As a Nurse Analyst, the individual is responsible for analyzing, compiling, and validating crucial medical data. The duties commonly associated with the role are listed on the Nurse Analyst Resume as – compiling and maintaining data needed by the company; offering insight to improve care systems, compiling important medical data through the use of computer-based applications; developing initiatives to provide more effective healthcare, solving current service issues, developing reports for upper-level management, preparing monthly status reports, comparing medical budgets, and developing enhanced reports.
Nurse Analysts require a bachelor’s degree in healthcare administration or nursing. Having a master’s degree is preferred, but not required by most hiring healthcare agencies. The individual should have work experience in handling intricate database and information management responsibilities. Knowledge of PC-based applications for data management is crucial. Working knowledge of data analysis tools, such as SAS and database language tools like SQL is very beneficial.
Summary : As a Nurse Analyst, responsible for Performing review of submitted documentation to assure planned services are medically necessary based on Medicare guidelines, Providing written explanations for non-affirming prior authorization requests.
Skills : Clinical/Technical/Medical/Policy Writer, Utilization Management, Case Management, Medical Appeals, Medical Claims Review, Benefit Administration, Mentor, Fraud and Abuse, Milliman Guidelines.
Description :
Evaluated allegations of criminal and civil false claims conduct, analyzes regulations and policies to identify potential areas of fraud, and independently sets forth the appropriate investigative steps and goals.
Employed nursing expertise to analyze and identify medical records, surveys and other medically-oriented documentary evidence to evaluate and prove allegations of Medicaid fraud and abuse and neglect of vulnerable adults.
Served as expert leader to direct, organize and control the work for the duration of the investigation.
Independently identified, located, contacted, interviewed and memorialized statements of key witnesses, confidential informants, state agents and others to develop evidence needed to evaluate and prove allegations of Medicaid fraud.
Prepared and served subpoenas, obtain search warrants, obtain and inventory evidence, and maintain appropriate chain of custody.
Served as the Unit's first-line health care advisor for all health care matters.
Provided consultation and expert guidance to assistant attorney generals, fraud investigators and auditors regarding physical and mental health care policies and standards.
Experience
10+ Years
Level
Senior
Education
MS In Nursing
Nurse Analyst Resume
Objective : Responsible for Identifying, evaluating, designing, and packaging division best practices, policies and procedures for clinical application implementation and use.
Skills : Management Ability Bilingual, Speak Both English.
Description :
Responsible for analyzing the first physician claims which come into the system.
Managed Pennsylvania, New Jersey, and DC/Delaware.
Viewed electronic records for surgery, office visits, ER visits and chemotherapy, making determinations for payment of same.
Viewed and determined that all documentation is accurate, timely, and fully informative.
Determined that payment is due, the claim is processed.
Testified in grand jury proceedings to assist in securing criminal indictments.
Served as an expert witness on medical related cases.
Experience
2-5 Years
Level
Junior
Education
GED
Nurse Analyst Resume
Headline : Nurse Analyst position at The Marker Group (third party records collection company) involved the review of medical records to extract the names of physicians, hospitals, clinics, etc. for the purpose of gathering additional records for attorneys.
Skills : Analyze Medical Records, Business Acumen & Clinically.
Description :
Planned and conducted research on internal and external inquiries for new products to be considered as new benefits for the traditional Fee for Service Medicaid.
Worked under limited supervision with considerable latitude for the use of initiative and independent judgment.
Worked knowledge of federal and state Medicaid policies and procedures.
Knowledged of medical diagnosis, procedures and accepted medical treatment patterns is required.
Skilled in interviewing techniques, organization of work and multiple tasks is important as the nurse analyst conducts meetings, internally and externally with stakeholders of the benefit that has been proposed or in policy review of existing policies.
Skilled in communicating effectively, orally and in writing is conducted on a daily basis.
Skilled in establishing and maintaining effective working relationships is vital in this position.
Experience
5-7 Years
Level
Executive
Education
MS
Nurse Analyst Resume
Summary : Desire to use my extensive experience in caring for critically ill Pulmonary/Medical Intensive Care unit patients in an alternate setting.
Skills : MS Office, Analyst.
Description :
Collaborated with the multidisciplinary team to improve quality and maximize length of stay while reducing readmission rates.
Coordinated care from admission to discharge to effectively utilize the continuum of care.
Provided denial management services for the care coordination department to reduce lost revenue, and continues to provide guidance for the denial management department.
Developed and implemented a plan throughout the Emory system to correctly identify inpatient only procedures to avoid denials and reduce lost revenue.
Used Expert in Centers of Medicare and Medicaid regulations.
Collaborated with multidisciplinary team for continuum of care and discharge planning.
Able to work under pressure, perform work under general supervision.
Experience
10+ Years
Level
Senior
Education
Master's In Nursing
Nurse Analyst Resume
Summary : Highly skilled career professional with more than 16 years combined practical experience in hospital, home health, and primary care environments. Established in patient support including assessment, education regarding medications and treatment, lab work, documentation with care plan for diagnosis, and administration of treatment procedures.
