Summary
Overview
Work History
Education
Skills
Timeline
Hi, I’m

David Ebinger

Analyst
Kapolei,HI
David Ebinger

Summary

Creative Operations Specialist skillful in executing effective operating rhythms and management systems structures. Expertise in analyzing, articulating and solving various problems. Analytical and organized professional comfortable working independently or as part of team.

Overview

19
years of professional experience

Work History

Emids Tennessee

Contractor (Analyst)
01.2023 - Current

Job overview

  • In collaboration with other clinical teams, data analysts, and technologists, performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information
  • Spearheads expansion and adoption of enterprise clinical risk and predictive capabilities, as well as design and development of various clinical performance models and visualizations
  • Develops, implements, and uses software and systems to support the department's goals
  • Develops and generates ad-hoc and standard reports using SQL programming, SQL Server Reporting Services (SSRS),Crystal Reports, Executive Dashboard, and other analytic/programming tools
  • Coordinates and oversees report generation by team members and distribution schedule to ensure timely delivery to customers, ensuring the highest quality on every project/request
  • Responsible for error resolution, follow-up, and performance metrics monitoring
  • Provides peer review of critical reports and guidance on programming/logic improvements; provides guidance to team members in their analysis of datasets and trends using statistical tools and techniques to determine significance and relevance
  • Demonstrates healthcare experience in quantifying, measuring, and analyzing financial and utilization metrics of healthcare.
  • Improved project efficiency by streamlining communication channels and optimizing resource allocation.
  • Delivered high-quality work on time and within budget, earning positive feedback from clients.
  • Collaborated with cross-functional teams to ensure seamless project execution and delivery.
  • Managed multiple projects simultaneously while maintaining strict adherence to deadlines and budgets.
  • Drove process improvements by identifying inefficiencies and recommending solutions for optimization.
  • Generated detailed reports to highlight product performance and usage metrics.

Next Level Business Services Inc. Georgia

Contractor (Analyst)
05.2022 - 01.2023

Job overview

  • Was responsible for accurate and timely implementation and maintenance of critical information on claims databases
  • Maintains critical information on claims databases
  • Synchronizes data among operational and claims systems and application of business rules as it applied to each database
  • Validates data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements
  • Negotiated expected completion dates with Health Plans and Project managers
  • Worked with internal and external stakeholders to understand business objectives and processes associated with the enterprise team
  • Problem solved with Health Plans and Corporate team to ensure all end-to-end business requirements has been documented
  • Created management reporting tools to enhance communication on configurations updates and initiatives.
  • Improved project efficiency by streamlining communication channels and optimizing resource allocation.
  • Mentored junior staff members in industry best practices, fostering a culture of continuous learning within the team.

Molina Healthcare Inc. California

Senior Analyst
09.2020 - 04.2022

Job overview

  • Responsible for accurate and timely implementation and maintenance of critical information on claims databases
  • Maintained critical information on claims databases
  • Synchronized data among operational and claims systems and application of business rules as it applied to each database
  • Validated data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements
  • Implemented benefit plans and benefit terms based on business requirements, medical coding guidelines, and federal and state mandates
  • Created Benefit Restriction Groups, Contract Restriction Group, and Diagnosis Groups to allow for term selection and to address scoring criteria break as needed by QNXT.
  • Delivered accurate financial forecasts by conducting thorough data analysis and research on market trends.
  • Provided expert advice for senior management, contributing to informed decision-making and strategic planning.
  • Identified and resolved problems through root cause analysis and research.
  • Queried databases for information needed for report processing.
  • Identified clear connections between policies and business results to eliminate or reduce confusion and help employees achieve goals.
  • Provided technical support for troubleshooting analytics and reporting issues.
  • Implemented business intelligence solutions to increase operational efficiency.
  • Created dashboards to monitor and track key performance indicators.
  • Identified patterns and trends in large data sets and provided actionable insights.

