Data Analyst Information Technology

C. Jean Adell

Frisco, TX, ***** c 646-***-****

****.******@*****.***

Tools/Methods:

Agile, Waterfall, Scrum, JIRA, QNXT, Facets, SalesForce HIPAA, SOX, PMP; SAS 9.4. Tableau, PowerBI, MySQL, Data- bricks, Oracle, Azure, Cognos, Business Objects, QlikView, MS Project, MS Office, SharePoint, Adobe, SoapUI, Toad, SQL Server Management Studio, Epic and Ultra Edit

Summary:

Experienced Information Technology professional with over 12 years of expertise in the healthcare domain, specializing in Facets, EPIC, SalesForce and QNXT Configuration, Claims processing, and Salesforce. Proven ability to plan, coordinate, and execute projects in a management consulting and global delivery environment. Excellent communication and technical analytical skills with a strong understanding of Agile and Scrum methodologies.

Certification/Training/Education

Scaled Agile Framework (SAFe) Training Certification (2016) Advanced SQL and Databricks (2021) College earned credit towards BS in Industrial Distribution, Eastern Michigan University; not complete.

Molina Health Care

Lead Data Analyst

June 2019 until April 2023

Worked as the Lead QNXT and SQL Data Analyst for the Enterprise Information Management Team (EIM)

Supported Stakeholders and business partner’s programs as the lead SME on look up tools for Claims, Authorization, Benefits, Clinical data, Adoption rate usage, COVID and other customized/ADHOC data report requests

Used data visualization dashboard reporting tools and skills like Tableau, Power BI, Visio, Service NOW, SSIS/SSRS data migration and integration to extract and transform data

Worked as the lead Program Owner and Project Manager on projects requiring Stakeholder attendance

Created data decision queries and statistical analysis using SAS, SQL, TOAD, Power BI on our L1 data- base from QNXT and other Acquisition data based on business requirements

Used Salesforce Health Cloud to help manage member relationships from enrollment through ongoing care management and for automating claims processing

Managed care plans using Salesforce solutions for tracking member health outcomes and ensuring corporate compliance care guidelines.

Integrated data across various business lines from Salesforce to provide a comprehensive view of member information to business Stakeholders thereby enabling informed business decision making.

Improved newly created report asset adoption rates over 70% with training, new releases and FAQ

Knowledge of various Epic modules like EpicCare Ambulatory, EpicCare Inpatient, and Epic Willow

understanding how to use these applications to manage patient records, order tests, document care, and more

Familiarity with the technical aspects of implementing and maintaining healthcare systems

Proficient in data security, technical writing to ensure compliance with healthcare regulations.

Strong knowledge of the backend infrastructure that supports QNXT and Epic, such as databases, servers, and

integration with other healthcare systems. This also includes understanding how to troubleshoot and resolve

technical issues.

Proficiency in using Epic's reporting tools to generate meaningful data and analytics that can improve patient care and operational efficiency.

United Health Care-Remote

Business Analyst Consultant March 2017 – February 2019

Worked on the (STARS/M&R) team for the UHCTransitions application which allows providers to better manage quality by way of closing care flow gaps/measures

Reported CMS QNXT data analytics that rate Medicare Advantage and Part D health plans on quality and performance scores of measures derived from a subset of HEDIS, CAHPS, HOS, Operational and

Administrative measures

Provided technical writing for the creation of requirements/user stories and UAT scripts

Developed and maintained predictive analysis, trending, forecasting and qualitative reporting techniques using SAS, SQL, Access, Excel,

Delivered various project related analytical and report outputs to Stakeholder using basic SQL queries.

Provided defect management results and training support for new application version releases.

oProduction testing, technical writing, regression testing, UAT and defect resolution traceability

Provide ongoing user training to ensure proper implementation and adoption of the solution

o(e.g., post-deployment support and training FAQs)

Cognizant/TriZetto

Benefit Configuration Analyst

2016-2017

Worked as a QNXT Benefit Configuration Analyst responsible for assuring that the data in the plan described the agreement between an eligibility organization and the health plan the organization has contracted with to provide coverage to eligible members.

