Selim Ketsi
Summary
Competent Healthcare Quality Analyst with 9+ years of experience in healthcare quality assurance (QA),healthcare quality improvement (QI), and revenue auditing that supports cross-functional collaborations, and contributes to policy development and process improvements. Proven ability to manage quality assurance in revenue cycles, who has demonstrated success in project management, maintains integrity and clear ethical approach to projects. Proven ability to thrive in complex environments, deliver high-quality results, and communicate technical concepts to both technical and non-technical stakeholders.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Claims Data Analyst
UnitedHealthcare
01.2022 - Current
- Reviewing processed health insurance claims to ensure compliance with UnitedHealthcare guidelines and addressing provider concerns pertaining to underpayments and overpayments which helps to reduce payments irregularities.
- Collaborating with cross-functional teams, including clinical, and operational, to gather data requirements and to deliver billing targets.
- Analyzing healthcare insurance data to identify trends, patterns, opportunities for process optimization and ensuring compliance with HIPAA and other relevant guidelines..
- Collaborating with healthcare stakeholders to understand data needs, challenges, and opportunities across clinical, operational, and financial domains.
Business Analyst
Sachindra Desaram Ltd
01.2020 - 09.2022
- Successfully initiated and secured US$1.4m Small Business Administration(SBA) loan facility to purchase the business real estate units for the company.
- Improved operational workflows by identifying areas of inefficiency and implementing appropriate solutions to ensure automation of processes which achieved 19.7% increase in annual revenues in the middle of Covid-19 pandemic in 2020.
- Audited data generated reports by reviewing reports, reviewing dashboards data and measured same with performance indicators to identify gaps.
- Worked with management team to prioritize business and information needs during quarterly reviews.
- Implemented data quality assurance and data quality improvement measures to ensure quality output and improved data process for effective decision making.
- Translated complex data findings into clear, concise reports and presentations for non-technical stakeholders for decision making.
Quality Assurance Analyst
Worldwide International Youth Organization.
09.2017 - 03.2019
- Ensured data quality and integrity by performing data cleansing, validation, and reported project progress reports via Salesforce to United States Agency for International Development for funding purposes which led to winning the third phase of the contract.
- Developed and maintained dashboards, reports, and visualizations using tools like Tableau and Power BI to provide the basis for decision making.
- Provided strategic support to develop and strengthen partnerships; provided support and inputs to develop new program initiatives to support the program of work.
- Utilized statistical methods to interpret data and provided recommendations for process improvements by implementing Quality Assurance and Quality Improvement procedures to ensure accurate data is captured, stored and used in accordance with relevant laws.
- Developed training materials and oversaw training of volunteers which helped to reach hard-to-reach hotspots.
Hospital Administrator ( Intern)
La General Hospital
09.2016 - 09.2017
- Assisted in directing day-to-day administrative and operational functions for the facility, providing guidance and leadership to over 50 employees across more than 8 departments.
- Participated in performing assessment of performance goals, incentive programs, service strategy and helpline issues for alignment with prudent, ethical and strategic objectives.
- Teamed up to develop policies and procedures for effective pharmacy management reducing duplicate costs.
- Monitored internal revenue generation points to ensure revenue targets are met.
Education
Masters in Health Administration
Ohio University
Ohio, USA.01-2024
Bachelor of Science - Business Administration
University of Ghana
Accra, Ghana.01-2016
Skills
- Healthcare Management Quality Assurance Quality Improvement Healthcare Data Analysis Healthcare Insurance Claims
- Program Management Project Management Resource Mobilization
- Enterprise Resource Planning (ERP) Management Information Systems
- Data Visualization Tableau Power BI R
- Microsoft Office Suite: Excel Outlook PowerPoint Teams Word
- Strategy Formulation Resource Allocation
Certification
- CompTIA Security Plus Certified (2021).
Timeline
Claims Data Analyst
UnitedHealthcare
01.2022 - Current
Business Analyst
Sachindra Desaram Ltd
01.2020 - 09.2022
Quality Assurance Analyst
Worldwide International Youth Organization.
09.2017 - 03.2019
Hospital Administrator ( Intern)
La General Hospital
09.2016 - 09.2017
Masters in Health Administration
Ohio University
Bachelor of Science - Business Administration
University of Ghana
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