Iolani School

Data Analyst
12.2018 - 09.2020

Job overview

  • Conducted individual quarterly report card reporting results for over 2200+ students.
  • Produced reports based off of benchmarks used to generate Dean's List and Honor Roll criteria benchmarks for the top 5% of student population
  • Conducted data mining, data modeling, statistical analysis, business intelligence gathering, trending, and benchmarking
  • Used data analytics to support decisions for high-priority, enterprise initiatives involving IT/product development
  • Also includes data analytics to support business needs to improve organizational realignment and procedures
  • Served as project lead for curriculum scheduling and deployment
  • Performed regular maintenance, troubleshooting, system restores, and system backups when necessary
  • Managed Oracle database administration for client needs
  • Including but not limited to report development, data cultivation, report deployment, and the writing of code for database development.
  • Enhanced business efficiency by identifying trends and patterns in complex datasets.
  • Streamlined data processing for faster results by implementing advanced analytics tools.
  • Improved decision-making processes with accurate data analysis and visualization techniques.
  • Developed custom algorithms to optimize data mining, increasing the effectiveness of analytical insights.
  • Used statistical methods to analyze data and generate useful business reports.
  • Developed required policies and procedures that reflected actual goals, tasks and workflows, while meeting all regulatory compliance requirements.

Insoursys

System Analyst
06.2017 - 04.2018

Job overview

  • Implemented system configuration changes of QNXT module to ensure accurate processing of data transactions for business functions such as eligibility, claims, authorizations, and case management
  • Conducted quality analysis on completed tickets and provided recommended configuration revisions and clarifications for solution documentation
  • Data Analysis using Microsoft SQL Server to develop reports used to identify inconsistencies in the system and ensured the accurate implementation of a system that increased daily throughput of claims by 10% and reduced manual review by 15%
  • Coordinated with leads to gather functional requirements to convert into technical requirements that could be unit tested and then implemented in the system
  • Configured system back-end via system QNXT GUI to meet client, federal, and state requirements
  • Ensured accurate coverage for members and providing on-time payments to providers
  • This included conducting unit testing to ensure the system was configured to meet previously mentioned requirements.
  • Collaborated with cross-functional teams to develop system solutions tailored to business needs.
  • Optimized database structures to improve data storage efficiency and query performance levels.

HMSA - BCBS

Configuration Architect
06.2005 - 05.2017

Job overview

  • Served as project lead for Yearly Core plan conversions and projects that spanned Multi-Year Revisions
  • This was done on a yearly basis, which included ensuring that all project milestones were met in a timely manner
  • This included performing complex analytics of system configuration (medical/payment policies, provider contracts, reimbursement methods, fees, and medical coding)
  • Conducted research via Microsoft SQL Server, database analysis, and the development of business reports
  • Analysis of reports was then presented to various internal customers, management, and other business analysts as needed
  • Held and coordinated project walk-throughs for stakeholders to capture, review, and translate requirements for the creation of project BRDs (Business Requirement Documentation) and converting BRDs to TRD (Technical Requirement Documentation) to ensure all specifications could be testable and meet system standards
  • Designed, developed, and maintained system configurations, such as Procedure Codes, 100+ Pay Codes, 30+ Benefit Plans, and 50+ Claim Edits.
  • Collaborated with clients to develop customized architectural solutions, meeting their unique needs and preferences.
  • Attended team meetings to resolve technical and project issues and review project schedules.
  • Determined project costs and made adjustments to keep projects within budget.

Education

Dev League
Honolulu, HI

Certification of completion in Full Stack Web Development
05.2017

Skills

  • Analytical Thinking
  • Business Processes
  • Data Warehouse
  • Microsoft SQL Server (10 years)
  • Technical Business Analysis
  • Business Analysis (15 years)

Timeline

Contractor (Analyst)

Emids Tennessee
01.2023 - Current

Contractor (Analyst)

Next Level Business Services Inc. Georgia
05.2022 - 01.2023

Senior Analyst

Molina Healthcare Inc. California
09.2020 - 04.2022

Data Analyst

Iolani School
12.2018 - 09.2020

System Analyst

Insoursys
06.2017 - 04.2018

Configuration Architect

HMSA - BCBS
06.2005 - 05.2017

Dev League

Certification of completion in Full Stack Web Development

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