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PHONE NUMBER AVAILABLEE-mail - EMAIL AVAILABLEEMPLOYMENT:Carefirst, Owings Mills Md (Remote)Technician-Enrollment I contractor (Tal team)July Street Address -current-Ensuring members are accurately enrolled into member enrollment system duel migration (Facets legacy and G6)-Coordinated with account installation team prior to issuing member id cards-Coordinate with the billing technicians to ensure that all group enrollments are processed prior to running monthly billsCCI Health Services, Silver Spring MdSr. Clinical Data Analyst October '23-April '24-Validate and analyze data to develop monthly, quarterly, and annual reports, trends, and process maps to present to the executive leadership- Evaluate the EMR to streamline documentation processes and to implement new workflows to improve efficiency for data reporting-Data Steward for the ECW (E-Clinical Works) database (including data mapping for claims accuracy)-Extracted data from SQL Server Management Studio for data comparison and validation- Collaborate with stakeholders, clinical and operational leaders to construct measurement and analytic plans for improvement initiativesand for the organizational quality plan-Developed Quality Performance Dashboard in Tableau tracking quality metrics for UDS reporting and Population Health-Submitted data for statewide grants including: Thrive by Three, Centering Pregnancy, HUD Dental Grants-Responsible for problem identification and resolution within data warehouse-Worked closely with Nursing staff to develop Care Gap plansBaltimore Medical System, Baltimore MdData analyst/Data Steward Feb 2020- Feb 2023-Developed Quality Performance Dashboard tracking quality metrics for UDS reporting-Developed School Based Health dashboard for quality metrics-Data Steward for the i2i tracks database (included data mapping and data governance of the system)-Collect data for UDS (HRSA),HEDIS, NCQA, NQTL, Joint Commission reports and submission-Collaborated with cross-functional teams to design and implement a comprehensive data warehouse, enhancing data accessibility and reporting capabilities-Generated Ad-hoc reports using Microsoft SQL server and I2I tracks-i2i Tracks (SME)/trainer -developed reports and patient searches for Population Health, gaps in care, health registry reports and quality-Responsible for problem identification and resolution within data warehouse using Microsoft SQL server-Participated in the development of project plans and schedules-Worked with key stakeholders for grant reports (Gilead, Maryland Dept of Health, American Cancer Screening Society etc)-Collaborated directly with Physician groups on process improvement and gap closures-Monitored and delivered daily, monthly, quarterly reports for external clients-CFO, COO, and VP levelUniversity of Maryland Medical Center, Baltimore Md.Transplant Data Analyst-Quality/Regulatory-Data Steward Jan 2019- Nov 2019-Data Steward for the United Network for Organ Sharing (UNOS) reporting including- candidate registration, recipient registration, follow-up-Prepares monthly Compliance and Regulatory reports for CMS-I-Prepares hospital reports regarding patient referrals, activations, registration, discharge, follow-up and nsured claims accuracy for solid organ transplant-Worked with transplant team members to coordinate timely submissions of patient data-Contacts nursing and medical staff to clarify documentation in patients records to ensure accuracy and consistency of data-Tracked immongenetic laboratory data for solid organs (heart, lung, and kidney) for monthly clinical reviewMedStar Family Choice Washington D.C.Data Analyst (Medicaid) Dec 2016 Mar 2017-Analyzed ER and Inpatient claims data for reduction on pay for performance initiative regarding recurring ER visits and Inpatient admissions-Assisted with monthly Encounter Reconciliation for district reporting-Responsible for problem identification and resolution within data warehouse (Data Steward)with respect to accessing, accumulating, and processing claims-Worked with Provider relations department on developing ongoing credentialing and developing opportunities in expanding network. Worked with representatives in developing process improvements-Aggregate and transform data to meet the needs of efficient data analysis and reportingUnited Healthcare Group - TelecommuteHedis Economic Consultant Data Analyst / Project Manager Claims Lead (Medicare) Feb 2016 Nov 2016 (Contract - Genesis 10)-Extract data from SAS, aggregate and perform Quality Assurance on applicable data from multiple sources and tables for purposes of root cause analysis, action development, and validation and measurement of HEDIS administrative data initiatives-Research, retrieve, design, troubleshoot, and deliver organized analytics regarding healthcare data pertaining to HEDIS measure performance and improvement opportunities-Developed claims Quality Assurance audit process and dashboard using Tableau-Create graphical presentation of market research results and data-Documented project requirements and developed test cases for claims audit process-Work with claims team to identify areas of opportunity and to drive efficiencies in Hedis measure performancePress Ganey, Elkridge Md.