Medical Health
Resume:
William (Doug) G Corson
**** * *** ****** **. Gilbert Az.
**************@*****.***
Summary of Experience
IBNR - Consulting - Network - Medical Management - Medical Spend - Cost Control Techniques
Normalizing Health Plan Data - Data Flow - Utilization - HEDIS - RAF – Data warehousing - Ad HOC reporting - HIX - Medicaid - Medicare - Commercial - Pharmacy - Risk Scoring - Capitation Rate Setting - Contract Analysis - Bundled Payments - Accounting - Certified Professional Coder - Advanced Analysis - MLR - Revenue – Medical Operations- Health Plan Operations, Financial Data, Utilization and Analysis.
Team Leadership, Using strengths of team members appropriately, Team building, Using technology appropriately, 15 years of analysis experience, Understanding of health care from claim to final reporting product.
Technical Skills: Access 10 years, TSQL 6 years, Excel 15 years
Certifications: Certified Professional Coder 2008 to 2015
Education: BS/BA in Accounting: University of Arizona 2000
Current Position
Director of Health Plans Medical Economics
Tenet Healthcare
October 2015 – Present (1 year 1 month)
9 Health plans with over 300 thousand members
Phoenix, Arizona Area
-- Oversee a team of Medical Economics Analysts, Financial Analysts, Data warehouse Developers,
-- HMO for Medicaid/Medicare/HIX/Self-Funded and Commercial Products: Arizona, Michigan and Texas
-- Actively worked with Medical Services Department on Medicare Cost overruns.
-- Streamlined and automated reporting for Medical Services: Census,Discharge, Case Management
-- Superutilizer reporting for members with high utilization or chronic conditions, Readmissions and Costs.
-- Bi-weekly cost meetings on Medicare, Medicaid and HIX members and what possible actions to take.
-- Built Team and Data from scratch
-- Financial, Utilization and Operational Analysis
-- Accounting and Actuarial Functions, IBNR, Lag Triangles, Revenue, Member Months
-- Dashboard Reporting, Medical Management and Contract Analysis
-- Monthly Medical Loss Ratio Analysis
-- Hospital Comparison, Readmission rates, Case Mix and Observation rate.
Health Choice 11 years (May 2004 to October 2015)
Director of Medical Economics
Health Choice
May 2013 – October 2015 (2 years 6 months)
8 Health Plans with over 600 thousand members
Phoenix Az.
--Led a 7 person team of med econ and financial analysts
--HMO for Medicaid, Medicare, HIX members: Arizona, Utah and Florida
--IBNR, Monthly close and analysis
--Advanced Analysis on a vast array of health plan data
--Medical and Pharmacy cost analysis, Utilization, Revenue and Membership
--100’s of financial and operational adhoc reports
--HEDIS / RAF / HRA
--Cost Control initiatives
--Medical Management, Network and Financial Consulting
--Developed Standardized SQL Financial and Operational Tables
--PCP Profiling, Hedis, Utilization and Financial
Manager of Medical Economics
Health Choice Arizona
November 2008 – April 2013 (6 years 6 months)
3 Health plans with 250 thousand members
Phoenix, Arizona Area
--Led a 5 person team.
--Medicaid and Medicare dual member HMO.
--IBNR results and analysis
--State Medicaid 5 year bid data and analysis
--Network contract changes, Medical Management Recommendations, Prior Authorizations
--Cost Control meeting reporting and recommendations
--Capitation Rate Setting, PCP’s and Ancillary Providers
--Medical Homes, Gain share and Profit/loss analysis
--Change Agent for data flow and validation, monthly close and Analytics from that data
Supervisor of Financial Analysis
Health Choice Arizona
November 2006 – October 2008 (2 years)
3 health plans with 200 thousand members
Phoenix, Arizona Area
--Led a 3 person Team
--Monthly IBNR modeling and Journal Entry
--HEDIS Measures
--PCP Profit and Loss Profiles (HEDIS, Utilization and Financial Data)
Senior Financial Analyst
Health Choice Arizona
November 2004 – October 2006 (2 years)
2 health plans with 150 thousand members
Phoenix, Arizona Area
Led a 2 person Team
Updated Monthly IBNR with Category of Service
Ad Hoc Reports for various departments, Dental, Network Services, Medical Services and UM/QM
Automated reporting
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