Research Analyst

• Sep 2022 - Present

CS Manager *Data Analytics*

• Jan 2016 - Nov 2021

• Experience in Data Analysis, Design, Implementation, Administration and Business Intelligence • Involved in Planning, Defining and Designing database based on business requirements and provided documentation. • Working collaboratively within and across development and project teams in a fast-paced work environment, utilizing multiple design BI methods • Analyzing and detecting data quality issues and recommending the corrective courses of action. • Manage relationships with multiple teams for new solution features and technical support. • Developed complex reports and dashboards utilizing Salesforce, Power BI, and advanced Excel skills. • Filtered bad data using Derived column, Lookups, Fuzzy Lookups, Conditional split. • Importing data from various sources (flat file, excel, raw file & various databases) and exporting to various destinations. • Work with high-performance data integration solutions that connect multiple data sources for extracting and rapidly transforming the data for loading into the pre-designed data. • Conducted data modeling, statistical analysis, BI gathering, trending, and benchmarking. • Used advance Excel skills by Extracting, compiling, tracking, and analyzing data from multiple sources to generate reports and pivot tables utilized multiple teams. • Designed and built statistical analysis models on large data sets for Sales team. (Power BI/Salesforce/Excel) • Lead “Off The Grid” internal innovative concept: Credentialing Tool *People’s Choice Award* • Lead “Spark Day” internal innovative concept: Digi Docs *Values Award* • Develop and maintain strong working relationships with health plan representatives at all levels. • Contribute to company initiatives by sharing industry subject matter expertise and best practices. • Identify configuration issues as they relate to new product release and prepare and document process necessary to support the product configuration specialists. Show less

NaviNet/NantHealth-Deployment Specialist

• Jul 2013 - Jan 2016

• Managed deployment for full Non-Beta implementation of NSU by coordinating the planning, providing implementation and communication for the end-user rollout, ensuring that the decisions made for this project were the best for the end user and for NaviNet as a whole. • November 2014 NaviNet All-star • Established Productive Enterprise Relationships and Expand Utilization of NaviNet Drug Authorizations • Managed, organized, and reported the Drug Authorization program • Created Training tools for Providers • Led interdepartmental meetings and kept stakeholders apprised of results for all projects • Provided Project Management for the Medicare Eligibility Pilot • Led interdepartmental meetings and kept stakeholders apprised of results for all projects • Lead Toolkit Development for the Initiative to create an Integrated Live and Digital Channel Product Adoption Process • Reported daily results and kept key stakeholders informed and apprised of progress and completion. • Created WIKI layouts for all initiatives • Provided Follow up with provider organizations from leads gathered at meetings. • Currently managing NaviNet NSU Communications and NSU Rollout. • Currently creating training materials for NSU/NaviNet Open Microsite. • Works closely with Health Enterprises throughout the country with Navinet Portal assistance. • Spearhead projects from conception through completion for launch of the Drug Prior Authorization application in physician offices. • Consult with clients to define project scope, identify the implementation process of adoption-based training modules, and develop project plan and schedule. • Function as an escalation point for change requests and client concerns, while working closely with department leads to prioritize issues and coordinate troubleshooting efforts. Show less

Director of FundraisingPresident

• Jan 2007 - Mar 2014

Delegated responsibilities and shared information of the overall goals of the organization to paid staff and volunteers. Lead fundraising programs and special events, and achieved organizational goals Ensured appropriate financial structure and understanding of accounting principles, overseen the use of resources, and adhered to revenue and expense budgets Ensured and created budget guidelines and maintained fiscal accountability Ensured availability of adequate funds to carry out organization’s work. Coordinated with administrative duties and tasks related to upcoming fundraising programs Helped with the recruitment of donations and funds to be used for upcoming programs and campaigns Show less

Credentialing Specialist

• Feb 2013 - Jul 2013

• Credentials and re-credentials physicians according to quality standards and company policies and procedures.• Maintains current physician licensure files and provides information to hospitals and other healthcare providers as appropriate.• Notifies physicians of licensure expirations and submits licensure applications and renewal forms with payment to State agencies and appropriate departments.• Requests and completes hospital credentialing and privileges applications for physicians.• Obtains and maintains physician participation in managed care plans in a timely manner and communicates information to practice sites.• Implements and maintains the contract management system to include terms of the contract, physicians credentialed to the payor and other contracted service providers.• Creates and implements new analysis tools to assist in reporting functions.• Training practice staff with respect to managed care contracts, policies, and procedures.• Performs advanced functions required to prepare correspondence and complex reports, spreadsheets, and graphs. Screens, refers, and replies to inquiries. • Maintains files and record systems in compliance with state and federal laws. • Plans, organizes, and prioritizes own tasks and responsibilities. Verify status and accuracy of specialty-specific privilege forms to reflect the hospitals’ current practices• Prepared accurate correspondence to practitioners in a timely manner regarding upcoming expiration of reappointment and timely communication following successful completion of the medical staff committee approval process as directed. Show less

Managed Care

• Jun 2011 - Mar 2013

• Education/ Presentations at a Corporate level as well as branch level for Managed Care intranet site Negotiator (proposal and development of non-participating providers) for hospitals and physician services• Proactive responses to provider questions and issues regarding contracts in an accurate, timely and professional manner• Independently prepare, schedule, analyze, and verify, format data for reporting needs; use data mining, data extractions software to define specific data if required. Responsible for educating physicians and office staff regarding contractual obligations, claims processes, pre-certification, utilization management requirements and member service processes• Reviewed and analyzed contract rates and language• Technical and functional understanding of financial reporting systems (MedAssets, McKesson, PrecisionBI and Lawson)• Ensure all data sent outside Cooper is secure and received only by the intended party, maintaining HIPAA security and privacy regulations at all times• Developed systems and Managed Care tools necessary for improved workflow• Successfully collaborate with other departments. Independently work with Hospital Billing, Physician Billing and Financing to continually analyze payer performance• Responsible for all aspects of system maintenance for MedAssets Contract Manager including, but not limited to, data validation and troubleshooting, even as it pertains to upstream systems (ie. claims, billing, etc.) Show less

Credentialing Specialist

• 2011 - 2013

Auditor

• Jan 2002 - Jan 2003

• Assisted with the processing of financial transactions, performed special projects, and responded to data requests from departments such as the Alcohol, Tobacco and Firearms division • Responsibilities included general accounting functions, completion and Maintenance of general ledgers and financial reports • Wrote audit programs and reports and presented results to upper management • Assisted with the processing of financial transactions, performed special projects, and responded to data requests from departments such as the Alcohol, Tobacco and Firearms division • Responsibilities included general accounting functions, completion and Maintenance of general ledgers and financial reports • Wrote audit programs and reports and presented results to upper management