- ContractorData Analyst - Oct 2015-Dec 2015- Perform and review daily/monthly routine system balancing and provide approval for subject areas- Documented project requirements and developed test cases-Responsible for modifying SQL queries for system updates- Map and consolidate data elements on various systemsValue Options/Beacon Health Lithicum Md. - ContractorQuality Data Analyst -July 2015-Aug 2015-Produce analyses and reports regarding healthcare quality, utilization, population management and associated costs-Develop new audit programs to ensure adequate quality control-Develop reports to determine provider accuracy on: outreach, claims, and credentialing-Worked with management to define processes, policies and standards relating to data quality.Inovalon, Bowie Md.Senior Data Analyst- Disease Management team-Jul 2012-April 2015-Analyze and evaluates the effectiveness of quality measurement and activities to identify and prioritize process improvements and gaps in care-Developed marketing strategies based on monthly claims data using provider surveys along with clinical staff in order to meet contractual obligations-Collaborate on survey design to ensure functionality of programmed surveys (IVR system/flu vaccines)-Extracting data using SQL to generate reports and supporting detailed data sets to address key business needs and support product operations-Created an Excel dashboard to show the monthly lifecycle of data for multi-departmental use for the reduction of daily meetings using Tableau-Served as the SME for system logic, using Microsoft SQL server-ETL production loads, and Quality Assurance process- Performed monthly financial validation, conducting and documenting financial / business variance analysis and research Agile environment-Developed ad hoc reports for the Provider relations departmentPhoenix House New York, New YorkData Analyst-temp August 2011-November 2011-Maintain contract repository, including key terms, rates, correspondence-Produced periodic reports of insurance enrollment in and around each site/region and changes from previous months-Maintain a listing of networks of each contracted payer, targeted payer and contractual rates-Developed a payer volume report (measured by dollars and services) by site and in aggregate-Produced operating metrics vs plan: marketing, sales, conversion, and retention-Worked closely with the IT department and clinical staff on the new software to develop reportsAdvantage Healthcare Solutions Warren, New JerseyData Analyst December 2008 - August 2011-Develop and analyze business performance reports: detail on performance deviations and anomalies-Perform and review daily/monthly routine system balancing and provide approval for subject areas such as Claims, Enrollment, Revenue, Employer Groups, Products and Providers so data can be released to internal and external users.-Maintain technical and functional systems documentation such as mapping documents, Standard Operating Procedures, extract specifications and transformation specifications to ensure information is accurate and up to date.-Generate and distribute standard reports for high profile accounts-Collaborated with regional VPs regarding data findings and provided recommendations as needed-Report analysis consists of: Practice Performance Analysis, Market Trend Analysis and Cost Analysis, Fee Schedule analysis. Monthly reports determine Denial Information, Production reporting, A/R reporting, and Occurrence Determinations-Identify systemic issues, gaps and inconsistencies. Work closely with IT dept. in developing, & modification to extract toolGreat West One Health Plan of N.Y. New York, N.Y.Sr. Provider Relations Supervisor February 2000-January 2007-Developed marketing campaign for recruitment of physicians, medical groups, IPAs and hospitals for the network based on claims data-Negotiate contracts with medical providers, including medical groups, IPAS, hospitals, and ancillaries-Develop in service training materials and performs in-service provider meetings and orientations concerning company benefit plans, credentialing, Quality Assurance programs, administrative procedures, and other policies.-Develop, and analyze competitive fee schedule for network enhancement-Project lead on new implementations within the department: including new system facilitator, CAQH, credentialing and sales.-Ensure compliance and HIPAA regulations within the provider network for N.Y. and N.J.-Supervised provider field reps, ancillary contractor and administrative assistant for the NY office.