As a Senior Risk Adjustment Data Analyst, I specialize in developing reporting and data analysis solutions related to Medicare Advantage and CMS risk models. I collaborate closely with internal stakeholders, risk adjustment vendors and medical groups to transform data into actionable insights that inform strategic business decisions. I oversee the calculation and tracking of risk factors and conduct trend analyses on risk scores. Additionally, I perform in-depth analyses and provide recommendations to optimize risk coding accuracy and improve submission processes.RESPONSIBILITIES: • Organizes and leads the team responsible for risk score tracking and improvement. • Maintains internal risk adjustment models using published documentation from CMS.• Develop data visualizations, reports and dashboards to support operational and clinical areas. • Build datasets that can be utilized by reports and visualizations to support productivity and key metrics. • Collaborate with users to identify data needs and business metric definitions. • Trains users to transform data into action-oriented information and to use that information correctly. • Directs, organizes, and leads BI workstream projects in the implementation and use of new BI software tools and systems.

Provided strategic leadership, vision, and guidance in the development of data intelligence, analytics and systems solutions that support both the direction and operational needs of SWHR. Oversaw data validation, accuracy and formats, data modeling, system and database design and development, and integration of data from various sources, both internal and external. Served as a subject matter expert for multiple ACO related datasets. Accomplishments: • Developed a comprehensive strategy to integrate Accountable Care Organization (ACO) claims data with internal Electronic Medical Records (EMR) data resulting in enhanced reporting and risk adjustable Hierarchical Condition Categories (HCC) recapture capabilities. • Devised a method for transforming and enhancing unsubmitted provider encounter data files, creating HCC supplemental submission files, and ensuring timely delivery to payors in accordance with CMS deadlines. • Successfully led a project to integrate risk adjustment data from various vendors and internal sources to transmit to a data aggregation vendor for ingestions. Provided a more complete data set for providers to work from and resulted in a 10% increase in closing HCC diagnosis recapture gaps. • Successfully led the project to improve the supplemental submissions process for Medicare Advantage plans, increasing the number of identified codes submitted. • Served as a subject matter expert for multiple ACO related datasets. • Successfully demonstrated adept management capabilities by providing interim leadership for a business operations team of nine for a period exceeding 18 months, culminating with the onboarding of a new director.

Drove the development of data intelligence, analytics, and system solutions to bolster ACO contracts, aligning with THR's operational imperatives. Pioneered innovative approaches, ensured seamless alignment between strategic direction and operational exigencies, fostered sustained growth and success. Ensured accuracy of data and file formats, data modeling, database and system design, maintenance, and the integration of data from multiple internal and external sources. Managed a team of 8 IT professionals responsible for delivering concise and actionable reporting analytics for commercial, Medicare, and Medicare Advantage ACO contracts with a combined population of 300,000 members. Accomplishments: • Managed a team of 8 IT professionals responsible for delivering concise and actionable reporting analytics for commercial, Medicare, and Medicare Advantage ACO contracts with a combined population of 300,000 members. • Provided reporting and analytics that contributed to the success of a Medicare Advantage contract resulting in ~$53 million in shared savings over a 4-year period (2010-2014). • Implemented a methodology for auditing Payor generated paid claims and performance reporting to ensure accuracy. The methodology effectively pinpointed errors, leading to the attainment of a $1.9 million bonus. • Established collaborative partnerships with multiple Payors, identifying and remediating issues in claims data sets.

Managed a team of three analysts that were responsible for the integration of claims data, performance reporting and operational analytics for Risk based (Medicare/Medicare Advantage) and commercial ACO contracts.Accomplishments:• Implemented processes to integrate disparate internal data sets for actionable reporting, meeting contractual requirements for ACO contracts.• Collaborated with both internal and external partners to establish, maintain, enhance, and resolve issues with data feeds.• Conceptualized, planned, and deployed data integration and analytic structures to support strategic initiatives in Care Management, Quality, and HCC RAF recapture.

Responsible for the integration of ACO Risk contract claims data, performance reporting and operational analytics for risk-based Medicare Advantage contracts. Engaged with external Payors to address any data quality issues with claims data sets and performance reports received.Accomplishments:• Designed an integration process that allowed for a member ID from an ACO contract to be successfully mapped to the corresponding EMR ID for the member.• Developed a systematic process for gathering and combining Medicare Advantage Payor claims data and internal EMR systems data to produce a per-member HCC recapture form.

Contracted with organizations to create and monitor IT computer controls, provided business analysis and project management for the creation/re-design of business processes, workflows, programing, and application development.Key Engagements: • Successfully accomplished a Sarbanes-Oxley General Computer Control Audit for a global airline parts distributor, ensuring regulatory compliance without penalties. • Identified process discrepancies during a user access account review, leading to workflow changes for enhanced account security to the financial system. • Developed a database application for user access account validation and managing access for contract- based labor. • Successfully concluded the second phase of a multi-phase Identity Management project for a global organization.

Ensured accuracy of data and file formats, data modeling, database and system design, maintenance, and the integration of data from multiple internal and external sources.• Implemented processes to audit and validate the accuracy of outsourced EDI file generation conducted by a third-party EDI data provider. • Was a subject matter expert on the Retail Electrical market ANSI X12 EDI file specs.• Represented the organization at an ERCOT EDI sub-committee, playing a key role in managing EDI data file transmission guidelines and resolving issues among market participants.