Optimization of medical record review performance by harnessing NLP and AI driven predictions. HHS-RADV IVA.

ROI analytics for In home assessment (IHA) and provider engagement programs. Yield modeling based on member utilization and disease burden profiles.Predictive analytics for disease suspecting (gap) model development for risk adjustment (CMS/Medicare, HHS/ACA and CDPS/Medicaid). Model types: Historical Dx, Pharmacy, Lab, Procedure, Demographic, Utilization.Technology: SQL, PowerBI, Python, Databricks.

Medicare risk adjustment.• Analytics for medical record retrieval prioritization, chart review operations, ASM submissions to CMS and chart review yield. • Predictive analytics for HCC capture, condition suspecting and support for internal risk adjustment initiatives.Technology: SAS, VBA, PowerBI

Financial and clinical analytics for Moda Health’s value-based care programs.• Pricing analytics and utilization re-direction (steerage). • Health economics and outcome research (HEOR). • Medicare risk adjustment. • Quality metrics and Medicare STARs.• Engage with health systems and clinic managers to understand the utilization, financial data and quality metrics data that Moda Health provides to them. • Analyze value-based care outcomes, ROIs and opportunities for improving financial and clinical performance.• Administer $1M+ per month in value-based care associated payments (Risk Models, CPC+, Primary Care Home supplements, Fully Capitated Arrangements, Quality Incentives, etc).• Develop algorithms and dashboards to analyze membership, utilization, PCP engagement, OON activity, cost trends, capitation programs, risk agreements, etc. • Manage internal and external financial reporting for most value-based care payments and regulatory filings for state and federal primary care and value-based care reporting.• Technology: SAS, SQL, Tableau.

Analysis of current and proposed contracts with healthcare providers.• Lead analyst on contracts covering $50M+ in annual spend across multiple LOBs.• Analysis of wide array of service categories, including Professional, IP/OP (DRG and %), ASCs, Behavioral Health. • Led analytics for successful launch of member-facing, online Healthcare Cost Estimator pricing tool.• Developed pricing normalization algorithm to identify high-cost and/or incorrectly configured contracts. Identified configuration errors that resulted in $250K+ in savings.• Analyzed custom reimbursement proposals, including bundled pricing approaches for joint replacements and substance abuse treatment.

Clinical trials and preclinical research for the development of immuno-oncology (I/O) therapies.• Predictive analytics. Built data pipelines from both clinical sources and advanced technologies (eg. flow cytometry).• Coordinated research initiatives through engagement with physicians, trial coordinators, pharmaceutical representatives and researchers.• Built interactive visualization and data mining platform for clinical trial data using JavaScript, PHP and Google Charts. Used tools to identify new predictive biomarkers for immuno-oncology outcomes.• Published multiple peer-reviewed scientific reports and wrote funded fellowship grant application. • Developed deep understanding of diverse immune-oncology therapies, including checkpoint Inhibitors, T Cell Agonists, Vaccines, TGFb Inhibitors and CAR T-cells.• Technology: JavaScript, PHP, SQL, FlowJo.

Infectious disease, immunology, bioinformatics.

Upper and lower division genetics.

I helped to organize the University of Oregon high school forensics (speech and debate) tournament, and the UO summer high school debate camp. The UO tournament is one of the largest high school debate competitions in Oregon.