Dana Ann Williams
Operations Analyst @Rialtic
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WORK HISTORY
Operations Analyst @Rialtic
As an Operations Analyst at Rialtic, I supported the development, validation, and operationalization of payment-integrity and claims-editing analytics, partnering closely with Product, Engineering, Content, Go-To-Market, and Client Experience teams. My work focused on translating CMS and payer policy into defensible, data-driven analytics used to evaluate how claims should pay.Key Contributions & Responsibilities:Payment Integrity & Policy Analytics:Supported pre-pay and post-pay claims analysis by translating written CMS, NCCI, Medicaid, and payer-specific payment policies into testable analytic logic used to evaluate claim accuracy and reimbursement outcomes.Advanced SQL & Healthcare Data Analytics:Designed and executed complex AWS Athena SQL queries across large-scale claims datasets in Amazon S3, leveraging multi-level joins, window functions, and conditional logic to analyze claim, line, and payment-level data.Claims-Editing Validation & Accuracy Analysis:Performed detailed analysis of modifier dependencies, frequency limits, overlapping dates of service, duplicate billing scenarios, place-of-service logic, and pre-pay vs. post-pay accuracy to identify false positives and missed savings opportunities.Cross-Functional Collaboration:Partnered with Product, Engineering, Clinical SMEs, and Content teams to validate policy intent and ensure analytics were auditable, reproducible, and aligned with payer expectations.Operational & Client-Facing Analytics Support:Delivered ad-hoc and recurring analytic outputs supporting Go-To-Market, Client Experience, Client Success, and Finance, translating findings into clear, actionable insights.Data Quality, Testing & Documentation:Investigated data integrity issues, mapping gaps, and inconsistent coding patterns; supported UAT, edge-case review, post-release monitoring, and maintained analytic documentation to improve reporting precision and alignment.
EDUCATION
Seminole State College of Florida
Technical Certificate, Office Specialist
University of Central Florida
Bachelor of Science (B.S.), Health Informatics and Information Management
University of Central Florida
Insurance
Seminole State College of Florida
Associate of Arts (A.A.), General Education
University of Central Florida
Bachelor of Science (BS), Health Services Administration
Seminole State College of Florida
Technical Certificate, Accounting Specialist
Seminole State College of Florida
Technical Certificate, Office Support
University of Miami Herbert Business School
Master of Science - MS, Business Analytics
ABOUT DANA ANN WILLIAMS
I’m a healthcare data analytics professional specializing in payment integrity, medical policy translation, and claims-editing analytics, with deep experience operationalizing CMS and payer policy into defensible, data-driven claim decisions. I’m dedicated to improving the data management and accurate claims processing experience for large-scale health systems and insurance companies, combining a strong informatics foundation with reimbursement, appeals, and claims operations expertise.My background spans Medicare, Medicaid, Commercial, Exchange, pharmacy, and PIP lines of business, where I’ve worked hands-on with complex claim, claim line, and payment data to ensure accurate reimbursement, regulatory compliance, and financial impact. I specialize in translating written payment policy, coding rules, and reimbursement logic into scalable analytic frameworks that evaluate how claims should pay — not just how they did.I thrive in fast-paced environments, balancing time-sensitive demands, client issues, and complex analytical work. I’m an out-of-the-box thinker and problem solver who turns ambiguous requirements into clear, executable solutions.At Rialtic, I supported the development and validation of payment-integrity and policy-edit analytics, using AWS Athena SQL, Python, and Amazon S3 to analyze millions of claim records. My work focused on modifier dependencies, frequency limits, overlapping dates of service, duplicate billing scenarios, place-of-service logic, and pre-pay vs. post-pay accuracy, as well as identifying false positives and missed savings opportunities. I partnered with product, engineering, clinical SMEs, and client-facing teams to ensure analytics were explainable, auditable, and aligned with CMS, NCCI, Medicaid, and payer-specific methodologies.I’m skilled at telling the “data story” through SQL queries, dashboards, and visualizations that drive ROI and informed decision-making. I take time to understand the why, how, and impact behind each dataset while identifying integrity gaps and improvement opportunities.Core Expertise:Payment Integrity • Claims Editing & Policy Analytics • Medical Coding & Reimbursement • Pre-Pay & Post-Pay Analysis • SQL & Data Modeling • AWS Athena & S3 • ETL Pipelines • APIs (REST/SOAP) • Tableau • Python, R, SAS • Regulatory Standards (CMS, HL7, HEDIS, MAC, RAC, URAC)I believe in leaving teams stronger than I found them through documentation, knowledge sharing, and collaboration. Education:M.S. Business Analytics — University of Miami (Miami Herbert Business School)
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