Summary
Overview
Work History
Education
Skills
Accomplishments
Websites
Affiliations
Timeline
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Daniel Cost

Nashville,TN

Summary

Experienced healthcare leader with a dynamic and innovative approach. Proven track record in leading cross-functional initiatives and driving organizational transformation through data and analytics. Expertise in developing and executing value-based care and capitation/global budget models, prioritizing quality, affordability, and performance outcomes. Demonstrated success in clarifying business requirements, designing and improving operational processes, and implementing effective SQL reporting and automated solutions to boost productivity and achieve strategic goals.

Overview

11
11
years of professional experience

Work History

Director, Strategic Initiatives

Vytalize Health
10.2022 - Current
  • Led efforts to enhance ACO performance by developing innovative underwriting processes, resulting in $75 million in savings.
  • Leveraged 14+ years of SQL experience in healthcare to work cross-functionally with engineering, analytics, and finance teams, optimizing data workflows, improving query performance, and advancing value-based care initiatives.
  • Spearheaded the creation of episodic payment models with PACES Grouper Software, designed provider scorecards with actionable KPIs, and developed strategies for risk adjustment and quality improvement programs across Medicare Advantage, MSSP, and commercial populations.
  • Drove data-driven decisions, operational improvements, and significant cost savings by leading healthcare analytics, ETL processes, and implementing cloud-based solutions like Snowflake, ensuring alignment with CMS changes and organizational goals.
  • Extensive experience in healthcare analytics, healthcare economics, risk adjustment, and quality improvement programs, with a focus on driving savings and operational enhancements.
  • Developed and executed data-driven strategies using Enterprise Data Warehouses in a healthcare setting, improving healthcare performance and ACO metrics through administrative claims, clinical, and operational data.

Payment Innovation Director, Value Based Solutions Strategy

Elevance (Formerly Anthem, INC.)
02.2020 - 10.2022
  • Defined requirements and implemented the Value-Based Capitation program around HCP-LAN Category 3 & 4 payment models, supporting independent physicians, advanced primary care organizations, and ACOs/IPAs in transitioning from Fee-for-Service to value-based reimbursement for Alternative Payment Models.
  • Managed the quality component of the Capitation program post-implementation, ensuring continuous improvement and alignment with company value-based payment and risk contracting strategies.
  • Developed operational analytics for leakage reporting, enabling targeted interventions to reduce leakage and optimize program performance.
  • Achieved the operational goal of increasing Capitation spend to more than 20% of total medical expenses by 2025, with an initial increase from 2.3% to 5.1% in the first year.
  • Defined technical, reporting, and analytics requirements for the Value-Based Capitation program across all lines of business, enhancing program transparency and accountability.
  • Responsible for QA/UAT of new Capitation program releases, researching opportunities for program expansion to maximize impact and efficiency.

Developer II, Central Region Operational Reporting and Analytics

Elevance (Formerly Anthem, INC.)
11.2016 - 02.2020
  • Developed and optimized over 50 high-impact SQL reports and visual dashboards, resulting in a 30% increase in reporting efficiency and actionable insights for business needs.
  • Clarified business requirements and performed data analytics that improved process productivity by 25%, leading to enhanced operational decision-making.
  • As a Tableau Developer and Report Manager, created over 20 data-driven visualizations that supported strategic decision-making and operational efficiency, contributing to a 20% improvement in decision accuracy.
  • Developed and executed innovative reporting and analytics strategies, which resulted in a 35% increase in data-driven decisions and operational improvements across the organization.
  • Implemented automated weekly reporting processes for internal operations and state-mandated metrics, improving reporting accuracy by 40% and reducing manual effort by 50 hours per month.
  • Collaborated with cross-functional teams to integrate new features, enhancing team productivity by 15% and streamlining project timelines.
  • Adapted to new technologies and programming languages, leading to a 20% increase in overall team productivity and project delivery speed.
  • Streamlined code for faster load times, achieving a 25% improvement in performance and user experience.
  • Participated in regular code reviews, ensuring high-quality standards and reducing code errors by 20% across all development efforts.

