Financial Analytics & Audit Sample Resume Format in Word Free Download

Sample Template Example of Beautiful Excellent Professional Curriculum Vitae / Resume / CV Format with Career Objective, Job Description, Skills & Work Experience for Freshers & Experienced in Word / Doc / Pdf Free Download

309 Oakdale Ave.                                                                                                                 Phone: (203) 757-9876

aterbury, CT  06001                                                                                                              Email:sadie.stewart@gmail.com

                                                                                                                                               

PROFESSIONAL SUMMARY

Healthcare professional with extensive clinical and analytical experience in both the hospital setting and the health insurance industry.  Worked in large Level 1 & 2 trauma centers and Fortune 500 healthcare insurance companies managing complex projects and departments.  Trained professional and non-professional staff and developed educational programs and policies and procedures for cross functional teams.

CORE COMPETENCIES

·         Medical / Financial Analytics & Audit ·         Project Management ·         Staff Training & Presentations

·         Accurate & Timely ·         Excellent Communication ·         Creative Problem Solver

·         Process Improvement ·         Research & Documentation ·         Mgt. Cross Functional Teams

PROFESSIONAL HIGHLIGHTS

HEALTH NET, INC., Shelton, CT                                                                                                           2000 – 2011

Senior Health Economist  (2006 – 2011)                                                                                                    

·         Developed a Large Claims Report to assist employer groups with forecasting the impact of large claimants on their bottom line.

·         Developed wellness programs for employer groups based on the medical analysis of the groups employees.

·         Prepared health metrics for fully insured and self insured groups including stop-loss reporting.

·         Provided Medical Management, Underwriting, Sales, Finance and Employer Groups with customized ad hoc reporting and medical consulting.

·         Consulted with actuarial and underwriting for risk assessment on million dollar claimants.

·         Created a reporting plan to assist with the smooth transition of employer group data from Health Net Northeast to United Health Care.

·         Successfully conducted presentations and training seminars for the sales department to help them facilitate the presentation of our reports to their clients.

Manager, Underwriting & Reporting  (2004 – 2006)

·         Expanded the role of reporting analyst to include underwriting for the new business middle market segment.

·         Facilitated the transition of reporting analysts to fully functioning new business underwriters during department reorganization.

·         Managed a department of six new business underwriters and a team responsible for providing self-insured client reports and submissions to reinsurance carriers on behalf of our employer groups.

·         Developed CQI /audit standards for new business quoting that resulted in a 97% compliance rate within 3 months.

·         Implemented HIPAA Coordinator role for the Underwriting Department, developing, maintaining and auditing roles for compliance to company and federal standards.

Consulting Underwriter  (2000 – 2004)

·         Provided complex standard and ad hoc reports for Health Net employer groups.

·         Consulted with cross-functional teams to insure reports were medically accurate.

·         Developed many new reports designed to help employer groups identify employee health issues and facilitate educational opportunities for their employees.

OXFORD HEALTH PLANS, Trumbull, CT                                                                                        1996 – 2000

 

Appeals Clinical Analyst  (1998 - 2000)

·         Developed a process that reduced backlog of appeals cases from 8,000 to less than 1,000 in 6 months.

·         Created and automated appeals letters to promote consistency amongst clinical staff of 20 professional nurses.

·         Assigned as appeals project manager for Once Check Project (2 years).

·         Responsible for hospital based and member appeals with expertise in Medicare, NY External and Commercial Appeals.

 

Triage Nurse – Auditor & Trainer  (1996 – 1998)

·         Provided medical assessment and education for health plan members 24/7.

·         Established offices and trained nurses in the use of triage software in CT, NY, PA and IL.  

·         Audited triage calls for compliance with established standards of care.

·         Selected as team leader for nurse triage call centers in CT, NY, PA and IL.

RELATED WORK HISTORY

Bridgeport Hospital, Bridgeport, CT – Manager, Emergency Department, Level 1 Trauma & Regional Burn Center

Waterbury Hospital, Waterbury, CT – Manager, Emergency Department, Level 2 Trauma Center

St. Mary’s Hospital, Waterbury, CT – ICU, CCU Staff Nurse

EDUCATION

Sacred Heart University, Fairfield, CT

MBA Candidate

Post University, Waterbury, CT

BS – Business Administration Management, Cum Laude

St. Mary’s Hospital School of Nursing, Waterbury CT

Diploma in Nursing

CERTIFICATE

Capital Community College, Hartford, CT

Health IT Certification Program Candidate – Graduate June 2012

Naugatuck Valley Community College, Waterbury, CT

Certificate – Grant Writing

TECHNICAL SKILLS

·         Microsoft Word

·         Microsoft PowerPoint

·         Microsoft Excel

·         Microsoft Access

·         Microsoft Publisher

·         MEDai Risk Navigator

·         Unity

·         MC400 (Reflections)

·         Business Objects

·         Adobe Acrobat Suites

·         Dreamweaver

·         MACES

PROFESSIONAL MEMBERSHIPS

Registered Nurse Licensure in New York & Connecticut

Alpha Chi National Honor Society

VOLUNTEER / COMMUNITY

·         Brass City Harvest

§  Be The Match-National Marrow Donor Program

Download Resume Format