Business Analyst Services Administration

SHALINI SINGH

917-***-**** *******.*********@*****.***

HEALTHCARE ANALYTICS PROFESSIONAL

IT, DATA, BUSINESS & FINANCE STATISTICAL MODELING VISUALIZATION LEADERSHIP Provide leadership in operations, finance and business analysis in managed care and population health analytics and successfully managed company's business strategy planning, analysis operations & data management activities. Essential responsibilities listed are providing leadership in business and system analysis along with reporting, modeling, visualization, critical decision making for implementation projects, key performance metrics development and leading different phases of IT project in business analysis/functional requirements/user testing, prioritization sessions, and supporting business planning processes. Recognized for saving millions of dollars by analyzing medical and pharmacy expenses, improving hospital front end processes and claim operations through clinical and data quality improvement initiatives. Expertise in HEDIS, Encounter Data submission for Medicaid, Medicare, and Commercial population with experience in Value based Reimbursement programs. Identified as 40 under 40 honoree in 2017 by Providence Business News, State of Rhode Island. PROFESSIONAL EXPERIENCE

SR. MANAGER OF VALUE BASED CARE ANALYTICS, 05/2021 TO CURRENT MEDSTAR HEALTH, MANAGED CARE, CORPORATE OFFICE, COLUMBIA, MD Leads Value based care program for ACO – Commercial and Medicare Advantage population. Manages relationships with Clinical, Financial and Operations leaders between hospital system and health plan organization. Creates key performance indicator (KPI) for patient experience, provider satisfaction and population health/quality. Responsible to lead cross functional teams to make data- driven decision making and implement and measure the KPI’s and improvement initiatives. Also, responsible for database design, reporting and visualization development leveraging health plan’s claims data and hospital’s EMR clinical and billing data. Key Accomplishments:

Automated Care Manager KPI Data tracker to help minimize resources spent by developing a tracker template with key data elements on SharePoint list for data tracking and using PowerBI for care coordination metric development.

Database Design for claims data files to successfully import Institutional, Professional, Emergency and Pharmacy Claims for Commercial and Medicare Advantage population.

Demonstrated data analytics capabilities through development of meaningful KPIs for palliative care, diabetes management and readmission rate to baseline current performance, measure quantifiable improvement, and drive outcomes that impact MedStar’s VBC efforts.

Lead ACO Data Integration and Migration meetings for hospital system and health plan.

Co-Lead Enterprise Data Governance Council for health system to streamline internal and external data requests and strategize efficient resource utilization. Management & Analysis Project Management, Leadership and management, Tableau, MS SQL Reporting Studio, SAS Enterprise Guide & Visual Analytics, Minitab Statistical Modeling, Python, Jupyter Notebook, PowerBI, Adaptive Insights, Cognos Reporting Suite, MedInsight Reporting Suite; Healthcare Informatics EDPS, RAPS, NCPDP, EDGE, MMIS Claims Systems, Edifecs & EMS Response Reader, HIPAA X12 Transactions (5010), CRISP Microsoft Office Access, Excel, Visio, SharePoint

Medical Coding CMS HCC Coding – Risk Adjustment; Diagnostic Coding – ICD 9/10 SHALINI SINGH

917-***-**** *******.*********@*****.***

PI ANALYTICS MANAGER, 09/2019 TO 04/2021

MEDSTAR HEALTH, PERFORMANCE IMPROVEMENT, CORPORATE OFFICE, COLUMBIA, MD Manages relationships with PI leaders and key business stakeholders to help in discovering solutions, and work with stakeholders to improve business outcomes. Effectively lead cross functional teams to make data-driven decision making and implement and measure the improvement initiatives. Also, responsible for collecting business requirements, data source identification, dashboard development, reporting, analysis, and interpretation. Skilled in working with operational, financial, and clinical data from disparate sources, including EMR, payroll, general ledger, billing, scheduling, and hospital encounter data.

Key Accomplishments:

Applied a structured problem-solving framework to collaboratively define and resolve complex business problems from data project conception to solution development, sustainment of results, and transition to operational ownership for COVID-19 analytical needs.

Demonstrated data analytics capabilities through development of meaningful KPIs and measurement systems to baseline current performance, measure quantifiable improvement, and drive outcomes that impact MedStar’s business operations. Used both lagging and leading indicators to characterize, troubleshoot and support sustainable change to business processes for PI clinical and financial projects.

Proactively managed and communicated risks and barriers for revenue cycle subgroup process management, managed transition of new processes, trained and coached teams, along with celebrating successes.

Developed and automated Inventory management schema for Critical PPE management for PPE Conservation group and Vaccination Command Center.

Oversee Revenue Cycle analytics to ensure facilities receive actionable insights to improve revenue yield, reduce system denials by $10.5 M, and identified future opportunities across the revenue cycle continuum.

