Mauricio Osorio
Chula Vista,CA
Summary
Seasoned Data and Business Intelligence Analyst: Driving Operational Excellence and Data Innovation Across the Organization. Experienced and versatile Data and Business Intelligence Professional with over 20 years of expertise. Proven track record of leveraging extensive knowledge and experience to drive operational efficiency and enhance data reporting and access. Skilled in providing insightful analytical solutions and tools across all organizational levels, fostering improved decision-making processes. Exceptional written and verbal communication abilities, adept at translating technical information into clear and concise insights for senior executives. Demonstrated leadership capabilities with over 5 years of experience in managing teams effectively. Proficient in SQL programming, data analytics, MS Excel, and MS Access database management, with additional familiarity in Tableau and Power BI.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Business System Analyst Consultant
Triple S Group Plan/ Sierra Solutions Group
New York
2024.01 - 2024.03
- Collaborate with business stakeholders to create, revise workflows, and translate into business requirements for new utilization management system implementation
- Assess integration with existing QNXT claims system
- Performed source to target data mapping by using SQL and MS Excel.
Senior Data Analyst, Government Practice - Consultant
FluidEdge Consulting
Malvern , PA
2021.04 - 2023.11
- Santa Clara Family Health Plan - Led implementation of Beacon Health Systems Virtual Grievances and Appeals Management (VAM) software and Created SQL Database for daily data feed from VAM’s backend
- Developed SQL stored procedures for Grievance and Appeals reports
- Analyzed healthcare claims data and identified trends and patterns, such as high-cost medical procedures and recommended cost saving measures
- Utilized QNXT to develop and report on Medicaid and Dual Member enrollment, validate Member and Provider information and report on and investigate Provider claims
- Provider Partners Health Plan - Developed a SQL database to house the client's source data and executed a third-party payor analysis and reporting for Medicare Part C Claims Audit, utilizing Excel for comprehensive analysis and reporting
- Developed Power BI paginated reports to support CMS regulatory reports and audits
- Dignity Healthcare - Automated financial report process at Dignity Healthcare by converting manual Excel and Access processes into SQL stored procedures decreasing processing and report generation time by 80%
- Provided QNXT support for Utilization Management and Claims reporting, collaborating with IT on SQL code implementation, and assisting UM Director in modifying compliance logic for regulatory reports
- Embedded Power BI reports on share point portal page and managed access of reports and data for individual
- Blue Cross Blue Shield of Arizona
- Supported Health Edge Member/Enrollment, conducting root cause analysis for data entry issues in Health Rules Payer claims system.
Health Care IT Consultant
FluidEdge Consulting
2016.01 - 2021.03
- Alameda Health Plan - Provided Program Management support for the implementation of Enhanced Care Management and Community Support programs, including gathering business and technical requirements, maintaining, and updating RTM, and developing new Policy and Procedures
- Santa Clara Family Health Plan - Enhanced daily operations efficiency in the Claim Department by creating and implementing staff productivity and claims workflow reports in collaboration with FluidEdge consulting Team and claims management staff
- Collaborated on guidance for implementation and development of Cal MediConnect regulatory reporting using QNXT back-end claims data, providing Support and guidance for CMS, DHCS, and DMHC regulatory reporting.
Informatics Manager
Community Health Group
Chula Vista , CA
2010.10 - 2015.10
- Spearheaded launch of Informatics Department at Community Health Group, streamlining data analysis and reporting by standardizing data collection processes across all departments using organization’s data warehouse and QNXT Claims and Utilization Management systems
- Collaborated with supervisors, managers, and executives to develop reports and visualizations of Key Performance Indicators, enhancing operational efficiency
- Partnered with IT Department managers and supervisors to evaluate, develop, and implement regulatory reports for DMHC, DHCS, and CMS on a monthly, quarterly, and annual basis
- Enhanced access to key performance indicators for medical groups and clinic executives through creation of dashboards and progress reports using iDashboards
- Led as the Reporting and Analytics lead for Community Health Group’s HEDIS Task Force, spearheading the delivery of necessary reports and analyses crucial for supporting HEDIS Measures
- Assisted IT Department in integrating specific area data marts (SQL Environment) to expand company’s data resources, while researching, evaluating, and implementing latest Business Intelligence (BI) and report automation tools
- Collaborated with Claims Manager and UM Director to establish and implement KPI reports tracking utilization for members with chronic conditions, contributing to development of disease management programs.
Education
Master of Science - Electronic Commerce
National University
Bachelor of Science - Business Administration
University of Mary
Associate degree in Nursing - Licensed Practical Nurse
Saint Phillip’s College
Skills
- Data Analysis
- MS Access / MS Excel
- Process Optimization
- SQL Programming
- SQL Server
- SSMS
- SSRS
- Power BI
- Business Intelligence
- Business Insights
- Dashboard Development
- HEDIS Measures Reporting
- Regulatory Compliance Reporting
- Reporting and Data Visualization
- QNXT Claims System
- Performance Metrics
- Data Extraction and Manipulation
Websites
Certification
- Tableau Foundations Certificate - 2019
- Lean Six Sigma Green Belt Certification - 2021
- Microsoft SQL Server 2022 Essential Training – LinkedIn 2024
- Power BI Essential Training – LinkedIn 2022
Personal Information
Title: Senior Data and Business Intelligence Analyst
Timeline
Business System Analyst Consultant
Triple S Group Plan/ Sierra Solutions Group
2024.01 - 2024.03
Senior Data Analyst, Government Practice - Consultant
FluidEdge Consulting
2021.04 - 2023.11
Health Care IT Consultant
FluidEdge Consulting
2016.01 - 2021.03
Informatics Manager
Community Health Group
2010.10 - 2015.10
Master of Science - Electronic Commerce
National University
Bachelor of Science - Business Administration
University of Mary
Associate degree in Nursing - Licensed Practical Nurse
Saint Phillip’s College
- Tableau Foundations Certificate - 2019
- Lean Six Sigma Green Belt Certification - 2021
- Microsoft SQL Server 2022 Essential Training – LinkedIn 2024
- Power BI Essential Training – LinkedIn 2022
Similar Profiles
ALEXANDER MARTINA MASONALEXANDER MARTINA MASON
In House Medical Underwriting Liaison at Iron Plan Solutions Group, LLCIn House Medical Underwriting Liaison at Iron Plan Solutions Group, LLC
PAWEL ADAMOWSKIPAWEL ADAMOWSKI
Business Development Executive at Pol-Plan / A-Plan / Howden GroupBusiness Development Executive at Pol-Plan / A-Plan / Howden Group
Jeremiah OlasojiJeremiah Olasoji
Pharmacy Sales Assistant at Group Plan PharmacyPharmacy Sales Assistant at Group Plan Pharmacy