-Responsible for providing weekly production reports to Provider Relations Director and conducting weekly production meetings with staff-Developed Provider/Credentialing database in Microsoft Access for storing of data. Developed reports from this database based on Claims, Credentialing, Production, and Network Development-Developed reports for Sales dept from patient and provider surveys which include cost Analysis & potential business interestsManaged Health Network New York, N.Y.Facility Contract Negotiator/Data Analyst July 98 - January 2000-Negotiate contracts with mental health facilities and ancillary groups-Interact with providers (individual and institutional) and their office staff, to provideprogram information and to accomplish problem resolution.-Responsible for implementation of new line of business into current MHN network-Responsible for determining holes in the network, by utilizing Geo-Access reports and claims data-Responsible for providing reports to VP of Network Development which include: in & out of network providers, status of credentialed provider, and claims data-Used Symphony program for monthly reports to be distributed for the entire Eastern region (23 states) which include: Status reports, Claims data, A/R reports, Credentialing, Geo-AccessSr. Prov Relations Network Development Coord. November 97-July 1998-Assist the Provider Relations department in the recruitment, application, credentialing, and contract issuance process.-Conduct and assist with provider education sessions.-Handled inbound/outbound calls to providers-Delegate work to support staff as appropriate.-Provide feedback to Provider Relations Manager as to the productivity of the support staff relative to the credentialing process.-Training providers on contractual issues as well as network issues.-Responsible for gathering, processing credentialing information for potential providers.HIP of Greater N.Y. New York, N.Y.Provider Relations Assoc. /Data Analyst-temp December 96-April 97-Conduct provider recruitment, education, claims resolution and communication of HIP policies and procedures to the provider community.-Developing and running database reports using SQL for data analysis.-Assisting in the recommendation of contracting strategies to maximize cost containment through report analysis.-Contributed as a liaison between network providers and business/sales team-Credentialing physician application for determinations-Answering provider inquiry calls regarding claims, applications, and miscellaneous questionsHealthScope United - Fidelis Care -Medicare New York, N .Y.Provider Relations Field Rep. July 96-December 96-Personally represent the Fidelis Plan to individual providers and members of their staff in the field-Conduct site reviews for new and prospective providers.-Negotiate contractual issues with existing hospital groups and IPAs.-Handled the provider inbound/outbound calls for any issues-Visit providers periodically for continuing education in Plan policies and procedures, managed care practice, and Utilization management guidelines.Multiplan Inc. New York, NYProvider Relations Physician Recruiter October 94-February 96-Recruiting physicians via telephone to participate in managed care network.-Tracking and inputting physicians applications.-Credentialing physician applications for determinations.-Answering provider and client inquiry calls regarding claims, applications, and miscellaneous questions.Blue Cross and Blue Shield of N.J.-Management Newark, N.J.Data Coordinator/Underwriting May 90 -April 94-Insure accuracy of data in departmental databases by continually updating and verifying data.-Running, release, and analysis of production reports using OLAP.-Analyzing utilization data for HMO specific products.-Coordinating the collection of data to support department accounts.-Maintaining back-up documentation to support program factor/database changes.Customer Service Medical/Surgical Specialist-Team Lead-Examines, researches, and defines the most appropriate method of resolution and performs thenecessary claims processing.-Examines, interprets, and responds to written correspondence and telephone inquiries receivedfrom customers and providers.-Ensure customer information for proper processing of claim information-Responsible for telephone unit production including preparation of weekly reports, assisted in weekly meeting with management regarding productivity and trainingEDUCATIONB.S. in Industrial Management May 1990New Jersey Institute of Technology Newark, N.J.Field of Specialization: Marketing Deans List 1989-1990Montclair Adult School April 2010 Advanced Excel 2010- Formulas & Pivot TablesSKILLS: Proficiency in the following: Windows, Excel, Access, Microsoft Word, Powerpoint, Tableau, BI Launchpad, NextGen, i2i Tracks, Epic Hyperspace, HIVE Project Management tool, ECW (E-Clinical Works EHR), EBO (Enterprise Business Optimizer), Relevant reporting tool, CPT 4,CPT II, ICD 9-10, DSM, UB82, Medical Terminology, Call Center, Jira, SharepointDatamining tools: SQL Server (SSRS), i2i Tracks |