MANAGER OF ANALYSIS, 07/2016 TO 08/2019

NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND, PROVIDENCE, RI Manage, plan and coordinate population health management dashboard and reporting responsibility, composed of staff with data analyst, business analyst and financial analyst with healthcare expertise, to oversee the development & deployment of clinical, financial and encounter programs and any related measures and databases in support of the Analytics department as well as its stakeholders. Responsible for executing analytic plans, providing data for value-based incentive payments for CHC’s, and hospitals. Provide reporting and analytical insights for payor-provider shared risk model. Provide data analysis and reporting for ACO Model development, Medicaid Encounter, EDGE Server, and Risk Adjustment program for Medicare (CMS).

Key Accomplishments:

Developed business intelligence dashboard and reporting package for provider group and medical management group to provide population health management insight.

Directed business architecture and design for reporting database for behavioral health and pharmacy SDLC implementation through completion.

Led business requirements, User Acceptance Testing (UAT) and reporting requirements for Medicaid, Exchange, and Medicare Advantage Population product deployment. SHALINI SINGH

917-***-**** *******.*********@*****.***

Implemented Budgeting Software (Adaptive Insights) to support 20% growth of over $1B annual budget and forecast reporting and managing budget’s financial analysis.

Streamline operations while ensuring accuracy by developing and implementing complex month-end medical expense reporting and risk gain share reporting, offline payments, and general ledger system reconciliation process.

Increased cost information accuracy while significantly decreasing resource requirements by designing Price transparency tool for members and providers as per Office of Health Insurance Commissioner requirements.

Developed Provider Contract Impact Analysis model by implementing set of value-based strategy models used by different provider groups.

Design enterprise wide Project work and Data Request tracking system (JIRA) and conducted training for each department.

PROJECT LEAD, 07/2014 TO 06/2016

NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND, PROVIDENCE, RI Spearheaded business analysis to improve technical operations organization-wide, completing an average of two Claims Processing software UI design, code review, and programming projects each quarter. Leveraged strong analysis, project management, and technical skills to develop and implement operational improvements to member pricing tools based on analysis, research, and collaboration with cross-functional business representatives. Supported a wide range of complex projects throughout organization by performing advanced analysis and reporting using relational database and creating budgets by accurately determining pricing, margins, and risk. Demonstrated astute project management skills by leading project meetings, developing and delivering progress reports and proposals, and providing requirements documentation and presentations. Key Accomplishments:

Led Encounter Data Project for RI State from requirements gathering to post-implementation, including performing gap analysis, testing of various EDI and XML files for 99% acceptance with Executive Office of Health and Human Services (EOHHS).

Directed project ensure compliance with Office of Health Insurance and Commissioner

(OHIC) regarding Pricing Tool. Led effort to collect OHIC business requirements, collaborating cross-departmentally to create and improve annual reporting process through automation.

Realized $5M gain for FY 2014 budget by leading analysis of revenue gaps observed in nursing home member premium billing issues.

Reconciled payments within acceptable error limit for EOHHS and CMS encounter submissions by collaborating cross-functionally with diverse teams.

Prevented downtime by delivering on-site and training support throughout analysis department for MS SQL, Amisys/Market Prominence Database and Health Rules System.

Created Predictive Analytics for Medicare population on all cause readmissions and high cost member in Medicaid population.

Created data reports and analysis for Shared Savings program for provider reimbursement and reconciliation.

SHALINI SINGH

917-***-**** *******.*********@*****.***

BUSINESS REQUIREMENTS ANALYST, 04/2012 TO 06/2014

NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND, PROVIDENCE, RI Key Accomplishments:

Performed business analysis project goals and expectations by creating business requirements, functional requirements, test cases and process flows for Medicaid Encounter data submission, MedInsight database reporting, and created SQL queries for reporting and data analysis.

Led HEDIS measure reporting and analysis using SAS Enterprise Guide for Lab Data Integration project.

Performed gap analysis of 4010 to 5010 HIPAA X12 for Encounter Data submissions to Executive Office of Health and Human Services, State of Rhode Island.

Created Business Requirement and functional requirement documents for 5010 HIPAA X12 Encounter files as part of EOHHS policy regulation.

Co-led HEDIS and Risk Adjustment Data Validation (RADV) Audit for both commercial and Medicare Advantage population.

Responsible to submit and manage reporting for Medicare-Duals program to Center of Medicare and Medicaid Services (CMS)

Actuals/Budget Cognos Reporting for Institutional, Professional, Pharmacy, Ancillary and durable medical equipment services to Community Health Plans (CHC’s) EDUCATION & CERTIFICATIONS

MASTER OF HEALTH ADMINISTRATION, HEALTH SERVICES ADMINISTRATION & LEADERSHIP STUDIES OUTSTANDING ACADEMIC & LEADERSHIP AWARD

WESTERN KENTUCKY UNIVERSITY, BOWLING GREEN, KY

BACHELOR OF PHARMACY

UNIVERSITY OF MUMBAI, MUMBAI, INDIA

Certifications: Tableau Healthcare Professional Intermediate, Business Intelligence & Analytics, Querying Microsoft SQL Server 2012, R-Data Analytics & SAS Enterprise Guide 1: Querying & Reporting, Quality & Process Improvement, Project Management & Leadership Studies, PROSCI Change Management, Minitab Statistics

Contact this candidate