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Dynamic and innovative healthcare leader with extensive experience in leading cross-functional initiatives and driving organizational transformation through data and analytics. Adept at developing and executing value-based care and capitation/global budget models, focusing on quality, affordability, and performance outcomes. Proven track record in clarifying business requirements, designing and improving operational processes, and implementing effective SQL reporting and automated solutions to enhance productivity and meet strategic goals.Core Competencies:• Data Analysis & Reporting: Extensive experience in financial reporting, KPI tracking, and operational data analysis. Proficient in creating and automating reports using tools such as Microsoft BI, Tableau, and Databricks SQL.• SQL Expertise: Advanced skills in T-SQL, Databricks SQL, Microsoft SQL SSMS/SSRS, and database programming. Proficient in using Toad for Oracle SQL and Teradata for Oracle SQL.• Value-Based Care & Capitation Models: Skilled in developing and implementing value-based care models and capitation strategies, including ACO REACH, MSSP, and various commercial and government programs.• Data Management & ETL: Experienced in CMS CCLF data management, ETL data processing, and data warehousing. Expertise in relational database data mining and data cleaning.• Technical Skills: Proficient in reporting automation, database structures, and data modeling. Experienced in QA/UAT of operational implementations and process/documentation management.• Additional Skills: Knowledgeable in EDI transactions, risk management, cost analysis, and performance optimization. Familiar with SharePoint workflow management and technical analysis, with coding experience in Python, HTML, C++, and Ruby.WORK HISTORY
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Manager, Network Adequacy ReportingCaresource Oct 2024 - PresentDayton, Oh, Us -
Director, Strategic InitiativesVytalize Health Mar 2024 - Sep 2024Hoboken, New Jersey, Us• Engaged in practice underwriting activities which led to a projected $250M turnaround in gross profit for PY25.• Leveraged 14+ years of SQL experience in healthcare to work cross-functionally with engineering, analytics, and finance teams, optimizing data workflows, improving query performance, and advancing value-based care initiatives.• Spearheaded the implementation of episodic payment models with PACES Grouper Software, designed provider scorecards with actionable KPIs, and developed strategies for risk adjustment and quality improvement programs across Medicare Advantage, MSSP, and commercial populations.• Implemented an episodic bundled payment program, focusing on procedural episodes, with an expected minimum savings of 5% for the year.• Collaborated with finance team to develop projections for capitated revenue vs. FFS equivalents vs. payouts to providers for a complete & accurate profitability projection• Developed and executed data-driven strategies in order to analyze data to uncover trends and insights, resulting in improved customer service and product development (e.g. Remote Patient Monitoring initiatives).• Implemented a High Value Provider strategy which led to an additional 15% savings -
Director, Network Development AnalyticsVytalize Health Oct 2022 - Mar 2024Hoboken, New Jersey, Us
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Payment Innovation DirectorElevance Health Sep 2020 - Oct 2022Indianapolis, Indiana, Us• Defined requirements and implemented the Value-Based Capitation program around HCP-LAN Category 3 & 4 payment models, supporting independent physicians, advanced primary care organizations, and ACOs/IPAs in transitioning from Fee-for-Service to value-based reimbursement for Alternative Payment Models.• Managed the quality component of the Capitation program post-implementation, ensuring continuous improvement and alignment with company value-based payment and risk contracting strategies.• Developed operational analytics for leakage reporting, enabling targeted interventions to reduce leakage and optimize program performance.• Achieved the operational goal of increasing Capitation spend to more than 20% of total medical expenses by 2025, with an initial increase from 2.3% to 5.1% in the first year.• Defined technical, reporting, and analytics requirements for the Value-Based Capitation program across all lines of business, enhancing program transparency and accountability.• Responsible for QA/UAT of new Capitation program releases, researching opportunities for program expansion to maximize impact and efficiency. -
Payment Innovation ManagerElevance Health Feb 2020 - Sep 2020Indianapolis, Indiana, Us
