Cody Epperson Email & Phone Number

Louisville, Kentucky, US

• Built pregnancy claim diagnosis and procedure code model to increase OB provider pregnancy risk assessments, improving early detection of potential complications for Ohio Medicaid members
• Created reporting to Monitor HEDIS measure compliance trends with custom claim logic that aligns with NCQA and Ohio Department of Medicaid minimum performance stands to meet contractual obligations
• Developed financial performance modeling and forecasted compliance rates for Ohio State minimum performance thresholds and a diabetes quality withhold project
• Successfully map, develop, test, deliver, and maintain data sourced from various systems to reporting and consumption layers, ensuring seamless accessibility and accuracy for stakeholders.
• Rx claims analysis to monitor children prescribed multiple antipsychotic medications, identifying potential risk and opportunities for intervention
• Executed lab claim trend analysis to identify members with elevated A1c and blood pressure for a continuous glucose monitoring project (CGM & DSME) initiated by the care management outreach

Louisville, Kentucky, US

• Built clinical out-patient claim audit reporting in PowerBI with prepay savings and postpay review findings, hit-rates, and claim level drill-down
• Improved legacy medical records management reporting to identify potential savings trends in technical denied claims
• Created IBM Watson IVR transfer analysis to summarize self-service metrics, provider call containment, and net promotor score survey data
• Utilized dashboard and object design best practices to improve user interface and functionality
• Developed clean executive and department level dashboard to encapsulate budgeted savings vs actuals findings vs forecasted historic payment trends

Louisville, Kentucky, US

• Strategic vendor retrieval management:
• Manage and produce outsourced vendor retrieval data summaries and metrics
• Build vendor relationships and act as corporate liaison for regional markets entrusted with retrieval management
• Resolve retrieval discrepancies through root cause analysis to offer technical solutions at lowest level of granularity
• Analyze data using SQL Server to summarize conclusions and present operational process recommendations
• Reconcile and verify vendor retrieval metrics and summaries for accurate provider invoicing

Louisville, Kentucky, US

• HEDIS data lead and process support:
• Technical subject-matter expert and point-of-contact for all HEDIS and Quality data related topics
• HEDIS Database administrator responsible for maintenance, continuous process improvement, and user training
• Assist operational end-users with business and system applications such as Qlikview, Versend, and ad-hoc SQL queries
• Accountable for maximizing data governance for accurate HEDIS reporting resulting in CMS star rating increases
• Support cross-functional teams, technical partners, business customers, and other stakeholders guaranteeing successful project implementations, completion of corporate initiatives, and closing HEDIS measurement gaps

Louisville, Kentucky, US

• Qlikview Development:
• Developed interactive dashboards and automated reports with action and document triggers
• Optimized set-analysis performance by reconfiguring back-end script workloads to reduce large front-end calculations
• Gathered requirements from end-users to design Humana’s first.qvd Qlikmart utilizing N-tier architecture
• Designed and built Qlikview star schema data models with greater than 10 tables and data sets of 100M+ rowsTechnical database analysis:
• Prioritized and executed financial reporting database one-shots required to update production environments