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• Standing member of the Data Governance Committee, contributing expertise in shaping and implementing data management strategies to ensure organizational compliance and maximize data integrity

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 • Mitigate risk to retrieval projects through procurement analysis ensuring vendor deadlines and retrieval standards are met by maintaining controls for tracking progress and productivity

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• Tested and presented technical conclusions to business attaining sign-offs for financial close production turns • Examined Informatica ETL’s and data-flows to pin-point reconciling outages and inconsistencies• Analyzed Oracle databases using Toad to understand table structure in order to optimize end users queries• Supported testing new process developed to allocate underwriting margin to products, companies, and platforms