Core Competencies:

Data Analysis Business Intelligence Developer Research Analyst Data Collection Root-Cause Analysis Financial / Statistical Analysis Decision-Making Problem Identification Resolution Report Summaries Statistics / Logical Methodologies Medicaid and Medicare Part D experience Computer Hardware and Software Knowledge

Confidential

HEALTH STATISTICS ANALYST

• Managed operational projects for PEBTF.
• Involved with planning, organizing, coordinating, and leading team efforts.
• Utilized standard project methodology and tools to monitor the progress of assigned projects.
• Provided trouble-shooting and problem resolution to ensure that projects are delivered on schedule, within budget and of high quality.
• Utilized MS Windows Office software, Share Point and MS Project
• Used reporting tools of SQL, SSRS, Excel, and Access
• Created a variety of reports to be utilized by members of the management staff.

BUSINESS INTELLIGENCE DEVELOPER

Confidential

• Assisted in the creation and maintenance of internal policies and procedures documentation pertaining to Healthcare for information systems and technologies
• Assisted in the creation and maintenance of end-user documentation pertaining to multiple prescription benefit web-based systems and functions
• Communicated and coordinated with Business Analysts, Subject Matter Experts, Business Owners, Project Managers, and other stakeholders to ensure accuracy and completeness of documentation
• Responsible for analytical data needs of the business unit handle complex data projects, researched the needs related to the program integrity function.
• Responsible for development of new Framework Manager Models using Cognos 10.1.1
• Responsible for development of new Report Studio and Query Studio Reports
• Responsible for training new users in Query Studio
• Assisted with the design of a data model in a star schema layout.
• Established project priorities and deadlines for current work within the team.
• Created views as necessary for reporting requirements
• Created several query joins in Report Studio. Used the results of these joins in Report Studio reports.
• Created project plans for reporting projects.
• Developed AdHoc Reports
• Worked closely with Client personnel on the most efficient use of Cognos Framework Manager packages as related to client needs through the use of Cognos.
• Troubleshoots various Cognos Query, and Reporting issues.
• Troubleshoots various Cognos Framework Manager issues

RESEARCH ANALYST/ PROGRAM SPECIALIST

Confidential

• Support activities and analytical research related to the Bureau program integrity function under the Medical Assistance program. T
• Review compliance plans, policies, contracts and procedures and made recommendations for updates as needed.
• Compile quarterly summary reports submitted by the Medicaid Managed Care Organizations MCOs .
• Review and analyze these reports for compliance and anomalies.
• Prepare reports for distribution to MCOs, providers and other investigative agencies.
• Receive, process and track fraud and abuse referrals from MCO.
• Review MCO referrals and prepare them for submission to other agencies such as the OAG, OIG, DOS for further investigation.
• Research and gather additional data, compiled statistics and managed care activities for distribution throughout DPW.

• Coordinate quarterly Provider Compliance Meetings with MCOs.
• Developed strong computer skills using Microsoft Access, relational data base design, extracting and reporting data using Excel, and Business Objects

DATA / STATISTICAL ANALYST /BI Developer

Confidential

• Conducted research on Medicare Part D data, using Medicare rules and regulations and other sources of information. Acted as agents for CMS.
• Identified Program Vulnerabilities
• Performed Internal and External Request For Information RFI
• Utilized a variety of statistical tools to detect situations of potential fraud or compliance violations.
• Supported ongoing fraud, waste and abuse and compliance investigations and audits.
• Developed subject matter knowledge to solve common and complex business issues within established guidelines and recommended appropriate alternatives.
• Exercised independent judgment within generally defined policies and practices to identify and select a solution.
• Acted as a team or project leader providing direction to team activities and facilitates information validation and team decision-making process.
• Gathered appropriate information and advice in order to make decisions on complex business issues.
• Developed experience with utilization of data analysis for fraud and compliance violation detection and prevention.
• Gained knowledge and experience with Medicare, Medicaid and Medicare Advantage rules and regulations.
• Participated in audit preparation and collection of data for an audit of insurance plans.
• Analyzed data to identify and compare norms, trends and patterns.
• Presented issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government.
• Reported work activity on a timely basis.
• Organized a case files, researched violations with accuracy and thoroughness while documenting all steps taken in project development. Developed strong computer skills using Microsoft Access, relational data base design, extracting and reporting data using Excel, Cognos, Crystal Reports and Business Objects.

