SUMMARY:

• Motivated self - starter with acute attention to detail, extensive experience and advanced proficiency in data management and various technological, reporting, and analytical tools.
• Career experience augmented with a solid in Management Information Science and Business Administration.

PROFESSIONAL EXPERIENCE:

Confidential

Managed Care Analyst

Responsibilities:

• Extract, upload, data onto SQL Server and analyze/reconcile large amounts of data across multiple system platforms and sources
• Provide analytical support to various departments and management.
• Develop system and operational resolution to increase provider data integrity.
• Assist in the development and documents operational workflow, systems requirement definitions, system input analysis, design, and process analysis.
• Provide quality assurance between functional specs or requirements and outsource testing for final user approval.
• Analyze system for ability to meet user need, creates estimates for completion, produce solutions for a variety of problem.
• System facilitator for the contract management system
• Ensure new contracts and updates are loaded accurately and timely
• Develop and enhance decision support systems databases/repositories
• Provide oversight for data collection. Provide technical and analytical expertise for evaluation, interpretation and analysis of managed care data.
• Provide user specific ad hoc reporting as requested

Confidential

Medicare Data Analyst

Responsibilities:

• Conduct research on Medicare claims data and other sources of information to identify problems
• Review sophisticated data model output and utilize a variety of tools to detect situations of potential fraud
• Support ongoing fraud investigations and requests for data
• Develop procedures to extract data from the database using various report writers and data extract tools
• Study, analyze and prepare reports as required by state and local authorities
• Utilize data administration knowledge in relational data bases to extract, design and create reports
• Demonstrate high analytical ability and basic knowledge of statistics and sampling techniques with sharp organizational and communication skills
• Prepare to testify at administrative and/or criminal proceedings to support data samplingrecommendations. Execute existing Business Object reports.
• Interface with Investigative Unit, Law Enforce, and OIG personnel to explain, clarify, and update the data/report provided to them
• Create, modify, and test for quality and accuracy of the templates and reports in Business Objects and SAS Enterprise Guide
• Identify opportunities to automate and/or improve measurement systems for reporting metrics in Business Objects, SAS, and other applications
• Create, modify, and test for quality and accuracy of the templates and reports in Business Objects and SAS Enterprise Guide
• Import or export large data sets using SQL. Create/modify and run SQL queries to manipulate data and export to Excel for user friendly format.
• Report mining, arranging flat text files with Monarch Pro
• Facilitate lead management data activities as required (e.g. scrubbing leads for quality, applying suppressions, reformatting data, performing QA steps and identifying opportunities to enhance QA processes)

Confidential

Billing Data Analyst

Responsibilities:

• Identify issues in billing system, practices and propose solutions
• Communicate with clients and solve any problems or issues arise from billing system
• Forecast prospective billings, analyze, and report outcomes to upper management
• Retrieve data from data warehouse and perform ad hoc and regular data analysis for management

Confidential

Senior Data Analyst

Responsibilities:

• Identify issues and propose solutions. Work with internal and external teams to implement changes
• Work with Medicare Reconciliation software from vendor to main and upgrade the systems
• Retrieve data from GHI&HIP Data Warehouses via Business Objects and Cognos Impromptu. Compare and contrast data against CMS data files, analyze and generate reports for management
• Monitor GHI and HIP operations to ensure that the program is in compliance with CMS regulatory requirements
• Manage FTP file transfers for all aspects of GHI Medicare program.
• Create and manage databases for management of Risk Adjustment, CMS financial reconciliation, and cash flow analysis
• Create/modify and run SQL queries to manipulate data and export to Excel for user friendly format.
• Create, modify, and test for quality and accuracy of the templates and reports in Business Objects, MS Access and Excel
• Write and maintain policies and procedures for GHI Medicare reconciliation processes, data management, and other technical processes for internal use and CMS Audit purposes

Confidential

Application Specialist

Responsibilities:

• Develop reports using various applications and statistical techniques
• Develop new relational databases to support new performance improvement initiatives
• Format retrieved data, presenting reports in graphical form (e.g., run charts, control charts, bar charts, histograms, etc.).
• Summarize findings in an executive report-type format.
• Assures accurate and timely reporting occurs to support Quality Management, Case Management, Risk Management, and all performance improvement activities
• Employ quality concepts and tools, as needed, to support the work of improvement teams

Confidential

Broker Commission Specialist/Sales Information Analyst

Responsibilities:

• Act as primary contact for the sales team in regards to sales and broker incentive programs
• Maintain and analyze the Sales Incentive and Broker Commission Programs
• Generate incentive program reports from Commission system (Acom3) and resolve data/reporting
• Coordinate and oversee the accuracy of Incentive and monthly Commission payments
• Analyze departmental processes to identify areas for business process and continuous improvement
• Coordinate vendor interaction within project and ensure smooth integration with CDPHP assets
• Run various reports from Data Warehouse using ReportNet. Generate Census Analysis, Geo Access reports, and Generic proposals
• Quality review of Sales paperwork and distribution