Wesley Shamburger
Secaucus,NJ
Summary
Experienced Medical Data Analyst with 10+ years of expertise in healthcare revenue cycle analytics, clinical coding, and cross-functional process optimization. Known for high-accuracy diagnostic and procedural coding, deep understanding of billing logic and compliance (HIPAA, DRG/APC), and strong collaboration with clinical, finance, and operational teams to maximize reimbursements, minimize denials, and improve data quality. Proven ability to leverage data analytics and automation to identify anomalies, reduce rework, and enable actionable insights
Overview
1
1
Certification
6
6
years of post-secondary education
11
11
years of professional experience
Work History
Medical Data Analyst
New York Presbyterian
New York, New York
03.2015 - Current
- Leverage data analytics and rule-based automation to identify billing anomalies, coding inconsistencies, and reimbursement risks, supporting revenue optimization initiatives.
- Perform high-volume diagnostic and procedural coding with high accuracy to optimize DRG/APC assignments, directly supporting >$1M+ in daily billing outcomes and compliant reimbursement
- Partner cross-functionally with Patient Accounting, Finance, and Revenue Integrity to ensure accurate claim preparation, minimize denials, and maintain audit-ready documentation
- Translate clinical documentation into structured billing data to maintain data integrity and support downstream revenue cycle analytics and reporting.
- Ensured ongoing compliance with HIPAA, coding guidelines, and hospital standards, recognized for accuracy and reliability in complex environments.
- Utilize decision-support tools and analytics outputs to prioritize high-impact billing issues and reduce rework.
- Collaborate with cross-functional teams to validate system intelligence outputs, ensuring alignment with clinical documentation and billing rules.
- Supported system changes and billing process updates by testing workflow impacts, validating coding logic, and communicating changes to operational partners, enhancing overall process integrity.
- Identified workflow gaps and escalated resolution opportunities to leadership, contributing to financial process improvement and reducing rework.
- Apply pattern recognition and trend analysis techniques to large clinical and billing datasets to improve accuracy, throughput, and downstream reporting.
- Assisted with AI-adjacent workflows by coordinating tasks and validating processes. including automated claim edits, system logic validation, and predictive denial indicators within hospital billing systems.
- Contribute to data quality governance, a foundational component of machine learning and AI-enabled healthcare analytics
- Engaged with healthcare teams to enhance data collection methods in clinical settings.
Education
Master of Arts - Health Administration
University of Arizona
Tucson, AZ 08.2022 - 06.2024
Bachelor of Arts - Public Administration
City College of New York
New York (City), NY 08.2016 - 06.2020
Skills
- Diagnostic coding
- Clinical data analysis
- Billing optimization
- Revenue cycle management
Certification
- Certified Professional Coder-American Academy of Professional Coders
- Business Intelligence-Healthcare Financial Management Association
Timeline
Master of Arts - Health Administration
University of Arizona
08.2022 - 06.2024
Bachelor of Arts - Public Administration
City College of New York
08.2016 - 06.2020
Medical Data Analyst
New York Presbyterian
03.2015 - Current