Lori (Lorraine) Napier Email & Phone Number

Trade, TN, US

Columbus, Ohio, US

Working to build advanced analytic content across Enlace's value-based healthcare solution suite, focused on episodes of care and bundled payments.Applies critical thinking skills and quantitative analysis to detect and measure business trends. Specifically, developed key metrics for provider performance to benchmarks and the financial impact of the.

Eden Prairie, MN, US

Developed advanced data analytics that identified Fraud Waste Abuse and Error (FWAE) using peer comparisons, statistics and healthcare payment policy knowledgeCreated analytic enhancement related to drug testing codes that increased savings by $4MProvided innovative ideation and exploratory data investigation to enhance and expand upon existing.

Saint Louis, MO, US

Provided advanced analytical support for business operations specializing in Medicaid, Medicare, and Marketplace provider performance and VBP reimbursementModeled and reconciled large amounts of data across multiple system platforms and sources including: Teradata SQL, Excel, MicroStrategy and AccessReviewed data to determine operational impacts and needed.

Reston, VA, US

Utilized data analysis techniques to detect aberrancies in Medicare claims data across Part A and Part B benefit types and compiled data findings into actionable informationDeveloped and presented quarterly reporting using SAS, Business Objects and Excel to monitor and trend key metrics in high fraud HEAT locationsCreated proactive data analyses that.

Columbus, Ohio, US

Managed daily operations of clinical integration analysts including distribution of work, quality control of reports, report design, and staff developmentAnalyzed health plan performance related to quality, clinical, utilization, and financial outcomes from a variety of data sources using Microsoft SQL ServerDeveloped reporting to meet customer needs and.

Lancaster, OH, US

Created and maintained scorecards, dashboards and reports involving quality outcomes and hospital performance data related to Value Based Purchasing (VBP), Pay for Performance (P4P) and Electronic Health Record (EHR) Incentive Program Hospital liaison for quality outcomes core measure data transmission and submission from outside vendors and governmental.

Reston, VA, US

• Development of complex data studies used for identification of outlier providers, significant areas of program variance and over $32 million in program vulnerabilities
• Key contact person for internal and external customers regarding Medicare deliverables
• Provided specialized training to data analysis staff and general training of reporting software
• Created “spike report series” to proactively identify fraudulent providers of identity theft resulting in millions of dollars in savings to the Medicare program
• Provided quality control of Medicare and other data products
• Developed reporting and analysis to support internal Benefit Integrity and Medical Review departments as well as external entities such as the Office of Inspector General (OIG) and Law Enforcement (FBI)

Dublin, Ohio, US

• Managed both internal analysis functions and external client reporting
• Developed quarterly/annual report package for self-insured employers
• Supervised and trained data analysis staff
• Experienced with all operational areas related to a health plan including: eligibility, utilization review, case management, medical claims, provider contracting, and benefit design
• Utilized Microsoft Access and Crystal Reports to design improved reporting tools and develop more efficient data mining capabilities
• Assisted in disease management program design and provided patient identification for specified diseases

Columbus, Ohio, US

• Worked with Medical Director to design physician profiling tool and developed several financial reports to identify areas of cost inputs for CEO and Senior Management
• Provided HEDIS measure production and evaluation
• Assisted in design and data collection for new physician pay for performance program (P4P) to reduce number of inpatient admissions

Chicago, Illinois, US

• Analyzed healthcare information to form action plans for managing healthcare costs for PHOs, PPOs, and self-insured employers
• Project Manager for implementation of new software system utilizing episode of care (ETG) and ACG case-mix/risk adjustment methodologies
• Account Manager responsible for maintaining and servicing existing accounts
• Conducted “Peer Review” meetings with physicians utilizing healthcare data
• Assisted in marketing of medical informetics product to prospective clients
• Supervised and trained other data analysts