Machine Learning Market Research

Mark Ireland MA, Statistics

**** ********* ******, *********, ** 48197-7167 (734-****-**** **********@*****.***

KEY COMPETENCIES

Statistical experience designing and executing predictive models that optimize financial, risk, marketing, and healthcare initiatives. Increased sales by using market research tools such as segmentation, digital attribution, and key drivers of satisfaction using survey research techniques. Application of predictive models and time series models for financial forecasting in several industries. Statistical sampling of large data sets for audit and refund projections that has saved the healthcare industry millions of dollars. I have that identifies key drivers.

More than 20 years of experience applying statistical analyses, predictive modeling, and SAS/R/Python programming across healthcare, financial, and mortgage industry data. Strong ETL experience ensuring data integrity and quality.

Statistical and programming support for disease management, quality improvement activities for NCQA accreditation, survey research activities, and support of legal and medical policy divisions of the health care industry

Experience in statistical detection of potential fraud, predictive modeling, and creation of mathematical and statistical models that measure risk

Over 25 years of experience as a professional statistician, with statistical expertise in multiple linear regression, cluster analysis, PCA and multivariate techniques, time series and forecasting, logistic regression, decision trees, neural networks, support vector machines, data mining, descriptive statistics, and meaningful graphical techniques

PROFESSIONAL EXPERIENCE

INDEPENDENT CONSULTANT/CONTRACTOR

STATISTICAL AND DATA SCIENCE CONSULTING

FEBRUARY 2022 – PRESENT

Major client was FL BCBS from 2/22 through 6/22, offering predictive modeling expertise

CORTEX ANALYTICS – REMOTE

DIRECTOR OF ANALYTICS

APRIL 2021 – FEBRUARY 2022

Lead all analytical activities of a healthcare software and consulting company including risk adjustment, quality and utilization analyses and management, care and disease management, predictive modeling, and database coordination and ETL

Utilized Natural Language Processing to train predictive models that included Electronic Health Records as predictive variables

Train, mentor, and direct all activities of the healthcare programmers and data scientists

GDIT / ELIASSEN – REMOTE

SENIOR DATA ANALYST

NOVEMBER 2020 – APRIL 2021

Created predictive models and analyzed Part A. Part B, and DME utilization for Medicare Fraud, Waste, and Abuse development

Re-programmed legacy SAS predictive modeling programs into Python

INFINITE COMPUTER SOLUTIONS – REMOTE

HEALTHCARE STATISTICIAN

FEBRUARY 2020 – NOVEMBER 2020

Develop risk stratification and analytical models for a Care Management System using Python

Developed Natural Language Processing (NLP) techniques in Python to examine patterns in Electronic Health Records (EHR)

IBM WATSON HEALTH, ANN ARBOR, MICHIGAN

MODELING LEAD

MAY 2017 – NOVEMBER 2019

Worked with an IT Team to develop a database used for Healthy China 2030, creating synthetic healthcare claims data and assuring clinical plausibility

As a member of a core team of programmers I implemented statistical computing and SAS/WPS programming for the QEYAS Dubai Hospital Quality Measurement project to develop Provider Quality Measures for Dubai facilities

Lead a team of statisticians and programmers to develop the FPS2 Fraud, Waste, and Abuse platform for the Centers for Medicare and Medicaid Services (CMS)

JACKSON-DAWSON, DEARBORN, MICHIGAN

DATA SCIENTIST

FEBRUARY 2017 – MAY 2017

Created predictive models that identified key characteristics of automobiles to present to various market segments for advertising

COMCAST SPOTLIGHT, BINGHAM FARMS, MICHIGAN

BUSINESS INTELLIGENCE ANALYST

OCTOBER 2015 – SEPTEMBER 2016

Used Time Series Models to forecast revenue for advertising lines of business within the Finance Department Identified business opportunities to implement financial corrections to increase revenue.

