Krista Mullen
Marshfield,WI
Summary
Proactive and goal-oriented professional with exceptional time management and problem-solving skills. Recognized for reliability and adaptability, with a quick ability to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
19
19
years of professional experience
Work History
Business Information Analyst Senior – Operations
Carelon Health System
10.2021 - Current
- Created and maintained databases to track business performance, ensuring accurate and up-to-date data
- Analyzed data and summarized performance using summary statistical procedures to guide decision-making processes
- Developed and analyzed business performance reports, including for claims data, provider data, and utilization data to monitor key business metrics
- Prepared and published periodic reports, including ad hoc reports for various departments within the organization, meeting diverse informational needs
- Made recommendations based on data findings and used mapping software to include geographical context, enhancing data interpretation and leading to the relocation of care centers in order to better serve our patients' needs
- Trained and lead other analysts in creating key reports for their territories, ensuring consistent reporting teams
Health Care Analyst Senior/Team Lead – Value Based Contracting/Value Based Care
SSM Health
10.2014 - 10.2021
- Worked directly with outside insurance companies to understand their contract terms, data, and performance to implement changes and enhance the performance of SSM based on the payor
- Reviewed contract language, created incentive models to estimate potential shared savings/losses based on contract terms, and provided negotiation suggestions based on model findings
- Involved in value-based care reporting, analyzed data to create best practice initiatives that ensured high quality patient care while being financially mindful
- Worked closely with leadership to develop best care practices, crafted new reports, and routinely presented data and findings to large teams, fostering data-driven decision-making processes
- Monitored changes in contracts with different payor groups and utilized data to identify system strengths and weaknesses; presented these findings in value-based care meetings enabling leadership to take impactful actions
- Gathered and interpreted project requirements and translated them into data and information deliverables using SAS, SQL, and other analytic tools
- Developed training manuals and instructions for software users to promote efficient and effective use of software tools
Health Informatics Data Analyst
Security Health Plan
11.2011 - 10.2014
- Provided measurable, data-driven solutions focused on improving members' health and cost of care, enhancing both healthcare outcomes and profitability
- Gathered and interpreted project requirements, translating them into data and information deliverables that address business customer needs effectively
- Expertly data mined large quantities of data, consistently meeting both internal and external customer expectations with accuracy
- Provided consultative services to different departments in generating data reports, aiding in resolving issues like preauthorization or high-cost claims
- Developed and maintained user-friendly reports using tools like SAS, Business Objects, Excel, and Access, improving the ease-of-use and accessibility of data insights
Operations Analyst
Security Health Plan
02.2011 - 11.2011
- Responsible for the design, development, preparation, and timely completion of Commercial and Government Claims projects, including the creation of a claim's dashboard, ensuring comprehensive and timely insights into claims data
- Identified internal issues and provided recommendations to claims department leadership for changes and improvements, enhancing departmental processes based on report analyses
- Played a crucial role in supporting external audits by downloading and extracting necessary data specific to various audits like HEDIS, SAS70, KPMG, and CMS audits, thereby ensuring the provision of accurate and comprehensive data for audit purposes
Recovery Audit & Appeals Database Coordinator
Ministry Health Care
09.2010 - 02.2011
- Ensured trackability of RAC audit requests and responses, acting as a system-wide resource for Federal and Commercial Audit Programs regulations, and verifying auditor adherence to claims request regulations
- Researched and reported opportunities for advancements and improvements in system data management, presenting recommendations to the Director of Recovery Audit and Appeals
- Prepared agendas, distributed minutes, attached presentations, and created reports for system-wide steering and operational meetings, also involving information presenting at these meetings
- Worked with computer systems, including hardware and software, to program, write software, and process information; responsively adapted software and reporting capabilities based on user requests for process improvements
- Approved, scheduled, planned, and supervised the installation and testing of new products and improvements to computer systems, such as new database installations or upgrades
- Managed system-wide contracted database security, including managing user access based on their need and maintaining and updating user profiles
- Provided technical support to system-wide users of an independently contracted database, resolving software and computer program problems, and provided operational user assistance, including interfacing issues
- Developed and kept up-to-date training manuals and instructions for system-wide users, also serving as the helpline and providing educational training across 20 facilities
Reversal & Appeals Analyst, Claims/Operations
Security Health Plan
08.2006 - 09.2010
- Served as the primary analyst for auditing charges to ensure correct processing; handled received claims, checks, and appeals from providers, correcting or denying based on new information received and in alignment with company policies and standards
- Adjusted charges as needed, providing clear communication to providers about reasons for adjustments and requirements for correct submissions
- Played a key role in team education and coordination; provided insights on the coordination of benefits and adjustment processes and proactively addressed recurring mistakes
Education
Some College (No Degree) - Psychology
Ashford University
Skills
- SQL
- SAS
- Business Objects
- Tableau
- Looker
- Python
- PowerBI
- Process improvement
- Project management
- Collaboration
- Dashboard creation
- Data analysis
Timeline
Business Information Analyst Senior – Operations
Carelon Health System
10.2021 - Current
Health Care Analyst Senior/Team Lead – Value Based Contracting/Value Based Care
SSM Health
10.2014 - 10.2021
Health Informatics Data Analyst
Security Health Plan
11.2011 - 10.2014
Operations Analyst
Security Health Plan
02.2011 - 11.2011
Recovery Audit & Appeals Database Coordinator
Ministry Health Care
09.2010 - 02.2011
Reversal & Appeals Analyst, Claims/Operations
Security Health Plan
08.2006 - 09.2010
Some College (No Degree) - Psychology
Ashford University
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