Jan 2015 – Jun 2015 · 5 mos · Nashville Metropolitan Area

Jan 2014 – Oct 2017 · 3 yrs 9 mos · Nashville Metropolitan Area

Feb 2013 – Dec 2014 · 1 yr 10 mos · Nashville Metropolitan Area

Jan 2010 – Nov 2012 · 2 yrs 10 mos · Nashville Metropolitan Area

• (Ingenix/OptumInsight acquired AIM Healthcare in 2009)
• Third Party Liability Service (Government Medicaid eligibility)
• Managed team of data analysts focused on implementing TPL clients and data operations
• Profitable in first year; $3M in revenue in second year as a new service
• Increased client savings/cost avoidance by 12%
• Designed and implemented TPL claim recovery process
• Enrollment Integrity (Commercial COB Service)
• Managed data operations team responsible for building new service from ground up, including client and data implementations
• Designed system requirements and data flow to identify overlap in healthcare coverage
• Product Manager for multiple products
• Responsible for successful delivery of products and services
• Identified and valued new functionality and ensuring quality of finished product
• Annual capital investment across products was $2.5M
• Responsible for developing and marketing a SAAS product, including managing tier 1 support team
• Identified and recommended new technologies to increase operational efficiency
• Decreased ETL time by 50%
• Implemented a screen scrape and automation tool that realized $3M in revenue
• Increased revenue per FTE using automation
• Predictive Analytics
• Managed team of statisticians focused on using predictive analytics to increase revenue and FTE efficiency in COB

Jan 2006 – Jan 2010 · 4 yrs · Nashville Metropolitan Area

• (Acquired by Ingenix/OptumInsight in 2009)
• Managed 35 data analysts in the commercial data mining division ($45M in annual revenue)
• Responsible for all data analytics (SQL) and data implementations
• Increased COB revenue by 60%
• Standardized analytic processes across clients and regions
• Managed Business Technology team
• Responsible for identifying and implementing new technologies to increase revenue/FTE
• Act as liaison between IT and business units
• Provide technical support and act as technical operations consultants to operations teams
• Responsible for functionality implemented into data mining application ($.5M-$1M annual investment)
• Managed team providing end user support and training for 100+ staff using data mining application
• Managed Trend Discovery Team
• Responsible for researching and documenting new analytics ideas
• Staff tested and vetted new trends before submitting to the analytics teams

Jan 2004 – Jan 2006 · 2 yrs

• Documented business requirements for proprietary discovery application used by all data mining claims analysts
• Identified and implemented processes to increase efficiency across claims analysts
• Recommended technology to improve business processes

Jan 2003 – Jan 2004 · 1 yr

• Implemented new client data; maintained existing client data
• Performed data analysis using native SQL
• Identified new healthcare overpayment trends
• Expanded scope of commercial data mining analysis to physician claims

Jan 2000 – Jan 2003 · 3 yrs

• Developed and implemented logic to identify claims payment errors using SQL Server 2000
• Identified overpayments and then implemented logic to prevent future payment errors
• Recovered $1M for individual insurance company on duplicate claims recovery project
• o Based on this project and a subsequent training engagement, the client hired PYA to perform an operational analysis, which lead to $20M in duplicate denials
• Performed recovery and consulting engagement for individual insurance company – project identified system holes in eligibility logic
• Worked with self-funded organizations, including an international retailer, a city government, a state government and a school district, to identify and recover overpayments from Third Party Administrators – realized savings 1%-3% of medical expense
• o Involved in all aspects of these projects including development, data acquisition, analysis, site visits and overpayment collection
• Database design and administration, including the creation of reporting tools, in the areas of budgeting, business development, compensation tracking and coding review
• Managed care contracting research and review in the areas of stop loss, timely filing, ambulatory surgery groupings, rate schedules and implants
• Identified underpayments at a health system and assisted in identifying affected accounts
• Created financial models for valuation and contract negotiations

May 1999 – Jul 1999 · 2 mos · Memphis, TN

• Tax and Management Consulting
• Re-determined FSC Commission using E&Y software; saved client over a million dollars
• Updated data model to comply with application development screens
• Project management support - work plan management using MS Project, tracked and audited engagement economics to manage project costs
• Used Global Consulting Services Workbench to plan and monitor engagement performance
• Prepared deliverables for submission to E&Y knowledge sharing database