NCI/ADVANCEMED, GROVE CITY, OHIO

SENIOR STATISTICIAN

APRIL 2015 – JULY 2015

Used multivariate statistical modeling and predictive analytics to fight Medicare Fraud, Waste, and Abuse

QUICKEN LOANS, DETROIT, MICHIGAN

STATISTICAL ANALYST/DATA MODELER, MARKET RESEARCH TEAM

AUGUST 2012 – FEBRUARY 2015

Developed statistical models to prioritize business leads, supported market research efforts, and built statistical models to identify market segments

Worked closely with internal marketing and mortgage banker clients to ensure the integrity of statistical models that were used for marketing attribution, using parametric and nonparametric approaches, including such methods as survival analysis and classification and regression trees (CART)

UNITED HEALTH GROUP – OPTUMINSIGHT, MINNETONKA, MN

PRINCIPAL STATISTICIAN

JULY 2011 – MARCH 2012

Developed reports and constructed statistical models using SAS® that analyzed and modeled professional claims data for utilization review and fraud detection

HEALTH PLAN OF MICHIGAN, DETROIT, MICHIGAN

SENIOR MEDICAL MANAGEMENT ANALYST

MARCH 2011 – JULY 2011

Developed reports, graphs, and statistical analyses for a Michigan Medicaid HMO

SAFEGUARD SERVICES, LLC (SGS), MIRAMAR, FLORIDA

STATISTICIAN

JULY 2007 – MARCH 2011

Designed innovative statistical models to identify aberrant Medicare providers across all task orders, drew statistically valid random samples for the state of Florida, and performed ad hoc statistical analyses

WELLPOINT, INC., INDIANAPOLIS, INDIANA

LEAD DATA MINING STATISTICIAN, STATISTICAL ANALYST III

FEBRUARY 2002 – JULY 2007

As a Lead Statistician, led a team of data mining analysts to support the Benefit Integrity and Medical Review departments of a durable medical equipment (DME) Medicare contract by mining a large data warehouse to search for suspicious provider practice patterns. Worked with federal law enforcement to assist in identifying DME providers that were fraudulently billing Medicare and conducted audit samples for projected provider overpayments. Provided the Medical Review department with statistical analyses that helped drive medical policy.

As a Statistical Analyst III, worked closely with Wellpoint’s Medical Directors to create statistical analyses that would identify providers who might benefit from provider education on proper usage of procedure codes. Gave presentations to the Centers for Medicare & Medicaid Services (CMS) outlining innovative statistical models and data analysis techniques. Developed state-of-the-art statistical models to measure utilization for the identification of audit candidates and to drive medical policy. Supported both contracts with statistical consultation as needed for ad hoc analyses.

HEALTH CARE EXCEL, INDIANAPOLIS, INDIANA

SURVEILLANCE UTILIZATION REVIEW STATISTICIAN

DECEMBER 2000 – FEBRUARY 2002

Provided the Surveillance Utilization Review department with statistical support to identify, sample, and audit Indiana Medicaid providers

Developed statistical models that assisted in the development of medical policies

Provided statistical consultation for ad hoc projects and served as a statistical expert for the state of Indiana in defense of audit sampling methodologies

BLUE CROSS OF NORTHEASTERN PENNSYLVANIA, WILKES-BARRE, PENNSYLVANIA

MANAGER, STATISTICAL SERVICES

DECEMBER 1995 – JULY 2000

Led a team of statisticians to support the Quality Management department using statistical design and implementation of all outcome studies and quality improvement activities

Provided statistical support of all quality of care and customer service initiatives as prescribed by the National Committee for Quality Assurance

Developed utilization management profiling models to measure over- and under-utilization and to track provider performance across specialties and regional teams

BLUE CROSS AND BLUE SHIELD OF MICHIGAN, DETROIT, MICHIGAN

HEALTHCARE RESEARCH STATISTICIAN

JANUARY 1990 – DECEMBER 1995

Developed Provider Profiling systems to measure facility performance versus Peer Groups

Draw statistically valid random samples of paid claims by facility and compute overpayment projections for the Provider Audit department

Supported the Medical Policy and the Legal departments with statistical analyses and estimation

TECHNICAL EXPERIENCE

SAS, SPSS®, R, Python, SQL, Power BI, Microsoft® Office Suite (Excel, Word, PowerPoint, Access)

EDUCATION

MA, Statistics, University of Michigan, Ann Arbor, MI

BS, Statistics, University of Michigan, Ann Arbor, MI

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