Michael Brown
Williamstown,NJ
Summary
Accomplished in driving innovative Medicaid/Medicare programs within a dynamic integrated delivery network, consistently delivering successful outcomes. Skilled in developing and executing cost-saving strategies that have resulted in significant expense reductions. Integral member of an Enterprise Information Management Leadership Team, leading the development and implementation of various healthcare services and strategic plans. Known for fostering strong professional relationships with colleagues, senior management, clinical and operational leaders, vendors, and process partners. Successfully implemented a Data Governance/Quality and Center of Excellence program to enhance organizational effectiveness.
Overview
25
25
years of professional experience
1
1
Certification
Work History
IT Software Engineering Senior Manager
Tabula Rasa HealthCare
09.2021 - Current
- Ensures the maximum level of data accuracy, integrity, consistency, and completeness in the various data sources used for end-user reporting purposes (e.g., Oracle Data Warehouses).
- Demonstrated experience with automating intake of non-production data sources into production data repositories or interim user managed repositories; ability to rapidly assimilate and integrate disparate data sources. Interacts with external parties as needed to establish new data sources and procure new data files. Responsible for creation and quality of data transformation rules and processes.
- Monitors and assesses impact of changes in utilization and cost patterns through modeling data trends.
- Responsible for application support for claims adjudication systems, internal and external end-user request, providing expert support for EDI compliance related issues, including but not limited to claims, clearinghouse data, demographic interfaces and all transaction code standards within organizational enterprise services. Develop procedures and business & technical documentation to enhance use of our processing systems; reporting and query capabilities to improve efficiency and accuracy; document deviations for client set-ups.
- Strong experience working with IT/technical counterparts and Business stakeholders to effect solid data and technology solutions to achieve corporate and strategic goals.
- Responsible for Supporting, migration efforts between systems, troubleshooting and resolve issues, request and inquiries from end users; monitor compliance with federal and state guidelines addressing issues in a timely manner.
IT Senior Manager, Data Quality/Profiling/Data Governance/Provider Directory & Reporting
AmeriHealth Caritas Family of Companies
08.2012 - 03.2021
- Responsible for ensuring that data resources, such as the Oracle data warehouse & Sybase environment leveraging the IBM Cloud, are providing maximum value to reporting staff across the corporation; focus includes data accuracy and completeness as well as training and business rule development.
- Responsible for the quality of data in production reporting systems and oversight of formal data quality processes and policies. Responsible for overseeing Statutory and Regulatory financial reports by ensuring State reporting is completed accurately and timely according to SLA’s. Respond to inquiries and oversee audits from regulatory agencies for financial reporting.
- Responsible for ensuring that provider data information is assessable for our members to have the opportunity to select and contact providers who deliver their medical assistance via website services.
- Demonstrated experience with automating intake of non-production data sources into production data repositories or interim user managed repositories; ability to rapidly assimilate and integrate disparate data sources. Interacts with external parties as needed to establish new data sources and procure new data files. Responsible for creation and quality of data transformation rules and processes.
- Strong experience working with IT/technical counterparts and Business stakeholders to effect solid data and technology solutions to achieve corporate and strategic goals.
IS Business Analyst Lead, Data Quality/Profiling/Data Governance/Provider Directory & Reporting
AmeriHealth Caritas Family of Companies
12.2007 - 08.2012
- Responsible for back-end support of medical cost/utilization reporting functions throughout all Plans in the corporation.
- Manage and oversee the workload of Informatics Data Analyst which ensures that a proper environment, equipment, processes, and tools are provided as required to perform tasks in day-to-day operations.
- Ensures the maximum level of data accuracy, integrity, consistency, and completeness in the various data sources used for end-user reporting purposes (e.g., Oracle Data Warehouses).
- Identifies any data-related issues, and conducts root cause analyses; facilitates resolution of known issues by working directly with end-users and IT staff.
- Generates and maintains thorough and accurate documentation related to data, databases, business rules, and reporting policies and procedures for all Lines of Businesses.
- Monitors and assesses impact of changes in utilization and cost patterns through modeling data trends.
Senior Pharmacy Informatics Data Analyst
AmeriHealth Caritas Family of Companies
03.2006 - 12.2007
- Designs, modifies and manipulates the databases for Pharmacy Services.
- Modify programs to procedure key data for internal and external reporting for Medicare and Medicaid members.
- Crete modules and macros for data manipulation and standard report generation. Maintains and expands Pharmacy trending, projection and reporting systems.
- Assists in the development and maintenance of Pharmacy provider and Physician provider network files.
PMO Business Analyst
AmeriHealth Caritas Family of Companies
07.2000 - 02.2006
- Assist and provide sound business direction for each project and the cost benefit associated with each.
- Assist with executing Project Management Office (PMO) projects on time and on budget for Medicare and Medicaid Health Plans.
- Accomplish goals associated with PMO projects.
- Analyzes and document current processes to identify flaws, enhancements, etc.
- Improve client service and reduce the cost of operations by focusing on key customer requirements and benchmarking performance.
Education
BA - Bible and Theology
Trinity Bible College and Seminary
05.2011
Skills
- Experience with SQL Server
- Applications: MS Office (Word, Access, Outlook, Excel, PowerPoint), Facets Application, Dream Weaver, Crystal Reports XI, BI Query, Business Objects Web Intelligence 65, Tableau, SQL Developer, SQL Advantage, SAS EG, Atlantis SQL Everywhere, DQ Analyzer, SAS DataFlux (DMS), SAS MDM, IBM Cloud, AWS, GCP, SSIS, SSRS, EZCAP, Plexis Claims Manager, Jira, PrimeSuite
Certification
- Business Objects 6.5 Intelligence Dec 2016
- Data Governance Institutional Professional Organization Aug 2012
- DAMA International Organization Sep 2012
- Leadership Life (Dale Carnegie) July 2013
- Executive Leadership Certification (Dale Carnegie) Aug 2013
- SAS Data Management Studio & Master Data Management Mar 2014
- Google Data Analytics Professional Certificate Sep 2022
Timeline
IT Software Engineering Senior Manager
Tabula Rasa HealthCare
09.2021 - Current
IT Senior Manager, Data Quality/Profiling/Data Governance/Provider Directory & Reporting
AmeriHealth Caritas Family of Companies
08.2012 - 03.2021
IS Business Analyst Lead, Data Quality/Profiling/Data Governance/Provider Directory & Reporting
AmeriHealth Caritas Family of Companies
12.2007 - 08.2012
Senior Pharmacy Informatics Data Analyst
AmeriHealth Caritas Family of Companies
03.2006 - 12.2007
PMO Business Analyst
AmeriHealth Caritas Family of Companies
07.2000 - 02.2006
BA - Bible and Theology
Trinity Bible College and Seminary
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