Danielle Bailey
Anna,TX
Summary
A seasoned Lead Data Analyst with a proven track record at Gainwell Technologies, excelling in data quality management and leadership. Expert in data analytics and compliance and adept at driving team success through training and support, I've significantly enhanced business insights and performance metrics, showcasing a unique blend of technical and interpersonal skills.
Overview
10
10
years of professional experience
Work History
Lead Data Analyst
Gainwell Technologies
11.2022 - Current
- Developed complex dashboard and reporting tools to track business performance metrics.
- Updated and developed scripts and queries to extract and analyze data from multiple sources.
- Generated standard and custom reports to provide insights into business performance.
- Generated ad-hoc reports to evaluate specific business requirements.
- Provide training, support and guidance to team members.
- Participate in client meetings for need assessments, business requirements and software design review.
- Create parameterized drill down reports utilizing SSRS and SSMS
- Develop and deploy codes to lower level environments
- Analyze large data sets
Pharmacy Auditor/Licensing Manager
TIN Rx
03.2022 - 11.2022
- Investigate and resolve instances of fraud, waste and abuse.
- Performed observations and evaluated supporting documents to supplement audit findings.
- Analyzed data and findings to prepare reports detailing financial information.
- Report audit results to management and assist in the development of remediation plans as necessary.
- Train staff on accurate pharmacy billing practices.
- Maintain Pharmacy Licensure and Permits
- Create standards of practice documents
- Conduct analysis and identify exceptions, issues, trends, and patterns of interest.
- Identified and addressed performance issues with a contracted company resulting in significant cost savings for the organization.
Pharmacy Auditor
Change Healthcare/Unicon
06.2016 - 02.2022
- Analyze Medicaid claims to identify instances of over-payments, underpayments and clarify discrepancies
- Conduct independent and complex audits of pharmacy billings to determine compliance with applicable laws, rules and regulations
- Prepare finding documents and provide concise explanation of findings, clarification and direction
- Prepare and submit monthly reports summarizing activities, audit findings, and audit recoveries
- Received pharmacy database configuration training involving formulary maintenance including drug file loads, new NDC's and formulary changes
Lead Coordinator, Quality Assurance
BioScrip Pharmacy
03.2015 - 02.2022
- Verify accuracy of NCPDP Medicare, Commercial, and Medicaid claims adjudication/processing.
- Oversee and implement the auditing process.
- Train new hire employees on clean claims submission.
- Distribute quality and compliance results to all locations.
- Assist with development and implementation of new policies and procedures.
- Oversee pharmacy intake workflow and call escalation process.
- Verify patient eligibility and benefits.
- Process and obtain insurance prior authorizations.
- Point of contact for all pharmacy claim rejections.
Education
Associate of Arts - Business Management
Ohio Christian University
Circleville, OH03-2017
Skills
- Data Quality Management
- Algorithm development
- Microsoft Office
- SSMS/SSRS
- Leadership
- T-SQL
- Organization and Time Management
- Data Mining
- Statistical Analysis
Timeline
Lead Data Analyst
Gainwell Technologies
11.2022 - Current
Pharmacy Auditor/Licensing Manager
TIN Rx
03.2022 - 11.2022
Pharmacy Auditor
Change Healthcare/Unicon
06.2016 - 02.2022
Lead Coordinator, Quality Assurance
BioScrip Pharmacy
03.2015 - 02.2022
Associate of Arts - Business Management
Ohio Christian University
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