Donna Tomasco

** *. ***** ***. 856-***-****

Audubon, NJ 08106 acxrtd@r.postjobfree.com

AmeriHealth Caritas 10/2012 to Present

*** ******* **., ************, **

Sr. Medical Economics Analyst

Coordinate with the HEDIS Managers to develop annual HEDIS project plans and monitor the HEDIS project plans for multiple Plans.

Proficiency with data extraction and file manipulation using a variety of data sources in Inovalon, SAS and SQL.

Supporting state required Non-HEDIS quality management reporting where applicable.

Created programs and analysis of data from several Data Warehouses for Quality and Medical Analytics.

Developed and maintain Disease Management Dashboards for a high-level overview Per Line of Business and tracked monthly/quarterly for certain disease/conditions.

Produce CAHPS reporting projects for all health plans for annual required reporting.

Submission using NCQA Interactive Data Submission System (IDSS).

Evaluate HEDIS requirements by monitoring and reporting on key performance indicators on a weekly and monthly basis, identifying trends, issues and potential solutions to those issues.

Assists and support the hybrid medical record retrieval processes.

Collaborate with several Lines of Business to implemented third party vendors and outsourced resources for data collection.

Research, analyze, evaluate and communicate all related HEDIS impacting Medicaid and Medicare.

HEDIS Analytics and Reports, as well as, Gaps In Care reports and Ad-hoc reporting requests.

Prepare HEDIS Road Map and all other documents required by auditors.

Clean, process, and manipulate external and internal data sources.

Analyze HEDIS rates over several years for different lines of business and look for areas of improvement.

Create and maintain monthly interim rate reports for all lines of business.

Collaborate with software vendor, business analysts and stakeholders throughout the HEDIS lifecycle process for multiple plans.

Blue Cross Blue Shield of Delaware 07/2010 to 7/2012

800 Delaware St., Wilmington, DE

Sr. Healthcare Informatics Analyst

Responsible for compiling analytical reports and analysis related to all aspects of medical costs by obtaining historical data, developing reports and analysis of trend fluctuations.

Analytical support for Medical Management initiatives, Provider Contracting, Finance, Pharmacy, and Marketing departments for intelligent decision-making.

Produce Manage Care Tracking Reports for comparison of Admissions, Case Mix Adjusted Admissions, Average Length of Stay, Charge / Admission, Charge / Case Mix Adjusted Admission, Paid / Admission, Paid / Day, Paid /

Case Mix Adjusted Admission.

Experience in the coding structures of hospitals and professional providers.

Evaluate HEDIS requirements, obtain data for reporting and prepare HEDIS reports

Ability to take data sets in SAS, SQL, Access, etc., to perform analysis.

Demonstrates proficiency in eliciting, documenting, gaining consensus and managing detailed business

requirements and functional specifications.

Analyze proposals and counter proposals related to provider contracting and present results to management.

Provide ad hoc reports and analysis as requested by various internal clients.

Compile data for Quality Management area for problem resolution and reporting to external vendors.

Donna Tomasco Page 2

Health Partners of Philadelphia 08/1999 to 05/2009

901Market St., Philadelphia, PA

Sr. HEDIS Analyst/Project Lead

Collaborates with business data owners to develop, analyze, maintain and submit reports used to measure, monitor and manage quality of care, service, compliance and quality improvement initiatives.

Developed and utilize knowledge of databases, information systems, managed care, Medicaid/Medicare/CHIP population, statistical tools and analytical principles to analyze quality outcomes that support strategies for managing health plan performance.

Participates in quality initiatives by assisting with data analysis, project design, inter-rater reliability studies and project documentation.

Proficiency with data extraction and file manipulation using a variety of data sources in Access, SAS and SQL.

Ability to take data sets in SAS, SQL, Access, etc., to perform analysis.

Compiled and analyzed data including comparison of outcome measures to benchmark, identifying trends, completing barrier analysis, and assisting in the identification of activities to reach performance goal. Set goals and percentile and ranking.

