Nancy Francis

Data Analyst - Claims

• Analyze and interpret healthcare data to identify trends, patterns, and insights.
• Collaborate with cross-functional teams to implement data-driven solutions.
• Conduct quality assurance checks to ensure the accuracy and integrity of data.
• Managed and analyzed healthcare data for a range of service lines.
• Improved data accuracy by conducting thorough data validation and cleansing processes.
• Identified opportunities for process improvement through a detailed assessment of existing workflows and systems integration challenges.

Data Acquisition - Biometrics.

• To organize and maintain databases, ensuring data integrity and accessibility.
• To utilize data acquisition tools and technologies to efficiently gather and process information.
• To work closely with data analysts, engineers, and stakeholders to understand data requirements and deliver relevant insights.
• To document data acquisition processes, methodologies, and sources for transparency and future reference.
• Clearly communicate findings, data sources, and insights to relevant stakeholders, contributing to informed decision-making within the organization.

Healthcare Database Experience.

• Designed and implemented databases for healthcare applications (e.g., claims processing, clinical trials).
• Created entity-relationship diagrams (ERDs) to model healthcare data (e.g., patients, providers, medications).
• Wrote SQL queries to extract data, medical records, and claims information.
• Analyzed healthcare data to identify trends, risks, and opportunities for quality improvement.
• Implemented data mapping and conversion for electronic health records.

• Health Insurance Claims Analyst
• Determines and understands the coverage provided under a member's plan
• Adjudicate claims for a variety of plans.
• Process medical, Medicare Part A & B, hospital, COB, ESRD & SNF claims
• Maintaining the different types of dashboards on production details
• Downloading the Files from EDI Server and prepare the reports
• Generating the reports after production hours and sending the report on client requirements
• Responsible for reviewing the claims submitted to ensure that proper guidelines have been followed

• Sourcing Profiles through various Job portals & Channels
• Screening resumes, scheduling and co-ordinating for walk in interviews.