MARK S. WOLIN
Temple,TX
Summary
Accomplished healthcare analyst with a proven track record of managing projects in diverse healthcare settings. Deep understanding of various healthcare data types, including claims, clinical data, quality metrics, and health outcomes. Effective collaborator with internal and external stakeholders. Skilled in compiling and analyzing data to create impactful performance measures, analyses, and reports.
Overview
20
20
years of professional experience
Work History
Customer Advocate – Providers
Baylor Scott and White Health
11.2023 - 11.2024
- Company Overview: Largest not-for-profit healthcare system in Texas and one of the largest in the United States, Baylor Scott & White
- Served as a primary contact for providers regarding eligibility, benefits, claims status and prior authorization.
- Surpassed call handling goals of 80% of calls answered within 30 seconds for 100+ calls per week.
- Consistently met quality goal of ninety-two percent (92%) and achieved a perfect score within my first 6 months.
- Accurately documented phone log records for each inquiry.
- Handled difficult customer situations with grace and professionalism, consistently meeting first-call resolution metrics.
- Provided exceptional customer service to high-volume customer base, resolving issues, answering inquiries and providing product information.
- Listened to customers in actively to assess issues and provide accurate information.
- Researched and resolved account and service problems with friendly, knowledgeable support.
- Maintained up-to-date knowledge of product and service changes.
Operations Analyst
Public Consulting Group (PCG)
11.2019 - 06.2023
- Company Overview: Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives.
- Provide data services, including analysis, management, validation, quality control, and client support for school-based and emergency medical services, ensuring accurate financial cost reports for public sector clients who receive Medicaid revenues.
- Consistently achieved a 95% or higher call resolution rate during my tenure in the call center, showcasing a strong track record of effectively and efficiently responding to customer inquiries and issues.
- Developed a Tableau report template for EMS that generated hundreds of reports across multiple states.
- Created a Tableau report template for school-based services that was used for internal client analysis.
- Transformed 80+ EMS files across multiple states into correct format for state submission.
- Completed 1152 Desk Edits and 16 Monitoring reviews for schools across three states.
Quality Measures Analyst, Quality, Analysis and Performance (QAP)
Community Care Collaborative (CCC)
03.2018 - 07.2019
- Company Overview: The Community Care Collaborative (CCC) is a public/private partnership between Central Health and Seton Healthcare Family designed to better manage the care of the shared safety-net population.
- Provided measure selection and data analysis expertise in support of the CCC’s Integrated Delivery System.
- Researched and created a metrics library of primary care and hospital quality measures.
- Developed Tableau dashboard to track results from the CAHPS (Consumer Assessment of Healthcare Providers and Systems) and PROMIS (Patient-Reported Outcomes Measurement Information System) surveys to monitor the CCC’s Patient Experience and Quality of Life programs.
- Automated process for reporting monthly provider quality measures. Resulting in a 50% reduction in production time.
- Designed Tableau dashboard to track monthly progress on provider’s Pay for Performance quality measures.
Program Manager, Policy and Program Management
Commonwealth of MA, Group Insurance Commission
07.2013 - 06.2017
- Company Overview: Provides high-value health insurance and other benefits to 430,000 state employees, retirees, and their survivors and dependents.
- Administered the Clinical Performance Improvement Initiative which improves provider transparency, quality, and efficient use of resources. Oversee performance of three health plans contracted by the GIC.
- Spearheaded annual development of comprehensive physician report packet and coordinated mailing to 14,000 specialists and primary care physicians across the state. Displaying quality and efficiency scores, medical services detail and physician-peer comparisons by specialty, the report was used to set copay amounts for state and municipal employees.
- Thirty percent decrease in physician grievances attributed to improvements in report design.
- Coordinated data process which combined 150 million commercial claims to assess the quality and efficiency of 14,000 individual physicians relative to their peers.
- Managed overall performance of three GIC contracted health plans (self and fully insured): Oversaw relationship with health plan account managers, annual member handbook review and editing, tracked contractual performance guarantees. Collaborated with consultants and senior management on benefit design and contract renewal.
- Managed and supervised administrative and daily program operations, complying with policies and regulations.
- Established strong relationships with key stakeholders, ensuring support for program initiatives.
Informatics Specialist, Quality and Performance Improvement
Highland Management
03.2010 - 04.2013
- Company Overview: The Highland Healthcare Associates IPA (Highland), a not-for-profit physician organization with nearly 400 members, is dedicated to raising the quality of patient care, preserving clinician independence and autonomy.
- Developed and presented in-depth analysis and reporting on physician performance, tertiary referrals, admissions, and out-of-network services. Primary role as singular analytic resource for the department.
- Created comprehensive reporting package with eighteen quality process and outcome measures for 100 PCPs.
- Monitored and evaluated physician key performance indicators (KPIs) and incorporated reporting enhancements as needed.
- Automated annual tracking tool used to determine the $20M differential distribution payment surplus to physicians.
Senior Business Analyst, Medical Data Analytic Services
Liberty Mutual Insurance
09.2004 - 11.2008
- Company Overview: One of the largest property and casualty insurance companies in the world
- Provided consultation and in-depth analysis on Worker Compensation Medical Claims data. Developed reporting tools for use by a variety of internal customers. Created training program on database analytic query tool.
- Uncovered $4.7MM in savings from physician prescribing patterns of Provider-based Drugs.
- Developed query that identifies one hundred patients per month for registration in a Chronic Pain Program. Program graduates demonstrated savings of $1.75MM in the first year.
- Built Price Indices for four medical service areas that enable comparison of medical service costs to national benchmarks. Regulators in 3-5 states used the tool in their analysis of Work Comp Reform initiatives.
- Created and conducted a month-long training program on the Decision Analyst Database Query tool for six inexperienced users resulting in 100% usage within 2-3 months.
Education
Master of Science - Health Services Administration
University of Detroit-Mercy
Detroit, MIBachelor of Science - Business Administration
Lawrence Technological University
Southfield, MISkills
- Performance Measurement
- Provider Report Development
- Quality Measures
- Key Performance Indicators
- Data Analytics
- Excel
- SQL
- Tableau
- Healthcare Policy
- Project Management
- Program Management
- Population Health
- Accountable Care Organizations
- Call Center
Timeline
Customer Advocate – Providers
Baylor Scott and White Health
11.2023 - 11.2024
Operations Analyst
Public Consulting Group (PCG)
11.2019 - 06.2023
Quality Measures Analyst, Quality, Analysis and Performance (QAP)
Community Care Collaborative (CCC)
03.2018 - 07.2019
Program Manager, Policy and Program Management
Commonwealth of MA, Group Insurance Commission
07.2013 - 06.2017
Informatics Specialist, Quality and Performance Improvement
Highland Management
03.2010 - 04.2013
Senior Business Analyst, Medical Data Analytic Services
Liberty Mutual Insurance
09.2004 - 11.2008
Bachelor of Science - Business Administration
Lawrence Technological University
Master of Science - Health Services Administration
University of Detroit-Mercy
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