Dedicated Senior Healthcare Utilization Analyst with 25+ years accounting experience in insurance/banking environments. Effective self-motivated problem solver with a strong track record of attaining the best outcomes for clients.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Senior Healthcare Utilization Analyst
The Reschini Group
07.2021 - Current
Review, verify, interpret, and analyze financial and healthcare utilization information from internal and external reporting systems.
Produce and analyze highly detailed reports. (Including loss ratios, financials, diagnostic, and adhoc reports.)
Invoice claims and consulting fees.
Investigate and resolve payment discrepancies.
Assist with external audits.
Reconcile detailed financial statements.
Healthcare Utilization Analyst
The Reschini Group
03.2009 - 07.2021
Responsible for collecting and interpreting financial and healthcare utilization information.
Validate data and work with various insurance carriers to correct any outstanding issues.
Analyze and interpret data for internal and externl clients.
Developed customized reports, summarizing and presenting data in visually appealing format.
Provided technical support for troubleshooting analytics and reporting issues.
Analyzed data to identify problems and recommend corrective actions.
Investment Operations Specialist
First Commonwealth Bank
01.2005 - 03.2009
Prepares monthly balance sheet, P&L Statement, cash flow and other financial reports.
Operates and maintains software that assists in Asset/Liability Model (IPS Sendero).
Assist Accounting Department in verifying initial setup for monthly process.
Designs and develops special spreadsheets or database reports for use by management in Asset/Liability process.
Established reports needed for Risk Management.
Accountant II
First Commonwealth Bank
01.2002 - 12.2004
Operates and maintains Asset/Liability systems software that assists in budgeting/forecasting process (IPS Sendero).
Completed modeling, budget, strategic plan and operating plan updates.
Proficient in preparation of monthly board and management reports for First Commonwealth Bank and Affiliates (First Commonwealth Trust Company, First Commonwealth Insurance Agency).
Maintains and distributes reports from general ledger system, prepares and post daily ledger entries.
Researches internal and external audit findings in collaboration with auditors; prepares account reconcilement, and provides support for finance staff.
Accountant I
First Commonwealth Bank
03.1999 - 12.2001
Researches and prepares spreadsheets and summarizes results, account reconcilement, ledger entries, assists in budgeting/forecasting process, and provides support for finance staff.
Jennifer M. Eberhart
03.1999 - 12.2001
Education
B. A. - Business, Accounting
University of Pittsburgh
Johnstown, PA
12.1998
Skills
Strong quantitative, analytical and organization skills
Ability to analyze and process detailed information
Ability to use advanced Microsoft Excel
Proficient in Analytics Navigator, Word, Synergy, and Sendero
Licensed Producer for Life, Accident, and Health Insurance
Financial reporting and analysis
Certification
Resident Producer Individual - Life and Fixed Annuities, Accident and Health
Vice President – Account Growth & NBD at Max Mudra - JV Between The Tribes Group and DDB Mudra From Omnicom (now The Max, a Tribes Group Company)Vice President – Account Growth & NBD at Max Mudra - JV Between The Tribes Group and DDB Mudra From Omnicom (now The Max, a Tribes Group Company)
Lead Fellow at Centers for Medicare and Medicaid Services (CMS), Office of Group Director Quality Improvement & Innovation Group, Center for Clinical Standards & QualityLead Fellow at Centers for Medicare and Medicaid Services (CMS), Office of Group Director Quality Improvement & Innovation Group, Center for Clinical Standards & Quality