Lead Vendor Management

CHRIS PERSAUD

South Ozone Park, NY *****

917-***-**** (C) Email: *************@*****.***

SKILLS SUMMARY:

Over 20 years of experience in health insurance industry, offering strong and broad background in Managed Healthcare data analytics. My core strengths include quality control, statistical analysis, data analysis, excellent interpersonal and communication skills. Successfully demonstrates ability to multitask and consistently meet and exceed deadlines. Highly competent with MS Excel, MS Access, data manipulation software (SAS, Truven Medstat), navigate spreadsheet, relational databases, and statistical applications. Possess technology procurement and staff development.

EXPERIENCE

Emblem Health 2012 - Current

Lead Vendor Management Analyst (February 2015 – Current)

Create and manages data exchange interfaces with vendors including standard and enhanced data sets with IT representatives and internal Emblem IT departments.

Assist with the development of Technical Requirements Documents.

Perform root cause analysis of technical performance enhancement opportunities in Vendor Management.

Senior Data Analyst (August 2012 – Jan 2015)

Prepared monthly medical cost and utilization trend report.

Performed drill down investigation on variances from monthly trend reports.

Collaborated with team members to assemble data for risk score database build.

Conducted population risk assessment for specific disease conditions and for different member populations.

Evaluated underlying factors relating to member cost trends by service, clinical conditions and episode of care compared to benchmarks.

Provided internal customers with “Pay for Performance” reports by Medical Centers.

Provided Provider Networks with reports on ambulatory sensitive condition relating to inpatient admissions.

Developed monthly/quarterly annual trend reports for senior management.

Provide internal customers with unit cost reports on Fee for Service Medical Centers relating to network experience.

Fidelis Care 2009 - 2012

Senior Medical Cost Economics Analyst (June 2010 – July 2012)

Developed reporting packages of financial models relating to Profit and Loss, impact statements and contract sensitivity.

Prepared monthly reports for Sr. management regarding cost and utilization metrics.

Mentored\trained Medical Economics team to use Facets and data warehouse.

Provided support in areas of medical claims accruals, medical cost management and variance analysis.

Provided ad hoc analytical support to other departments such as Contract Management, Quality Health Care Management, Provider Relations and Vendor Oversight.

Collaborated with Enterprise Data Warehouse team to improve data extraction and aggregation.

Downloaded and prepared inpatient\outpatient rates for system updates.

Validated Medicare and Medicaid rates uploaded in test and production.

Medical Cost Economics Analyst (August, 2009 – May 2010)

Gathered data and generated information used to understand medical cost, trend and utilization.

Performed ongoing analysis and evaluation of fee schedules.

Prepared new fee schedules for system update supporting Provider Reimbursement Department.

Parallel process data extraction using Rapid SQL and Enterprise Data Warehouse for data validation.

Liaised with Enterprise Data Warehouse Team providing business rules relating for Profit and Loss analysis in order to build measures.

Health Plus 2004 - 2009

Sr Data Analyst, 2006 - 2009

Generated reports and did analysis using MS Excel, MS Access, Business Objects and Medstat for Benchmarking and predictive modeling in manage care.

Uploaded monthly files to data warehouse vendor at Thomson Reuters.

Provided support for the Medical Management department projects and programs concerning utilization, quality and disease management using Medstat and Med Measure.

Assisted with the data manipulation and formatting required for preparing large data sets needed to feed medical management decision-support applications.

Created and maintain Microsoft Access and SQL databases.

Problem solved to overcome inconsistencies related to data sources and quality.

Maintained an Immunization database to support Quality Improvement and Outreach departments of children missing immunization each month.

Cleaned data to publish Provider and Ancillary directory.

Configuration Specialist, 2004 - 2006

Tested new functionalities for Facets system upgrade to meet business processes.

Executed XML batch processing for Capitation test each month.

Worked with end users to validate data reported on monthly Capitation.

Tested Facet fixes and maintain MS project for all fixes.

Maintained a test bed for all test scripts.

Generated Capitation reports for Finance.

Wrote and executed simple SQL queries for data analysis in test as needed by Model Office Team.

Assisted to develop a Correspondence application in MS Access for inter department use.

Created and maintain a MS access tracking application on Provider Configuration for Model Office.

Design, Develop and support an Issue Tracking application in MS access utilized by Claims, Provider Relation and Model Office department.

Developed\maintained a Change Control process using Fuego (A Business Process Management).

Wrote procedures for the Issue Tracking database, Fuego portal usage in Model Office, Change Control process and XML Batch processing.

HIP Health Plan of New York, NY 2003 - 2004

Business Analyst,

Compiled statistical information within Grievance and Appeal department for tracking and trending.

Produced daily, quarterly and yearly reports for Grievance and Appeals using Crystal Reports

Edited files in Grievance and Appeal for timeliness and accuracy.

Produced performance reports on quality.

Designed an Excel automation system for Grievance and Appeal quality program.

Empire Blue Cross Blue Shield, New York, NY 1979 - 2001

Senior Business Analyst, 1990 - 2001

Oversaw a standardized project, which promoted a reduction in membership errors and improved processing cycle time from 14 days to 7 days.

Identified and coordinated performance improvement initiatives, which increased performance in customer satisfaction to 95 %.

Compiled monthly statistical information on performance indicators, created Pareto charts of enrollment failures and generated reports for plan's long-term functional improvement.

Maintained an online Access application for membership quality program.

Oversaw and tracked aged claim suspensions, then alerted operational units of danger in order to prevent prompt payment penalty.

Supervised a staff of three.

Generated divisional system and adhoc reports for senior management.

Performed quality audits for enrollments according to NMIS guidelines.

Supervisor, 1985 - 1990

Managed staff of ten responsible for subscriber and group application processing, group cancellation, group reinstatement and cash reconciliation.

Formulated monthly production and backlog reports and presented it to upper management.

Prepared evaluations and recommended salary increases for staff.

Assistant Supervisor, 1982-1985

Managed workflow for a staff of sixteen.

Assessed quality and integrity of work produced by staff and identified areas for improvement.

Reconciled large sensitive accounts for over 250 members in a timely manner.

Worked with supervisor to reconcile involved cash on a daily basis.

EDUCATION: Baruch College, City University of New York (2002) New York, NY

BBA. Computer Information Systems.

La Guardia Community College (2000) New York, NY

Associate in Business Administration.

SKILLS: Strong MS Office Skills, SAS Enterprise Guide, MS Project, Power Point, MS VISIO, Outlook, Lotus Notes, Cognos Query 1, Crystal Report Design 8.5 I, II, III, SAS, Truven MedStat and MedMeasure (Data manipulation and reporting).

RELEVANT COURSES: C++, MS SQL Server 2000, Oracle 9i, Networking and Reuters 1, 2.

Ingenix GeoAccess and Directory Expert for Provider Publishing.

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