Worked on both government and commercial plans composed of a group of Benefit Terms under various eligibility organization health insurance plans.

Outlined the specific type of QNXT healthcare services a health plan member is eligible to receive and described the specific cost share, co-pay, covered services, capitation, procedure, diagnosis codes, restriction, limits applicable under the benefit.

Configured each plan's benefits not limited to accumulators, co-payments, deductible options, service codes, restrictions, providers, POS restrictions, EOB/remit reasons, Coinsurance% (if the Coinsurance will apply to the Deductible and/or MOOP and limits.)

Created test plans and UAT results testing excluded services, service groups, benefit services and/or

service groups applicable for benefit to be considered as a Non-Covered or Excluded service.

Dean Health Plan-Madison, WI

Sr. Quality and Business Analyst,

2014 – 2016

Provided EMR clinical insight reports and analytics that helped identify trends, forecasting, monitoring of patient outcomes, and improved clinical practices.

Used SQL queries to manage back end electronic health records, (EHR) stored in SQL databases which made it easy to update and retrieve information improving the accuracy of patient care.

Experienced with the front end where the data are entered by physicians and nurses as well as the backend electronic data warehouse where queries are written to pull stored data from a relational database.

While working at Dean Healthcare, I was involved with the Meta Vance conversion to QNXT. One of the projects I worked on was converting the HL7 data from MetaVance to their EMR system.

oManaged centralized EMR system that involved several data mapping steps to ensure data integrity and compatibility.

oGathered all the data requirement and completed the data extraction in the HL7 format

oExtracted data was mapped to the corresponding fields in Dean’s EMR system.

oEnsured that each piece of data from MetaVance was correctly placed in their new system.

oMatched the data transformation format and structure required by the EMR which involved converting data types and some instances of reformatting date values.

oUsed APIs for transporting the data, testing and validation ensured that the data was accurately transferred and functioning correctly within the EMR.

Provided Behavior Driven Development (BDD) automated test scripts in the Agile methodology to assure the successful Medicare Advantage and Part D data conversions from MetaVance to the QNXT in both waterfall and Agile environments.

Created Gherkin Syntax user stories in Cucumber/Selenium in basic domain Specific Language.

Reported analytics on all system limitations between both applications to identify gaps using ALM Quality Center in the Agile and waterfall methodology.

Created and entered claims test data, enrollment, provider data and eligibility.

Catalyst Health Solutions

Quality Assurance Manager, Pharmaceutical Benefit Management-Frisco, TX

PBM Health Solutions: 2007 – 2010

Managed a team of eight QA Analysts and one Technical Analyst in the design and Project Management of existing and new Pharmaceutical Benefit Plan Designs for the (PBM) Health Care Industry.

Technical Writing responsibilities for all departmental policies and procedures.

Acceptance of integrated manual tests and test plans for all formulary plan parameters prior to automated testing.

Used automated unit testing tool WinRunner to assure accuracy in the drug plan design.

Responsible for assuring accuracy in all documentation (remediation plans, Regression/Parallel testing).

Deliverables of various test plans and scripts for tracking defect resolution in plan designs.

Analyzed and evaluated current and future systems under SAS-70, SOX, URAC, and HIPAA Compliance Audits and alternative methods to solve problems to meet current and future needs.

Defined the client’s intent and financial risks associated with any planned parameter changes.

Amerisource-Bergen- Frisco, TX

Manager of Business Process Management, Pharmaceutical Quality

2006 – 2007

Responsibilities including overseeing large-to-medium sized project management methodologies for change controls.

Managed a team of Business Process Analysts that focused primarily on the audit documentation controls for systems that managed the distribution of pharmaceuticals and related professional services.

Technical Writer for all IT change control and remediation plans resulting from various corporate mergers.

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