Professional Summary

• Experienced in workingwith health system executive leadership and physicians to measure and analyzeclinical outcomes in meaningful ways to drive and support their decision makingto meet goals
• Proficient in the use of SQL Server Enterprise Manager to create and manage databases and Query Analyzer to write programs to extract data for analysis, in addition to having advanced knowledge and use of Access, Excel, Word, and PowerPoint
• Experienced in providing analytic and reporting leadership that supports and improves business opportunities and relationships
• Experience with analyzing and reporting measures across integrated healthcare delivery systems, including creating facility and health system statistical process control charts and specialty charts to measure performanceagainst benchmarks
• Experience developing and producing routine and custom reports for program performance measurements
• Experienced in negotiating, analyzing,managing and administering contracts and increasing revenues in an academic and private practice setting
• Significant and diverse analytic and project management experience associated with chronic disease management, as well as academic and private physician practice reimbursements and modeling of physician/hospital package pricing arrangements
• Extensive experience managing, interpreting, cleansing, normalizing, linking together, and analyzingexceedingly large and complex medical claims, pharmacy claims, and eligibility data sets
• Exceptional organizational, written, verbal, and interpersonal communication skills resulting in successful internal and external clientrelationshipbuilding and maintenance

System Director

Responsibilities:

• Oversight of a system-level department of application and clinical analysts responsible for supporting a health system with 12-hospitals, as well as the clinical applications supporting care management and business intelligence
• Collaborate with executive leadershipto develop and implement measurement tools to track respective clinical quality measuresand aid in improvement efforts through additional analytics in order to meet system clinical goals
• Collaborate with executive leadership to establish hospital-specific and system-wide clinical goals relating to Quality and Risk
• Createcustom ad hoc reports and analytics as well as ensure production of ongoing deliverables
• Oversight of vendor relationships associated with clinical applications and assist in negotiatingtheir contracts
• Guide system committees on how their measures as well as what additional measures should be analyzed in measurement tools so they can properly track and improve outcomes, then build those tools

Accomplishments:

Analytics:

• Developed clinical analytics that support Quality, Risk, and Patient Safety in a more informed manner that allows executive leadership to focus efforts to improve patient outcomes
• Developed interactive dashboards on Surviving Sepsis to measure compliance with bundle requirements, Wake Up And Breathe to measure patients who are re-intubated, and Stroke Protocol adherence

Vendor Relationships:

• Negotiated the addition of a critical reporting application for free for one-half of the health system which did not have it, resulting in significant annual savings, in addition to numerous other contractual discounts
• Uncovered an issue with how a vendor's application was calculating date/time fields that although they were aware of it, was not corrected for all clients, resulting in a change in their correction procedure and notification process
• Uncovered that avendor did not properly implement their system prior to my arrival and was able to have them re-load multiple years of claims at no cost and re-map charge codes savings of over 36,000 enforcedoversight of contractual consulting days used for projectsand transferred completed project work for ongoing support rather than using consulting days again for it or similar projectsthat would have resulted in per-diem charges and caught 50,000 in invoice inaccuracies
• Negotiated trainings from a vendor for free, which saved 32,000

Director, Data Operations

Responsibilities:

• Managed and mentored a staff of 7Analysts in the Data Operations and Analytics group
• Worked with health systems' senior leadership to ensure that all data received met the requirements for ongoing deliverables and custom consulting analytics
• Acted as the liaison between clients and internal Client Service Delivery and Consulting groups on all data-related issues
• End-to-end oversight of the data operations and analytic process
• Managed the production queue of client deliverables

Accomplishments:

• Restructuredthe Analytics and Data Operationsdepartmentsin order to redefine analytic and data analyst roles andresponsibilities, then aligned them with Client Service Delivery leaders to streamline project work and enforce accountability that ultimately resolved long-standing issues with collecting, processing, analyzing data and then delivering projects to health system clientsthat ultimately led to a project delivery success rate increasing from below 30 to greater than 90
• Instituted a detailed and standardized data quality assurance process that resolved a long-standing issue of not understanding client dataandconsistently complicated and prolonged projects, resulting in a significant improvement in client satisfaction
• Mentored analysts on healthcare claims data so they could properly QA all client data sets received and then effectively communicate results to all project stakeholders, as well as how to write SQL code to further understand and support additional analytics or modify data when clients are unable to provide data as required for deliverable production

Director, Medical Informatics

Managed and developedall aspects of cohort-based analytics,and reporting on chronic condition populationsrelated to tele-health remote patient caremonitoring/management programs implemented at health systems, hospitals, and health plans to aid the efficiency and effectiveness of their care teamsto prevent readmissions and improve financials through cost savings, in addition to collecting and managing all medical claims data provided by clients.

