Manager Data

James Weathersby

Email: abpnb2@r.postjobfree.com

Address: *** ********** **

City: Franklin

State: TN

Zip: 37067

Country: USA

Phone: 615-***-****

Skill Level: Management

Salary Range: $130,000

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

EXPERIENCE

OptumInsight (formerly Ingenix)

Director and Product Manager, Emerging Solutions (2010-Current)

aa Third Party Liability (Government COB service)

o Managed team of data analysts focused on implementing TPL clients and data operations

o Profitable in first year

o $3M in second year as a new service

o Increased client savings/cost avoidance by X%

o Designed and implemented claim recovery process

aa Enrollment Integrity (Commercial COB service)

o Designed system requirements and data flow to identify overlap in healthcare eligibility between commercial payers

o Managed team of data analysts responsible for data implementation and operations

aa Product Manager for multiple products aaa responsible for successful delivery

o Set and managed capital budget for multiple products

o Product Manager for Data Mining workflow application

aa Primary data mining software application (4 terabytes of claims data)

aa Responsible for identifying new enhancements, calculated ROI and managed IT project to develop and implement functionality

aa Represents $750K-$1.5M in capital spend annually

aa Managed team responsible for supporting software product

aa Expanded product from internal application to commercial SAAS

aa Improve data mining process aaa cut ETL development in half

o Enrollment Management system (50+ client datasets in implementation pipeline)

aa $1.2M annual investment

aa Identify and implement new technologies for data mining operation

o Screen scrape and automation tool - $3M in increased revenue

o Increased FTE efficiency through automation

aa Predictive Analytics

o Lead team of statisticians and analysts using SPSS to increase revenue and efficiency through predictive modeling

aa Medicare coverage related to disability

aa Health care claim payment outliers

AIM Healthcare Services, Inc (acquired by Ingenix)

Director/Assistant Vice President, Data Mining Technology (2008-2010)

aa Managed 35 data analysts in the commercial data mining operation ($45M annual revenue)

o Responsible for all data analytics (SQL) and data implementations

o Increased COB revenue by $XX

o Standardized analytic processes across client regions

aa Managed Business Technology team

o Responsible for identifying and implementing new technologies to increase FTE efficiency

o Acted as liaison between IT and business units

o Responsible for functionality implemented in data mining workflow application (annual $.5-$1.0M investment)

o Provided end user support and application training to 100+ data mining staff

o Review business processes and make recommendations to decrease costs and increase efficiency in the data mining operation

o Integrated COB workflow into existing data mining workflow application

o Worked with IT to decentralize enterprise data mining architecture

aa Managed Trend Discovery team

o Expand revenue through identification of new analytics

o Responsible for documentation of healthcare trends across all client regions

o Tracked testing and implementation of healthcare trends

Business Analyst (2004-2006)

aa Documented business requirements for proprietary discovery application used by all data mining claims analysts

aa Identified and implemented processes to increase efficiency across claims analysts

aa Recommended technology to improve business processes

Data Analyst (2003-2004)

aa Implemented new client data; maintained existing client data

aa Performed data analysis using native SQL

aa Identified new healthcare overpayment trends

aa Expanded scope of commercial data mining analysis to physician claims

Pershing Yoakley & Associates, Knoxville, TN

Consultant aaa Managed Care Service Line (2000-2003)

aa Developed and implemented logic to identify claims payment errors using SQL Server 2000

aa Identified overpayments and then implemented logic to prevent future payment errors

aa Recovered $1M for individual insurance company on duplicate claims recovery project

o Based on this project and a subsequent training engagement, the client hired PYA to perform an operational analysis, which lead to $20M in duplicate denials

aa Performed recovery and consulting engagement for individual insurance company aaa project identified system holes in eligibility logic

aa Worked with self-funded organizations, including an international retailer, a city government, a state government and a school district, to identify and recover overpayments from Third Party Administrators aaa realized savings 1%-3% of medical expense

o Involved in all aspects of these projects including development, data acquisition, analysis, site visits and overpayment collection

aa Database design and administration, including the creation of reporting tools, in the areas of budgeting, business development, compensation tracking and coding review

aa Managed care contracting research and review in the areas of stop loss, timely filing, ambulatory surgery groupings, rate schedules and implants

aa Identified underpayments at a health system and assisted in identifying affected accounts

aa Created financial models for valuation and contract negotiations

Ernst and Young LLP, Memphis, TN

Summer Intern (1999) - Tax and Management Consulting

aa Re-determined FSC Commission using E&Y software; saved client over a million dollars

aa Updated data model to comply with application development screens

aa Project management support - work plan management using MS Project, tracked and audited engagement economics to manage project costs

aa Used Global Consulting Services Workbench to plan and monitor engagement performance

aa Prepared deliverables for submission to E&Y knowledge sharing database

EDUCATION THE UNIVERSITY OF TENNESSEE

Master of Business Administration in Finance and Information Technology

Mable A. Hayward & Winifred H. Brown MBA Fellow

VANDERBILT UNIVERSITY

Bachelor of Arts in Economics, cum laude

SKILLS SQL Programming, Capital Budgeting, Project Management, SDLC, SCRUM methodology

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