Logan R. Houchens Email and Phone Number

-Co-built and maintained a SAS based Part D claim adjudication model for individual Part D business and leveraged the model in support of Part D benefit, formulary and network modeling, financial forecasting as well as PDE testing/error resolution.-Maintained and utilized EGWP pricing model to provide premium increase suggestions based on overall EGWP group performance, funding arrangements, and historical MLRs.-Engineered an internal PDE scanning algorithm that proactively identifies incorrect claim adjudication resulting in a PDE reject rate of <0.02% for Medicare book of business.-Initiated and built new areas of proactive data quality control measures on eligibility, claims, PDEs, claims adjudication, operational processes, and more in order to reduce audit findings, improve client and member experience, reduce PDE Rejection rates and improve operational efficiency.-Led annual benefit and claim testing associated with the 1/1 launch of new plan years, resulting in no PDE benefit and claim adjudication errors following 1/1 plan launch for multiple years in a row. -Built a new team to maintain and build more extensive QC measures and trained cross-functional teams in claim adjudication and PDE error resolution.-Executed monthly monitoring and evaluation of Part D claim adjudications and lead remediation efforts for all financial or operational findings, especially in Daily Cost Sharing (DCS), MSP, LTC, and more.-Assisted with CMS 1/3 Financial Audit, Acumen Audit, IAP, and independently contracted audit inquiries as it relates to Claims Adjudication, PDE calculations, and DIR filing.-Maintain financial and actuarial models with an eye towards continuous improvement and expansion of capabilities.-Stay abreast and lead internal discussions of all Medicare Part D regulatory changes related to PDEs, claim adjudication, eligibility, etc. Update models accordingly for testing of system processes.

Government Programs Financial Analyst III, Reporting and Analytics Team-Created and developed an internal company scanning algorithm that proactively identifies incorrect claim adjudication, data integrity, internal system errors, and more. -Assisted in Part D quarterly forecasting and annual budgeting.-Developed financial impact analysis and resulting accruals triggered by various claim adjudication issues. -Co-led and maintained targeted QC efforts that resulted in the retention of a major client and alleviated concerns around associated PDE accuracy and compliance.-Co-created DIR filing, refiling, and developed responses to CMS’s Desk Review questions for 2022 DIR season for individual Part D Book of Business.-Participated in resolving internal and external audit inquiries. -Created internal use documents from CMS provided Landscape and Public Use Files (PUF) for market analyses, internal configuration efforts, and 1/1 testing.

Government Programs Business Analyst, Prescription Drug Event (PDE) Team-Maintained SAS databases necessary for all Part D processes (CMS communication files, Public Use Files, Landscape files, MMR, PDEs, P2Ps, DIRs) -Performed regression testing analytics associated with established PDE logic and protocols.-Processed and analyzed claims as needed and Performed manual PDE adjustments to ensure accuracy. -Validated benefit configurations to ensure accurate claim adjudication and PDE records.-Assisted in the development of standards and related documentation and training materials-Reviewed data sources to ensure accuracy, completeness and overall data integrity-Administered the Retro LIS reprocessing-Troubleshot Medicare PDE issues, reconciled audit findings and proactively identified claim adjudication and PDE errors-Effectively communicated complex pharmacy benefit processing issues, challenges, and occurrences to both internal and external clients-Created, distributed and resolved monthly and bi-monthly PDE error reports-Performed user-acceptance testing (UAT) for new PDE and Medicare Cornerstone logic-Processed and analyzed claims as needed for PDE correction-Performed Ad-hoc reporting, financial analysis and impact estimations as needed in support of all Elixir Part D lines of business-Participated in the development and implementation of Government Programs initiatives, as needed, to improve processes and procedures

• Investigated and conducted study on patient data for 1.5 million individuals to forecast, predict, and understand the risk for different types of substance abusers to incur psychiatric problems.• Successfully interpreted data to draw conclusions for health policy action/insurance strategy and for future biological studies on brain matter for substance abusers.• Utilized Stata statistical software to track and analyze data.• Extracted knowledge and actionable insights from public census as well as private structured and unstructured data. • Presented findings and data to WKU Economics Faculty to improve strategies and operations of study.• Proposed solutions to improve health system/insurance efficiencies and reduce undiagnosed psychiatric problems.• Created and led the full research project.

• Used statistical techniques for hypothesis testing to validate data and interpretations.• Optimized data mining/cleansing procedures and generated an automatic data integrating warehouse from separate data reports on weekly, monthly, and independently chosen bases.• Coordinated advanced Mathematica functions to create data representations, machine learning algorithms, and other functions with my project co-creator.• Created and led the full research project.

• Utilized Java (Basic, Android, and Glass XE) packets to track and analyze micro-interaction data.• Optimized functionality and menu procedures to minimize interaction time.• Coordinated group research report for implementation of micro-interaction strategies for Google Glass Developers and the 2014 Siemens Competition.• Managed the planning and development of design and coding framework for application and data acquisition.• Developed new reports and delegated tasks and training to two junior computer science team members.• Created and led the full research project.