DATA / FINANCIAL ANALYST

Confidential

• Collaborated with operational and financial personnel to investigate and resolve all vendor parts
• Initiated escalations as required and notified IBM SPS Financial Management of potential exposures related to APC '4' parts that did not meet threshold requirements and required resolution.
• Investigated and resolved billing and receipt variances greater than 10,000 for the shipment and transfer of parts from plants to SPS inventory, using SAP .
• Provided monthly reconciliation for inventory aging of all outstanding parts returns by plant/vendor for both offices 702 and RPR .
• Ensured IBM's ledger and financial statements accurately reflected the financial position of ITS parts inventory and expense.
• Provided general accounting and data support that included preparing and submitting all required journal entries to IBM for IBM SPS.
• Purged and deleted variance records when no resolution could be made and adjustments were made to the cost systems. Records for all deletions and adjustments were maintained with business justification and management approvals.
• All monthly reconciliations and measurements of the RNB, RPR, and 702 processes along with accounting procedures were presented to all levels of management for review and approval.

STATISTICS ANALYST Level 2

Confidential

• Worked closely with project managers and application development teams to authenticate data types and design statistical models to create enterprise-wide reports and planning aids.
• Analyzed and determined relationships within various databases, created reports using Crystal Reports to support planning efforts for senior staff.
• Assisted 11 Engineering Districts with data requests, offering guidance on what methodology to use that is most feasible when analyzing Highway Administration data.
• Designed and managed data studies to determine relationships and/or forecast future behavior patterns as a basis for Bureau planning efforts.
• Constructed statistical measurements for quality indicators, producing summary reports for data analysis.
• Recommended and validated forecasts and models for various data systems and functions for ECMS and related systems.

DATA, REPORT, BUDGET ANALYST / STATISTICIAN / BI DEVELOPER

Confidential

• Developed and implemented budget databases and documentation to meet department needs.
• Identified and recommended hiring/ training plans based on capacity planning and forecasting of staffing requirements.
• Interacted with various departments and systems to capture statistical data, establishing methods to store and retrieve data in a useable format.
• Identified and resolved many IT problems from software to hardware issues.
• Gathered and analyzed raw data related to quality, budgets, staffing, and other department operations, using statistical and logical techniques to insure the accuracy, relevance and reliability of data collected - ensuring data collected was relevant to the intended purpose of the statistical analysis.
• At times a vast array of calculations and analysis had to be done on a set of data samples, especially when preparing findings for budgets, future volumes, staffing and costs.
• All data and calculated data were stored and maintained in databases, Excel spreadsheets and other documents I created.
• As a separate function for supervisors, managers, and directors, I created, maintained and produced reports from databases and spreadsheets for their private use to track pay reports, presentations, budget data, promotions, yearly evaluations, and special projects.
• Produced presentations, which could include many media types, which were presented to corporate headquarters.
• A critical and specialized task I did was to set security permissions for management on databases, spreadsheets, folders and network folders.
• Developed strong computer skills using Microsoft Access, relational data base design, extracting and reporting data using Excel, and Crystal Reports.

• Performed in-depth research and causative analysis of major discrepancies found as a result of location surveys, inventory counts, inventory reconciliation, denial processing and intranet research relevant to receipt, shipment and storage transactions.
• Ensured that records of items received, stored and shipped by the Defense Depot were properly reported through electronic transmission to Defense Supply Centers DSCs , Military Services, and General Services Administration GSA .
• Documented all investigative procedures and followed up with affected areas to prevent future discrepancies related to inventory.
• Balanced records and expedited supply items as requested by customers.
• Reviewed all system changes and determined impact on local procedures, and recommended necessary changes.
• Responsible for corrective actions to be taken in balancing records and expediting supply items requested by customers.