SUMESH B. KARIVELIL
Summary
U.S. Citizen Federal Experience: Department of Homeland Security/Immigration and Customs Enforcement -8 years. Active Security Clearance: Department of Homeland Security, Public Trust. Health informatics professional with 20 years of experience in various aspects of healthcare including health data analytics, clinical care, electronic health records training and implementation, public health research, and project management. Possess a comprehensive understanding of healthcare policies, quality measures, accreditation standards, regulations, and legal requirements. Adept at leveraging advanced analytic tools and technologies to deliver strategic solutions for Federal health clients. Dedicated to using excellent research, investigation and project management abilities to optimize management, organization and reporting of clinical data. Results-driven, precise and systematic with quick learning and collaborative nature. Strong history with [Type] companies.
Overview
22
22
years of professional experience
Work History
Senior Health Informatics Analyst
US ICE Health Service Corps (IHSC)
05.2015 - Current
- D.C
- Provided health data analytics, data management and application support to federal agencies; Collaborated with cross-functional teams to develop key performance indicators (KPIs) and metrics
- Performed advanced statistical and predictive analysis methods for forecasting with up to 98% accuracy; Presented findings and actionable insights with senior leadership
- Served as subject matter expert in Medical Payment Authorization Request (MedPAR) and the medical referral process, ensuring timely and accurate claims processing; Worked closely with VA Financial Services Center and resolved thousands of denied medical claims; Managed medical coders
- Sourced data from agency-wide repositories using ETL (Extract Transform and Load) techniques for data warehousing; Managed data projects
- Utilized business analytics and reporting tools (IBM Cognos, SAS, R, PowerBI, SQL, Python, Tableau, PowerBI) to analyze health and custody data, create reports, dashboards and visualizations, provided workload statistics and forecasts
- Updated Medicare fee schedule periodically in the EHR system
- Used CPT and ICD-10 for analyzing disease prevalence and financial implications
- Developed applications and solutions using PowerApps and MS Access
- Served as SharePoint developer and site administrator
- Performed software testing
- Completed numerous FOIA (Freedom of Information Act), and external agency data requests.
- Collaborated closely with physicians and nursing staff to improve quality of patient records documentation.
- Participated in committees to discuss electronic health records and methods to improve overall workflows.
- Conducted education and training activities for physicians, nursing staff and administrative personnel.
- Participated in quality assurance reviews to verify accuracy and reliability of data.
- Created data management plans and provided input on study designs.
- Minimized manual system errors with streamlined data entry process.
- Developed comprehensive data dictionary for efficient and accurate data tracking.
- Assisted with database upgrades and migrations by performing user acceptance testing.
- Built complex data analysis reports and provided timely feedback to stakeholders.
- Skilled at working independently and collaboratively in a team environment.
- Self-motivated, with a strong sense of personal responsibility.
- Proven ability to learn quickly and adapt to new situations.
Clinical Application Analyst
Frederick Memorial Hospital
07.2014 - 05.2015
- Analyzed and evaluated business and technical needs of ambulatory physician practices, providing solutions to meet regulatory and compliance requirements; Conducted workflow analysis and implemented process improvement solutions
- Advised and prepared physician offices in achieving meaningful use incentives, PQRS and HEDIS measures, and PCMH recognition
- Managed EHR implementation projects; Conducted training sessions for physicians, nurses, billers, coders, and support staff on EHR applications; Trained more than 100 staff from various disciplines
- Implemented and configured patient portals, enhancing communication and engagement with patients
- Served as clinical informatics liaison between leadership, customers, end users, technical team and vendors for multiple ambulatory practices including primary and specialty care
- Established goals and objectives for electronically maintaining medical records in accordance with CMS, state and federal laws and regulations and accrediting standards
- Performed EMR application updates, configuration, testing and template development.
Electronic Health Record Specialist
Holy Cross Health Network
01.2013 - 07.2014
- Analyzed healthcare data, aided management in decision-making, and developed process improvement solutions
- Analyzed and developed workflows
- Performed EHR implementation project management for multiple ambulatory clinics, providing go-live support and training for staff; Managed over 100 EHR training sessions
- Served as principal EHR training instructor and subject matter expert; Coordinated all EHR implementation activities for multiple ambulatory clinics and provided go-live support; Implemented and configured patient portals, facilitating patient access to health information
- Coordinated activities among supervisors, facility trainers, contractors, and Project Management Offices; Participated in system upgrades and conducted user validation testing; Managed and coordinated activities involving digitization of paper records and data abstraction; Provided onsite and remote troubleshooting.
