Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Sravanthi Gorusu

Shelby,MI

Summary

Healthcare Lead Data Analyst with more than 11 years of experience with the past 5 years focusing on HEDIS/CMS Stars and Gaps in Care. Recent experience managing a team of 3, and reporting on HEDIS, Pharmacy, SUPD and PQA measures, and CMS Stars and claims to meet the CMS/NCQA submissions and star calculations. Experience working on more than 20 measures such as COL, EED, FMC, HBD, OMW, SUPD, TRC, BCS and pharmacy measure. Experience with SAS, SQL, Power BI, Oracle, Tableau, Unix, Jira, Confluence, MS Access, MS Excel, CSV, XML, CPT, HCPCS, ICD-10, Healthcare Outcomes Survey (HOS), CAHPS, HEDIS, Medicare Stars, CMS, Quality Rating System (QRS), and NCQA.

Analytical professional adept in data interpretation and strategic insights. Proven track record in transforming raw data into actionable business intelligence, fostering team collaboration, and adapting to dynamic project requirements. Known for problem-solving abilities and proficiency in data visualization tools.

Overview

14
14
years of professional experience
1
1
Certification

Work History

Lead Data Analyst

UST HealthProof
03.2023 - Current
  • Manage a team of three, served as a Lead analyst in DA team in Regulatory Project, worked for various clients for reporting purpose on CMS STARS, HEDIS, Pharmacy, SUPD and PQA measures, data and claims data to meet the CMS/NCQA submissions and star calculations, in generating Monthly, Quarterly, and Yearly reports by using SAS/SQL, access database and power BI
  • Work on more than 20 measures such as COL, EED, FMC, HBD, OMW, SUPD, TRC, BCS and pharmacy measure
  • Communicate and coordinate with target, execution teams to meet the client requirement, and work with Inovalon from sending the files and making sure that the load process is successful
  • Loading and executing data runs, perform full run every January and full administrative refresh in April to load any lag claims
  • Closely coordinate HEDIS certified team Inovalon,Q360 specialized in creating a quality measure processing and reporting tools as they have a large amount of IT infrastructure, they extract the data from claims and medical records to determine which patient is eligible for which measure, they provide the consolidated date to us in the form of DA files, flagged and detailed files, we usually work with the in the month of January through April
  • Develop and maintain HEDIS based report to support Quality Initiatives
  • Support IDSS/PLD Testing, Primary Source Validation (PSV) support, Chase file cleanup, Sample/Chase result review and MRRV Support
  • Support data file review, regulatory test runs, provider clean up, roadmap support, quality checks and MRR validation
  • Collaborate with the HEDIS to develop annual HEDIS project plans and monitor the HEDIS project plans for multiple clients
  • Assists as necessary in the HEDIS Road Map and all other documents required by auditors
  • Involved in QA and validation of financial and incentive reports yearly
  • Knowledge on Membership, and Gaps in care tables
  • Updates HEDIS value sets, NDC list tables updated by CMS yearly twice along
  • Current work targets provider reporting for BCBS of Michigan, BCN, Premera products to meet star rating
  • Automate the process to run monthly reports by using SAS and SAS task scheduler
  • Use of SAS statistical software and SQL to manipulate health care and related databases, import, validate, merge and append files, group and collapse data, generate variables/indices, develop SAS code and programs, and produce appropriate and valid statistical output
  • Work with Health care data which includes various HEDIS measures details and of the members With STARS DATA and Medicare star rating systems and measures
  • Generate reports throughout the year such as Incentive, MLDR, PCR reports
  • Extract data from oracle database using SQL pass-through facility, retrieved the data from flat files, oracle database and converted to SAS data sets for Analysis
  • Use Jira/Confluence for creating and resolving workflow tickets
  • Prepare new Datasets from raw data files using Import techniques and modified existing datasets using Set, Merge, Sort, and Update statements, functions, and conditional statements
  • Create reusable Macros and used existing macros for Data Validation analysis and Report generation
  • Source and analyze data from a variety of sources like SAS data sets, MS Access, MS Excel, CSV, XML, and flat files of management information systems
  • Extensively used various SAS ODS techniques to generate complex reports
  • Use to manage data collection and reporting to support client management activities
  • Coded SAS programs with the use of Base SAS and SAS/Macros for ad hoc job
  • Research for the cause of errors in code and modified code according to requirements

Expert Data Analyst

Advantasure BCBS
05.2020 - 03.2023
  • Served as a subject matter expert in DA team, worked on CMS Stars data for various clients on HEDIS measures, risk adjustment claims data to meet the CMS requirement in generating Monthly, Quarterly, and Yearly reports by using SAS/SQL and Access Database
  • Communicated and coordinated with target team execution and BI team to meet the client requirement
  • Involved in QA and validation of financial and incentive reports yearly at PO and PU (Provider organization and unit) level
  • Knowledge on Membership, and Gaps in care tables
  • Updated HEDIS value sets, NDC list tables updated by CMS yearly twice along
  • Targets included, provider reporting for BCBS of Michigan, BCN, and Premera to meet star rating
  • Automated the process to run monthly reports by using SAS and SAS task scheduler
  • Used SAS statistical software and SQL to manipulate health care and related databases, import, validate, merge and append files, group and collapse data, generate variables/indices, develop SAS code and programs, and produce appropriate and valid statistical output
  • Worked with Health care data including, various HEDIS measures details and of the member with STARS DATA and Medicare star rating systems and measures
  • Generated reports throughout the year such as Incentive, MLDR, PCR reports
  • Extracted data from oracle database using SQL pass-through facility, retrieved the data from flat files, oracle database and converted to SAS data sets for Analysis
  • Used Jira/Confluence for creating and resolving workflow tickets
  • Prepared new Datasets from raw data files using Import techniques and modified existing datasets using Set, Merge, Sort, and Update statements, functions, and conditional statements
  • Created reusable Macros and used existing macros for Data Validation analysis and Report generation
  • Sourced and analyzed data from a variety of sources like SAS data sets, MS Access, MS Excel, CSV, XML, and flat files of management information systems
  • Used various SAS ODS techniques to generate complex reports
  • Used to manage data collection and reporting to support client management activities
  • Coded SAS programs with the use of Base SAS and SAS/Macros for ad hoc job
  • Researched for the cause of errors in code and modified code according to requirements

Senior Data Quality Analyst

Pradot Technologies
12.2013 - 06.2016
  • Responsible for the design, architect, and development of reporting Commercial insurance datasets in SAS which includes creating and validating input files

Healthcare Analyst

Apollo Health Street
04.2011 - 12.2013
  • Accessed multiple databases using SAS and provided ongoing reporting that supported information-based decision-making, measured the execution of company strategy, and identified opportunities for improving existing processes
  • Generated Statistical analysis files, tables, listings, and graphs
  • Extracted data from Oracle using SQL Pass through the facility and generated reports

Education

Master of Science - Health Informatics

Purdue Global University
01.2023

Skills

  • Base and Advanced SAS
  • ETL development
  • SQL expertise
  • Data quality management
  • Tableau software
  • Big data processing
  • Data mining techniques
  • Advanced analytics

Certification

Certified Base SAS Programmer, 4EZJ80C21F441D55

Timeline

Lead Data Analyst

UST HealthProof
03.2023 - Current

Expert Data Analyst

Advantasure BCBS
05.2020 - 03.2023

Senior Data Quality Analyst

Pradot Technologies
12.2013 - 06.2016

Healthcare Analyst

Apollo Health Street
04.2011 - 12.2013

Master of Science - Health Informatics

Purdue Global University

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Sravanthi Gorusu