Tony Cox Email & Phone Number

• Conduct data collection for Healthcare Effectiveness Data and Information Set (HEDIS)/medical evaluation studies including data requests, analysis, evaluations, and reporting.• Perform medical record reviews and chart abstraction to identify and evaluate source data. • Conduct system analyses to locate and retrieve HEDIS and quality data from claims, pharmacy, financial, provider, member and other internal and external sources. • In collaboration with Quality Improvement team, identify quality issues and root causes, develops interventions and supports implementation to facilitate improvement in provider compliance and HEDIS scores.• Partner with colleagues internal to Family Health Network as well as external (provider/designated group contacts) in the evaluation, communication, outreach and support of non-compliant members, providers and groups.• Coordinate the timely distribution, completion, and submission of approved HEDIS related documents to auditors and National Committee for Quality Assurance (NCQA) as aligned with Family Health Network calendar of HEDIS activities. • Run reports and prepares materials for medical group distribution and quality meetings. • Retrieve and manage medical record requests in compliance with HIPAA and Family Health Network policy/procedure. • Participate Quality Assurance/Utilization Management & Public Relations Committee meetings.• Participate in educational sessions for medical groups and physicians on issues identified during Quality Improvement and/or HEDIS processes.• Internal data cleansing and data reconciliation analysis.• Trend analysis in various functional areas of health care management.• Create and generate reports through Microsoft Excel and Business Objects interfaces using SQL and direct links to core databases.• Gather and interpret business requirements and monitor data trends to proactively identify issues.• Execute data changes and update core systems as needed.

Greater Chicago Area

• Ability to assess and measure the process capability to capture and maintain the quality of data throughout all business and system processes.• Monitored Uniform Data System (UDS) Measures for reporting trends and analysis.• Analyzed data trends and create processes and policies to improve patient outcomes.• Conducted data quality assessments and derive metrics for the data elements of most business value.• Provided data recommendations and solutions to Chief Medical Officer to improve provider processes• Discovered, documented, and analyzed data collection and data transformation processes to determine the cause of systematic errors or data quality improvement opportunities.• Identified quality issues and root causes, develops interventions and supports implementation to facilitate improvement in provider compliance and UDS scores.• Created business process workflows.• Ran reports and prepared materials for medical group distribution and quality meetings. • Identified trend analysis in various functional areas of health care management.• Produced reports for and interfaced with senior management and other stakeholders.• Served as committee member for process, policy and performance improvement.

Chicago

• Conduct data collection for Healthcare Effectiveness Data and Information Set (HEDIS)/medical evaluation studies including data requests, analysis, evaluations, and reporting.• Perform medical record reviews and chart abstraction to identify and evaluate source data. • Conduct system analyses to locate and retrieve HEDIS and quality data from claims, pharmacy, financial, provider, member and other internal and external sources. • In collaboration with Quality Improvement team, identify quality issues and root causes, develops interventions and supports implementation to facilitate improvement in provider compliance and HEDIS scores.• Partner with colleagues internal to Family Health Network as well as external (provider/designated group contacts) in the evaluation, communication, outreach and support of non-compliant members, providers and groups.• Coordinate the timely distribution, completion, and submission of approved HEDIS related documents to auditors and National Committee for Quality Assurance (NCQA) as aligned with Family Health Network calendar of HEDIS activities. • Run reports and prepares materials for medical group distribution and quality meetings. • Retrieve and manage medical record requests in compliance with HIPAA and Family Health Network policy/procedure. • Participate Quality Assurance/Utilization Management & Public Relations Committee meetings.• Participate in educational sessions for medical groups and physicians on issues identified during Quality Improvement and/or HEDIS processes.• Internal data cleansing and data reconciliation analysis.• Trend analysis in various functional areas of health care management.• Create and generate reports through Microsoft Excel and Business Objects interfaces using SQL and direct links to core databases.• Gather and interpret business requirements and monitor data trends to proactively identify issues.• Execute data changes and update core systems as needed.

Chicago

• SAS programming, merging SAS Data Sets, developing SAS procedures, preparing data and SAS Formats.• Develop, validate, and implement new or modified SAS and SPSS programs to load data from the source and create study specific datasets for analysis.• Prepare statistical reports using SAS, SPSS, STATA, and Survey Documentation and Analysis (SDA) software after data extraction.• Analyse data using SAS procedures PROC FREQ, PROC MEANS, PROC SUMMARY.• Maintain programs in SAS and SPSS in a user support environment.• Various data management skills: merging, reading raw data files, handling programming errors, accessing and managing data, appending, concatenating, interleaving data sets.• Program various applications to be used for survey data collection and analysis.• Program documentation on all programs, files and variables for accurate historical record and for future reference.• Review project requirements and ensure alignment of test, support, and training plans with the business objectives.• Fix programs and change existing code to ensure smooth run of the programs that are scheduled.• Provide revisions to databases identified as erroneous by validation error checks.• Improved dataset production procedures, reducing the time to produce datasets by 50%, saving the department money and providing the clients faster receipt of data deliverables.