Jacqueline J. O'Connor
REDFORD TWP,MI
Summary
Thorough Senior Analyst with over 18 years background in the health insurance industry. Experience in NCQA HEDIS specifications, initiatives, rate analysis, and audits. Familiar with reporting on utilization data including HMO, PPO, Marketplace and Medicare. Team-oriented, meticulous, and self-reliant in performing analysis to ensure data integrity. Looking for an analyst position that will capitalize on the vast HEDIS experience acquired and offer the opportunity for professional growth and development.
Overview
16
16
years of professional experience
Work History
Senior Analyst
Blue Cross Blue Shield
10.2022 - Current
- Provide technical and analytical skills to complete assigned and ad hoc projects.
- Perform quality checks on HMO and PPO projects and data to ensure data integrity.
- Project Lead for the annual HMO Gaps in Care member letter outreach campaign which affects over 100,000 members, and an annual HMO Gaps in Care provider fax blast campaign which affects over 1,000 providers.
- Mentor and coach 2 junior staff. Advise on HEDIS audit measure drill downs, roadmaps, and reports.
- Participate on special projects or workgroup as assigned.
- Assist in updating HEDIS reports and documentation for customers.
- Complete HEDIS roadmaps, drill-down analysis, and participate in annual audits for HMO and PPO NCQA accreditation.
Analyst
Blue Cross Blue Shield
10.2018 - 09.2022
- Provided functional technical and analytical support to various departments (Pharmacy, Senior Health Services, Quality Management, Communications, Quality and Provider Education).
- Supplied support to assigned departmental leadership through technical, analytical and subject matter knowledge.
- Researched problems reported by other staff; evaluated possible corrective actions, recommended and implemented solutions.
- Investigated and responded to inquiries from other internal departments and external entities.
- Assisted in documenting departmental procedures and updating departmental processes.
- Tested and documented new and modified system changes.
- Monitored monthly reports to support departmental performance (data integrity) and to ensure adherence to goals, internal and external customer expectations, and requirements from external entities such as CMS.
Data Technician
Blue Care Network
06.2007 - 10.2018
- Assisted assigned departments with Healthy Blue Living product questions (Grievance, Ombudsman, Field Services, Provider Affairs, Customer Service and Quit the Nic).
- Contacted providers to collect data for the Continuity and Coordination of Care Audit and document retrieval.
- Direct contact with external vendors when resolving member inquiries.
- Conducted telephone outreach to members who were in need of a preventative health screening or immunization.
- Evaluated source documents to locate information needed for each data entry field.
- Kept optimal quality levels to prevent critical errors and support team performance targets.
- Outlined appropriate processes and procedures to fulfill and complete inquiries.
Education
Bachelor of Arts - Sociology; Chinese
Oakland University
Rochester Hills, MI05.1997
Skills
- Microsoft (SQL Server Workbench)
- Oracle (SQL)
- Azure Databricks
- Amazon Redshift
- Microsoft Word, Excel, PowerPoint, Visio, Access
- Inovalon -QSI/QSIXL tool
- Facets
- MACESS
- NCQA HEDIS specifications, Health Plan Ratings
- CMS STARS specifications
- Drill-down analysis, roadmaps, annual audit, dashboards
- Work with minimal supervision
Timeline
Senior Analyst
Blue Cross Blue Shield
10.2022 - Current
Analyst
Blue Cross Blue Shield
10.2018 - 09.2022
Data Technician
Blue Care Network
06.2007 - 10.2018
Bachelor of Arts - Sociology; Chinese
Oakland University
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