Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Irene Smitherman

5204 Ivy Summit Ct, Cumming,GA

Summary

  • 3.5 years in Cigna MA payment integrity, cost avoidance & recovery, and affordability reporting and financial impact analysis. Familiar with claim editing, rule development and pre/post pay vendors.
  • 17+ years hands-on healthcare claims data analysis and strong computer programming skills. Proven ability to identify patterns, anomalies and emerging trends.
  • Stay up-to-date on latest payment integrity technologies and propose innovative solutions.

Overview

13
13
years of professional experience
1
1
Certification

Work History

Business Analytics Advisor

Cigna Healthcare
Work From Home, GA
02.2017 - Current
  • Develop and maintain payment integrity and cost avoidance and recovery reporting.
  • Utilize data analytics to identify opportunities for overpayment and savings.
  • Perform financial analysis for MA affordability initiatives.
  • Conduct vendor performance and validate vendor edits.
  • CareAllies IPA shared savings analysis/reporting.
  • ROI and statistical modeling for clinical programs and initiatives.

Sr. Informatics (Consulting) Analyst

BCBS of NC
Durham, NC
05.2015 - 01.2017
  • Created comprehensive reporting packets for ACO and value-based care programs.
  • Developed provider scorecard and served as provider access SME.
  • Developed predictive models to identify high risk members.

Sr. Clinical Information Analyst

Norton Healthcare
Louisville, KY
09.2011 - 05.2015
  • Provided analytical and reporting support to Humana-Norton ACO and Patient-Centered Medical Home models.
  • Conducted complex ad hoc analysis on medical cost trend and clinical programs.

Education

Biostatistics (2-year PhD coursework)

University of Alabama At Birmingham
Birmingham, AL

Master of Science - Statistics

University of Idaho
Moscow, ID
06-2003

Clinical Medicine

Tianjin Medical University
Tianjin, China
07-1996

Skills

  • AWS Cloud and Data science knowledge
  • Data mining (SAS/SQL, Python)
  • Data visualization (Tableau, Excel)
  • Research and documentation
  • Teamwork and Collaboration
  • Effective Communication

Certification

  • Associate of Society of Actuaries
  • AWS Certified Practitioner
  • Python Intermediate Programmer
  • SAS Certified Advanced Programmer

Timeline

Business Analytics Advisor

Cigna Healthcare
02.2017 - Current

Sr. Informatics (Consulting) Analyst

BCBS of NC
05.2015 - 01.2017

Sr. Clinical Information Analyst

Norton Healthcare
09.2011 - 05.2015

Biostatistics (2-year PhD coursework)

University of Alabama At Birmingham

Master of Science - Statistics

University of Idaho

Clinical Medicine

Tianjin Medical University

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Irene Smitherman