Anix Vyas

Healthcare Analyst / Consultant

E-mail: ad1ai2@r.postjobfree.com

Phone: +1-717-***-****

Areas of Expertise:

- Business Analysis

- Requirements Gathering

- Health Information Mgmt.

- Managed Care / Outcomes

- Healthcare Payer Systems

- Inpatient Hospital Workflows

- Data Analysis

- HEDIS Measures

- Scrum / Agile

- System Testing / Change Control

- EPIC EMR

- Meaningful Use / Patient Portal

- API Integration for Data Retrieval

- Vendor & Utilization Management

- Social Determinants of Health

- Tableau, Power BI, Clarity

Professional Experience:

Steelton Family Medicine, Steelton, PA December 2022 – Current

HealthCare Business Analyst/ Quality Improvement Lead

Maintain relationships between physicians and technology vendors to enhance clinical data utilization.

Develop requirements and oversee actionable items to completion for clinical practice growth, wellness, and quality outcomes.

Perform analysis, track outcomes, and present findings, strategies for improvement (PowerPoint) to physician stakeholders.

Develop SEO (Search Engine Optimization) strategy, identify low-competition keywords of medical practices in local geographic areas for increasing website traffic and patient acquisition.

Conduct research and document current trends in healthcare, therapies, patient needs, inquiries, with regards to promoting education and sustainable healthcare guidance.

Ciox Health, Alpharetta, GA (Remote) January 2021 – August 2022

HealthCare Business Analyst /Product Owner

Served as the primary liaison between stakeholders and development teams for creating products that transform raw clinical data into digitized structured meaningful data:

Chase Intelligence Suspect Analytics: Optimize risk adjustment by identifying patients with suspected undocumented conditions appropriate for prospective and retrospective targeting.

NERDS (Normalized, Enriched, Raw, Data, Synthesized): Extraction of raw data that is digitized so clients achieve measurable clinical value for individuals, populations, and operational efficiencies.

SDOH (Social Determinant of Health): Data extraction in a digitized format to support value-based strategies and improve outcomes by identifying socioeconomic attributes (over 400).

NLP (Natural Language Processing): Medical coding application to decrease redundancy and inaccurate code usage and improve accuracy above 95%.

Worked in Agile and assisted the Scrum Master with daily stand-up meetings.

Implemented API and SFTP platforms for requesting/receiving digitized clinical data.

Consulted with stakeholders to define requirements, created epics, and features from user stories.

Worked with medical coders, performed detailed analysis on areas of improvement in the workflow.

Responsible for documenting specifications, creating roadmaps, and wireframes.

Tracked the progression of action items and updated backlog items (JIRA platform).

Facilitated grooming sessions before the end of each Sprint cycle.

Capital Blue Cross, Harrisburg, PA December 2019 – July 2020

Clinical Services Project Consultant, Project Management

Collaborated with Pennsylvania’s Department of Health Services (PDHS) to establish appropriate methods for capturing data, technical systems analysis, and define performance targets for: Emergency Dept. & Inpatient Utilization, Well Child & Adolescent Well Care, Comprehensive Diabetes Care, Breast Cancer Screening, and Controlling High Blood Pressure.

Oversaw a 4-person team working to enhance and evaluate an in-house clinical application used for patient correspondence, wellness outreach, and utilization reporting.

Performed detailed analysis of clinical impacts along with associated risk factors.

Tested software upgrades and presented findings to executives and department directors.

Trained several managers across the company’s clinical departments in the utilization of software.

Capital Blue Cross, Harrisburg, PA June 2018 – December 2019

HEDIS Business & Data Systems Consultant

Evaluated HEDIS (Health Effectiveness Data & Information Set) strategy, updated project roadmaps for multiple Lines of Business.

Revised requirements for data utilization compliance and based on annual updates.

Advised health system partners and clinical leadership on new HEDIS protocols and regulatory standards.

Utilized clinical experience with reviewing patient medical records to support the Population Health and Medical Values departments’ initiatives.

Performed detailed analysis of supplemental data to ensure CMS (Centers for Medicare and Medicaid Services) requirements.

