Maureen Tayse Email & Phone Number

New Carlisle, Oh, Us

• Key developer of a Provider Profile, used to prioritize provider outreach and contracting discussions. I built this product to be flexible with pick-and-choose elements available to the business leaders to have a 360 view of the provider, including such things as utilization, financial, risk, quality, capacity, value scoring, and volume stratification. • Selected for a 6 month special assignment to lead analysts to identify, research and improve Operations. A concerted effort with representatives from all areas of business, we collaborated with all levels of the company, resulting in improvements of claims processing, provider identification, and member data. • A critical thinker who collaborates with all levels of the company, and uses broad knowledge to advise on the implication of issues to the overall business. Represent the department as subject matter expert in meetings or projects.• Use effective visualization, tell the data's story in a way which can be easily understood by varied audiences.• Wrangle diverse, dirty and disparate data sources, making connections to find meaningful information.• Primary trainer for department, including identification of knowledge gaps and assist with first projects.

Dayton, Ohio Area

• Selected for special assignment to identify, research and improve Medical Cost Ratio. Over 18 months, team achieved over $400 million savings, while creating structure and training for permanent team. At all levels and areas of the company: identified gaps, process breakdowns, and risks. Financial impact identified through changes in claim edits, utilization management, pharmacy, and contracting. • Perform in-depth analyses for internal and external publishing, including peer reviewed, IRB standard research.• Develop protocols, process and training for analysts in new Research Department.• Healthcare data experience includes: claims, provider, member, case management, pharmacy, HEDIS, laboratory, ACG, mental health, maps, internal/external claim edit processes, and encounters.

• Find actionable populations for member health and HEDIS score improvement using enrollment, authorizations, case management data, claims, and HEDIS specification knowledge. • Provide appropriate level summaries of analysis, including effective graphics to explain key findings. • Interact and collaborate with peers, management, and business units to provide subject matter expertise on HEDIS.

• Responsible for analysis and reporting associated with regulatory, special projects, or performance measures (e.g. HEDIS, state-specific), including the review and response of all regulatory notifications that involve analytic departments. • While managing own workload, trained and coordinated projects of 4 analysts’, including internal tracking. • Quantified critical issues and provided recommendations, along with risks and issues involved with each alternative.• Represents the department in project meetings and other meetings that require subject matter knowledge and input.

• Perform in-depth healthcare data reviews and analysis associated with regulatory performance measures for HEDIS and Ohio Department of Jobs and Family Services.• Assist in the review and response of all regulatory notifications that involve analytic departments.• Lead regulatory efforts on an as-needed basis, managing multiple projects and deadlines simultaneously.

• Conduct examination and explanation of complex data relationships to answer questions identified either within the department or by other departments.• Generate graphics that effectively describe, explore and summarize analyses for communication to appropriate parties.

• Converted, implemented, and maintained servicing asset predictive modeling software MIAC to manage $2B asset valuation and hedging, acting as liaison with IS department. • Performed department process engineering from conception to completion to training, creating new procedures.• Developed financial packets for corporate committees, and federal regulatory compliance documentation (SOX). • Developed, implemented, and maintained disaster recovery plan, including off-site testing.

•Operated servicing asset modeling software (Busch Analytics). •Previous staff accountant duties continued with the position.