Accomplishments:

• Moved the company away from reliance on summary data provided by clients to receiving detail claims data feeds, which allowed us to create detailed reports, statistical process control charts, and other analyticsshowing the efficacy of using the technology. Reports include:
• Clinical outcomesmeasures such as condition/non-condition admission and 30 day re-admission rates, averted admissions, average length of admission,average cost or paid per admission, and all patient program participation measures
• Operational measures such as medication adherence, level of depression, and program satisfaction

Senior Analyst

Accomplishments:

• Devisedcohort-based analytics that measurethe impact of chronic disease management programs on employer healthcare trends relating to:
• Incidence and prevalence rates point and period of chronic managed conditions
• Program penetration and opportunity rates
• Enrollee healthcare costs versus expected healthcare costs and control group healthcare costs
• Revised the methodology for calculating overall return on investment to more accurately reflect program impact
• Devised and produced analytics that show the correlation between nurse interventions, enrollee clinical outcomes, and return on investment
• Devised new opportunity analysis reporting analytics for prospective clients that resulted inthe awarding of new business
• Produce quarterly and annual reports for clients
• Relied upon to interact, explain, and resolve data-related issues with internal and external clients

Senior Analyst

• Network, products type, and line-of-business historical and projected costs, trends, and savings on a pmpm, utilization per thousand, and provider and hospital basis, includingreimbursement comparisons and trends
• Cleanse, normalize, and warehouse extremely large medical claims and eligibility data sets
• UtilizedSQLServer Enterprise Manager and Query Analyzer to:
• Workedclosely with internal Marketing and Sales Department management, as well as with prospective and existing clients' technical and business staff to ensure that data files were sufficient to perform required analytics and support implementation and ongoing needs
• Createand manage client data and databases
• Perform all aspects of health plan radiology imaging management pre-program benchmark and program performanceanalytics:
• Created final presentations and present findings to prospective and current clients
• Created new and updated existing organization fee schedules based upon State and County-specific CMS physician fee schedules
• Reviewed and organized contractual reporting requirements into a crosswalk against actual reports produced by the Reportingand Analytics Department to ensure thatcontractualobligations were met

Project Manager

Senior Business Analyst

Promoted to Project Manager in the Information Management Department to provide analytic and programmingsupport to programmers, and actedas liaison between IM and internal Sales, Healthcare Services and external clients regarding clarifying claims and eligibility data requirements and resolving gaps in data provided for analytics and new client implementations.

Accomplishments:

• Managed a project that resolved long-standing differences in identification methodologies between Information Management and Analytics so that there was one, company-wide standard methodology
• Helped bring in-house the Impact Pro analytical application, an advanced predictive modeling software used for identifying high-risk patients in need of disease management
• Managed personal analytic work that included reviewing if raw medical and pharmacy claims, and eligibility data files received from established and prospective clientswere sufficient to support analytical requirements, and then cleansed and normalizedthe data sets to perform analyses that supportedthose chronic disease management business relationships and opportunities.

Accomplishments:

• Developed analytical spreadsheet to ascertain the correct acuity level mix on disease program participants and their impact as a cost to manage compared to contractual fees
• Relied upon to interact, explain, and resolve data-related issues with internal and external clients
• Quickly reviewed and understood medical, pharmacy, and eligibility data setsfrom various, non-related organizations and information systems, thenrelated all issues surrounding normalizing and analyzing data

Manager

Managed a six-person Billing and Accounts Receivables Department at a private nine-physician Gastroenterology practice.