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Business Information DeveloperAmerigroup Nov 2016 - Feb 2020Virginia Beach, Virginia, Us• Developed and optimized over 50 high-impact SQL reports and visual dashboards, resulting in a 30% increase in reporting efficiency and actionable insights for business needs.• Clarified business requirements and performed data analytics that improved process productivity by 25%, leading to enhanced operational decision-making.• Leveraged capabilities in (SSRS) Report Manager and Tableau Developer to create over 20 data-driven visualizations that supported strategic decision-making and operational efficiency, contributing to a 20% improvement in decision accuracy.• Implemented automated weekly reporting processes for internal operations and state-mandated metrics, improving reporting accuracy by 40% and reducing manual effort by 50 hours per month.• Collaborated with cross-functional teams to integrate new features, enhancing team productivity by 15% and streamlining project timelines.• Streamlined code for faster load times, achieving a 25% improvement in performance and user experience.• Participated in regular code reviews, ensuring high-quality standards and reducing code errors by 20% across all development efforts. -
Business Change ManagerAmerigroup Dec 2014 - Nov 2016Virginia Beach, Virginia, Us• Led the provider data integrity initiative and implemented the Employment and Community First (ECF) DIDD program as an extension of the LTSS CHOICES program in Tennessee, ensuring seamless integration and operational efficiency.• Developed and maintained operational reporting for Medicaid Long Term Services & Support (LTSS), resulting in a 30% reduction in reporting errors and a 25% improvement in process efficiency through data-driven insights.• Provided data analytics and reporting for over 10 Key Stakeholder RFIs/RFPs and legislative inquiries, contributing to successful proposal responses and informed decision-making.• Organized and executed the provider data integrity initiative for LTSS operations, leading to a 50% increase in the accuracy and completeness of provider data.• Led QA/UAT testing for 2+ new operational implementations, ensuring a 95% success rate in the deployment of new processes and systems.• Created and maintained over 15 reporting solutions for LTSS operations, including automated processes that addressed complex needs and reduced manual reporting efforts by 30%.
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Data Analyst / Data Services EngineerAdvent Health Partners Dec 2013 - Jul 2014• Led the development and execution of reporting and analytics tools to data mine claims data from 13 major MCOs and payees, ensuring compliance with emerging ERISA law changes.• Conducted operational data reporting and financial analysis, developing tools that reduced claims analyst turnaround time by 25% and increased overall efficiency.• Developed over 15 targeted reporting solutions for EDI data, providing actionable insights that supported multiple divisions and led to a 30% improvement in operational performance.• Extracted and analyzed data to identify overpayments and recoveries, driving a 15% increase in financial recoveries and optimizing recovery efforts
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Inventory AnalystMaxor National Pharmacy Services, Llc Jan 2012 - Dec 2013Amarillo, Texas, Us- Managed inventory of over $9 million in pharmaceutical drugs- Increased operational efficiency across 6 functional areas by leveraging SQL to optimize counts and volume, balancing workloads, and streamlining output across departments. - Utilized SQL queries and data analysis to conduct in-depth reviews of utilization and pricing trends, resulting in a 20% reduction in on-hand inventory through targeted strategies. - Designed and implemented daily quality assurance reports using SQL-based reporting tools, ensuring compliance, accuracy, and data-driven decision-making. - Established maintainable inventory levels with SQL-triggered re-order alerts, improving supply chain reliability and minimizing stockouts.
Daniel Cost Skills
Daniel Cost Education Details
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Middle Tennessee State University (Mtsu)General -
Database Training AcadamyDatabase Admin And Developer Courses
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CourseraAi & Development - Ibm
Frequently Asked Questions about Daniel Cost
What company does Daniel Cost work for?
Daniel Cost works for Caresource
What is Daniel Cost's role at the current company?
Daniel Cost's current role is Data Driven Healthcare Leader.
What is Daniel Cost's email address?
Daniel Cost's email address is da****@****msn.com
What is Daniel Cost's direct phone number?
Daniel Cost's direct phone number is +172732*****
What schools did Daniel Cost attend?
Daniel Cost attended Middle Tennessee State University (Mtsu), Database Training Acadamy, Coursera.
What skills is Daniel Cost known for?
Daniel Cost has skills like Data Analysis, Databases, Business Analysis, Sql, Microsoft Excel, Analysis, Process Improvement, Microsoft Sql Server, Management, Troubleshooting, Time Management, Microsoft Office.
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