Health Care Resources - Certified Medicaid Anaylst Resume Example

Anna Gonzales

XXXX XXXXXXXX XXXXXX, Baton Rouge, LA 70811

Ph: XXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXXXX

Professional Summary:

Certified Medicaid Analyst with expert knowledge of medical terminology and HIPPA compliance. Support quality patient care and education.

Skills:

Experience:

Certified Medicaid Anaylst Nov 2013 －Present Health Care Resources Baton Rouge, LA

Collaborate with other professionals to evaluate patients' medical or physical condition and to assess client needs.
Refer patient, client, or family to community resources to assist in recovery from mental or physical illness and to provide access to services such as financial assistance, legal aid, housing, job placement or education.
Interview patients or their representatives to identify problems relating to care.
Maintain knowledge of community services and resources available to patients.
Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution.
Explain policies, procedures, or services to patients using medical or administrative knowledge.
Collect and report data on topics such as patient encounters and inter-institutional problems, making recommendations for change when appropriate.

Call Center Business Analyst Jun 2011 －Nov 2013 Blue Cross Blue Shield of Louisiana Baton Rouge , La

Analyze technology trends to identify markets for future product development or to improve sales of existing products.
Generate standard or custom reports summarizing business, financial, or economic data for review by executives, managers, clients, and other stakeholders.
Identify or monitor current and potential customers, using business intelligence tools.
Maintain or update business intelligence tools, databases, dashboards, systems, or methods.
Maintain library of model documents, templates, or other reusable knowledge assets.
Create business intelligence tools or systems, including design of related databases, spreadsheets, or outputs.
Conduct or coordinate tests to ensure that intelligence is consistent with defined needs.
Disseminate information regarding tools, reports, or metadata enhancements.
Create or review technical design documentation to ensure the accurate development of reporting solutions.
Provide technical support for existing reports, dashboards, or other tools.

Quality Reviewer Jun 2010 －Aug 2011 Blue Cross Blue Shield of Louisiana Baton Rouge, LA

Collect and analyze data to detect deficient controls, duplicated effort, extravagance, fraud, or non-compliance with laws, regulations, and management policies.
Prepare detailed reports on audit findings.
Supervise auditing of establishments, and determine scope of investigation required.
Report to management about asset utilization and audit results, and recommend changes in operations and financial activities.
Produce up-to-the-minute information, using internal computer systems, to allow management to base decisions on actual, not historical, data.

Provider Advisor III Sep 2007 －Aug 2011 Blue Cross Blue Shield Baton Rouge , LA

Confer with customers by telephone or in person to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints.
Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
Review insurance policy terms to determine whether a particular loss is covered by insurance.
Check to ensure that appropriate changes were made to resolve customers' problems.
Determine charges for services requested, collect deposits or payments, or arrange for billing.
Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.

Education: