Experience

EmpiRx Health

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Sr Business Intelligence Analyst - Strategic Analytics

  • Sep 2022 - Present

  • Built dashboard tools for the network management team to inform their financial management strategy, with features to track recent changes to manufacturer pricing index (AWP), account profitability over time, and top drug categories with upward or downward trend in profitability. • Built client-facing dashboards to estimate future plan costs ahead of national changes in pricing and/or clinical guidance. Products analyzed include COVID vaccines, weight loss drugs, and insulin. • Partner with off-shore resources in providing requirements, reviewing work submitted, and fostered critical thinking skill development to increase self-sufficiency. • Tools used: Domo, SQL, Excel Show less



Rightway Healthcare

• United States
• Medical Practices

• Manager, Strategic Operations - Data Integrations

  • Apr 2020 - Sep 2022

  As a cross-functional expert, I provided comprehensive company-wide support for critical data management and exchange projects, including the launch of Rightway’s PBM and the creation of an eligibility software service for member eligibility processing. • Managed data engineers and consultants to execute platform migration across 20 clients covering over 25,000 lives. Day-to-day activities included project management, requirements gathering, educating new hires in industry knowledge, and prioritizing work for development sprints. • Created an operational playbook to standardize requirements documentation process, day-to-day checklists, and establish knowledge management system. • Built multiple SQL-based dashboards to anticipate service disruptions across the company. Areas include real-time pharmacy claim rejections, processed pharmacy claims, file exchanges, and iPhone/Android app utilization. • Primary SME for dynamic eligibility software to identify members in HIPAA compliant manner and grant access to the mobile app. • Implementation project manager for the largest client to date (covering over 9,000 lives). Activities consisted of ensuring requirements on plan design and data exchanges were documented, lead “go-live” monitoring, and post-implementation account support. • Promoted to people leader in 2022 for emerging Data Exchange Operations team. • Contribute as an SME to several iPhone/Android app features, including drug price search, digital ID card, and eligibility integration for app access. Show less



Magellan Rx Management

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Account Manager

  • Aug 2018 - Dec 2019

  Leader in the development of consultative and data-oriented account management strategy for the AIDS Drug Assistance Program (ADAP) Center of Excellence. Responsible for all operational, contracting, and technical initiatives to service California ADAP, the largest AIDS Drug Assistance Program in the country.• Led the ADAP account management team in the execution of a data-oriented strategy. Accomplishments include implementation of Tableau Server and creating a standard quarterly business report with Tableau to cover trends on drug spend, prior authorization utilization, clinical quality improvement, and contraindicated regimens. • Mentored two business analysts in requirements documentation, critical processes, and client management to self-sufficiency.• Led regulatory and operational research on a new post-exposure prophylaxis (PEP) program, covering drug supply chain analysis, pharmacy network engagement, and the development of a new patient enrollment system. Show less

• Business Analyst

  • Sep 2017 - Aug 2018

  Improved business processes and efficiency as a liaison between IT and business teams, conducting data and workflow analysis.• Identified and defined system design flaws impacting insurance eligibility for approximately 2,500 patients, and coordinated the development of a solution with multiple IT groups.• Formulated and executed a plan to streamline subrogation payments and back billing, totaling over $4 million in unpaid claims, for 2 large government client accounts. • Authored and presented requirements from the California Department of Public Health to implement a Post-Exposure Prophylaxis program, from claims adjudication to drug procurement.• Executed process improvement to automate Quality Assurance activities, such as use of Excel Macros in custom reports and writing test cases in SQL for a new pharmacy rebate system. Show less

• Pharmacy Rebate Analyst

  • 2016 - 2017

  Responsible for posting and reconciling drug rebate payments. Communicated with drug manufacturer and pharmacy contacts regarding rebate documentation and discrepancies. • Invoiced pharmaceutical company rebates for Tennessee’s and New Hampshire’s Medicaid programs according to the Centers for Medicare and Medicaid Services (CMS) and contract requirements, with quarterly invoices worth $237 million in aggregate. • Performed pharmacy benefit claims data analysis on CMS guidelines and pharmacies, ultimately becoming the primary contact for dispute resolution between several Medicaid programs and pharmaceutical companies. Show less



Medical Aid Nicaragua: Outreach Scholarship

• Team Researcher

  • Apr 2012 - Feb 2014

  • Analyze triage data collected at 8 sites over 3 years using Excel, Tableau Public, and SPSS to determine most common diagnoses and population demographics. • Point of contact for Nicaraguan community members, businesses, and physicians. • Responsible for travel logistics: budget, air travel, car rental, hotel reservations, and team food. • Lead community meetings (up to 25 people) to fulfill Five Year Plan of improving access to clean water. • Participate in 3-credit seminar. • Analyze triage data collected at 8 sites over 3 years using Excel, Tableau Public, and SPSS to determine most common diagnoses and population demographics. • Point of contact for Nicaraguan community members, businesses, and physicians. • Responsible for travel logistics: budget, air travel, car rental, hotel reservations, and team food. • Lead community meetings (up to 25 people) to fulfill Five Year Plan of improving access to clean water. • Participate in 3-credit seminar.



Riverside Health System

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

• Public Policy Intern, CEALH

  • Jun 2013 - Jul 2013

  • Evaluate impact of Chronic Disease Self-Management Program for nursing home eligible adults at Program for All-inclusive Care for the Elderly (PACE) through qualitative and quantitative analysis of patient surveys and electronic medical records (EMR) using SPSS. • Primary author on preliminary report to Virginia Dept. of Health. • Awarded Community Engagement Grant of $1,090 from William & Mary. • Evaluate impact of Chronic Disease Self-Management Program for nursing home eligible adults at Program for All-inclusive Care for the Elderly (PACE) through qualitative and quantitative analysis of patient surveys and electronic medical records (EMR) using SPSS. • Primary author on preliminary report to Virginia Dept. of Health. • Awarded Community Engagement Grant of $1,090 from William & Mary.