LaShonda Mcknight

Senior Data Analyst

ad3f6m@r.postjobfree.com • 225-***-****

Addis, Louisiana

Summary

Accomplished and detail-oriented professional with 15+ years of experience reviewing large and complex data sets and documents to investigate medium to highly complex fraud, waste, and abuse activity. Proven track record of identifying and mitigating fraud risks through analysis of complex data sets and conducting thorough investigations. Exhibit capacity to communicate complex findings to both technical and non-technical stakeholders in a clear and concise manner. Demonstrate expertise in delivering high-quality, data-driven insights to drive business value and facilitate strategic decision-making. Possess exceptional communication and interpersonal skills; adept at establishing collaborative and goal-achieving relationships with regulatory agencies and law enforcement while guiding and assisting SIU team members to ensure effective and successful fraudulent case resolution.

Areas of Expertise

Data Analysis

Data Visualization

Investigative Analysis

Data Mining

Strategic Planning

Business Intelligence

Risk Management

Training & Development

Team Building & Leadership

Technical Skill

Microsoft Office Suite MySQL Tableau JIVA Facets & ITS Access Data Pulls Blue Web ILink Blue Edifecs Common / Provider Query Financial Investigations Case Log (FICL) Fraud and Abuse Management System (FAMS) TLO ChatGPT Microsoft Power Platform Workday Epic Payer Platform

Professional Experience

Blue Cross and Blue Shield of Louisiana, Baton Rouge, LA 2006 – Present

Senior Fraud Informatics Analyst Fraud Informatics Analyst, 2021 - Present

Perform fraud prevention measures through scrutinizing anomalies, researching emerging trends associated with suspicious activity, and thoroughly documenting analysis. Utilize data analysis and visualization techniques to identify trends and patterns, generating actionable intelligence for reporting and recommendations to top-level management. Collaborate as a member of medical coding committee to revise and identify discrepancies. Evaluate, test, and scrutinize software and systems for seamless integration into current departmental applications. Employ reporting tools, queries, and applications to configure new reports and dashboards. Validate accuracy, completeness, and consistency of departmental output by peer reviewing medical and pharmacy claims data and procedures. Monitor fraud, waste, and abuse by developing dashboards using various tools and using data analysis, collection, and research to detect emerging trends.

●Transformed the fraud department by demonstrating exceptional skills in managing a large caseload, processing complex data, and cultivating strong relationships with multiple departments, resulting in multiple promotions from Fraud Analyst to Fraud Informatics Analyst, and ultimately Senior Fraud Informatics Analyst.

●Collaborate with fraud investigators and IT Teams, to implement and test the updated workflow processes, monitoring their performance and fine-tuning as necessary to ensure optimal fraud detection and mitigation.

●Recovered millions of dollars from fraudulent providers through effective detection and prevention of fraud, waste, and abuse.

Fraud Analyst, 2015 - 2021

Conducted 80+ intakes, triages, and research of fraud/abuse allegations simultaneously while consistently meeting high-quality standards. Provided accurate documentation, generated compelling evidence, and presented findings to management with possible plan of action. Performed complex data analysis, reviewed reports from CMS's Outlier Prescribers of Controlled Substances, and peer comparisons to identify and expose fraud and abuse schemes with high accuracy.

●Successfully implemented medical policies to curb overuse of CPT codes in collaboration with medical directors.

●Streamlined fraud investigation process by effectively triaging fraud allegations and referring cases to investigators, resulting in increased efficiency.

●Worked with our accounting department to set a process up for repeat non-sufficient funds (NSF) members and meticulously analyzed financial transactions to detect and prevent fraudulent activities.

Appeals & Grievance Analyst, 2012 - 2015

Investigated claims, contracts, and medical policies to ensure proper appeals process. Maximized overpayment recovery and maintained financial stability by reviewing processed claims. Presented committee members with comprehensive second-level appeal cases.

●Contributed to enhancement of legal contracts by collaborating with legal department and updating language in provider and subscriber manuals.

Additional Experience

Call Center Specialist, Blue Cross and Blue Shield of Louisiana, Baton Rouge, LA

Education

Master of Business Administration

Louisiana State University, Shreveport, LA

Bachelor of Science in Criminal Justice

Southern University and A&M College, Baton Rouge, LA

Professional Training

Professional, Academy of Healthcare Management (PAHM)

Licenses & Certifications

Google Data Analytics Certificate

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