Oct 2018 – Present · 7 yrs 7 mos

• Created a self-service report for Provider Enrollment and Outreach to get their denial based metrics for providers to help with provider education.
• Proficient in using the CMS Integrated Data Repository (IDR) including Microstrategy, SAS and StarsInformant
• I helped streamline the creation of standard documents so that the code to generate the reports as well as the reports produced had a common location which streamlines bringing new analysts aboard. Familiar with helping with audit processes.
• Analyze data-driven output utilizing SAS programs to make recommendations relating to critical business directives
• Developed alternative SAS programs for use as standardized programs and utilized by other analysts and medical staff.
• Formulate Extracts and Report updates to meet immediate turnaround necessary for CMS and upper management.
• Auditing SAS code and SAS output to verify the accuracy of the data and to determine if the output met the requestor’s specifications.
• Active participant in First Coast Diversification initiative project for Florida Blue helping determine if Medicare Advantage exhibits gaps in enforcement of LCD protocols.
• Devised Spike Billing Report for Part A providers ranking providers based on percentage of claims with KX modifiers, providers claims that have crossed the per bene cap for physical therapy and occupational therapy, paid dollars above a specific threshold and beneficiary crossovers between different providers within same month. Report aids in examining historical trends and identifying
• Lead programmer for creating provider and service specific probe samples for both Part A and B lines of business. I co-authored the Part A and B Probe Sample procedures, the validation of Statistical Samples for Overpayment Estimations as well as the Quality Control Audit procedures
• Worked closely with the IT Department to resolve data issues. Helped in the creation of data dictionaries

Jul 2013 – Present · 12 yrs 10 mos

May 2010 – Jun 2013 · 3 yrs 1 mo · Jacksonville, Florida Area

• Coordinate data collection from sources including, but not limited to, transactional systems and data warehouses in support of research projects
• Assess data quality and integrity of research data collected
• Coordinate consumption characterization and load research projects
• Perform all phases of consumption characterization and load research including research design, sample selection, data collection, data analysis and presentation of results and recommendations

Aug 2004 – Apr 2010 · 5 yrs 8 mos

• Design, code, and execute algorithms for the extraction and presentation of data and adhoc reporting
• Create report documentation for standard reports explaining the purpose of the report, the files used to generate the report, the logic and the limitations of the report
• Responsible for creating DB2, monthly summary and trending tables that customers can access through the internet using Web Intelligence tools
• Perform statistical analysis to guide national and regional medical review efforts, including data compilation and verification
• Use statistical programming tools to identify utilization patterns and trends to show aberrant behavior in suppliers or providers
• Participate in writing of articles suitable for internal/external publication to support medical review efforts for Medicare claims
• Responsible for CERT analysis, producing CERT white papers for Part A and Part B lines of business, and presenting analysis to executive-level personnel
• Provide data to the GAO or CMS for providers who are being investigated when needed

Jan 2000 – Jul 2004 · 4 yrs 6 mos

• Created inmate profiles
• Updated statistics for the department monthly and annually such as infractions per institution, average length of stay, inmate visitation rates, and most serious offense per year
• Used SAS to generate data and Excel to produce statistical reports for the department as well as outside agencies, e.g., the Bureau of Justice Statistics and the Immigration and Naturalization Services
• Co-authored a document for my department using Federal funds provided by the U.S. Department of Justice titled “Evolving Optimum Classification Policies in the Implementation of Truth-in-Sentencing: A Dynamic Model to Predict Bed-Type Mix, Final Report”