Rhiannon Redman
Healthcare Operations Analyst
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About
▪ In -depth experience of Long Term Service Support (LTSS) programs in the various managed care programs.
▪ Business Analyst/Data Analyst with insurance industry experience
▪ Knowledge of state and federal laws, regulations and processes regarding Medicaid Managed Care and CHIP (STAR, STAR+PLUS, STAR Kids, STAR Health) .
▪ SQL, data mining and VLOOKUP experience
▪ Commercial Insurance Plans, HIPAA
▪ Possess strong application skills in the use of relational databases
▪ Familiar with database extract and analyzing tools
▪ Proficient in Microsoft Office (Excel, Word, Outlook) and relational databases
▪ In-depth knowledge of healthcare and claims concepts
▪ Excellent written and oral communication skills
▪ Excellent analytical, critical thinking and problem solving skills
▪ Compile data, create reports and display information
▪ Ability to communicate with technical and nontechnical personnel
▪ Extensive knowledge of government agency and insurance company programs, coordination of benefits guidelines.
▪ Familiar with billing and payment guidelines ▪ Ability to build good relationship with customer ▪ Wide knowledge of healthcare programs:
▪ Managed care enrollment and claims systems
▪ Data entry validation
▪ Report generation
▪ Ability to design, build, and implement business solutions
▪ Facilitate large business requirements sessions. Able to translate business processes into functional requirements
Experience
▪ In -depth experience of Long Term Service Support (LTSS) programs in the various managed care programs.
▪ Business Analyst/Data Analyst with insurance industry experience
▪ Knowledge of state and federal laws, regulations and processes regarding Medicaid Managed Care and CHIP (STAR, STAR+PLUS, STAR Kids, STAR Health) .
▪ SQL, data mining and VLOOKUP experience
▪ Commercial Insurance Plans, HIPAA
▪ Possess strong application skills in the use of relational databases
▪ Familiar with database extract and analyzing tools
▪ Proficient in Microsoft Office (Excel, Word, Outlook) and relational databases
▪ In-depth knowledge of healthcare and claims concepts
▪ Excellent written and oral communication skills
▪ Excellent analytical, critical thinking and problem solving skills
▪ Compile data, create reports and display information
▪ Ability to communicate with technical and nontechnical personnel
▪ Extensive knowledge of government agency and insurance company programs, coordination of benefits guidelines.
▪ Familiar with billing and payment guidelines ▪ Ability to build good relationship with customer ▪ Wide knowledge of healthcare programs:
▪ Managed care enrollment and claims systems
▪ Data entry validation
▪ Report generation
▪ Ability to design, build, and implement business solutions
▪ Facilitate large business requirements sessions. Able to translate business processes into functional requirements
Education
- University of Texas at San Antonio - Bachelor of Science in Healthcare Management - Health Informatics November 2013
