Donovan T Rose Email and Phone Number

Optum Insights - Technology Engineering - Healthcare Claim Administration & Payment Accuracy- Advanced Communication Engine (ACE) - Claims Edit System (CES) Claim Payment Accuracy- Claims Manager (CM) Claim Admin- Provider Communication Gateway (PCG)Lowering the cost of healthcare by reducing medical billing overhead via transparent Payer-Provider Communication. We develop tools that improve medical coding and claim preparation accuracy, providing the ability for Provider systems to talk to Payer systems and communicate missing or incorrect items on the claim. The industry term is “Edit”. It is like spelling and grammar check for medical claims. When these items are corrected before submission Acceptance/Approval is more likely thus reducing the administrative costs of reworking the claim.

Facilitated implementation of EDW and Analytics for large ambulatory health system. • Complete on time and within budget (Less than 1 year) • Replaced BI/Report needs in 8 months (Removing costly licencing contract) • Created complex analytics dashboards for LEAN (Process improvement) • Used innovation (Design Thinking) to remove roadblocks • Designed self-service BI/ data access solutions • Prepared them to be self-sufficient via training and mentor coaching • Returned high ROI in both cost and customer satisfactionDesigned and lead data warehouse migration project, from department based data warehouse to an EDW (enterprise data warehouse) • All managed care/ shared risk data, logic, and measures • Quality Reporting: HEDIS, PQRS, MACRA, MIPS, APM, VBP4P, NCQA • MA Stars - CMS (Medicaid & Medicare) Medicare Advantage Quality Reporting • IHA’s (VBP4P) Value Based Pay for Performance - Combined logic for all shared risk into one code set - Created QlikView analytics application to show these different patient populationsTools & Technologies:• Late-Binding Data Modeling• Meta-Data Driven ETL• Qlikview• Tableau• SQL Server 2012 & 2014• EHR/EMR; EPIC/Clarity, Cerner, GE Centricity PM, Allscripts TouchWorks • SSIS, DTS• SPC (Statistical Process Control)• Statistics: R & Stata• Python• Machine Learning

• Implement first EDW solution for finance and academics utilizing Informatica and Business Objects.• Kimball data modeling of complex 6000+ table/object production system.* PeopleSoft

• Analyze, Design, Create, and Implement process improvement solutions• Building Data Marts for use by Auditors• Designing Custom T-SQL Solutions (ETL, Stored Procedures, Functions)• Optimizing and performance tuning 100+Terabyte Multi Database Systems• SQL Server 2008 R2 / 2012• MS Access VBA

SRS provides business intelligence & reporting solutions to companies of all sizes and industries. Our philosophy is to take complex needs and provide solutions that simplify the decision making process.

Business IntelligenceReport Architecture and DesignPharmacy Benefit Management (PBM)PBM - Medicad & Medicare (Reporting Compliance - CMS)PBM - NCPDP Encounter (Claims) Files - [versions 2.0, 3.2, 5.1, & D.0]Healthcare EDI X12 4010/ 5010 Data Analysis- PL/SQL, SQL- Oracle Database- SQR - Brio- TOAD- Hyperion Interactive Reporting

• Provide consulting and business solutions in the use of database applications and Business Intelligence• Sell, plan, and conduct upgrade & new installation projects• Organize, coordinate, and maintain diverse projects • Create custom programming, SP, triggers, functions, views (SQL,MS SQL Server 2000 & 2005) • Create complex reports using SQL and (Crystal Reports 8.5, 9, 10, XI, 2008)• Manage client accounts, build positive relationships and resolve conflicts • QA new application releases using client scenarios to ensure a high quality product

Neuro-pharmacology research studying neuro-cellular effects of cocaine and meth-amphetamines in the midbrain.

Actively drilling reservist with the 4 LAR Battalion in Utah.

1st Battalion 3rd Marine Division in Hawaii. Primary training 81mm Mortars. Additional training and certification as a Water Survival Instructor. (Teaching Marines to be able to swim even if say their hands and feet were tied)

West Indies Mission