Himani Sharma
Brooklyn,NY
Summary
Experienced Data Analyst with a demonstrated history of working in the hospital & health care industry. Skilled in SQL Analytics, Quality Assurance , Healthcare Management. Strong finance professional with Master's of Public Administration - MPA focused in Health/Health Care Administration/Management from Long Island University, Brooklyn, NY and Bachelor's of Science in Nursing from reputable Baba Farid University of Health Sciences in India.
Overview
16
16
years of professional experience
Work History
Risk Adjustment Analyst
MetroPlusHealth
New York, United States
01.2023 - Current
- Oversee and manage the risk adjustment data submissions to the Centers for Medicare & Medicaid Services (CMS) for the Medicaid, Medicare, and Commercial lines of business, ensuring that all submissions are accurate, timely, and compliant with regulatory requirements
- Ensure high-quality encounter submissions by analyzing submission reports prepared by our actuaries to determine the impact of submission errors
- Utilize CMS response files, vendor reports, and internal claims data to identify the sources of errors
- Utilize dashboards to identify trends and potential opportunities in data collection and reporting
- Assist with the RADV Audit for QHP and manage the quality of the chart chase
- Monitor data submitted by vendors to ensure that project goals are met, and that submitted data is complete and accurate while quickly identifying errors
- Identify the root cause of issues, devise plans for remediation, and ensure on-time completion from all stakeholders
- Work collaboratively with both external and internal partners to resolve issues
- Monitor submission reports for Risk Adjustment and Encounter data, especially for Medicare
- This includes calculating the number of encounters accepted and rejected in the Medicare project
- Calculate the financial impact of Risk Adjustment activities, including the revenue impact of resolving errors
- Access our Data Warehouse to conduct in-depth analysis of member and provider claims and enrollment data
- Provide complex analytical, reporting, and data mining support to the Risk Adjustment Department for Medicare and Medicaid
- Organize, prioritize, and manage various simultaneous tasks and projects to meet deadlines
Claims Analyst
Carecube
02.2019 - 12.2022
- Designed and maintained reports, auditing tools, and related documentation to enhance operational efficiency
- Conducted prospective and retrospective audits of claims, ensuring compliance and accuracy
- Led process improvement initiatives, identifying potential problems and implementing solutions
- Engaged with internal Health Plan Departments, including claims staff, customer service, and marketing, as well as external customers such as Health System Internal Audit and Client Audit teams, responding effectively to various requests
- Collaborated with Reimbursement and Configuration Specialists to ensure accurate payments and address payment inaccuracies
- Assigned and coded ICD-9 and ICD-10 diagnoses and applicable CPT procedures, performing concurrent coding as needed
- Assisted in the development and revision of Quality Assurance department policies and procedures
- Analyzed ICD-10 diagnoses and CPT billing codes to verify accurate recording of information in patient encounters prior to billing
- Composed weekly and monthly reports to facilitate the monitoring and reporting of clinical quality measures
Quality Assurance ( Care Coordination)
New Horizon Counseling Center
Far Rockaway
01.2018 - 02.2019
- Provided administrative, organizational, and technical support to the coordination team in the tabulation and analysis of data
- Evaluated care coordination data to identify errors resulting from operational, claims, and eligibility processes
- Collaborated closely with vendors and government agencies, including Medicaid and Medicare, to monitor, analyze, and communicate both aggregate and individual encounter metrics
Quality Assurance Specialist
Lakeville Pharmacy
Greater New York City Area
05.2017 - 12.2017
- Established and maintained a comprehensive record-keeping system and prepared annual budgets to ensure financial accuracy and accountability
- Designed and organized job descriptions, conducting annual performance evaluations for all employees to foster professional development
- Managed the selection process for departmental staff, providing orientation and supervision to ensure effective onboarding
- Oversaw weekly drug inventory management by reconciling Excel spreadsheets from micro-merchant systems and wholesalers
- Ensured proper labeling of drugs, supplies, and chemicals to comply with safety and regulatory standards
- Processed medical insurance claims and facilitated payment acceptance efficiently
- Delivered exceptional customer service, building rapport and enhancing pharmacy patient relations
Senior Pharmacy Technician
Richmond Hill Pharmacy, Ltd
Greater New York City Area
05.2015 - 04.2017
- Conducted weekly drug inventory management by reconciling data from Excel spreadsheets provided by micro-merchant systems and wholesalers
- Ensured proper labeling of drugs, supplies, and chemicals to adhere to safety and regulatory standards
- Processed medical insurance claims and handled payment acceptance efficiently to optimize revenue cycles
- Delivered exceptional customer service, fostering rapport and enhancing patient relations within the pharmacy
Teaching Assistant
Fortis Healthcare
Chandigarh Area, India
12.2011 - 01.2014
- Developed interdisciplinary care plans and case management tools, actively participating in various meetings to enhance patient outcomes
- Fostered cooperative relationships among healthcare teams by effectively communicating information, responding to requests, and building rapport
- Coordinated care requirements with other healthcare providers to ensure comprehensive patient management
- Resolved conflicts and promoted peer support through education on the case management process
- Evaluated care outcomes by measuring the effectiveness of interventions in collaboration with the healthcare team
Healthcare Specialist
Government Hospital
Amritsar Area, India
02.2010 - 12.2010
- Documented patient care services by accurately charting in patient and department records to ensure comprehensive care continuity
- Maintained continuity among nursing teams by effectively documenting and communicating actions, irregularities, and ongoing patient needs
- Preserved patient confidentiality and protected operational integrity by adhering to privacy protocols and safeguarding sensitive information
- Ensured the proper functioning of equipment through preventive maintenance, troubleshooting malfunctions, coordinating repairs, and maintaining equipment inventories
- Enhanced professional and technical knowledge by attending educational workshops, reviewing industry publications, establishing networks, and participating in professional societies
Student Intern
Community Health Center, India
, India
08.2009 - 02.2010
- Provided a range of family planning services and accurately documented patient interactions in department records
- Promoted sanitation and hygiene practices within various community groups to enhance public health awareness
- Conducted risk assessments and screenings for communicable diseases to identify and address potential health issues
- Delivered health education activities on diverse topics tailored to different age groups, fostering community health literacy
- Maintained government healthcare records and facilitated healthcare referrals to ensure comprehensive patient support
Education
Master of Public Administration - MPA - Health/Health Care Administration/Management
Long Island University
Brooklyn, NY01.2017
Bachelor's degree - Nursing Education
Khalsa College Of Nursing
India01.2011
Skills
- Risk Adjustment
- Analytical Skills
- Financial Analysis
- Root-cause analysis
- SQL and databases
- Excel proficiency
- Documentation and reporting
Timeline
Risk Adjustment Analyst
MetroPlusHealth
01.2023 - Current
Claims Analyst
Carecube
02.2019 - 12.2022
Quality Assurance ( Care Coordination)
New Horizon Counseling Center
01.2018 - 02.2019
Quality Assurance Specialist
Lakeville Pharmacy
05.2017 - 12.2017
Senior Pharmacy Technician
Richmond Hill Pharmacy, Ltd
05.2015 - 04.2017
Teaching Assistant
Fortis Healthcare
12.2011 - 01.2014
Healthcare Specialist
Government Hospital
02.2010 - 12.2010
Student Intern
Community Health Center, India
08.2009 - 02.2010
Master of Public Administration - MPA - Health/Health Care Administration/Management
Long Island University
Bachelor's degree - Nursing Education
Khalsa College Of Nursing
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