Collaborated with ETL Developers for data mapping and back-end functionality of clinical platforms.

Represented the HEDIS team in the annual audit with NCQA (National Committee for Quality Assurance).

AmeriHealth Caritas, Harrisburg, PA April 2016 – June 2018

Clinical Outcomes Specialist/Consultant

Oversaw company-wide compliance with state and federal healthcare regulations.

Reported quarterly outcomes data to the Pennsylvania Department of Health.

Presented SMEs with updates in HEDIS technical specifications and identified areas for improvement.

Collaborated with the Quality department director to better manage outcomes concerning Super Gaps (noncompliant members).

Enforced use of CPT II codes by some providers and correct listings of individual providers under Federally Qualified Health Center (FQHC) rules that could have resulted in lower HEDIS rates.

Met with provider groups to share data trends and solicit ideas for refinements.

Pinnacle Health, Harrisburg, PA June 2012 – March 2016

Principal Trainer, Epic EMR (In-patient Clinical Documentation)

Led efforts with successful implementation of the EPIC EMR system and trained in-patient clinical staff to a proficiency level.

Leveraged clinical and IT experience to conceptualize workflows before creating a new documentation system.

Facilitated meetings with hospital leadership presenting results on long-term business goals.

Analyzed the new clinical documenting process in an operational environment before going live.

Teamed with department heads and application analysts to draft custom documentation and educational materials for hands-on training.

Pinnacle Health, Harrisburg, PA June 2012 – June 2015

Business Analyst/Project Manager – Quality Improvement

Team Lead for successfully implementing Quality Improvement Initiatives:

Improving Communication Between Clinicians and Admitted Patients

Developed an in-hospital electronic communication system that delivered real-time patient information. I co-designed this as an in-house platform for text messaging patients, to and from staff. This resulted in meeting goals for greater inpatient satisfaction, improved engagement, and raised CHAPS scores.

Meaningful Use – Health IT and Implementation of the Patient Portal

Led a 15-person team that equipped three hospitals for meeting Meaningful Use requirements. This team was successful with also integrating patients/consumers through in-room demonstrations of the patient portal.

Accountable Care Organization (ACO) Admissions/Readmissions Reduction

Worked with the Internal Medicine dept to create solutions for improving hospital admission and readmission rates of ACO patients. Successful in decreasing the 15-day readmission rate by 35% along with decreasing 30-day readmission rates. I successfully trained and oversaw 20 Resident Physicians in data mining and analysis. This project was added to the Internal Medicine Residency Program’s QI rotation.

Get with The Guidelines – Heart Failure Assessment and Improvement

Helmed multidisciplinary team to enhance quality and maximize revenue for Pinnacle Health Cardiovascular Institute (PHCVI) through alignment with guidelines for current heart failure treatment. Analyzed over 300 medical records involving heart failure and developed new standards.

Decreasing Avoidable Emergency Department Visits of Super-Utilizers

Reengineered referral processes to decrease rates of avoidable ED visits. Following detailed analysis and modeling, prescribed better methods to manage medical, social, and behavioral needs of high-risk patients. Met weekly with the super-utilizer Community Health Navigation Network to review outcomes.

Capital Blue Cross, Harrisburg, PA, December 2011 – June 2012

Senior Business Analyst

Curated project plans, improving data repository for HEDIS compliance.

HEDIS Data extraction and analysis

Developed Business Requirements Document (BRD), defined process flows.

Lead the CBC HEDIS team in the annual HEDIS compliance audit conducted by NCQA (National Committee for Quality Assurance)

Additional Experience

Business Analyst, Emblem Health, New York, NY

Business Analyst, RSA Medical, Naperville, IL

Data Analyst, National Foundation for Alternative Medicine (NFAM), Washington D.C.

Data Analyst /Telecommunications Administrator, Ticket Master, Virginia Beach, VA

Researcher/Assistant in Pediatric Surgery, Children's Hospital, Pittsburgh, PA

Education

Doctor of Medicine - Medical University of Silesia

Bachelor of Science in Information Technology - University of Pittsburgh

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