Your Name
Summary
A health economist who writes programs to evaluate cost-structures. Excels in the analysis of unstructured problems. Notably skilled in turning complex data into actionable results that drive decision-making and create solutions. Unique blend of experience from both provider and payer perspectives.
Overview
9
9
years of professional experience
Work History
Senior Health Economist, Health Economics
Uc Health
Firestone, CO
04.2022 - Current
- ·Oversee healthcare economics and analytics for statewide networks, prioritize financial impacts to achieve Provider Network Optimization.
- Perform complex modeling exercises on rates and reimbursement methods to identify new and innovative strategies to control costs, as well as manage and grow value-based relationships.
- Leads complex, large-scale initiatives with high-dollar cost-savings opportunities through highly visible, highly impactful analysis
- Design and perform complex fee modeling exercises and cost impact analysis on a wide range of negotiation proposals, contract structures and reimbursement methodologies for all provider types- physician, ancillary (national and local), hospital, vendor (national and local).
- Prepare and present negotiation prep analysis and make recommendations to senior leadership regarding the development of a negotiation strategy. Provide analytic support during active and complex provider negotiations.
- Measure outcome for healthcare initiatives and make recommendations to senior leadership that dive population health and cost-effective care.
- Simply Healthcare – Medicare (70K) and Medicaid (750K)
- Maintains advanced knowledge of data warehouse design, data definitions, predictive modelling technologies (ETG, DxCG), system capabilities and data integrity standards.
- Assists Director of Provider Economics in the hiring, training and the assignment of roles and responsibilities of team members to optimize productivity and skill alignment.
- Maintain relationships with varied business partners and cross-functional teams - including Cost of Care, Actuary, Provider Relations, etc.
Business Information Analyst II (Finance)
Anthem Inc.
City, STATE
03.2018 - 04.2022
- Expert level proficiency in SQL and Excel, Working Experience with Python, R, Tableau.
- Evaluate physician, ancillary and hospital provider contracts to examine provider performance through financial analysis of claims, member, and/or encounter data to identify unit cost and utilization trend drivers and any potential opportunities for improvement and movement toward Network Optimization.
- Lead financial review during JOC meetings with Value-Based providers. Perform complex Medical Loss Ratio (MLR) analysis to baseline PCP financial performance and communicate trends and areas of opportunity to client.
- Apply statistical methods and advanced analytics to cost and trend drivers (healthcare economics).
- Collaborates efficiently with partners on cross-functional teams. Able to build strong relationships and manage expectations within the organization (Finance, Provider Relations, Actuaries, Operations, etc.).
Practice Administrator
Tampa Cardiac Specialists, LLC
City, STATE
02.2015 - 10.2017
- Managed a staff of 15 consisting of 5 providers (Physician & non-physician practitioners) and 10 clinical and administrative employees for a private multi-specialty Cardiac practice located on-site at St. Joseph Hospitals – Main and North.
- Oversaw budgetary and fiscal management in conjunction with practice CPA.
- Tracked financial performance to ensure alignment with quarterly and annual budget.
- Provided financial analysis, forecasting and modeling for strategic business planning. Presented analysis to practice CEO, provided guidance on business decisions.
- Performed in-depth evaluation of all existing third-party payer contracts. Renegotiated contracts with multiple payers, utilizing varied reimbursement models to achieve improved profitability of relationship.
- Directed the evaluation of ancillary and vendor contracts. Handled renegotiation of multiple contracts, notably with a nuclear imaging vendor that directly resulted in a 37% reduction in ancillary services overhead.
- Recruited, hired, trained and performed annual performance evaluations for all non-practitioner staff.
- Developed policies and procedures for effective practice management.
Education
Bachelor of Science - Healthcare Administration
The University of West Florida
Pensacola, FL06.2013
Skills
- CORE COMPETENCIES
- Microsoft SQL Server
- Teradata
- MS Excel
- Power BI
- Tableau
- DATA WAREHOUSES
- Enterprise Data Warehouse (EDW)
- Facets (ODW)
- Enterprise Data Management (EDM)
- Restated Financial Reporting
- (FNCL)
- Payment Innovations Management System (PIMS)
- PAYER PLATFORMS
- TriZetto Facets
- TriZetto QNXT
- ANALYTIC SKILLS
- Advanced Statistical Analysis
- Programming & Developing
- Statistical Analytics
- Data Warehouse structure and resource
- HEALTHCARE INDUSTRY
- Network Optimization
- Reimbursement Methodologies
- Value Based Agreements & Market Saturation
- Provider Economics
- Healthcare Analytics
- Vendor Management
- Cost of Care Analysis
- CMS / AHCA
- FINANCIAL SKILLS
- Financial Reporting
- Financial Modeling & Analysis
- FP&A
- Price Modelling and Valuations
- PERSONAL SKILLS
- Natural Leader & Clear Communicator
- Strong Intellectual Curiosity
- Observant, Strategic Thinker
- Exceptional Verbal and Written Communication Skills
Timeline
Senior Health Economist, Health Economics
Uc Health
04.2022 - Current
Business Information Analyst II (Finance)
Anthem Inc.
03.2018 - 04.2022
Practice Administrator
Tampa Cardiac Specialists, LLC
02.2015 - 10.2017
Bachelor of Science - Healthcare Administration
The University of West Florida