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Business Analysis, Project Management, Strategic Healthcare Initiative

Location:
Los Angeles, CA
Posted:
March 17, 2019

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Resume:

Daniel Edelstein, MHA

310-***-**** ac8s9y@r.postjobfree.com

Los Angeles, CA 90014

EXPERIENCE

L.A. Care Health Plan October 2014- present

Project Specialist: Business Process Improvement, Customer Solutions Center, and IT departments

Wrote and executed vendor contracts in conjunction with Health Management Systems, Inc. vendor representatives and Legal team for claim data cleanup services for LA Care’s Medi-Cal line of business (includes 2 million members), which resulted in several million in cost savings; presented the project proposal to the CFO to get leadership buy-in

Served as the liaison between L.A. Care, the Center for Medicare and Medicaid Services, and Department of Healthcare Services to execute a Coordination of Benefits Agreement which established a data exchange to ensure L.A. Care would receive the most up to date claims data; this ensured more accurate payment of claims and resulted in the elimination of unnecessary overpayments

Writes business requirements which serve as the specifications for the development of Salesforce application by working with a cross-functional team spanning 6 departments; has reduced the number of systems and applications used by Call Center staff and create an improved workflow; reduced call time for Call Center staff by fifty percent which is expected to reduce department costs

Lead team to create new reporting, call codes, and metrics for Salesforce application; simplified convoluted reporting and provided information that drives decisions within the Call Center

Implemented Microsoft Project Server as the project management system in the Information Technology department; provided leadership with increased visibility into the resource hours, costs, and schedule of all department projects

Successfully redesigned an enterprise-wide intake form for the submission of call campaigns; more efficient intake lead to departments conducting more member outreach campaigns

Developed procedure documents for the department which made processes more consistent and set standards for quality assurance and service level metrics; made department compliant with regulatory requirements of government agencies (DMHC, DHCS, CMS)

Lead report remediation initiative to ensure over 200 reports would be capable of including larger diagnosis codes during the transition from ICD-9 to ICD-10, preventing potential report errors; analyzed provider billing data pre and post ICD-9 to ICD-10 to determine financial impacts to the organization

St. Francis Medical Center Summer 2013

Risk Management Intern

Ensured compliance with California OSHA law by aiding in implementation of new Safe Patient Handling Program; trained hospital staff on new equipment for lifting patients

SKILLS

Computer and Software: Excel, PowerPoint, Outlook, Visio, Project, Project Server, Access, Webex, Lotus Notes, Salesforce, Customer Relationship Management (CRM) tools, analytics tools: R and SAS

Healthcare systems: QNXT, MHC

Communication: Concision, Articulation, Adaptability, Collaboration

EDUCATION

University of California, Davis

Bachelor of Arts: Psychology, June 2014

University of Southern California

Master of Healthcare Administration, June 2018

Upsilon Phi Delta Honors Society Board Member



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