Skills : MS Office, Multitaking.
Description :
Utilized review for the state of NC Medicaid recipients for medical approval for placement into skilled facilities, and home healthcare services.
Reviewed medical history, diagnosis, and activities of daily living.
Followed the strict guidelines/policies put forth by the state of NC of the title NCXIX and in the best interest of the recipients/patient for approval/denial for skilled placement or at home care.
Apply developed subject matter knowledge to solve common and complex business issues within established guidelines and recommend appropriate alternatives.
Worked on problems/project of diverse complexity and scope.
Assisted with North Carolina's new electronic Medicaid system NC Tracks start up Skills Used Communications with clients, educating them on the new system a walking trough process to get their prior approvals accepted by the system.
Able to maintain a professional attitude.
Experience
10+ Years
Level
Senior
Education
BS In Nursing
Nurse Analyst Resume
Summary : Responsible Nurse Analyst with excellent communication skills demonstrated by 15 years of experience in healthcare.
Skills : Leadership, MS Office.
Description :
Responsible for reviewing medical records to determine if a case meets medical necessity.
Responsible for reviewing medical documentation to determine whether all relevant information had been submitted.
Made decisions based on Medicare guidelines.
Worked with Local Coverage Determination (LCD) policies Work with National Coverage Determination (NCD) policies.
Trained in Medicare part A and Medicare part B.
Worked with FISS and MCS.
Worked at meeting production metrics.
Experience
7-10 Years
Level
Management
Education
Certificate In Practical Nursing
Nurse Analyst Resume
Summary : Twenty-two years of experience as a Nurse Analyst professional in both private and public settings. Background Disease management Home health Managed care Legal nurse consulting Case management Policy development Texas Workers' Compensation Utilization and quality review.
Skills : MS Office, Planning Skills.
Description :
Reviewed, analyzed and summarized medical records of the injured party.
Prepared medical work product/chronology for use by case team.
Identified and assisted in developing medical and scientific defense expert witnesses for complex product liability litigation.
Prepared discovery deposition, as well as, trial direct and cross outlines of fact, scientific and medical expert witnesses.
Managed multiple cases ongoing.
Responsible for medical review for medical necessity and make determinations of requested services for both adult and EPSDT for 21 and under.
Prepared appropriate cases for MD consult with my recommendations for denial or approval.
Experience
7-10 Years
Level
Management
Education
Bachelor Of Science In Education
Nurse Analyst Resume
Headline : Responsible for Performing review of submitted claims to ensure billed services are medically necessary and correctly coded based on Medicare guidelines.
Skills : HEDIS, Utilization Management, Case Management, Fraud Investigations.
Description :
Assisted staff with appeals and escalated requests.
Participated in staff review meetings and advisements to increase productivity and streamline processes.
Served as a key onsite clinical IT resource for facility implementation and support of a broad set of clinical applications.
Led and facilitated the facility's core clinical systems team on clinical IT activities.
Worked with the Division EHR Support Team to lead, monitor, and facilitate new module/application testing and Implementation for the facility.
Facilitated and managed maintenance of facility-specific dictionaries.
Provided input to customize base division policies and procedures, training, and best practices for use within the facility.
Experience
5-7 Years
Level
Executive
Education
GED
Nurse Analyst Resume
Objective : As a Nurse Analyst, responsible for performing clinical application report writing as needed and coordinate priorities for reporting requests with the Division Reporting Analyst and the Division EHR Support Specialist Team.
Skills : Team Work, MS office.
Description :
Developed training materials and deliver hands-on training as needed.
Worked with the Division EHR Support Team to actively promote and support division standardization, utilization, integration and optimization plans for a broad set of clinical applications.
Coordinated facility clinical application reporting requests, assists with defining report requirements, and validates reporting results.
Performed quality audits and tracks metrics related to clinical application use.
Participated in meetings as a member of facility clinical leadership.
Promoted system security and patient confidentiality and helps ensure compliance.
Coordinated the execution and use of tools for audits.
Experience
2-5 Years
Level
Executive
Education
MS
Nurse Analyst Resume
Headline : To establish a long-term career in a company where I may utilize my Nurse Analyst professional skills and knowledge to be an effective Associate Program Manager and inspiration to those around me.
Skills : Planning Skills, Directing Skills.
Description :
Built strong relationships at the facility with core customer base (nurses, physicians, core team members, etc.) and facility leadership.
Communicated effectively, verbally, in writing and via telephone regarding sensitive and confidential issues while maintaining a professional image.
Assessed, problem solved, analyzed, planned and evaluated situations using critical thinking skills, reasoning and research.
Self-directed, self-motivated, made independent decisions, and prioritize daily activity.
Handled sensitive situations in a positive, professional manner.
Possessed high degree of honesty, loyalty, and integrity.
Clinically researched/analyzed reports and recommend, create, and implement processes or medical policy changes.
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