Michelle Lynch Email & Phone Number

Baltimore, Md, Us

Louisville, Kentucky Area

In this role, I manipulate and analyze complex, high-volume, high-dimensionality data from varying sources using a variety of tools and data analysis techniques. My primary day-to-day work includes data mapping and troubleshooting mapped data.I assist with the development of reports and projects, including documenting methodology, designing reports, and making recommendations based upon data analysis.I identify complex healthcare data problems or issues, I research solutions, make recommendations and implement steps to achieve higher level of efficiency for analytic and product offerings.I provide analytical support to the Data Science, Clinical, Data Logistics, and Operational Teams.I conduct research and perform root cause analysis as part of responsibility for analytics projects. Skills: Knowledge of health care administration, mathematics, statistics, business, computer science. Drawing on 15+ experience working in the capacity of a data analyst; and 25+ years of working with healthcare data. Understanding of key managed health care concepts and terms (e.g. PMPM, CPT, ICD coding, HCPCS, DRG, etc…)Experience with data analysis and reporting, and knowledge of data visualization software packages.Ability to write complex SQL code, extract data and generate queries/reports without guidance, integrating data when necessary between different data sources.Experience with building reports, analyzing results, and communicating findingsUnderstanding of data structure/integration and relational database design.Strong attention to detail and data accuracy.Proven team player with strong analytical and interpersonal skills.Exhibits creative thinking skills.http://certilytics.com/

Arlington, Va

In this role, I analyze data files, data layouts and data dictionaries from providers of health care administrative data to understand data structure and operating rules for transforming to common data format. I gather, define and document data transformation (ETL) requirements and author data mapping dictionaries based on an understanding of operational and business process. I review these documents with ETL developers and QA team members to ensure they understand coding work and testing work needing to be carried out.Daily, I use SQL / MS T-SQL for analysis of incoming files and troubleshooting production data problems (via Salesforce ticketing notification).I have a thorough knowledge of healthcare data and the relationships between each domain: Medical Claims, Pharmacy Claims, Eligibility, Benefit and Group/Plan Account Setup and Provider Credentialing. I understand the end-to-end processes around these subject areas for the authorization of services and adjudication of claims.I strive to maintain a strong working relationship with client-facing support team, other internal stakeholders, clients and vendors.Data analysis skills: I can deal with large with healthcare datasets and find relationships in the data and identify any gaps/issues.I have patience and persistence to sift through complex data/information to get to the core knowledge.I have a thorough knowledge of medical claim file contents (both UB04 and HCFA-1500) and significance of individual fields.

Columbia, Md

In this role, I provided analytical support to the Payment Integrity Team (Fraud, Waste, Abuse) and Special Investigation Unit (SIU) Team. I developed, reviewed and performed in depth analysis and reporting on post-pay claim data. Subject areas I worked with included membership/eligibility, provider rates and contract inaccuracies, processing errors, coordination of benefits (COB) and subrogation.I assisted with conducting focused claim audits to identify overpayments. I then determined if recovery opportunities met the requirements of state and federal regulations for recoupment. I prepared reports on audit results, and recommendations of process improvement. I worked with the claims processor training team to identify training gaps/needs. I worked with the system configuration and benefits set-up team to perform root cause analysis when claims were not paying according to contract or fee schedule. Daily, I prepared reports and analysis using Oracle SQL and Excel. These included impact analysis, design, process analysis and testing. I had some exposure to creating proprietary algorithms and business rules in conjunction with business owners, for the purpose of identifying overpaid claims. I coordinated and performed research to resolve complex unsolicited refunds, including tracking withholding for recoupment. Because of my extensive understanding of claims adjudication at both a system level and benefit payment level, I was often called upon to provide technical systems and subject matter expertise to Regional Service Centers, Claims, Network Development and other similar departments and staff.I always strived to develop & maintain working relationships with the Finance Department, Legal Department, Claims Processing Operations, Claims Benefit Configuration, Network/Provider Credentialing and Analytical Services Department, as appropriate.Daily use of Cognos Business Intelligence, Daily writing advanced/complex Oracle SQL queries.

Columbia, Maryland

• Generated ad-hoc reports via SQL query for claims/eligibility/provider subject areas. Supported claims operations as the designated analyst for operational reporting including claims timeliness, auto-adjudication rates, claims edit and denial tracking, and pended claims inventory.• Participated in full-life cycle software development for mid-size to complex projects – using Actuate or Cognos. Provided technical support and training to users of enterprise-wide self-service reporting tools. Developed and documented workflow and system requirements, performed system impact analysis, process analysis and quality assurance testing using software development methodology. Worked closely with programmers to communicate detailed report design specifications. Demonstrated ability to meet deadlines on multiple tasks and prioritize appropriately.• Drawing on my extensive knowledge of claims processing operations workflow and procedure, I served as a point of contact for interpreting requests for analysis from business owners. • Served as liaison between Analytical Services / Information Delivery and cross-functional business areas. Maintained excellent working relationships across the enterprise with business owners, end users, IT programming staff/management and data warehouse operations team. • Built and maintained exemplary relationships with users of reporting tools throughout the organization to foster increased acceptance of self-service reporting and provide direction as to how use of available reporting tools can help users do their jobs more effectively and efficiently. • I have experience with data warehousing methods and modeling and with requirements gathering for Extract/Transform/Loading (ETL) of data.• Advanced experience writing Oracle SQL queries and working with large data sets. Intermediate experience with the IBM Cognos Business Intelligence tool suite. Daily use of Microsoft Excel and other Office applications.

Columbia, Maryland

Responsible for generating ad-hoc reports using various spreadsheet and graphic applications. Serves as a liaison between the Claims Department and IS Department for meeting customer and internal reporting requirements.Extracts data from databases, manipulates and analyze information to ensure that reports are accurate and meet the needs of internal and external clients.Researches and implements reporting systems to generate recurring monthly, quarterly, annual and bi-annual reports, including graphic presentation of trends and written data analysisEnters data and maintains databases to support trending analysis and graphicsResponsible for trouble shooting and problems solving, client server generated reports, SQL generated reports and other custom reportsAnalyzes reviews and makes recommendations to management in implementing enhancements to increase operating efficiency.Assists in the developing of new reporting system, system design, coding, and testing

Supervises cross-functional team members to meet or exceed service requirements. Serves as a team site coordinator.Independently examines and analyzes the team’s performance; develops, recommends and implements plan(s) of action to improve the team’s service level. Reports on team service measurements against goals.Serves as product and process expert and resource to team(s)Assesses, investigates and resolves difficult issues to achieve customer satisfaction

Adjudicate claims, adjustments and special projects.Resolve complex claims edits and suspended claims.Complete projects consisting of adjustments and perform root cause analysis.Handle all types of requests, inquiries and complaints accurately and timely.Work effectively with external and internal customers and others in providing requested information and solving problems.Serve as a resource (buddy) for newly hired associates and/or assist with remedial training for existing associates as needed.

Claims Processor

Aa, Database Technology

Activities and Societies: Student Advisory Board Database Technology

Ba, Sociology And Anthropology

Activities and Societies: Program Distinction in Sociology and Anthropology Sociology and Anthropology