Health information specialist
Holy Cross Health Network
11.2006 - 01.2013
- Provided EHR support for physicians, assisted in maintaining clinical registries
- Administered document imaging solutions including abstraction, prepping, scanning and validation
- Executed release of information including subpoenas, chart deficiency analysis, and chart abstraction
- Completed more than 50,000 release of information requests as per HIPAA guidelines and privacy laws
- Developed an automated electronic notification system to notify physicians about documentation deficiencies saving more than 40 manpower hours a week
- Coordinated efforts to convert paper forms to electronic templates
- Provided data analysis assistance to billing and coding professionals.
Quality Assurance Specialist
Universata, Inc
06.2005 - 08.2006
- Performed document imaging activities to include medical records scanning and validation
- Assisted IT department in system testing and process improvement
- Handled customer relations, clinical documentation quality analysis, release of health information, and training and orientation of new employees.
Public Health Research Assistant
Indian Institute of Management
06.2001 - 07.2003
- Provided assistance in executing various public health, financing, and policy research projects
- Effectively identified various research areas, performed information abstraction and literature review, designed research instruments, performed data collection, data analysis, and interpretation of data
- Drafted research reports
- Coordinated the network of technical partners of the projects, liaised with various government agencies and private contractors
- Completed research and consultancy assignments under supervision.
Education
Post-Graduate - Artificial Intelligence for Leaders
The University of Texas At Austin
2023
No Degree - Project Management Boot Camp
EdWell
Maryland12.2022
Certificate - Project Management
Montgomery College
Maryland2020
No Degree - Power BI
Dynamic Edge
2019
No Degree - SAS Viya Analytics
SAS Institute
2019
Certificate - Business Analytics
Harvard Business School Online
2019
No Degree - Azure Fundamentals
Microsoft Learning Center
2017
Master of Science - Health Administration Informatics
University of Maryland University College
2012
Master of Arts - Hospital Administration
Tata Institute of Social Sciences
Mumbai, India2001
Bachelor of Science - Physical Therapy
Mahatma Gandhi University
India1999
Skills
- SKILLS/TECHNICAL EXPERTISE:
- EHR: eClinicalWorks, NextGen, Cerner
- Data Management/Analytics/ Programming:
- SPSS, SAS, R Studio, Cognos, Tableau, MS Access, Power BI, Excel, SQL, Python, VBA, MySQL
- Other: Statistics, SWOT Analysis, Root Cause Analysis, Regression, JIRA, Agile, MS Project, MS Visio, SharePoint, Power Point, Publisher, Adobe InDesign, Adobe Captivate, Power Apps
- Health Information Confidentiality
- Regulatory and Statutory Compliance
- Informational Releases
- Workflow Processes
- Government Regulations
- HIPAA Requirements
- Health Records Review
- Electronic Health Records Systems
- Health Management Information Systems
- Medical Abstraction
- Performance Improvement
- Facility Workflow
Additional Information
- PUBLICATIONS:, Health Insurance and Third-Party Administrators: Issues and Challenges. Economic and Political Weekly. Vol 39, No. 28 (July 10-16, 2004), pp. 3149-3159 (co-authored with Dr. Bhat, R.).
Publications
Health Insurance and Third-Party Administrators: Issues and Challenges. Economic and Political Weekly. Vol 39, No. 28 (July 10-16, 2004), pp. 3149-3159 (co-authored with Dr. Bhat, R.).
Timeline
Senior Health Informatics Analyst
US ICE Health Service Corps (IHSC)
05.2015 - Current
Clinical Application Analyst
Frederick Memorial Hospital
07.2014 - 05.2015
Electronic Health Record Specialist
Holy Cross Health Network
01.2013 - 07.2014
Health information specialist
Holy Cross Health Network
11.2006 - 01.2013
Quality Assurance Specialist
Universata, Inc
06.2005 - 08.2006
Public Health Research Assistant
Indian Institute of Management
06.2001 - 07.2003
Post-Graduate - Artificial Intelligence for Leaders
The University of Texas At Austin
No Degree - Project Management Boot Camp
EdWell
Certificate - Project Management
Montgomery College
No Degree - Power BI
Dynamic Edge
No Degree - SAS Viya Analytics
SAS Institute
Certificate - Business Analytics
Harvard Business School Online
No Degree - Azure Fundamentals
Microsoft Learning Center
Master of Science - Health Administration Informatics
University of Maryland University College
Master of Arts - Hospital Administration
Tata Institute of Social Sciences
Bachelor of Science - Physical Therapy
Mahatma Gandhi University
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