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Sr. Healthcare Pharmacy Data Analyst - Informatics Resume

PROFESSIONAL SUMMARY:

  • 7+ years of experience as a Data Analyst in Healthcare/Life science industry that accepts the responsibilities to support both external clients and internal management.
  • Broad understanding of healthcare data like Claims, Clinical data, Lab results data, Provider data, Pharmacy drug/ prescribers’ data, FDA AHFS Drugs details, quality metrics and health outcomes.
  • Capable of analyzing problems and designing recommendations including workflows processes and procedures.

TECHNICAL SKILLS:

OS: HP - UNIX, Windows 95/98/NT/XP

Language: SQL, T-SQL, SAS programming, R, Python, Tableau, Excel, MS Access

Databases: Teradata database, AEDW, Microsoft Access and MS SQL Server, Relational database

Content Management: Documentum, e-Room, SharePoint, Clear Case

Testing Tools: SAS Enterprise Guide, R Studio, Advance Query Tool (AQT), Teradata SQL Assistant, PyCharm, Tableau, Power BI

Regulations: HEDIS, NCQA, CDER, CDC, CMS, HIPAA, X12 (EDI), FDA guideline, 21 CFR Part11

PROFESSIONAL EXPERIENCE:

Confidential

Sr. Healthcare Pharmacy Data analyst - Informatics

Responsibilities:

  • Involved in Advanced analytics for New Drugs to Market, New policies, Biologic Drugs class, Hepatitis C drugs, STARS measure, and Commercial formulary. As well supporting pharmacy department copiously through informatics analysis.
  • Created reports of analysis to control drug over dosage or drug abuse such as Opioids/Narcotics in the market using R studio.
  • Mainly involved in to CCT (Clinical Care Transformation) project - to aware providers or specialists with constant drastic cost increase in drug price.
  • Constantly involved in CCT quarterly reports and follow-ups to measure impact of these initiatives and to make sure that providers have taken corrective actions to improve patient’s health and maintain copay lower.
  • Also measured the highest cost drugs therapeutic classes such as Dermatologics and Cardiac drugs and approached specialties for awareness.
  • Also, we keep observing which Top 50 drugs have been utilized highest by which population such as Commercials, Medicare, Fully Insured and Self-Funded.
  • Provided report to Government Market department for Medicare population who is receiving the DDC (Discount Drug Card) Part D benefits from medical and pharmacy claims.
  • Also, actively supported data migration for FDA drugs list from Medispan to our database system. Attended client meetings to discuss the requirements and what format of datafiles we required to plug in into our system. Discussed the process flow and worked with our ETL team. Supported data validation and how to combine with our claims to get this updated FDA information at claims level.
  • Doing Analysis in to see how we can predict the side effects that patient will have having with medication consistently with same dosage longer. Such as Diabetic, Lower Lipidemic, CKD, CHF, AMI, etc.
  • Constantly supporting Pharmacy department with their Ad- Hoc requests or drugs cost analysis or CDC case studies such as Migraine members, HIV members or having Diagnosis codes for Chronic conditions and their treatment analysis.
  • Experiencing in making final deliverable to providers for the patient chart information chasing for HEDIS, MED MEASURE, QPM etc.
  • Creating monthly, quarterly, annual reports for Medical Injectable rebates, Auth, legal lawsuits & pharmacy spent using R studio & Teradata SQL.
  • Involved in Medicare STARs program to analyze how we can increase the Star rates.
  • Provided data analysis from both within and outside of department. Prepared executive level presentations on off label drugs utilization for management and clients.
  • Converted all SAS programs for reoccurring reports and analysis to R, Python & SQL using various tools R studio, Teradata SQL Assistant.

Environment: Teradata, R Studio, AQT, SAS, Python, Tableau, SQL Server, AEDW, Big Data, Hadoop, SharePoint, ServiceNow, MS Visio, Microsoft word, Microsoft excel, Microsoft access, HP quality center, Unix, Windows.

