Healthcare Data Analyst - Population Health Analytics

Nagalakshmi Rentapalla

USA +1-520-***-**** ***************@*****.*** https://www.linkedin.com/in/nagalakshmi-rentapalla-9a703532b/ SUMMARY

• Healthcare Data Analyst with 6 years of experience across population health analytics, clinical data analysis, and revenue cycle operations, supporting U.S. Medicare, Medicaid, and commercial healthcare programs.

• Proven track record of delivering end-to-end healthcare analytics solutions by translating clinical and business requirements into actionable insights that drive quality improvement, utilization management, and value-based care initiatives.

• Extensive experience working with medical and pharmacy claims, eligibility, provider, SDoH, and EHR-derived clinical data to build analysis-ready datasets and decision-ready reporting for healthcare stakeholders.

• Strong background collaborating with care management, clinical, actuarial, and operations teams to improve data accuracy, reporting consistency, and adoption of analytics across enterprise healthcare programs.

• Demonstrated ability to validate and reconcile healthcare data across multiple sources, ensuring reliable reporting outputs while adhering to HIPAA privacy standards and organizational data governance practices.

• Industry-grounded professional with hands-on experience spanning medical coding, clinical analytics, and enterprise healthcare data analysis, bringing deep understanding of healthcare workflows, data quality, and regulatory expectations. CORE SKILLS

Healthcare & Clinical Analytics: Healthcare Data Analytics, Clinical Data Analytics, Population Health Analytics, Medical & Pharmacy Claims Analysis, EHR Data Analysis (Epic), Patient Encounter Data, Provider Performance Analytics, Care Gaps Analysis, Value-Based Care Analytics

Quality Measures & Regulatory Reporting: HEDIS Measures, Clinical Quality Measures (CQM), CMS Reporting, Medicare & Medicaid Analytics, Quality Measure Numerator/Denominator Logic, HIPAA Compliance Data Sources & Medical Coding: Medical Claims Data, Pharmacy Claims Data, Eligibility & Enrollment Data, Provider Data, Social Determinants of Health (SDoH), ICD-10-CM, CPT, HCPCS, Diagnosis & Procedure Code Mapping Databases & Querying: SQL (Advanced Joins, CTEs, Window Functions), SQL Server, PostgreSQL, Healthcare Data Warehousing, Data Validation & Reconciliation

Data Analysis & Programming: Python (Pandas, NumPy), Cohort Analysis, Longitudinal Analysis, Risk Stratification, PMPM Cost Analysis, Utilization & Trend Analysis

Reporting & Visualization: Tableau (Dashboards, Calculated Fields), Power BI (Data Modeling, DAX), Clinical & Executive Reporting Data Governance & Documentation: Data Quality Assessment, Data Cleaning, Data Governance, Data Dictionaries, Metric Definition Documentation

Tools & Workflow: Microsoft Excel (Pivot Tables, Power Query), JIRA, Confluence, Requirements Gathering, UAT Support Healthcare Operations: Hospital Performance Metrics, Readmissions Analysis, Length of Stay, Utilization & Throughput Analysis Soft & Functional Skills: Stakeholder Communication, Clinical Team Collaboration, Requirements Gathering, Analytical Problem Solving PROFESSIONAL EXPERIENCE

Healthcare Data Analyst CVS Health, USA Aug 2024 – Present

• Analyzed large-scale medical and pharmacy claims, eligibility, provider, SDoH, and Epic EHR encounter data to support population health and clinical reporting for 3M+ Medicare and Medicaid members, ensuring adherence to HIPAA minimum-necessary standards.

• Partnered with care management, clinical, and actuarial stakeholders to define population health and utilization KPIs (PMPM cost, readmissions, utilization rate, quality), documenting metric definitions, logic, and validation rules to ensure consistent enterprise reporting.

• Developed analysis-ready healthcare datasets using SQL Server, writing optimized queries with joins, CTEs, and window functions to calculate cost, utilization, quality, and high-risk member indicators used in executive and client-facing analytics.

• Leveraged Epic EHR encounter, diagnosis, and procedure extracts to validate claims-based utilization and quality metrics, improving attribution accuracy and identifying gaps where claims data alone was insufficient.

• Standardized diagnosis and procedure groupings (ICD-10, HCPCS) using SQL-based mapping tables, establishing a governed population health data structure that reduced reporting inconsistencies and lowered client data clarification requests by approximately 25%.

• Integrated Social Determinants of Health (SDoH) attributes (housing stability, income proxy, transportation access) into member-level datasets using SQL joins and scoring logic, enabling care teams to prioritize outreach and improving successful interventions by 20%.

