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Utilization Analyst , Outside Utilization Resource Service
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Competencies
Utilized various data systems like VectorCare, CRM, Excel, and WDE to obtain and analyze healthcare and transportation data.
Handled patient, provider, and internal inquiries effectively, resolving issues and providing education on benefits and charges.
Applied knowledge of ambulatory care practices, claims review, and medical transportation programs to support healthcare delivery.
Coordinated and supervised data/reporting needs, and assisted in program planning and implementation within healthcare settings.
Ensured adherence to policies, procedures, and regulatory standards in healthcare and security operations.
Education
Summary
Experienced healthcare analyst with expertise in data reporting, claims review, and patient education in healthcare environments.
Key Achievements
- Supported billing reconciliation and provided data analytics at Kaiser Permanente.
- Coordinated claims review processes and suggested system improvements across healthcare projects.
- Managed data collection and reporting to ensure timely and accurate utilization analytics.
Experience
Utilization Analyst , Outside Utilization Resource Service
Answers inquiries and educates patients, physicians and hospitals on covered benefits and charges., Frequent contacts with other organizational units and outside facilities staff to obtain, verify and/or provide information, e.g., works with Regional Claims and outside hospitals to reconcile...
Utilization Analyst, Emergency Prospective Review Program
Ensures projects/cases are completed on schedule following established procedures and schedules., Provides information and assistance to Health Plan members during claims review process and coordinates authorized and non-authorized claims review., Recommends and evaluates processes to improve...
Medical Transportation Analyst
Frequent contacts with other organizational units and outside facilities staff to obtain, verify and/or provide information, e.g., works with Regional Claims and outside hospitals to reconcile billing charges., Utilizes various data systems to obtain the medical transportation program information...
Service Representative
Excelled in a role requiring the ability to handle a variety of customer service and administrative tasks and resolve customer issues adeptly., Implemented and monitored departmental policies and procedures which support the organization's goals and business objectives and ensures they are...
Care Experience
Planned, implemented and managed programs and services in a healthcare facility including personnel administration, training and development., Assisted in organizing, scheduling, evaluating and conducting clinical staff training and developments necessary to meet established Care Experience...
Security Officer
Management of Aggressive Behavior Certified; skills and techniques needed to recognize, de-escalate, reduce and manage violent and aggressive behavior., Emergency Department Specialist Certified: implement and oversee the security operations in the emergency department under organizational and...