Data analytics, business analyst, BI Intelligence Developer

Juan Lopez

Brandon, Florida *****

813-***-**** • adcrl6@r.postjobfree.com • adcrl6@r.postjobfree.com

Senior Business/Product Development Analyst

Multifaceted technical professional with 15+ years’ experience maximizing performance and profits

Technically sophisticated business analyst is adept at optimizing operational processes to achieve business goals, reduce costs, and increase revenues. Strategic thinker able to effectively communicate data-driven solutions across all levels of the organization. Talented relationship builder successful at partnering with senior operations leadership, internal management, and external clients to gather and understand business objectives, needs, and processes.

Core Competencies:

Requirements Gathering

Functional Specifications

Workflow Analysis

Data Analysis / Validation

Change Management

Project Management / Scoping

Operations / Collaboration

Problem Solving / Risk Mitigation

NCQA Quality Measures

BI Dashboard / Reporting Analytics

Provider Health Systems

Healthcare BI Systems

MEG and DCG Cost Groups

HIPPA Claims, Benefits, Eligibility

QA / Testing/ Scripting

Professional Experience

Blue Health Intelligence, Tampa, Florida

Senior Business Data Intelligence Report Analyst / Supervisor, 7/2012 – Present

Serve as the consulting agent for the development of Blue Cross Blue Shield custom reporting and dashboards. Build QlikView BI objects to render Employer-driven KPIs for healthcare data. Develop and refine methodologies, tools and templates in support of successful analytic deliverables. Ensure code versioning aligned with new releases, troubleshoot table data content to adhere with visualizations, and test BI object and calculations.

Key Projects:

Evaluated requirements for new client requests of reporting tool products – dashboards and metrics. Provided recommendations to the Product Manager in the complexity of implementation of particular items based on the existing BHI BI system environment. On average, the number of client requests exceeded 15 user stories per month. Coordinated with the technical team, the feasibility of making changes to the existing system or new implementations.

Reporting and Compliance: Developed 60,000+ monthly, quarterly, and ad-hoc reports system including executive summaries, member and financial KPIs; sampled reports to ensure compliance with business requirements; Collaborated with product managers to define requirements and resolve client concerns. Build scripting logic in CIApartners’ Report Manager software to extract, transform, and load data for the build of dynamic and static report books

Analytics: Analyzed random samples of the facility, professional and pharmacy claims (based 0n 25+ million members’ claim system); Verified data transformation accuracy; Built applications to visualize member and claim data via KPI’s graphical charts and objects; Interpreted Inpatient and Outpatient metrics based on claims/member data.

QA / Testing / Scripting: Assisted QA team with the build of possible scenarios for proposed testing of new deliverables, highlighting critical impact aspects sections and upon receipt of QA outcomes, review and analyzed failed items for a corrective course of action. The process was managed via the JIRA issue resolution system through scrum meetings and workflow management. On average, resolved 45 issues per month.

Business Intelligence: Liaised with Product, BHI Client Services team, Technical, QA, and Project Management to define BI requirements; Documented changes included but not limited to Episodic Measured Conditions to measure risk member use of high-cost services; Analyzed provider-based claims and enrichment data.

Key Health HMO Plan, Tampa, Florida

Consulting - Healthcare System Integrator, 9/2011 – 6/2012

Developed critical Business Intelligence (BI) analyses, including enrollment trend reports, member billing invoices, broker commissions, pharmacy utilization, subrogation and reinsurance, and financial case reports.

Key Project:

Operations / Collaboration: Coordinated user requests and issue resolution for operational system processes; documented workflow of IT processes; Served as SME for performance quality initiatives.

WellMed Medical Management/UnitedHealth (Acquired Citrus Health Care in 2010), Tampa, Florida

Senior Business Analyst, 5/2010 – 9/2011 (WellMed Health Plans)

Advised business managers and IT directors on plans for system migration. Served as the key contact for regulatory audits of QA systems. Developed interim system processes to support critical business functions during the migration, including pharmacy, appeals and grievances, customer service, authorizations and referrals, providers, claims, fulfillments, and enrollments.

Key Projects:

Change Management: Supported multi-disciplinary teams for the migration of Citrus Health data and infrastructure to WellMed headquarters and third-party organizations; Created position papers, data mappings, flowchart diagrams and documentation related to the transfer of Medicare/Medicaid systems;

Project Management: Managed Citrus Health interfaces and ancillary providers to ensure business continuity and transfer of processes to the new system environment.

Data Quality Implementation: Liaised with key UnitedHealth Group directors to build CMS’ patient-center initiatives (cardiology, oncology, hip replacement) for quality and safety for retirees; Developed SQL-based scripting code to support those initiatives.

Senior Business Process Analyst, 7/2008 – 5/2010 (Citrus Health Plan)

Served as a trusted advisor to management on the effort to develop system enhancements, improved services, and quality initiatives between Member-Provider and HMO relations for at-risk chronically-ill members. Analyzed complex Medicaid claims data to audit quality performance rates, including coronary artery, diabetes, hypertension, antipsychotic medications interactions, child and women well care, and HIV.

Key Projects:

Regulatory Compliance: Served as the lead liaison for Quality Improvement Standards, including NCQA-2008 and CMS Regulatory reporting measures; Designed and developed end-to-end system processes to capture performance measures requirements; Documented regulatory conformance process requirements.

Continuous Improvement: Defined requirements and built SQL system process implementation scripts for the formation of member ID card/fulfillments, member complaints, and regulatory reporting; Collaborated with off-site IT development for translation of business case requirements to functional requirements.

BayCare Health System Tampa, Florida

Managed Care Contract Analyst, 8/2005 – 6/2008

Created ad-hoc reporting and monthly market-driven reports. Coordinated claims and appeals meetings with hospital CBO offices. Produced reports and data analyses to assist with resolutions of contract negotiations and reimbursements. Trained hospital staff users on the Envision Claim system and development of Crystal Reports.

Key Project:

Vendor Negotiations: Developed parameter-driven revenue modeling reports used by the company Vice President when negotiating contracts with Managed Care Organizations; Designed complex hospital claims reports to support Six Sigma Black Belts for the measurement of crossover projects between BayCare hospitals and contracting managed care payers.

Prior Experience

Senior System Manager at Centers for Medicare & Medicaid Services, Baltimore. Maryland

Technical Proficiencies

Platforms:

MS SQL 2008; Windows NT, 7, 10; MS Office 365 and Office 16; CyberArk

Tools:

CIA Partners Report Manager, SQL (T-SQL, SSIS, SSRS), QlikView, MS Word, Excel-Advanced MS Access-Advanced, Outlook, PowerPoint, MS Development Tools, SFTP, Crystal Reports, CMS, Visio, Web Page WordPress development

Data:

Datamart/Data Mining, Database, ETL, TFS/JIRA Tracking, Healthcare KPIs analytics and metrics, Regulatory Reporting, ICD-9 Codes, BI Visualization, Prototyping, SDLC

Education and Credentials

Master of Science in Business Administration, Concentration in Management

Johns Hopkins University, Baltimore, Maryland

Bachelor of Arts in Information Systems

Barry University, Miami Shores, Florida

Professional Development

QlikView, BI Tools, Accounting, Statistics, Crystal Reports, MSQL 2008, Relational Database Concepts

Microsoft Office Tools, Advanced Access and Excel

On-the-Job Training

Requirements Development and Tracking Use Case Development System Requirements Crosswalks

HIPPA Privacy and Security Compliances Change Management Fundamentals of Six Sigma

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