We provide IT Staff Augmentation Services!

Director Of Health Services Resume

San Francisco, CA

SUMMARY:

  • Statistical Analysis
  • Health Services Research; Health Care Cost and Quality Analytics (Provider Profiling/Scoring, Provider Performance Measurement and Reporting, Cost Driver Analytics, Benchmarking, Dashboards, Fraud, Waste and Abuse)
  • Demographic and Health Surveys
  • Teaching: Math, Statistics, Methods of Research, Survey Design

TECHNICAL SKILLS:

Analytic software and tools: SQL (basic), SPSS (extensive) * SAS (basic) * MS Office Suite (extensive) * 3M s All - Patient Refined DRG Grouper (extensive) * 3M s Patient-Focused Episode Grouper (low) * 3M s Clinical Risk Groups (moderate) * Optum s Episode Treatment Groups (moderate) * Thompson s Medical Episode Groups (low)

Consulting: CAHPS survey sampling design ( Confidential Government Solutions) * Validation of AHRQ s Inpatient Quality Indicators and Patient Safety Indicator (Wisconsin s Employer Health Care Alliance Cooperative) * Theses and dissertations * High profile court case on racial discrimination * State and national surveys

Community leadership and organization: President, Philippine-American Bayanihan Association of Utah (PABAU) * Editor in Chief, PABU newsletter

PROFESSIONAL EXPERIENCE:

Director of Health Services

Confidential,San Francisco,CA

Responsibilities:

Designed analytics related to benchmarking, provider performance measurement and profiling (cost and quality) and health care cost estimation. Applied well established statistical principles as well as proprietary algorithms in a wide range of analytics including identifying cost drivers, inferring patient mix of providers from medication data, attributing patients to responsible providers, scoring providers on cost and quality performance, projecting out of pocket cost, outlier trimming, and risk and severity adjustment.

Asst. Vice President

Confidential,Los Angeles,CA

Responsibilities:

Directed analysts in claims and utilization data collection, processing, analysis, reporting and dissemination to address business needs including medical claims analysis and reporting, fraud and abuse detection, and monitoring of cost and utilization patterns and trends and treatment outcomes. Established monthly cost and utilization reports for the company and developed analytical strategy to detect potential fraudulent and abusive practices.

Director, Office of Health Care Statistics

Confidential,Salt Lake City

Responsibilities:

Managed statewide health care information infrastructure of Utah, including Hospital Inpatient Discharge Database, Ambulatory Surgery Database, Emergency Department Database, Health Care Performance Measurement or Report Cards (enrollee surveys and Healthplan Employer Data and Information Set (HEDIS), Hospital Financial Performance Database, Health Care Facilities Database (Hospital, Nursing Homes, Home Health).

Hire Now