• Designed and delivered Tableau dashboards visualizing utilization trends, network performance, quality outcomes, and high-risk populations, replacing manual Excel reporting and reducing recurring reporting effort by 30+ hours per month.

• Performed end-to-end data validation and reconciliation by comparing source claims totals and Epic encounter counts to analytical outputs, implementing audit queries that consistently achieved >99.5% data accuracy prior to client delivery.

• Supported value-based care and quality improvement initiatives by identifying preventable ER visits, care gaps, and cost drivers through integrated claims and EHR analysis, contributing to 5 to 7% improvement in selected preventive care and quality measures.

• Maintained data dictionaries, KPI documentation, and technical specifications in Confluence and tracked requirements, defects, and UAT sign-offs in JIRA, supporting audit readiness, HIPAA compliance reviews, and streamlined analyst onboarding. Clinical Data Analyst NextGen Healthcare, India May 2021 – Aug 2023

• Analyzed U.S. medical and pharmacy claims data (5 to 8M+ records annually) using PostgreSQL, performing complex joins across eligibility, diagnosis (ICD-10), procedure (CPT/HCPCS), and provider tables to evaluate outpatient utilization and cost patterns.

• Built patient-level analytical datasets for 250K to 400K members by integrating claims data with ambulatory EHR encounter extracts, supporting clinical quality, utilization, and population health reporting.

• Implemented HEDIS and CMS clinical quality measures using SQL-based numerator and denominator logic, identifying compliant and non-compliant populations with >98% reconciliation accuracy against expected counts.

• Developed PMPM utilization and cost metrics in Python (Pandas) across 24 to 36 months of data, enabling longitudinal trend and variance analysis for commercial and Medicare populations (150K+ members).

• Conducted longitudinal cohort analysis in Python for 20K to 30K chronic condition patients, evaluating medication adherence, follow-up compliance, and treatment patterns across multiple measurement periods.

• Created risk stratification datasets to identify the top 10 to 15% high-risk, high-utilization members, supporting care management teams in prioritizing outreach and intervention strategies.

• Designed and maintained Tableau dashboards used by clinical operations and leadership teams (30–50 users) to monitor care gaps, quality scores, utilization trends, and provider-level performance.

• Automated recurring clinical and quality reports using Excel (Power Query, Pivot Tables), reducing manual preparation time by 35 to 45% and improving reporting consistency across monthly and quarterly cycles.

• Executed SQL-based data quality checks and validation routines across claims and EHR sources, reducing diagnosis and procedure mapping errors by 25% in downstream reports.

• Ensured 100% HIPAA compliance by following role-based access controls, PHI handling standards, and organizational data governance policies throughout the analytics lifecycle.

Medical Coding Analyst HCL, India Jul 2019 – Apr 2021

• Reviewed physician progress notes, operative reports, discharge summaries, and encounter forms using Epic EHR, analyzing 40 to 60 patient encounters per day to assign accurate ICD-10-CM diagnoses and CPT/HCPCS Level II procedure codes in accordance with AAPC and CMS coding guidelines.

• Analyzed diagnosis–procedure linkage and modifier usage while assisting in coding outpatient and professional claims, supporting a coding accuracy rate of 95%+ as measured through internal quality audits.

• Prepared and validated CMS-1500 (professional) and UB-04 (facility) claims using internal billing systems, performing pre-submission quality checks that reduced initial claim rejections by 10 to 12%.

• Identified and analyzed coding discrepancies such as unsupported diagnoses, incorrect modifiers, and documentation gaps across 200+ claims per month, documenting findings and escalating complex cases to senior coders.

• Reviewed Explanation of Benefits (EOBs) and Remittance Advices (RAs) through payer portals, assisting in claim corrections that helped recover timely reimbursement for 85 to 90% of resubmitted claims.

• Applied Medicare, Medicaid, and commercial payer guidelines while validating claims, ensuring compliance with CMS policies relevant during the period.

• Utilized 3M Encoder and official references including CPT manuals, ICD-10-CM codebooks, and CMS updates to validate code selection, reducing coding-related errors by 8 to 10% over the project duration.

• Analyzed coding accuracy and documentation completeness to support clean claim submission, contributing to improved first-pass acceptance rates.

• Maintained strict HIPAA compliance while accessing and updating patient records in Epic EHR and internal tracking tools.

• Managed assigned coding queues independently, consistently meeting daily productivity targets and turnaround time SLAs under supervision.

EDUCATION

Master of Science in Healthcare Administration /Management Indiana Wesleyan University, USA

B.Sc. in Nursing

The Salvation Army Evangeline Booth College of Nursing, India

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