Yamilet Truex Email & Phone Number

Remote

• Manage team of direct reports in creating innovative new analytical concepts for Medicare and ACA Risk Adjustment within Veradigm's Risk Adjustment Analytics and Risk Mitigation products, focusing on condition gap.
• Triage, assign and assist in customer inquiries for deep-dive data analyses.
• Perform critical-to-quality analyses of customer data and P8 analytics to ensure high-quality and accurate results. Including trending large data sets over time to distinguish anomalies quickly and thoroughly.
• Serve as the subject-matter-expert for Medicare/ACA RA guidance and staying up-to-date on latest regulations, including ACA Edge ICD and BRDs, MA Advance and Final Notices, HPMS memos etc.
• Oversee team members time and project allocations, sprint planning, quarterly priorities, and assisting in shifting when needed.
• Perform sales demonstrations for prospective customers on the value and innovation P8 offers.

Remote

• Assist team of data scientists, researchers, risk adjustment experts, and developers in leading business cases for algorithm development and improvement, researching customer queries of analytics performance, creating.
• Perform in-depth, detailed data analyses for customers, including claims, enrollment, pharmacy, lab data and government files (Medicare MMR, MOR, RAPS Returns, MAO, ACA Edge RARI, RARSD, RARCSD etc,).- Monitor.
• Act as company subject-matter-expert, supporting training, guidance, and strategy for customers and more junior staff.
• Work closely with developers and engineers on business requirements, unit and regression testing for new enhancements and bug resolution.
• Work closely within an Agile structure and collaborate with teammates for innovation of new algorithms.
• Design new analytical concepts for Risk Adjustment Data Validation (RADV) software (Valid8) including identifying scenarios and conditions at higher risk for audit failure. Identifying and establishing propensity scale.

Cleveland/Akron, Ohio Area

• Responsible as a primary data analytics and reporting expert for Medicare Government Operations, including enrollment, appeals and grievances.
• Provide leadership and guidance to more junior level staff in the use of reporting tools and identifies areas for improvement in data mining and analytics.
• Provide triage and oversight of data analytics requests, assigning of projects/tasks to appropriate staff and monitoring of progress towards to deliverables.
• Monitor and evaluate departmental processes and leads improvements.
• Resolve highly complex issues through the reconciliation of large data sets.
• Present complex materials to all levels of management and ensures that it is easily consumed by various audiences, including executive leadership.

Cleveland/Akron, Ohio Area

• Responsible for defining all required reporting and frequency for government programs both within health plan and clinical operations.
• Design, develop and implement new reporting policies, procedures and submissions as it relates to government regulated plans by the Centers for Medicaid and Medicare (CMS) and Health and Human Services (HHS).
• Manage data transmission programs including Medicare Risk Adjustment (RAPS/EDS), CMS (HPMS) and (ACA) Edge Server.
• Defining, designing, data collection, analytics, quality review and submission of all regulatory reports to federal and state agencies such as Medicare Part C/D annual reporting, Medicare and Commercial Risk Adjustment.
• Production of health plan analytics for both Medicare and Commercial Risk Adjustment including attribution of Hierarchical Condition Categories (HCCs) through various model scenarios, future risk score forecasting and.
• Complex programming and monitoring of ACA Edge Server submissions. Creation and monitoring end-to-end from source system extraction, normalization across multiple systems, transformation to HHS compliant regulations.

Cleveland/Akron, Ohio Area

• Organize and maintain processes for the submission of data for Medicare risk adjustment.
• In depth knowledge of complex transition system planning, data governance and normalization.
• Responsible for the design, creation and extraction of data from multi-platform source systems for submissions to CMS Risk Adjustment Processing System (RAPS) such as Oracle, SQL SSMS and Teradata data stores.
• Project management and analytical oversight of submissions through CMS Encounter Data Processing (EDPS).
• Responsible for organizing collaboration of government regulations with claims processing, membership administration and clinical operations for optimal diagnosis capture and claims submissions.
• Collaborate with multi-regional teams, trouble-shoot and perform analysis on complex data spanning several years.

Cleveland/Akron, Ohio Area

• Primary role to provide leadership over conversion project to ICD-10 Diagnosis Code billing for the organization’s Ohio region.
• Leadership over regional team (business project managers, IT project managers, testing leads, organizational readiness teams etc.).
• Experience with working within national and regional program management structures.
• Coordinate project issues between both business and IT to establish priorities, ensuring the timely implementation of deliverables.
• Evaluate and assign staffing resources as well as managing local project budgets and accruals.
• Contribute in developing alternative solutions and assesses the ability to meet business objectives. Resolve specific issues (policy changes, staff requests, project delays, etc.) and other issues including providing.

Cleveland/Akron, Ohio Area

• In depth knowledge of revenue cycle operations and systems, with a focus on providing technology solutions in revenue cycle planning, system issue resolution, workflow development, and associated staff training.
• Promote and support billing and collections system functionality and identify best practices including observing trends and inconsistencies in system use and provide feedback to management to identify opportunities for.
• Certified to perform changes in Epic Resolute Professional Billing as administrator. Extensive awareness of all data sources and system triggers that are impacted by system changes and downstream impacts.
• Provide expertise in Epic Resolute PB end-to-end data flow and revenue cycle processes.
• Initiate and track progress for correction of reported systems problems, enhancements, or changes.
• Prioritization of outstanding work requests and act as intermediary between IT and business operations.

Cleveland/Akron, Ohio Area

• Create, maintain, trend and distribute business operation reports used by management to monitor backlog, measure performance against established goals and identify areas of concern.
• Create tools to assist staff in compiling and transmitting data.
• Ability to work with large amounts of technical data, identify and resolve anomalies. Develop new processes for check-out organization and offsite service charge capture.
• Create training materials and provide staff training on Epic charge capture and check-out process.

Cleveland/Akron, Ohio Area

• Reception duties including check-in, telephone services and direction. Cashier responsibilities including acceptance of co-pay fees and monthly dues. Customer service responsibilities.
• EMR coding responsibilities including accessing patient records, entering appropriate billing codes (ICD, CPT) and updating pertinent electronic medical records in both Epic and legacy systems.
• Collecting coding productivity and quality assurance data. Communicating results through reports, graphs, and other office utilities.