Confidential

Business System Analyst

Responsibilities:

  • Performed a BSA role in Healthcare Informatics and Prescription Drug Management for Chronic Disease Care Management, Chronic Disease Risk Adjustment, Interventional Care-Management Module, Invasive Cardiology Care Management and Antidepressant, Antipsychotic, Antibiotic Prescription drugs.
  • Created Utilization reports for Antidepressant, Antipsychotic and Antibiotic Prescription drugs with frequencies ofMonthly, Weekly and Quarterly based on NCQA DUR specifications.
  • Involved in conducting Root Cause Analysis and GAP Analysis - Invasive Cardiology, statins & Sovaldi Drug cost analysis. In details to see why Insurance company have sudden spike in HEP C class drugs payments. Also compared their medical and pharmacy cost to see the trend of patient cure vs cost investment for 4 quarters.
  • Strongly involved in researching details and developing Work flow Diagram, Process flow diagram and Data flow diagram using MS Visio specific for the medical device which helps to reduce inpatient hospital stay for the cardiac patient. Strongly conducted this project with FDA approved medical device manufacturer in Canada to bring this device in USA market to identify their pros and cons. Conducted this team to IBC place for their presentation & explored the vision of purpose to the IBC’s higher organization. created Software Development Lifecycle (SDLC) deliverables Business Requirement Document (BRD), Functional Requirement Document (FRD) and Requirements Traceability Matrix (RTM), during pharmacy claims data migration from HMK to IBC database systems.
  • Executed Server Query Language (SQL) queries on SAS for data extraction from Active Enterprise Data Warehouse (AEDW) healthcare database for HealthCare Analytics purposes. Mostly worked with pharmacy department for supporting drugs cost analysis, high cost marketed drug analysis, specific therapeutic class (AHFS for HIV, Migraine, Statins) analysis.
  • Created System documents for developers to create java-based web, i-pad, and smart phone application (Lab Alert Rx) development.
  • Also involved in creating presentations for project meetings based on real information, including PMPM Cost model, Health care Database, Claims, etc.
  • Strongly involved in Risk management analytics for mapping AHFS therapeutic class to identify potential diagnosis code using pharmacy claims for the predictive modeling. Created the very the code for the developers or users to run the query for the chronic condition and comorbidities.
  • Involved in CMS audit for the pharmacy claims & their clinical information requirements.
  • Helped the data modeler for to invent the logic for the IBX Wire application which helps IBC members to get the alert for their Lab results, medication incompliance and their coming up appointment or checkup requirement.
  • Created standard cross walk of NDC (National drug code) to the various Therapeutic class such as AHFS, USC, ANT SPC, STD classes which Informatics can use uniformly for the all-purpose.
  • Involved in the SAS transitions to different programming since company has decided to remove SAS Enterprise Guide.

Environment: Teradata, R Studio, AQT, SAS, Python, Tableau, SQL Server, AEDW, Big Data, Hadoop, SharePoint, ServiceNow, MS Visio, Microsoft word, Microsoft excel, Microsoft access, HP quality center, Unix, Windows

Confidential, NY

Business System Analyst

Responsibilities:

  • Created Business Processes and Work Flow Diagrams using MS Visio.
  • Rigidly followed FDA’s 21 CFR Part 11 to create, modify, maintain, archive and retrieve Electronic records required throughout all the phases of SDLC.
  • Worked extensively with IT team for developing and documenting Technical Requirements for the implementation of the Service Now tool
  • Prepared RTM (Requirement Traceability Matrix) using HP Quality Center to link all requirements with Test scripts.
  • Created Project plan and tracked critical project milestones effectively and reported them to management on weekly basis.
  • Also, created and maintained project budget and resource allocation reports.
  • Developed UAT scripts for the system and performed dry run to find out the issues in system workflow
  • Facilitated User Acceptance Testing (UAT) for different modules of Laboratory Information Management System (LIMS)
  • Authored IQ/OQ/PQ scripts and coordinated with System Analyst to make sure the system gets qualified through complete IQ/OQ/PQ execution.
  • Interacted with developers and various members of team to discuss and resolve defects arose during the UAT (User Acceptance Testing) execution with the help of HPQC.
  • Reviewed the requirements for calibration and maintenance, developed as draft procedures and finally issued as authorized Standard Operating Procedures (SOPs) as part of the SOP program of the company.
  • Active participation in creating system User Access Guides, Training materials, FAQ’s, Statement of Work (SOW) and End Users manuals.
  • Identified opportunities for improvement such as updating SOPs, creating templates and modifying defect tracking cycle.

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