Experience

Elevance Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Medical Economics Consultant

  • Mar 2022 - Present



CareSource

• United States
• Insurance
• 700 & Above Employee

• Financial Analyst Senior, Business Analytics:

  • Mar 2020 - Mar 2022

  Partnering with senior Analytics Department and Behavioral Health (BH) management on clinical and financial metrics and processes. Delivering results across health plan markets, products, and platforms:• Development of infrastructure and tools to provide timely insight on utilization and financial trends, revenues, costs, and impact and forecast for all categories of populations.• Provide front-line and ad-hoc decision support to the entire corporate structure by identifying and implementing cost-saving, quality improvement, and patient satisfaction initiatives.• Project manage analytical data design, development, implementation, and support in meeting the needs of internal and external customers.• Managed monthly Profit & Loss and telehealth reporting, analytics, insights, and presentation to BH leadership for six different markets (GA, IN, KY, OH, WV) and various Medicaid and Marketplace products.• Technical training and mentorship to teammates in meeting our collective professional and personal goals.Honors and Awards:• Heart2Heart Award — We Demonstrate Accountability to Deliver Results (Provider Analytics) | 5/2021 • Heart2Heart Award — We Demonstrate Accountability to Deliver Results (Analytics Team) | 1/2021 • Heart2Heart Award — We Collaborate to Support a Matrix Environment (Behavioral Health) | 12/2020



SCAN

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Senior Analyst, Health Care Informatics (Risk Adjustment)

  • Jul 2019 - Nov 2019

  Data:• Support all aspects of Medicare Risk Adjustment leadership, including investigative research, root cause analyses, interpret results, identify trends, data management, quality improvement studies, statistical analyses, forecasting for clinical and financial impacts, and providing data-based recommendations and presentations to senior management.Programs:• Support 6 different Medicare Risk Adjustment (RA) and Quality (HEDIS) vendor outreach programs: including multiple in-home, clinician chart review, and care-gap (CareAlert, CareRx) vendors.• Develop and manage processes and solutions, including stakeholder relationships, outreach lists, tools, back-end data structures, data submission, documentation, and real-time reporting (dashboards, ROIs).



OptumCare Medical Group

• United States
• Medical Practices
• 1 - 100 Employee

• Program Manager

  • Apr 2019 - Jul 2019

  Strategic development, analysis, implementation, and management of process and solutions to maximize collection, validation, submission, revenue, monitoring, improvement, and education of Medicare Risk Adjustment (CMS-HCC) clinical data for our 150,000 Senior population. • Managed risk adjustment data and processes between operations, providers, claims, clinical IT, vendors, and health plans.• Ongoing data mining, analysis, predictive modeling development, and identification of opportunities to improve reimbursement, improve population health outcomes, minimize costs, and develop proactive interventions.• Developed complex SQL algorithms in multiple databases for executive decision support in our project implementation efforts, financial ROI, quality of care, and healthcare logistics.• Developed, implemented, and maintained high-visibility business solutions to various stakeholders: — Member Outreach Tool (MOT)—Created and program managed corporate-wide patient outreach application to eliminate silos and improve coordinated care on 50+ HCC, HEDIS, and STAR outreach. — CMS data validation and submission tool—Created and program managed a web-based solution for data submission to our 13 Senior health plans. The new process resulted in efficiency gains of 80%, reduced overall errors by 7%, and reduced process time from 3 weeks to 3 days. — Point of Care report—Maintained infrastructure, algorithms, and functionalities of our population health management dashboard by providing visibility to chronic diagnosis for our front-line caregivers. — Annual IPA bonus program—Program managed our 1000+ IPA PCP providers based on coding accuracy and documentation.• Oversight of physician clinical review and outreach program (Home Visit, Mobile Clinic, Clinician Chart Review, Behavioral Health).• Partnered with regional management on key physician activities by disseminating, monitoring, overseeing central initiatives, and data reporting for productivity and opportunities.

• Manager, Data Analytics (SQL)

  • Mar 2017 - Apr 2019

• Senior Business Analyst

  • May 2014 - Mar 2017

• Business Analyst

  • Feb 2012 - May 2014



Johnson & Johnson — Biosense Webster, Inc.

• Health Information Consultant

  • Jul 2011 - Dec 2011

  Health Information ConsultantManaged and coordinated Healthcare Compliance related business practices to comply with financial, corporate, regulatory, and industry standards.• Program support and analysis, process development, due diligence, and monitoring.• Corrective activities as appropriate (e.g., implementing control points, training, audits).• Conduit between J&J legal, sales, marketing, and promotional activities.• Copy review processes for all internal and external product communications.• Collaborated with regulatory, trademark, legal, and marketing to meet standards and guidelines (industry and FDA) regarding the promotion and distribution of products.



Department of Public Health, County of Kern, California

• Management Intern

  • Apr 2011 - Jul 2011

  Principal internal HIPAA auditor and evaluator for California Children’s Services department.• Developed organizational compliance framework in advance of independent county-wide year-end audit during the interim of privacy and security officer vacancy.• Managed quality improvement for HIPAA compliance by establishing: (1) research review, (2) materials for employee HIPAA training deck, (3) Pareto approach for troubleshoots, (4) frameworks for privacy policies and procedures, (5) audit tools and process evaluation, and (6) ongoing privacy compliance monitoring.



Warren Lee

• Owner / Consultant

  • Sep 2007 - Jul 2011

  Provided extensive project management across exhibition, environmental, graphic, and web platforms.• Collaboration with Orlando, Florida’s Economic Development Commission and the Orlando Magic basketball team on the new Amway Center sports arena exhibits. Projects included The Orlando Magic’s basketball Hall of Fame and Information Garden visitor experiences.• Designed and managed Thomas Property Group and CBRE’s Campus El Segundo corporate headquarter in Los Angeles to promote the city’s business-friendly community with eight Class-A campus buildings.



RTKL

• United States
• Architecture and Planning
• 200 - 300 Employee

• Associate, Architectural Environments Group

  • Sep 2007 - Apr 2008

  Designed, developed, and managed architectural projects within a highly creative multi-disciplinary design group by providing branding strategies, interiors, and experience-driven environmental design services.• Portfolio includes local, national, and global projects ranging from life-style and mixed-use architectural centers to retail and hospitality environments. Designed, developed, and managed architectural projects within a highly creative multi-disciplinary design group by providing branding strategies, interiors, and experience-driven environmental design services.• Portfolio includes local, national, and global projects ranging from life-style and mixed-use architectural centers to retail and hospitality environments.



Whirlwind Creative, Inc.

• Design Services

• Creative Manager

  • Nov 1996 - Sep 2007

  Multi-disciplinary project manager specializing in the marketing and management, research, planning, design, development, and delivery of 100+ visitor experiences for museums, non-profits, corporations, economic developments, and cultural destinations.• Responsible for all stages of a project’s evolution: client relations, master planning, conception, training, presentation, design, interface, production, and final execution.• Trained and mentored young designers and design interns. • Project highlights include Development of Ground Zero/World Trade Center with New York City’s Lower Manhattan Development Corporation, New York International Auto Shows, National Parks Service, The Smithsonian Institute, Mercedes-Benz, Atlanta History Center, Madison Square Garden, Columbia University, Foster + Partners, Daniel Libeskind Architects, etc.