• Designs, produces and analyzes reporting data for Sentara Health Plans efforts to raise risk adjusted revenue to the level of insured’s true health status. • Under the direction of the Risk Adjustment Manager, creates and maintains reports and visual dashboards for business operations and special projects related to retrospective and prospective risk score optimization activities. • Utilizes knowledge of numerous databases, information systems, statistical tools, and analytical principals to monitor and analyze information in support of risk adjustment activities. • Creates visual tools using SQL Server Management Studio, Tableau, and Microsoft Excel for tracking and monitoring data related to risk adjustment activities. • Works closely with Risk Adjustment Team Coordinator and Actuarial Analysts whose emphasis is on the technical and data management aspects of Risk Adjustment such as data submission, data integrity, and calculation of key performance metrics.

• Manage and coordinate provider data such as physicians, facilities and specialists who are part of provider networks such as Medicaid, Medicare• Collaborate with business owners to create data extracts capturing measurable data for project/program analysis• Work with business owners to document report requirements and produce agreed upon data extracts• Responsible for producing key deliverable to project managers and business partners to monitor the progression of providers that are targeted, contracted and loaded to claims platform (NDB) and other mandatory state requirements such as provider network file• Responsible for accessing multiple internal data sources and compiling the data using templates supplied by internal and external customers• Serve as initial contact with project managers to fulfill servicing needs such as standard and ad Hoc requests, RFPs, regulatory reporting• Design and/or develop specifics for collection, tracking and reporting to facilitate analysis

• Extracted and analyzed medical and behavioral claims data from external source to evaluate key operational and financial metrics• Summarized and presented data and relevant findings in Microsoft Excel and PowerPoint• Worked collaboratively to develop and provide useful tools and technical assistance to affiliates• Communicated effectively by describing the relevance and utility of the medical claims, productivity, and other data analyses provided• Facilitated data collection from multiple sources to provide credible data that were used in high-level decision-making process. This can also include providing input on process improvements for more efficient data extraction• Designed and developed relational databases for collecting data as well as building and designing data inputs• Maintained data tables of key performance indicators analysis

• Queried data fields from health data tables to analyze the design and specification of data structures• Performed validation and testing of metadata for anomalies, recorded anomalies in Excel and address each anomaly as appropriate• Analyzed and organized technical data and reports into summaries for management review, defining problem, evaluation, and possible solution(s). Responded to requests for technical assistance in person, via phone, or electronically, advise user on appropriate action, identify and escalate situations requiring urgent attention, track and route problems and requests and document resolutions

• Provided comprehensive reporting of medical, behavioral health, pharmacy claims cost and utilization• Responsible for design and develop of reports and analyze data to measure clinical outcomes, network performance• Designed and created high-level databases and spreadsheets using MS Access and Excel, SAS to support internal and external customers’ needs such as automation to simplify their day-to-day processes• Addressed in a timely manner any and all ad Hoc requests as well as answering any user inquiries resulting from the daily, weekly, monthly and quarterly generated reports in MS Access• Proactively met with customers to determine specific data requirements in order to exceed their immediate and future needs• Participated in the development of documentation including edit, format and proofread for internally-developed software applications or enhancements