Data Management Health Equity
Resume:
Consuela Simmonds, MSHI
(c) 407-***-**** (e) ***********@*****.***
PROFESSIONAL SUMMARY
Healthcare analytics professional with over a decade years of healthcare experience. Strong background in data analytics, research, patient data management and utilization. Proven knowledge in generating forward-thinking public health and health equity solutions through various applications of information. Health equity champion with a passion for helping underserved and marginalized populations through strategic planning and discoveries in technology. Extensive data extraction and interpreting experience with a proven track record in health & business enhancing outcomes. Impeccable interpersonal skills, written & verbal. Self-starting problem-solver dedicated to achieving unmatched results across healthcare enterprises while utilizing process optimization and other data management & analytics tools. KEY COMPETENCIES
● Population Data
● Process Development
● Strategic Planning
● Cost Analysis
● HIPAA Compliance
● Stakeholder Collaboration
● Medicare Advantage
● Project/Product Management
● Pharmacy Benefit Management
● Utilization/Operations Management
Technical Skills: Microsoft Office Suite (i.e., PowerPoint, Word, Excel, SharePoint), Avaya communication phone system, Salesforce, RxHome, CRM, IAssist, Cover My Meds, Python, SQL, Colaboratory, SAS, Tableau, Google Suite
PROFESSIONAL EXPERIENCE
AssistRx- Pfizer 2023-Present
Patient Solutions Supervisor
● Performed analysis of healthcare data to detect insights for strategic decision-making
● Oversaw and led a team of patient solutions representatives, providing guidance, support, and training.
● Troubleshot and resolved complex client inquiries to optimize business outcomes.
● Developed and implemented standard operating procedures to streamline processes and enhance efficiency.
● Conducted audits and assessments of internal healthcare data to provide crucial business insights
● Monitored key performance indicators (KPIs) such as call volume, response time, and customer satisfaction, routine reports to management.
● Facilitated training sessions for onboarding associates & executed ongoing training for team members.
● Partnered with internal teams to adhere to government regulatory standards, policies, and procedures.
● Collaborated cross-functionally to resolve complex technical issues.
● Identified areas for process improvement and implemented changes to enhance customer & client satisfaction.
● Maintained working knowledge of industry best practices to consistently improve business model.
● Provided escalated support for complex client inquiries
● Managed daily reports to pinpoint & address trends in data to optimize patient outcomes Copilot Provider Support Services 2022-2023
Program Implementation Specialist
● Implemented and assisted in management of three drug programs
● Aligned as primary point of contact for provider/client support
● Facilitated end-to-end reimbursement process
● Initiated process optimization through data management which increased efficiency by 15%
● Evaluated program success and implemented necessary changes to streamline processes
● Cross-functional collaboration to ensure accuracy and client satisfaction
● Created and maintained data models and dashboards to track key performance indicators (KPIs) and provide actionable insights for decision-making.
● Demonstrated ability to approach complex problems analytically and develop innovative solutions Morehouse School of Medicine 2021-2022
Health Informatics Research Assistant
● Extracted data & conducted investigations on the impact of health informatics on the path to achieving health equity through the intervention of pipeline programs resulting in overwhelming evidence proving that educational opportunities as such effectively drive diversity in healthcare and technology
● Deployed qualitative & quantitative research and analysis strategies to assess participant knowledge & impact while focusing on results needed to engage the healthcare sector.
● Partnered cross-functionally to ensure research and data were in alignment with overall goals for publishing.
● Interpreted data results and applied programming language (Python) to display visual data to emphasize significance of program matriculation. Finalization of data reports
● Responsible for cleaning and converting findings into usable data to promote integrity & optimization
United Biosource Corporation 2017-2021
Account Manager Team Lead
● Managed daily case portfolio (25+) and facilitated end to end resolution for healthcare provider, patient & client resulting in 15% increase in retention.
● Lead facilitator on multiple business improvement projects
● Performed data analysis/extraction to ensure on/off label quality & safety regulations were met
● Timely management of project deliverables to ensure data integrity & quality performance guidelines were met & valuable business insights gained resulting in business enhancing tools
● Conducted weekly patient data collection reports to evaluate trends and increase visibility for value-based care providers
● Supported analytics reporting between internal & external stakeholders including HCPs to expand business relationships and ensure operational methods for value-based arrangements were adhered to
● Demonstrated comprehensive understanding of disease states, medical terminology & pharmacy benefit infrastructure
● Deployed strategies for all aspects of project & worked cross-functionally to implement tasks
● Reported internal/external quality data directly to stakeholders and managed resolution to emerging concerns.
● Training & education delivered to providers on optimizing clinical processes for regulatory standards & patient outcome optimization
● Collaborated with IT team & external vendors for EHR system upgrades
● Implemented quality assurance processes that assured HIPAA & state regulatory compliance AssistRx 2016-2017
Denial Management Specialist
● Collaborated with internal team in developing the infrastructure of the department (30+ employees) by establishing standard of procedures, building out job description.
● Responsible for multiple provider and specialties (50+) offices nationwide to streamline prior authorization process.
● Coordinated with stakeholders to assess project business requirements for IT system enhancements
● Direct patient clinical and demographic data reporting via Excel dashboard to PM daily
● Researched, analyzed, and resolved daily authorization (20-30 cases) processing issues Xerox 2015 - 2016
Eligibility Specialist
● Proficiency in navigation through multiple large EHR databases (3+) to process patient data to enhance workflow & efficiency by 10%
● Demonstrated broad knowledge of data code along with expertise in medical terminology
● Researched, analyzed, and resolved denial management (20-30) issues for process optimization Accredo Health Group 2009-2015
Escalation Supervisor
● Collaborated cross-functionally (6+) to ensure compliance, customer satisfaction, and resolution including de-escalation of an average of 50 daily inbound and outbound cases to improve client approval rating by 15% (member and HCP complaints)
● Analyzed and managed patient UM data to optimize treatment initiation
● Supported policy implementation for underperforming associates & trainees
● Developed working relationships to effectively coach/mentor onboarding team members throughout employee acquisition process (10+)
● Organized and managed performance enhancement methods for process improvement
● Facilitated delivery and development of training content geared towards performance development strategies
● Performed clinical data analysis to report drug related outliers to stakeholders and clients to improve patient compliance
EDUCATION
Master of Science, Health Informatics
Morehouse School of Medicine, Atlanta, GA
Bachelor of Science, Interdisciplinary Social Sciences, Communication Sciences & Disorder University of South Florida, Tampa, FL
Certifications: Good Clinical Practices, 2022
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