SUMMARY

Highly motivated and enthusiastic career health care professional with exceptional analytical, research, and management skills and experience. Broad working knowledge of public health and healthcare management issues. Exceptional technical skills. Highly experienced in working with various types of data and information statistical, epidemiological, medical, financial, and pharmaceutical. Extremely strong oral and written presentation skills and political savvy. Ability to effectively manage and communicate with staff of various levels including executive and C-level, backgrounds and work ethics.

ACCOMPLISHMENTS

TECHNICAL SKILLS

TECHNICAL SKILLS PROFILE

Broad, strong, hands-on experience with a variety of business intelligence and data analysis tools. Strength in utilizing a hybrid of technologies to produce desired analytical presentations in desired formats. Access skills include macros, forms, dashboards, ODBC connections to SQL Server, for example, complex, nested queries, and the creation of automated feeds of data into Excel, PowerPoint, and Word for dynamic charts and graphs, mail merges, and drilldowns. Excel skills include complex formulas and calculations, clear, complex and dynamic graphs and charts, linking of spreadsheets, and clear and concise presentations. SQL Server skills include complex, nested queries, strength in rapid, dynamic identification and mining of appropriate data in consultation with internal and external clients, predicting a majority of future requests, minimizing rework based on eliciting unrealized requirements, and identifying issues and barriers to data acquisition and presentation early on. SAS skills include strength in statistical appropriateness of data, skillful presentation of drilldown data, providing important footnotes and disclaimers, and presenting data appropriately in line with the business message that is sought. SSRS, SSAS, SSIS, Cognos, Business Objects, and Crystal Reports skills include hands-on elicitation of business requirements, defining, deploying, and assessing performance of cubes and hands-on creation and implementation of business monitoring reports, KPIs, dashboards, and eye pleasing presentations, and strong ability to anticipate and offer dynamic drilldown of high-level data. In-depth, lengthy experience in business intelligence, data analysis, mining, and acquisition experience results in the confidence to assure employer that the technical job will get accomplished within the day of request, if generally feasible, regardless of any small, specific gaps in knowledge.

EXPERIENCE

Confidential

Data Reporting and Analysis

• Utilize SQL and data analysis tools to extract client data and format the results to answer specific business questions for client teams and assist in the development and evaluation of rules used in client modules.
• Interact with executives both internal and external.
• Work with a wide range of audiences from developers to senior management.
• Perform data mining and analysis using SQL tools.
• Perform data analysis and format reports using Microsoft Excel.
• Design and develop ad-hoc reports.
• Enhance and automate daily activities to improve business productivity.
• Manage multiple data related projects throughout the year.
• Maintain a high level of customer satisfaction.
• Utilize analytical skills to effectively handle problem identification through the proposal of potential solutions.
• Work collaboratively with other departments to resolve complex issues with innovative solutions.

Self-Employed Confidential

Report writer for Office of Alumni and Development utilizing Oracle PL/SQL Developer and Crystal Reports.

Confidential

• Clinical data analysis to support client's Revenue Integrity Unit RIU program.
• Collect and report data, supporting Associate CFO to meet milestones of the project.
• Positioned on the Business Intelligence Team, develop functional requirements for a more strategic reporting and interfacing process.
• Assist in identifying data quality problems and in determining options for how they will be handled.
• Collaborate with developers and subject matter experts to establish the technical vision and analyze tradeoffs between usability and performance needs.

Healthfirst, Confidential

• Completion of the analysis and reference tools needed to support PBM implementation, contract oversight and enhanced member / provider experience.
• Analyze all data exchanges to ensure/confirm accuracy and identify any discrepancies.
• Identify and define criteria for all reference tables, utilizing SQL and SAS. Formulary / Drug group reference table Non-formulary RDUR reference tables using FDB data Benefit reference tables Claims rejection reference tables POS hierarchy reference tables Client set up/group eligibility reference tables
• Identify and define criteria for additional data elements needed to support pharmacy control plan, including eligibility, enrollment, Smart PA criteria.
• Work with internal downstream entities to transition current reporting based on data/data storage methodologies to the industry standard data/data storage less PBM dependencies, increased interdepartmental engagement with PBM . Finance, Actuarial, Product Retention , CPM.
• Define process for and begin cataloging policies, procedures, reference materials and communications, job aids, best practices.
• Provide guidance/maintenance on pharmacy share common drive structure.

Confidential

• Gathered and formalized requirements for EHR / EMR data capture and reporting.
• Elicited, clarified, and finalized requirements for Meaningful Use reporting measures for Stroke and VTE utilizing Sunrise Clinical Analytics and Sunrise Clinical Manager systems.
• Provided ad-hoc and drilldown analyses as determined necessary in consultation with client, North Shore-Long Island Jewish Hospital System's Clinical Analytics team, to provide necessary insight into issues surrounding clinical data availability, sufficiency, quality, and integrity.
• Presented concise, pinpointed and meaningful findings regarding data issues and concerns to client to maximize momentum of project progress.
• Tracked project progress on the technical side utilizing Clarity system and other project management tracking tools.
• Provided technical and clinical leadership in interpretation of HITSP requirements for Meaningful Use measure numerators, denominators, indicators, reference sets, and population sets.
• Configured and tested Meaningful Use data elements in Sunrise Clinical Analytics system in test environment.

Confidential

• Investigated data transfer issues between disparate Blues systems.
• Took charge of issues by creating queries to drill down to point of failure.
• Identified and managed internal contacts to assist in resolving issues as necessary, on a project to project basis.

Medco Health Solutions, Confidential

• Benefits installations for employer groups for client Coventry Health Plan.
• Accountable for manual testing and signoff of installed benefits.

Hudson Health Plan, Confidential

• Medical management analysis projects for CMO.
• Some projects included:
• Vendor audit analysis of Radiology claims leading to discovery of flawed global claim adjudication logic.
• Presentation of statistical results for ADHD study.
• Determining provider outliers for cesarean section rates.
• HEDIS / QARR data analysis.

Affinity Health Plan

• Data analysis projects for finance and medical management related to optimizing medical cost ratios and quality scores for self-insured and outsourced services.
• Some projects included:
• Vendor audit analysis of behavioral health claims to determine overpayment due to noncompliance with contract.
• Determining provider outliers for cesarean section rates.
• Medical cost ratio analysis of taxi services for members.

Confidential

Manager, Operational Analysis and Reporting/Manager, Data Quality and Reporting

Confidential

• Gathered and defined business requirements for and created client disease management / HEDIS data dashboard reports in direct consultation with client.
• Gathered and defined business requirements for and created ad-hoc and ongoing operational data analysis designed to highlight KPIs of internal care management / utilization management programs.
• Designed new and re-engineered existing processes to improve operational efficiency of the entire data processing cycle.
• Ensured high quality of all incoming and outgoing data through complex data mining and data cleansing methods.
• Spearheaded development of company data dictionary and refinement of data warehouse.

Confidential

Manager, Data Acquisition and Integration

• Championed and implemented automation of QA test case and data selection leading to exceedingly quick turnaround time of data integrity sign-off.
• Initiated and created ad hoc data quality statistical analysis of medical, laboratory and pharmacy claims previously not addressed by department.
• Significantly contributed to Six Sigma project implementation and management.

Sr. Business Analyst, Confidential

• Created and automated countless statistical reports and analysis to identify outliers for potential audit opportunity.
• Instituted many new fruitful pharmacy audit selection criteria.
• Identified numerous extremely high dollar audit opportunities.
• Commendably delivered training in analytical processes to all department staff.