An experienced professional with an expert knowledge of the healthcare delivery system from the patient interactions through claims delivery systems and insurance delivery systems

EXPERIENCE

WPS Medicare

Data Analytics Leadership

• Managing a team of four data analysts and a statistician.
• Provide guidance on vendor software and warehousing development.
• Data Mining, Data Analysis and performs applied statistical analysis of integrated healthcare data, validate output, interpret results, document code, and make recommendations based on analytic findings.
• Provide recommendations for data collection methods, metrics definition and evaluation methods.
• Present analytic reports to division personnel as well as external clients and stakeholders.
• Collaborate with internal and external partners and organizations to design and execute analytic studies to answer business and research questions.
• Design and conduct analyses and outcome studies using various data sources, which may include healthcare claims, pharmacy, and lab data, employing appropriate research designs.
• Assist with the creation and maintenance of the WPS data warehouse.
• Develop project plans, research study designs and timelines.
• Train Staff on data analysis, data mining and sql programming.
• Manage projects and customer expectations to achieve client satisfaction.
• Responsible for project commitments to quality and on-time deliverables.
• Create and evaluate the data needs of assigned projects and assure the integrity of the data.
• Use existing data applications within the enterprise SAS Base programming, SAS/Graph,MS-Access Oracle pl/sql, Arc Gis, Tableau, Powerpivot .

Confidential

Business Analyst III - Medicaid Professional Consultant - Healthcare Analytics

• Operational performance improvement working as a consultant to the State of Wisconsin on Pay for Performance
• Hedis NCQA measures analytical coding of four measures and strategic analysis for HMO rate setting and quality initiatives,
• Data integrity quality initiatives for warehousing and policy improvement for state of Wisconsin,
• Coordinating with Medical Directors and Quality Director toward identification of clinical initiatives to control costs Medicaid and improve quality.
• Revitalized staff production and client engagement by working with team to improve communications, change management, orientation and education.
• Mentoring and Coaching the State of Wisconsin by providing educational support to State of Wisconsin staff on SQL, SAS, Business Objects, Access and clinical interpretation.
• Implemented process improvement and thorough documentation of departmental analytics monitoring, tracking, trending and forecasting reports.
• Leading several large operational projects, for quality outcomes, compliance and evaluation of quality improvement initiatives that require coordination across departments and the organization.
• Consultant on the recommended best quality options toward policy intent discussions.
• Provide root-cause analysis, research and investigation of processes to meet state and federal regulations.
• Provided fraud and abuse analysis and sql coding from MDS 2.0, 3.0 and long term
• Integrated Health care data modeling for the State of Wisconsin for mental health and chronic conditions
• Consult and mentor Medication Therapy management team on quality best practices and disease groupings.
• Population Health disease profiling.
• Pharmacy claims and quality measures.
• Mentor Foster Care on quality best practices and disease groupings.
• ICD10 Policy Remediation and Analytics - ICD9 diagnosis and surgical procedure code expert. Expert knowledge of hcpcs, cpt and claims billings code sets.
• EAPG 3M product Analytics team sme.
• Subject matter expert: Training Health Care systems, Business Analysis, Data Analysis, Claim code sets, Claim processing, Clinical processes.

Confidential

Project Manager/Systems analyst

• Medication Reconciliation Project Medication Taken At Home, coordinating with various departments the ability to profile patient medication including medications taken at home.
• OB/GYN Interoperability Project Coordinated project with HL7 team, OB Department manager and IT staff to create a system that communicated with Enterprise system.
• New 50 Bed Patient Tower Coordinated Enterprise System updates for new patient tower. Project managed interoperability and coordination of system updates and cutover for a project lasting over one year.
• Coordination of all departmental and bed changes for Enterprise Hospital System
• System Upgrade Project Manager for Enterprise System upgrade.
• Infection Control Project to automate reporting to CDC.
• Programmer
• Programming in SQL, COBOL, MS-ACCESS, Business Objects and proprietary application reporting tools.
• Clinical Documentation Report, Cardiac Report, OB Report, Medication Report, Registration and Scheduling reports including Patient Itinerary report.
• Business Analyst
• Security management and staff role management for enterprise system.
• Analyst in patient information management, health information management, clinical management and problem solving, data analysis, research, design, programming and coordinating of projects.

Confidential

IT Business Analyst

• Electronic Data Interchange - Interpret Medicare guidelines to healthcare providers and vendors to provide resolution of ANSI format and billing issues with a 100 percent HIPAA implementation earlier than other contractors.
• Lead for special projects which involved reporting monthly and weekly statistics to the Center for Medicare and Medicaid. Lead analyst responsible for researching, updating, and tracking provider changes using an Access database.

Confidential

Business analyst Data Center Operations Healthcare Clearinghouse.

• Implementation of ANSI formats to successfully process medical/hospital claims with analysis of the EDI formatted files.
• Project management skills used for strategic business approach to data center improvement.
• Created standards and documentation of the clearinghouse processes for improved communication and controlled change management processes.
• Increased clearinghouse efficiencies by providing guidance to implement automated file delivery systems and processing of claims using programming languages.
• Interfaced with providers to guide them on billing/coding protocols, claim adjudication, and medical record interpretation.