Data & Analytics Leader with PMI, SAS, MBA
Resume:
Brenda M. Morinia
*******@***.***
Jamaica, NY 11434
Summary of Achievements
ETL Processing is done to load provider credentials from multiple hospitals into one centralized Database.
Microsoft Access was used for this process, because it was the only software available at this time.
As Anthem acquired hospitals, conversion programs were written in SQL running in SAS for macro processing.
All data was extracted through ETL processing to one standardized format.
Combined 10 Daily Reports into one interactive Excel Spreadsheet using SAS Macro Processing and VB code in Excel.
This gave the save functionality as Tableau using Excel
Throughout my career, I have successfully written and supported large-scale analytical spreadsheets and flat files.
Within the last 15 years I have done major exploratory analysis for specific requests from upper management. This was primarily done to find out why there were discrepancies in final totals when doing QA of input data. I also did a lot of troubleshooting and/or investigative work to find out why claims were being rejected in rare circumstances.
I did major clean-up on “messy datasets”, by standardizing the data through conversion programs. This usually happens when an outside vendor is changed.
The closest I got to hypothesis methodologies was in risk score calculations. I identified outliers in within a certain group, which was based on age, Sex, numbers (i.e. blood pressure, cholesterol levels, BMI index, residence, and education. Numerical calculations were done for averages and outliers. I worked with an epidemiologist to deep dive what was going on.
The closest I go to P-value interpretation is in the calculation of risk scores for thousands of patients. Based on certain criteria to see if the actual numbers aligned with the expected totals. When there was a significant number of outliers, “deep diving “was done to see where the problem was.
Created an automated process using one SAS Control Card and SAS Generation Datasets to eliminate all manual creation of datasets which originally required days to run and changing of dataset names. A control file generated in SAS was the only change necessary to run the monthly process. I was awarded a plaque and received a salary increase for the automation and reengineering of the AVIS Yield system.
Created a multi-faceted report which identified claims that were in a pend/reject status with a member diagnosis that prevented the company from risk adjusting on the respective diagnosis. The project had originally been categorized by IT as not having the necessary bandwidth (resources to do the job). I was able to write multiple programs in SAS for 22 Medicaid states using a control file and SAS macro processing. This identified hundreds of claims in error and calculated aggregated totals at different levels of loss revenue.
Converted 5 hospitals credentialing systems into one centralized credentialing system when North Shore LIJ purchased several Long Island Hospitals.
Converted COBOL programs to JAVA for consistency of code.
Automated several Claims Report to split the report into separate tabs to be given to each claims’ examiner every morning. This task was being done manually every morning by hand.
Converted Cobol module to Easytrieve to be able to run logic outside of COBOL.
Responsible for contracting one of the largest Health Care Provider groups in Northeast for Epic Payer Platform.
Automated manual process of updating file to feed to CMS
Project Manager for Medicaid Risk Adjustment Processes
BUSINESS APPLICATION/AREAS SUPPORTED
Retail Employers: Avon Products, Bristol Myers, and Zale Corp – Programmer Analyst
General Business Applications: Inventory, Human Resources, Sales, Marketing, Finance, Payroll, Operations Research, General Ledger, Fixed Assets, and Capital Projects.
Healthcare Applications: Credentialing, Actuarial Reporting, Claims Processing (Provider, Hospital and Pharmaceutical), Medical Management, and Risk Adjustment, Compliance, Policy and Regulatory Reporting, Marketing, and Product Support. Medicare and Medicaid Risk Adjustment, Value Base Care
Software Development: Systems Analysis and Reengineering of Systems, Programming, QA Testing, Data Compliance, ETL Loads. Data Mapping, Table Design. Project Management, Database Administration, CICS Tables. IMS DBA, QA Engineer: QA Software at Computer Associates.
Skills
Base SAS and SAS Enterprise Guide with Macro Processing; SQL Server; Oracle Server; Databricks, /SQL; SSIS; Snowflake; Microsoft Office, Microsoft Access, and Microsoft Excel with Visual Basic). Tableau, MS Project; Data Analysis; Business Analysis; Microsoft Power BI; R; Pivot Tables, JAVA, IBM Mainframe to Client Server platforms; Power Point; COBOL, DB2, and IMS for legacy systems. Creation of Charting and Dashboards for Medical Management Team, Agile Training, Base SAS Certification, PMP Certification. Project Manager; Lead Analyst/Programmer experience; Project Management; Systems Design; DBA; QNXT Claims Workflow; Systems Programmer. Claims Processing (Institutional and Professional). Proficiency in Macro Processing in both SQL Server and Oracle SQL in SAS, Snowflake and Databricks; Strong VB skills in both Access and Excel (VLOOKUP, If/Else, Match, Index) SQL code was used in excel in VB for macro processing in Excel.
Summary
Over 25 years of Experience in Business/Systems Analytics with 15 years in Healthcare Data Analysis, (rejected claims analysis), Credentialing, Risk Adjustment, Support of Medical Management Team in outreach and home visitation and Value Based Quality Care Analysis. Reporting and analysis done multiple reimbursement models, inclusive of FFS, capitation, shared savings and risk contracts.
