Nina Lu Email & Phone Number

San Diego, California, US

San Diego, CA, US

• Transforming a $3M program in-house from an outside vender by performing a reverse engineering on logics
• Architecting, building and maintaining a scoring engine to perform risk assessment on over 450M records of claims annually, which brings in $4.2M savings on average
• Refining audit rules and enhancing claim scoring algorithms, resulting in 50% increase on the hit rate along with 30% overpayment recovery improvement
• Forming measurable metrics, conducting dimension reduction and evaluating multi-variate models for pharmacy outlier detection finalized with an embedded model achieving around 60% precision rate
• Working with software development team to design and create an audit tracking system plus an aberrant billing pattern detection algorithm
• Constructing and distributing KPI reports to team leaders to evaluate the team performance

San Diego, CA, US

• Renovated the approach to audit rule generation by applying decision tree algorithm over 50K NDCs
• Created dashboards with SAS Visual Analytics to deliver a thorough review on the activities of 58K con-tracted pharmacies across the board, focusing on denied/reversed transactions
• Modernized data streamlining processes, resulting in a 25% redundancy reduction and decrease in time needed to populate data in data warehouse
• Automated flat file creation to vendors so as to reduce manual errors to maintain the data quality

San Diego, California, US

• Completed the FDA submission of G6 glucose monitoring device which made the company revenue grow 52% in the 1st quarter of 2019 versus the same quarter of the previous year to $280.5 M
• Led statistical designs and conducted sample size calculations for 5+ clinical trials to improve the accuracy of the next generation glucose monitoring system

Long Beach, California, US

• Designed and involved in 10+ intervention studies from measure selection, sample size calculation, targeted population randomization, program implementation, process supervision and final project evaluation
• Built and compared 10+ predictive models on medication adherence member data to detect high risk mem-bers, including data clean-up, filtering and performance evaluation
• Performed and visualized monthly performance analysis to detect over $116M opportunity per year on risk adjustment and medication usage for management team
• Offered systematic quality control on Physician Incentive Program, involving $3M payout annually

Long Beach, California, US

• Be in charge of 3+ yearly study programs, aiming to identify trends, draw appropriate conclusions and translate analytical findings into member management and budget planning
• Conducted ongoing performance tracking and success metrics for real time calling system
• Converted, merged and consolidated data from a wide variety of sources across enterprise platforms to sup-port 50+ internal and/or external data requests
• Developed the algorithm to identify potential ESRD members, reimbursing the company >$17M
• Performed Ad hoc analysis to identify significant differences among sources and answer business questions

Frisco, Texas, US

• Provided a baseline for new application testing by reading in data from 380+ Excel spreadsheets
• Automated data load from SQL tables to 400+ Excel spreadsheets on the daily basis which replaced the manual key-in process and reduce typing errors dramatically
• Captured 25% of profit opportunity on production workload by analyzing churn rates