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Lori Richards is listed as Chief Analytics Officer at eNhance CCM, based in Sarasota, Florida, United States. AeroLeads shows a work email signal at humana.com and a matched LinkedIn profile for Lori Richards.
Lori Richards previously worked as Owner at Richards Consulting & Analytics, Llc and VP, Innovation and Health Insights at Lucina Analytics. Lori Richards holds Master’S Degree, Management Information Systems from University Of Central Florida.
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Over 30 years in the healthcare industry with 20 in claims data analysis, mining, reporting, and management experience. Today, I am proud to be a part of eNhance CCM, working and learning alongside some of the best and brightest in the healthcare claims cost management world. eNhance CCM is your trusted partner for healthcare claims cost management services.eNhance CCM is home to industry-leading experts with decades of experience in claims cost management, revenue cycle solutions, programming, and data analytics. We have developed a stable of eNhance CCM core services and established partnerships with vendors on the cutting edge of the healthcare world to provide you with solutions to accelerate the healthcare claims recovery process. At eNhance CCM, our aim always has been and will always be meeting – and exceeding – our clients’ goals. We believe a collaborative approach is the only way to see that happen. We’ll work together to eNhance your vision, strategy, and bottom line – while making the recovery process simple, efficient, and economical.
Listed skills include Process Improvement, Visio, Sharepoint, Sql, and 32 others.
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Designed, developed and implemented from concept all ETL, mining logic, business processes and reporting deliverables to facilitate a new business concept in the identification of missed subrogation reimbursement opportunities for all health care and provider clients. Served also as lead contact with clients and partners in developing business process in data sharing and revenue generation.
Tampa, Florida, Us
Developed and designed ETL and mining logic to facilitate new business concept in maternal case management. Developed internal and external insight reports measuring operational successes and opportunities. Interfaced with clients to develop new concepts and business opportunities. Led new client implementation and served as liaison with new and existing clients.
Lagrange, Kentucky, Us
Designed and led the development of a new mining system with enhanced algorithms and tracking to increase the volume and effectiveness of the mining results that are delivered to the COB auditors and subrogation analysts. This provided a comprehensive mining process that takes advantage of both global and targeted mining algorithms developed within our area. These changes led to an increase in both deliverable file volume and invoicing of over 350% in a 7 year period. Additionally, process and logic improvements were made in the selection of claims for submission to costly external enrichment sources that increased the success rate and decreased the cost per positive result of over 200% within 3 years.Led the Enterprise Reporting Team: Developed new queries, reports and initiated an analytics area utilizing both claims and operational systems data to closely monitor the results of all mining process and logic improvements. This resulted in a more proactive approach to issue identification as well as the illumination of errors in data integrity and processes upstream and downstream from mining. Ongoing efforts were initiated to cleanse the systems data and work with the clients to clarify and better define elements provided in their claims data feeds. Process improvement was then expanded to include upstream and downstream departments and I developed a team specifically to define, clarify and in some cases create efficient processes across all departments and provide reporting and user analysis tools to identify missed opportunities and significant efficiencies on an ongoing basis.
Lagrange, Kentucky, Us
Established the company's first research and development department and led the development of new and innovative systems, processes and mining algorithms to increase and improve mining results. Hired and developed a team of cross- functional experts that promoted continual growth by challenging conventional thinking and promoting a culture of creativity, innovation and continual improvement there and across the company. Key Accomplishments: Established metrics and reporting tools to enable the monitoring and management of query development and results in real time. Used this information to closely monitor results and facilitate our ‘ fail fast ' approach to new query and process development. Expanded traditional mining philosophy from global across- all- client mining logic into client- specific queries designed to make the best use of all claims data elements received in our clients ' claims data. Currently houses over 300 client- specific queries. Removed communication barriers and established a formal feedback loop between the auditors and the lab / mining team as a tool for the continual improvement of both mining and auditing processes. Prioritized mining results based on the actual performance (hit rate) of each individual client query developed. This concept was translated into a tiered mining and distribution system that enables a more timely and efficient review of high priority mining results.
Louisville, Kentucky, Us
Hired and managed a team to examine existing mining logic and processes within Financial Recovery operations and to identify redundant tasks and automation opportunities. All tools were built within our area so that we could implement new logic and functionality quickly to adapt to the ever-changing needs of the Financial Recovery department. Several also served as prototypes for formal IT development after the changes were stabilized. Notable process improvements include
Louisville, Kentucky, Us
Managed a team established to develop tools, reporting and workflows to maintain the continual growth of the department and overpayment identification.Designed process / workflow analyses and developed multiple working MSAccess databases and Excel programs established to quickly increase workflow efficiency within the claims overpayment audit and recovery collections and resolution areas. This enabled FR to increase overpayment identification and collections while reducing staff by 50% over a five year period.Worked with multiple claims and recovery platforms to develop extensive weekly and monthly FR reports and self-service tools to enable improved monitoring of results for management teams and executive management.Completed budget, financial and staffing analysesRedesigned cash posting workflows and systems to establish a lockbox to ledger reconciliation processDeveloped audit tool to automate the application of provider contract terms to claims data for audit and overpayment identification as well as manual calculation of provider contract terms
Louisville, Kentucky, Us
Quick answers generated from the profile data available on this page.
Lori Richards works for eNhance CCM.
Lori Richards is listed as Chief Analytics Officer at eNhance CCM.
AeroLeads has found 1 work email signal at @humana.com for Lori Richards at eNhance CCM.
Lori Richards is based in Sarasota, Florida, United States while working with eNhance CCM.
Lori Richards has worked for Enhance Ccm, Richards Consulting & Analytics, Llc, Lucina Analytics, The Rawlings Group, and Humana Inc.
You can use AeroLeads to view verified contact signals for Lori Richards at eNhance CCM, including work email, phone, and LinkedIn data when available.
Lori Richards holds Master’S Degree, Management Information Systems from University Of Central Florida.
Lori Richards is listed with skills including Process Improvement, Visio, Sharepoint, Sql, Data Analysis, Access, Business Analysis, and Project Management.
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