Facilitates the gathering and analysis of all business requirements and defining information systems solutions to address complex business needs for the assigned program domain.

Support systems to provide trended data related to member satisfaction, complaint and appeal processes, provider satisfaction, provider access and availability, provider performance, and other areas required for the quality program evaluation.

Participated in job sharing projects with Operations Management, Disease Management, Quality Management, Pharmacy, Finance and other departments.

Coordinated clinical and pharmacy focus study activities, serving as project lead, as assigned.

Translating business requirements into conceptual, logical and physical data models.

Establish and maintain source -destination mappings, document metadata;

Experience in claims operations with knowledge of claims coding techniques, including CPT and ICD9 coding.

Managing HEDIS and CAHPS reporting projects for multiple markets with year-round monitoring and annual required reporting and submission using Data Transformation Services (DTS).

Supporting state required Non-HEDIS quality management metric reporting where applicable.

Develop data validation criteria and perform data validations

Participated in clinical focus study development, data collection, analysis and report writing.

Develop and document Quality Improvement Activities (QIAs) for NCQA accreditation purposes.

Working with Health Plans and vendors to review their programs and processes and develop data collection

strategies for HEDIS/QM reporting.

Managed the hybrid medical record retrieval processes.

Actively participates in plan-wide or state-wide preparation for accreditation surveys and regulatory audits by creating and maintaining compliance roadmaps, as assigned.

Created programs and analysis of data from several Data Warehouses.

Developed Access Database Applications, Tools and Reports for projects for Healthcare Management.

Created multiple databases to support diverse business units including Medicare Risk Adjustment (RAPS), EPSDT, HMN and PEP programs for identifying high medical risk members and to collect information for hybrid measures in HEDIS and Pay for Performance, Appeals & Grievances

Conducted troubleshooting with management and IT as problems in data management systems arise to promote consistency in reporting.

Provide input to business cases and/or proposals, manage requirements change requests for changes to specifications, and provide analysis of costs, resource, and timeline implications as requested during the project life cycle.

Manages third party vendors and outsourced resources to ensure business requirements are successfully implemented.

Donna Tomasco Page 3

Tenet Healthcare/Allegheny Health, Education and Research Foundation

100 Laurel Ave., Cheltenham, PA 1995 - 1999

System Analyst for Managed Care

Primary responsibilities included the supervision of four programmers and various technical/administrative staff.

Developed and maintenance of a Physician Relations, Contract, and Credentialing database in Access.

Served as principal liaison to other departments, served on ad hoc committee to develop system standards and provided support services for Novell Network users.

Evaluate and recommend new software packages and systems for Managed Care.

Installed an enterprise Case Management and Disease Management System.

Maintain data integrity from Payor Plans for data downloads and conversions.

Setting standard for database warehouse.

Provide assistance with debugging, coding, application design, performance, and system software.

Responsible for Network Administration for Novell Network.

Monitor daily trouble tickets. Prioritize and focus Technology Analyst on system problems.

Monitor and provide reports to CIO, directors and managers, and project leaders on current service request activity, backlog, and staff productivity.

Technical Experience:

Software: SAS Enterprise Guide 5.1, SAS (Certification) SAS Base and SAS STAT modules, SQL Server 2008, MS SQL Server Management Studio, SQL, Project Tracking, Microsoft Office 2010 including (Word, Excel, Project, PowerPoint, and Access), Visio, Crystal Reports, Monarch, Hyperion, SharePoint, FACETS

Web Base: Certified HEDIS software – Inovalon QSI and QSHR, McKesson including (CCMS, CRMS, Inter-Qual, Chart Review), MEDecision,

Operating: Terminal Service Client, DB2/2 Data Warehouse, Windows 7

Hardware: Installed and maintained various routers, remote and local communications, modems, Token Ring, and Ethernet Adapters

Other Experiences:

Staff Member/Writer for newsletter had column called The Computer Corner.

Software Specialist for Secret government program.

Education

Attended Business/Computer School in 1986 and have taken various computer, technical and training courses.

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