Effectively manages regional key business development functions through the use of quantitative and qualitative data systems and sources to evaluate, expand and align services throughout the organization. These functions include business plan development, business plan implementation, physician referral development, strategic planning, reporting of critical value statistics as well as coordination of activities with Managed Care. Researched, analyzes through various methods, and compiles reports, presentations and summaries of valid and reliable findings for hospital and headquarters management, hospital governing boards, the Boards of Directors and Trustees, and other key stakeholders for Shriners Hospitals for Children.

Manage analytical contracting support Analyzes, evaluates, and negotiates network management and provider contracts related to and within scope of job responsibilities, and implements plan changesWorks with the financial, operational and delivery aspects of network management and provider contractsReviews fee schedules to determine appropriateness and compliance with regulations and consults with other affected departments as needed and directed; recommends annual fee changes and pricing policiesAnalyzes the compliance with payer contracts ensuring that claims are paid accurately and on time, reports to appropriate parties and monitors results to ensure efficiency and effectivenessAssists with compiling data sets, market analysis and financial modeling for future revenue projectionsManage staff designated to support this processManages the provider relations, Network management education, and facility credentialingOversees and facilitates the effective dissemination of information to the hospitals and payors in order to have an efficient contractual between SHC and the payorsOversees the system education programs and implementation from the Network management initiatives

Liaison between provider claims and internal data systemsensure accuracy of provider data loadsanalyze claims data to determine appropriateness of billingassess and maintain monthly capitation payments to providersresponsibility for accuracy capitation paymentsDesign of new risk based payment modelsmodel revitalization of HMOs via patient risk scoresliaison with predictive modeling vendor and provider groupassess payment reserves to determine profit shareDesign and maintenance of Delivery System scorecard to assess performance

Provide necessary analysis to determine success in meeting strategic goalsdevelopment of system dashboardrecommend appropriate measures and benchmarksdetermine appropriateness of goalsassess individual and enterprise strategic initiative successmanagement of system reporting initiativesResearch, analyze and develop Environmental Assessmentsforecasting of financial, utilization, and human capital datause of SAS, Excel, Access and Business Objects to analyze dataregional demographic assessments as well as hospital specific demographics

Process Improvement AnalystProvided technical and analytical support for monitoring and evaluationUsed SAS and SAS/SQL to manipulate large databasesProvided support for all CQI activitiesUtilized statistical analysis to determine business unit driversServed as administrator of Improvement OpportunitiesServed as the liaison for data integrity co-existence effortsHealthcare Data Analyst / Team LeaderDeveloped utilization and financial reportsDeveloped and analyzed ad-hoc medical cost reports Provided supervision, leadership, recruiting, and guidance to HCDA teamUtilized SAS and SAS/SQL to manipulate large databasesPerformed analysis of pricing and reimbursement methodologies

Developed methodologies of measurement for quality improvement projectsDeveloped appropriate criteria and selection of random samples of medical recordsOversight of medical record data abstraction, reliability and validationPerformed statistical analysis, formal testing and regression modeling of dataLed all technical and analytical aspects of multiple quality improvement projectsPerformed statistical programming through SAS and SAS/SQL