Professional Experience
VNS Health System New York, NY
Data Analyst 10/2024 – 02/2025
Programming on both SAS and Snowflake platforms
Financial Analysis for quarterly submittals to NYS Department of Health
Identified potential issues in CMS submissions especially risk adjustment due to Product vs LOB
Value Base Care Analysis
Apex Systems Richmond, VA
Data Analyst (Contractor) 09/2023 – 01/2024
Led the implementation of data-driven strategies to optimize managed care contracts, improving financial performance by aligning incentives between providers and payers.
Onboarded providers into Epic System
Monitored Requests on Work Front
Analysis of Potential Provider Groups for Epic Payer Platform (EHR System)
Identified Provider Groups that were a part of a corporate merger/sale for Provider Group NPI Numbers
Initiated demos for potential Epic Payer Platform customers.
Identified issues with Risk Adjustment errors in NPI numbers causing CMS acceptance failures
Extracted Member Data from Epic Payer Platform
Molina Healthcare Long Beach, CA
Data/Risk Adjustment Analyst 08/2022 – 07/2023
Creation of Excel Spreadsheet with new payee invoice information
oManually input vendor payee information into Excel spreadsheet into one common format
oWrite program in SAS to load data from Excel spreadsheet into Payor Table
oWrite programs to QA Payor Table for errors
oAutomated processes to QA input from outside vendors causing rejected claims from CMS
Ad-Hoc Reporting and Data Cleansing. Snowflakes are used for data cleansing.
Analysis of claims rejected by CMS. Analysis of Reason and Solution – SAS used for all data extractions
Aggregation of Financial Data for reporting – SAS and SQL Server used for Data Reporting and Analysis
Analysis of claims data to assess the effectiveness of managed care contracts, identifying opportunities for cost reduction and improved patient care outcomes in both fee-for-service and capitated environments
Updated state risk score weight tables for each state as necessary
SSIS Deployment to SQL Server.
Project Manager for Data Feeds from External Vendors
QA of NPI codes for Missing and Incorrect Codes
Metroplus New York, NY
Financial Analyst 01/2022 – 05/2022
Ad-Hoc Reporting and Data Cleansing
Automation of data extraction from reports into data files using Excel Macro Processing in VB
Conversion of SQL programs to SAS for automation purposes
Extraction and aggregation of data for Financial Data Review relative to user request
i.e. period, Provider Group, PCP, Hospital, Diagnosis (CPT) Code,
Prescription (NDC Code)
LIFQHC Westbury, NY
Data Analyst - Contract 07/2021 – 12/2021
Reengineering processes to ensure maximum return on gaps and care analysis and in compliance.
Creation of Supplemental Data Files for submission to CMS through extracts from EMR System
For multiple Health Care Carriers
Supplemental data files created using required CPT Codes identified as missing and needed to increase Quality scores (i.e. blood pressure screenings, cholesterol screenings for diabetes mellitus, diabetic retinopathy, diabetic foot exam, bone density, heart rate
Anthem Health New York, NY
Advanced Analytics Consultant (Actuarial Group) 08/2015 – 02/2020
Lead Analytics Team Members in Risk Adjustment calculations for their respective state
Project Manager for Risk Adjustment/Loss Revenue Project
Risk Adjustment Analysis and Data Quality checks for Payment Integrity and Procurement.
Evaluated the financial impact of managed care contracts by comparing fee-for-service and capitated rate models, leading to actionable insights that improved revenue cycle efficiency and strategic planning.
Conducted comprehensive risk adjustment analysis utilizing hospital, provider, and pharmacy claims data to inform managed care contracts, optimizing cost management and enhancing care outcomes for Medicaid, Medicare, and commercial populations.
Integrated SAS macro code supplied by SAS Inc into my SAS programs for HCC hierarchical processing to ensure correct Risk Score calculations.
Proc SQL and Macro Processing are used for automating SAS programs.
Computer languages such as “R”, Python and Power BI were used more for Data Visualization and Data Modeling.
Emblem Health New York, NY
Lead Business Data Analyst 02/2014 – 07/2015
SAS Reporting and analysis of both Institutional and Professional Claims.
Automation of Daily Assignments for Claims Processors
Concatenation of Actuarial Data and Provider Data for side-by-side presentation for user
Conversion of Mainframe programs to Oracle SQL and SAS Macro Processing
Oracle PL/SQL used in SAS Enterprise Guide using pass-through queries
Healthfirst New York, NY
Information Analyst/Marketing Analys 08/2010 – 01/2014
SAS is used for all Data Extractions and Excel reporting. Both Base SAS and SAS EG
Worked with an actuarial team to pull data from the Chargemaster to extract rates for invoicing.
Provided systems analysis for Medical Management, Product Management, and Marketing Departments.
Worked with client and project team members to develop specifications of data management systems.
Determined scientific and statistical needs for the project. Writing specifications for new database system.
Analyzed plan’s structured and unstructured data across different systems and platforms through various data manipulation and merging techniques to develop advanced statistical/modeling analyses.
Education and Certifications
Dowling College, MBA, Management May 2010
PMP Certification Sep 2017
SAS Certified Base Programmer for SAS 9 Sep 2016
Affiliations
Project Management Institute – New York State Chapter of PMI
Awards
Health Care Analytics – Excellence in Analytics – (Actuarial Team) Anthem 2015 and 2016
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