Business Change Manager, Medicaid LTSS Operations

Elevance (Formerly Anthem, INC.)
12.2014 - 11.2016
  • Led the provider data integrity initiative and implemented the Employment and Community First (ECF) DIDD program as an extension of the LTSS CHOICES program in Tennessee, ensuring seamless integration and operational efficiency.
  • Successfully led the provider data integrity initiative, improving data accuracy and completeness by 40% across LTSS systems and enhancing operational efficiency.
  • Developed and maintained operational reporting for Medicaid Long Term Services & Support (LTSS), resulting in a 30% reduction in reporting errors and a 25% improvement in process efficiency through data-driven insights.
  • Provided data analytics and reporting for over 10 Key Stakeholder RFIs/RFPs and legislative inquiries, contributing to a 20% increase in successful proposal responses and informed decision-making.
  • Organized and executed the provider data integrity initiative for LTSS operations, leading to a 50% increase in the accuracy and completeness of provider data.
  • Led QA/UAT testing for 2+ new operational implementations, ensuring a 95% success rate in the deployment of new processes and systems.
  • Created and maintained over 15 reporting solutions for LTSS operations, including automated processes that addressed complex needs and reduced manual reporting efforts by 60%.
  • Implemented automated weekly reporting for internal and state-mandated metrics, improving reporting efficiency by 40% and reducing manual effort by 50 hours per month.
  • Worked closely with IT partners to maintain automated SFTP transfers, enhancing data flow reliability and reducing integration issues by 25%.

Data Analyst/Data Services Engineer

Advent Health Partners
12.2013 - 07.2014
  • Led the development and execution of reporting and analytics tools to data mine claims data from 13 major MCOs and payees, ensuring compliance with emerging ERISA law changes.
  • Spearheaded the creation of reporting and analytics tools for claims data from 13 major MCOs and payees, enhancing compliance with ERISA law changes and improving regulatory adherence by 30%.
  • Conducted operational data reporting and financial analysis, developing tools that reduced claims analyst turnaround time by 25% and increased overall efficiency.
  • Developed over 15 targeted reporting solutions for EDI data, providing actionable insights that supported multiple divisions and led to a 30% improvement in operational performance.
  • Extracted and analyzed data to identify overpayments and recoveries, driving a 15% increase in financial recoveries and optimizing recovery efforts.
  • Produced and analyzed 12 monthly reports using advanced SQL data mining and Excel functions, which improved reporting accuracy and efficiency by 35%.
  • Utilized data visualization tools to communicate business insights effectively, leading to a 25% improvement in decision-making processes.

Education

Bachelor of Science - Management

Middle Tennessee State University
12.2008

Skills

Professional Skills:

  • Financial Reporting & KPI Tracking
  • Operational Data Analysis & Business Intelligence
  • SQL Development & Data Management
  • Value-Based Care & Capitation Models
  • ETL & Data Processing
  • Reporting Automation & Visualization
  • Technical Problem-Solving & Communication
  • Technical SME in TriZetto Facets Core Administration Program
  • Project Management
  • Contract Management
  • Staff Management
  • Business Planning
  • Program Management
  • Financial Reporting

Accomplishments

NESA - National Eagle Scout Association

Affiliations

NESA- National Eagle Scout Association

Timeline

Director, Strategic Initiatives

Vytalize Health
10.2022 - Current

Payment Innovation Director, Value Based Solutions Strategy

Elevance (Formerly Anthem, INC.)
02.2020 - 10.2022

Developer II, Central Region Operational Reporting and Analytics

Elevance (Formerly Anthem, INC.)
11.2016 - 02.2020

Business Change Manager, Medicaid LTSS Operations

Elevance (Formerly Anthem, INC.)
12.2014 - 11.2016

Data Analyst/Data Services Engineer

Advent Health Partners
12.2013 - 07.2014

Bachelor of Science - Management

Middle Tennessee State University
Daniel Cost