Health Data
Resume:
PAULA NORMAN
***** ******* ****** *****, *******, Florida 33598
PROFESSIONAL SKILLS:
. Advanced data management skills including data collection, data
validation, data warehouse integration and database development
. Health Plan utilization and financial analysis and development of key
clinical statistical indicators
. Health Plan medical expense forecasting and budget development
. Data mining, development and validation of Health Plan cost containment
initiatives
. Employer group financial statement development and employer group
healthcare budget development
. Advanced programming and skills with SQL, SAS, Crystal Reports, ACCESS,
budgeting software, and relational databases
. All Rating Methodologies including Traditional Community Rating,
Community Rating by Class,
Prospective Experience Rating, and Administrative Services Only
. Rate setting for employer groups from 50 - 5,000+ lives
. HMO, POS, PPO, Dual Option and Triple Option benefit plans
. RFP preparation including experience with the Federal Employees Health
Benefit Program
. Aggregate and Specific Stop Loss Underwriting
PROFESSIONAL EXPERIENCE:
2/03 - Present: Health Data Analyst, Johns Hopkins Health Care - Glen
Burnie, Maryland
Strategizes with internal business units in order to develop and maintain
reports, data sets and analytic models required to support internal
business units monitor clinical and financial statistics associated with
the Health Plan's Medicaid and Commercial Managed Care population. Applies
SAS and SQL programming and analytical skills to interpret, validate and
integrate health plan utilization, revenue and membership data from
multiple sources into the corporate data warehouse. Performs as a data
manager for clinical research projects including cleaning and analyzing
multiple health plan enrollment and claims data and developing clinical
outcome measures. Designs and develops ACCESS databases, including user
interfaces, forms and reports to house clinical survey data.
4/01 - 2/03: Performance Analyst, AMERIGROUP Corporation -
Linthicum, Maryland
Served as the analytical member of the budget team responsible for budget
model development and medical expense forecasting based on historical
utilization, expected trends and implementation of clinical initiatives.
Collected, organized and created reports exhibiting clinical and financial
statistics of the Plan's 130,000 member Medicaid population, using a
variety of analytical tools and databases. Strategized with senior
management in order to define and quantify cost containment initiatives and
developed data sets and reporting tools to monitor and validate the
initiative outcomes.
5/00 - 4/01: Health Care Consulting Analyst, William M. Mercer,
Incorporated - Tampa, Florida
Projected future employer group medical costs based on historical
utilization in conjunction with external client financial budget
preparation. Served as a resource for company proprietary relational
databases and analytical tools. Prepared and evaluated Request for
Proposals and Request for Renewals, organized vendor responses and
participated in vendor review and selection for external clients.
9/99 - 5/00: Underwriter, National Underwriting Services - Helotes,
Texas
Evaluated employer group medical risk by analyzing historical utilization
in connection with group specific rate and attachment point development.
Served as the technical resource for ad-hoc Access customized reports and
report enhancements within the client relational database.
10/97 - 4/99: Underwriting Analyst, AvMed Health Plan - Gainesville,
Florida
Developed group specific claims, enrollment and premium queries and reports
using Business Objects as the relational database interface. Performed risk
evaluation and group specific price setting for HMO, POS and Indemnity
products. Analyzed internal and external claims and cost reports in
connection with group specific rate development and financial monitoring of
existing business.
2/97 - 8/97: Underwriting Analyst, Kaiser Permanente - Rockville,
Maryland
Performed renewal group and prospective group rating for a group model HMO
insuring over 500,000
Mid-Atlantic members. Analyzed claims, enrollment, and cost reports
relating to such groups in order to evaluate potential financial risk while
continuing to maintain nonprofit company social mission.
3/94 - 2/97: Underwriting Analyst, Principal Health Care - Bethesda,
Maryland
Performed renewal group and prospective group rating by applying basic
principles of risk management, medical underwriting, underwriting theory
and benefit design. Generated and analyzed census, premium, and claims
reports. Performed calculations and review of rates for the Midwest
Region.
EDUCATION:
Bachelor of Science in Business Finance University of Maryland,
College Park, Maryland
Associates Degree in Computer Science Montgomery College, Rockville,
Maryland
SKILLS:
SAS Certified Advanced Programmer for SAS 9.0, MS SQL 2005, MS Data
Transformation Services, Crystal Reports, Excel, ACCESS, Hyperion Pillar,
Johns Hopkins ACG Software
Contact this candidate