Tim Douglas Email and Phone Number

Financial analytics and reporting, healthcare analytics

Financial Analytics & Reporting

Managed day to day operations of five data analysts focused on financial reporting, dashboard creation and upkeep, process automation, and ad hoc reportingResponsible for supervising the SNAPSHOT financial reporting initiative by managing business objectives, coordinating with IT Development and assigning value based tasks to internal data and IT teams Coordinated and maintained recurring financial and encounters reports used for rate setting, risk adjustment, and market actualization resulting in elimination of sanctions as well as increased data integrityAccountable for data analytics, reporting and visualization surrounding billions of dollars of member claims activity for Medicaid, Medicare, and Marketplace services Team subject matter expert that served as primary point of contact for escalations, urgent requests and issue resolution Led committee focused on creation and oversight of documentation focused on data and policy governance, knowledge retention, and departmental best practices

Generated ad hoc reports leveraging SQL, Python, SSIS, as well as various data presentation tools concentrated on quality and process improvement Provided comprehensive mentoring and development focused on onboarding and supporting junior analystsImplemented automated check and validation in EBO Lag process resulting in the reduction of hundreds of labor hours as well as increased accuracy and reportingFostered relationships with health plan senior leadership, accounting, IT, Encounter Business Operations, and corporate data and financial support groups

•Create geographical access reports and maps focused on modeling client and pharmacy metrics•Develop customer data queries to determine pharmacy disruptions due to network changes using SQL and Alteryx•Generate ad hoc and reoccurring reporting to meet Medicare, Medicaid, and commercial network compliance•Design process flows and queries focused on customers unique network requirements, requests for proposal, and pricing guarantees•Managed large scale multiyear projects concentrated on implementation and renewal of client contracts•Collaborate with project and account managers to find creative solutions involving reporting and data interpretation•Organize, analyze and produce GeoAccess reports focused on performance guarantees

•Initiated client specific health and safety reviews based on medical and prescription profiles•Issued resolution reports and made suggestions to clients focused on treatment options for patients that exhibit drug seeking behavior and patient safety concerns•Performed data mining and query creation to obtain data to execute employee investigations for clients•Investigated prescription and medical fraud, waste, and abuse that resulted in client recommendations to restrict pharmacy and prescriber use of the identified patient•Conducted audits on doctors and pharmacies to confirm accurate patient health and prescription information•Managed the triage process for the fraud tip hotline resulting in escalation or resolution of the fraudulent concern