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Richard S., MBA
Highly driven, resultsoriented professional with broad experience in Star, medical informatics, HEDIS, project management and healthcare analytics. Experienced problem solver with a proven track record of process improvement, team building, and operational and technical leadership with proven ability to interact and collaborate effectively with multiple levels of management to achieve critical business results.
Healthcare Data Analysis
Technical Team Development
Data Quality Management
Root Cause Analysis
Scott and White Health Plan Director of Quality Improvement / /
Increased frequency, reliability and accuracy of HEDIS reports for all lines of business. Coordinated efforts between IT, HEDIS vendor and QI team to bring HEDIS processing internally. Leveraged data from HEDIS software to develop detail level compliance reports that showed trends by region, clinic and provider and by measure. Results: Allow the organization to target region, clinic or providers on actionable HEDIS process improvement.
Orchestrated efforts cross functional teams to conduct root cause analysis and fix critical workflow issues related to how data was being gathered. Worked with various teams on a detailed review of key measures to understand root cause of noncompliance resulting in the discovery of coding and configuration issues. Result: The code fixes resulted in significant increases in several measures including Upper Respiratory Infection and Mental Health Day Follow Up.
Collaborate with leadership to develop cross functional teams to address Quality of Care issues. Worked with the case management and other organizational leaders to better understand how departments could coordinate care better for patients. Results: Ability to show a yearoveryear improvement in several key measures for reporting year and began working with senior leadership to change processes to improve rates.
Directed HEDIS project. Coordinated efforts between IT, HEDIS vendor, HEDIS auditor and leadership to ensure a timely and accurate HEDIS submission. Results: Final results for Commercial line of business was an % increase for measures that applied to NCQA accreditation.
Heritage Health Systems Project Manager Analytics //
Oversaw the software implementation and system migration. Collaborated with the Subject Matter Experts and the key business people to understand the specifics of the data configuration. Result: Led process by which both IT and the vendor compromised on how the data loads would be designed allowing for all the loaded accurately.
Led Analytics team in user acceptance testing of software to ensured accuracy of data. Worked with individual team members to conduct User Acceptance Testing and in situations where there was a discrepancy worked the vendor to understand why the discrepancy occurred. Results: Vendor rectified how calculations were done to account for different contracts with various Independent Physician Associations.
Served as the business lead with software vendor to ensure that project remained on track. Responsible for conducting weekly meetings including setting up of agendas, sending out minutes and following up with responsible parties in between meetings to ensure timely completion of tasks necessary to move project forward. Results: Ensured key issues were escalated to stakeholders.
Heritage Health Systems Data Quality Manager //
Implemented and CoChaired the Physician Advisory Board with Senior Medical Director. Led effort with Medical Director, Quality Improvement Department and Provider Relations to increase engagement
engagement in pay for performance. Led the group discussions to review feedback from the field and discuss modifications to the program. Results: Established program creditability as providers who began to feel the program was led by their peers within the health plan.
Collaborated with Regional Trainer and Medical team to modify reports based on feedback from provider offices. Operationalized and optimized the report delivery process based on the feedback received the field on how to make the program and reports follow current clinical guidelines and work better for practice. Results: Pay For Performance program participation increased by an estimated %.
Analyzed the concerns that were coming back from the field about the lack of accuracy of the reports. Created a new position exclusively for the purpose of data entry which reported to Quality Improvement instead of Utilization nurses. Results: Centralized data entry to one dedicated person. Company saved over $k a year in rework costs and increased the accuracy of the data and credibility of core reports.
Heritage Health Systems Quality Program Analyst / /
Reduced report creation time from months to hours by redesigning process. Results increased by x and was able to produce new reports that increased provider satisfaction and participation.
HEDIS Project Manager and data analyst. Coordinated with various departments to ensure accuracy of data and kept Executive team aware of status and roadblocks. Results: Timely and complete reporting of critical HEDIS data.
Health Help Senior Analyst //
Developed ROI calculator to determine the cost of rolling out product lines and to markets with various roll out dates. Led initiative to create a standard ROI tool for senior management to show the total cost based on various roll out scenarios. Results: The tool became a standard for all new accounts as it was easily modified for various clients; tool also used by accounting for forecasting purposes.
Coordinated with Director of Reporting to design training program for employees. Assembled a training schedule, trained new employee, reviewed all work before sending out and acted as mentor. Results: The employee orientation time was greatly reduced and staff was able to work independently on projects sooner.
Compaq Computer/HP SALES REPORTING SPECIALIST / BUSINESS ANALYST //
Worked with team leads in creation, development and automation of a standard reporting packet for Senior Management. Automated reports using various tools including SQL Server and Business Objects in conjunction with inhouse databases to develop customized reports. Results: Teams reports became the standard by which management compared all other reports to and were used on a daily basis to help guide direction for the company.
Served as subject matter expert for specific business groups and upon implementation of data warehouse served as contact for business owners. Served on team to teach business users how to write and implement their own ad hoc reports from data warehouse. Results: A reduction of support calls and emails to the group and an increase in customer satisfaction.
Primary data lead for SKU reduction project with the goal of reducing inventory while increasing turnaround time and production. Interfaced with Project Management team as a data specialist inventory control and the Strategic Planning And Management team on project. Results: SPAM team analyzed the data and helped to successfully reduce inventory and carrying costs while increasing turnaround time.
Conducted User Acceptance testing on new data warehouses. Crossreferenced data with existing warehouse and documented differences and reported findings to IT. Results: IT used findings to modify load processes therefor adding to the credibility and success of the data warehouse.
HewlettPackard Star Employee Award two times
Heritage Health Systems Distinguished Service Excellence Award
BBA University of Houston
MBA Letourneau University
References available upon request