL / SAS and/or other statistical programs
- Corporate reporting experience, preferably with financial, operational, or regulatory data
- Demonstrated proficiency in SAS or SQL programming
- Experience in data manipulation and reporting
5
Skills For Senior Healthcare Economics Consultant Resume
- Experience with SAS, R, SPSS, or other statistical programming language
- Experience with hypothesis testing, clinical program evaluation and/or regression analysis
- Experience working with claims data and medical codes
- Experience using SQL, SAS query techniques to access relational databases
- Health care experience working with healthcare claims data and medical codes
- Experience in analytics and working with large data sets
- Experience in a corporate setting
- Experience interfacing with NICE and COSMOS systems
- Experience managing teams of people from 2 to 10
6
Skills For Healthcare Economics Consultant Resume
- Business Analysis experience, working with large data sets
- Experience with process improvement, workflow, benchmarking and / or evaluation of required processes in a collaborative environment
- Experience working in a corporate environment
- Experience in data manipulation and reporting
- Work experience in a corporate setting
7
Skills For Senior Healthcare Economics Consultant Resume
- Strong analytical expertise; Data analysis, statistical analysis, data manipulation, data extraction, and reporting required
- Experience with healthcare data analysis, focusing on utilization, cost drivers, and trends
- Experience performing data analytics
- Experience working with health care claims data and medical codes
- Experience creating workflows in ETL software (Alteryx, SSIS, etc.)
- Data reporting/analysis experience
- Experience consulting within a managed care, health insurer, or healthcare management organization
8
Skills For Healthcare Economics Consultant Resume
- Claims payment review, analysis or cost reporting experience
- Solid understanding of relational database fundamentals
- Strong analytical expertise; Data analysis, statistical analysis, data manipulation, data extraction, and reporting
- Experience developing conclusions and recommendations
- Experience Communicating results to relevant audiences
9
Skills For Senior Healthcare Economics Consultant Resume
- Utilize various statistical analysis methodologies to validate performance trending and results
- Experience with T-SQL (Microsoft SQL)
- Intermediate to advanced skill with R statistical software
- Tableau and/or SSRS experience
- Experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity
- Experience with of SAS and SQL
- Medical cost or healthcare financial analysis experience
- Experience with relational databases (Oracle, SQL Server, DB2, etc)
- Experience with provider payment methodologies and healthcare products
10
Skills For Healthcare Economics Consultant Resume
- Data visualization experience with MicroStrategy or Tableau
- Experience with UnitedHealthcare’s Icue system
- Professional experience in Excel
- Data analysis work experience
- At least basic knowledge of statistical methods, either from educational study or professional experience
- Experience as a Statistician
- Health care experience
- Experience in health care analytics
- Experience in data analytics
List of Typical Responsibilities For a Healthcare Economics Consultant Resume
1
Responsibilities For Senior Healthcare Economics Consultant Resume
- Data analysis experience to determine effectiveness of Program Integrity functions
- Prior UHC Experience
- Experience billing, coding, and auditing claims
- Experience in the health care industry (Medicare, Medicaid, Commercial), with deep exposure to Payment Integrity
- Experience with SQL, SAS, and/or other statistical programs
2
Responsibilities For Healthcare Economics Consultant Resume
- Working knowledge of CMS rules and regulations, and knowledge of procedure and diagnosis codes (CPT, ICD-9/10 coding, HCPCS, and DRGs)
- Identify clear and compelling contributing factors and root causes for excessive health care expenditures
- Lead projects to completion by contributing to database creation, statistical modeling and financial reports, and provide insights to help assess outcomes
- Provide claims, premium, and membership data in support of Underwriting, Actuarial, Product, Network, and utilization analyses
- Supports Medicare Advantage bid filing process
- Financial and clinical reporting development
3
Responsibilities For Senior Healthcare Economics Consultant Resume
- Act as a consultant to project managers, recommending approaches to help achieve organizational objectives
- In-depth knowledge of medical claims processing
- Advanced level of proficiency with SQL programming
- Intermediate level of proficiency in performing data analytics with Business Intelligence tools
- Beginner level of proficiency working with MS Access
- Financial analysis in a healthcare setting
- In - depth knowledge of claims processing within COSMOS, CSP, or UNET
- At least an intermediate level of proficiency in MS Excel including formulas, calculations, charts, graphs, pivot functions
4
Responsibilities For Healthcare Economics Consultant Resume
- Fluent with SAS programming
- Statistical analytics background, familiar with statistics-based modeling (i.e. biostatistics, clinical data management, etc.)