Accomplishments:

• Negotiated new group and facility contracts, and renegotiated allexisting independent physician association contracts into significantly higher reimbursing group-based and controlled contractswith 100 reimbursementprompt-payment language
• Increased revenues by over 40,000 by thoroughly analyzing, auditing and reconciling payer accounts against contractual reimbursement rates and prompt-payment time frames
• Self-trained on practice's MEDIC practice softwareand then:
• Added all payer fee schedules so that reimbursements could be accurately tracked on a real-time basis
• Created reports on referral relationships, contractual reimbursements, and physician clinical and utilization data
• Added the responsibility of system month-end close from the practice manager
• Educated staff on contractual guidelines and obligations
• Trained staff to use Excel, Word and Outlook in order to be more efficient and to better perform, organize and track their work
• Developed policies and procedures, established back-up responsibilities, and created a work flow chart for the staff to follow in working with patients and payers, as well as working with each other

Consultant

Consulted with integrated health systems, hospitals, physician groups and health plans to assess their current state of organizational security and privacyas it related to HIPAA Security Privacy regulations. Responsibilities focused on performing risk and gap analyses that involved comprehensive interviews withsenior management,physicians, non-physician clinicians, and administrative staff, reviewing of organizational policies and procedures to discover operational, educational or work-flow deficiencies,and reviewing ofinformation system and application controls to ensure there was proper protection of patient and business data. Lastly, I provided project plans that organizations could follow in implementing recommendations needed to comply with proposed regulations.

Accomplishments:

• Created an engagement management tool in Access that was used to increase HIPAA consulting business by showing a detailed and organized compliance audit. In addition, this tool aided consultants in performing HIPAA assessments and educating non-HIPAA consultants on HIPAA regulations and issues for backup consultant purposes
• Relied upon to write HIPAA engagement business proposals based upon Request For Proposals from prospective clients

Programmer Analyst

Managed Care Application Systems Analyst / Contract Administrator

Contract Administrator

Transitioned seamlessly into IS Department from Managed Care Department where I performedall aspects of month-end close for the Department of Managed Care, including running, preparing and distributing all statistical reports

Accomplishments:

• Acting as the Information Systems Department liaison to the Managed Care Department on system issues and set-up for new or evolving operational needs
• Creating the first comprehensive manual outlining Managed Care month-end close for IS Department backup
• Writing ad hoc DBMS reports for all NMFF clinical departments and divisions, and then using theIDX Custom Report formatter, Access and Excel to produce the final output of reports and analyses for distribution
• Increased position flexibility and department productivity by:
• Setting up system restrictions and creating over twenty DBMS end-usersystem interface forms so end-users could run their own reports on a real-time basis, thereby freeing department resources
• Handling IDX system maintenance and service request follow-up as needed
• In addition to performing Contract Administrator responsibilities, for seven months I handled the non-management and technical responsibilities associated with the Manager of Managed Care position.

Accomplishments:

• Assisted director in contract negotiations and redlining contracts, as well as disseminating contractual obligations and information to clinical and administrative departments
• Compiled, prepared and distributed to senior management all month-end statistical reports associated with HMO contract maintenance
• Developedas-needed ad hoc DBMS reports for the department director
• Wrote system reports to meet the HEDIS and utilization management guidelines for HMO contracts
• Monitored capitation revenue and handled processing of monthly capitation payments to capitated vendors
• Provided software interface and integration support as new capitated contracts were negotiated
• Quickly learned IDX Managed Care and DBMS, then applied knowledge to coordinate and represent department on system issues, as well as assess impact of changes made to the system and integrity of system dictionaries
• Responsible for negotiating all IPA, vendor, and case-specific agreements
• Responsible for maintaining contractual relationships and resolving all contract, credentialing and reimbursements-related issues
• Participated in the executive committee meetings on managed care and lead a managed care task force committee to discuss payer-related issues

Accomplishments:

• Created the first comprehensive financial spreadsheet that tracked HMO/POS enrollment and capitation payments on a monthly basis for current and future budgetary purposes

• Trained Department and Division Administrators on in-house fee schedule tracking application

Reimbursement Financial Analyst

Redlined contracts and performed reimbursement analyses associated with new and existing contracts

Accomplishments:

• Considerably expanded department contracting, analytic, and reporting capabilities by providing comprehensive physician/hospital transplant and non-transplant financial analyses, reviewing current and historical payer reimbursements for each department and divisionbased on actual patient utilization, and comparing contracted HMO's pmpm reimbursements against LUPF's pmpm costs
• Wrote, produced, and disseminated a monthly specialty-specific newsletter outlining Medicare Part B issues
• Developed methodology that captured all physician charges associated with burn cases, thereby increasing reimbursements from Public Aid