- Intermediate to advanced proficiency level with SQL query writing
- Working in/from a data warehouse environment
- Support complex contractual financial arrangements
- Regional leadership team, key functional (clinical, network, actuarial and payment integrity) leaders and local Plan leaders
- Design and develop data queries
5
Responsibilities For Senior Healthcare Economics Consultant Resume
- Analyze reports to measure utilization, cost data, clinical outcomes, network performance and assist in development of management presentations
- Work with very large data sets and see projects from conceptualization to completion by contributing to database creation, statistical modeling and financial reports
- Interpret and analyze clinical data from various sources and recommend best approaches for aggregation
- Serve as a team lead in the absence of the Analytics Manager
- Provide utilization, membership, care management activity and membership data in support of Operations
- Interpret and analyze data and recommend best approaches
- Provides management with statistical findings, explanations and conclusions
6
Responsibilities For Healthcare Economics Consultant Resume
- Collaborates within and outside the Medical Informatics department, UHC, and UHG to lead the development and continuous improvement of methods, processes, and technologies to enhance healthcare quality, affordability, outcomes, and member/provider experience
- Proactively discovers potential areas for medical cost improvement and management/healthcare initiative strategies
- Develop tools that track strategies and process improvements post-implementation
- Perform mathematical analysis that provides management with statistical findings and conclusions
- Provide management with unbiased advice and opinions in regard to our clinical program strategy
- Serves as healthcare economics / analytics consultant for national and local market projects
- Solves complex problems and develops innovative sustainable solutions
- Serves as healthcare economics/analytics consultant for national and local market projects
- Collects, analyzes, and performs quality assurance on analytic initiatives that consume data from multiple sources
7
Responsibilities For Senior Healthcare Economics Consultant Resume
- Provides consistent and timely communication on projects, results, and conclusions from analyses
- Analyze and interpret various forms of utilization and healthcare data (i.e. utilization, unit cost, year over year, local benchmarking, national benchmarking) to identify potential areas for medical cost improvements
- Present findings and collaborate with business partners (i.e. Medical Management, Pharmacy, Provider Relations, Operations, National HCE Affordability team, etc.) to identify actionable initiatives
- Research and understand national affordability initiatives and evaluate for feasibility in the Nevada market
- Quantify actual value and ROI for Affordability initiatives and work with national HCE team to get initiatives quantified
8
Responsibilities For Healthcare Economics Consultant Resume
- Maintains comprehensive summary of medical capitation contracts with healthcare providers
- Serves as subject matter expert on capitation contract information available for various claims platforms (primarily NICE platform, as well as NDB / COSMOS Capitation)
- Manage data requests, such as spend by provider, by market, by region, by specialty
- System audits and research
- Interpret and analyze claims, premium, capitation, membership and provider data in support of financial, clinical, medical, operational, and utilization analyses
9
Responsibilities For Senior Healthcare Economics Consultant Resume
- Collect, manipulate healthcare data; create Key Performance Indicator (KPI) reporting
- Develop and improve Coordination of Benefits (COB) analytics
- Present recommended process improvement solutions through research and analysis of data and implement when appropriate
- Interpret and analyze clinical data from various sources and recommend best approaches for identifying other healthcare insurance primary for Commercial and Medicare payers
- Claims cost and other data analyses
- Pull and manipulate data from internal data warehouses
- Presentation of results to leadership
- Identifies and implements appropriate analytic approaches and methodologies and sets performance targets
10
Responsibilities For Healthcare Economics Consultant Resume
- Extracts, aggregates, and quality assurance on applicable data from multiple sources and tables for purposes of root cause analysis
- Interprets and analyzes clinical data from various sources and recommend best approaches
- Creates and updates automated processes
- Produces and reviews reports
- Serve as liaison between the business and IT
- Develop, monitor, and evolve the affordability initiatives model
- Work independently and interact with peers
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