ANDREA ACEVEDO
Florida
Summary
Senior Analyst with more than 5 years of experience in the healthcare industry. Adept in interpreting and analyzing data for payment analysis and reporting. Proficient knowledge in mathematics and analytics. Excellent understanding of business operations and analytics tools for effective analyses of data.
Overview
10
10
years of professional experience
Work History
Financial Analyst
MSO of Puerto Rico, LLC
2019.09 - 2020.11
- Creates and validates different utilization reports and analysis for business decisions
- Continually creates and implements strategies to improve contracting decisions
- Analysis of provider’s capitation and any other PCP payment data
- Identify issues and opportunities in contracting process (front to end)
- Supervises quality procedures to ensure compliance with contracting standards
- Support development, maintenance and implementation of contract information and documentation
- (monthly, quarterly and annual)
- Ensure correct configuration in all related areas for special contracts in all line of businesses
- Verify, monitor and ensure accuracy and completeness of information in all departments
- This information must be updated at any appropriate time
- Prepare and analyze Contracting/payments Dashboard
- Prepares adequate documentation in order to create automatic report to evaluate contract performing on monthly basis
- Maintain and keep track of changes required for contract information that could affect general reporting and payments
- Liaison of information between Providers Division, Contracting Department, Business Configuration Unit, Analytics and any other division related to contract.
Senior Reconciliation Analyst
MSO of Puerto Rico, LLC
2018.07 - 2019.07
- Develop initiatives and strategies that optimize and improve internal and external reporting
- Conduct research and analyzing data to develop and suggest department methods to improve their practices and processes including but not limited to designing modifications
- Detailed data analysis, outlining problems, opportunities and solutions of reports including through using data modelling techniques
- Prepare reports by collecting, analyzing and summarizing information and trend
- Perform daily, weekly and monthly reviews and analyses of current processes using operational metrics and reports
- Develop and implement databases, data collection systems, data analytics and other strategies that optimize statistical efficiency and quality
- Acquire data from primary or secondary data sources and maintain databases/data systems
- Identify, analyze, and interpret trends or patterns in complex data sets
- Analyze daily summary report of processed disenroll transactions received from CMS.
Reconciliation Analyst
MSO of Puerto Rico, LLC
2015.01 - 2018.07
- Responsible for analyzing MSO Capitation, Specialist and Incentive payment analysis, including but not limited to IPA Surplus distribution
- Analyzes, verifies and prepares all documentation necessary to support following payments: IPA Providers monthly capitation and other payments, Non-IPA Providers monthly capitation and other payments, Admitting Physician Program payments (all regions), Special Arrangement payments as contracted with providers and Preferred
- Provider Network Surplus Incentive payment
- Liaison of information between Providers Division and MMM PMC Finance Division for
- Non-IPA's and IPA's
- Prepares adequate documentation to validate capitation and administrative fee payments presented in Financial
- Maintain and keep track of changes required for providers’ information that could affect general reporting and payments.
Contracting Clerk
MSO of Puerto Rico, LLC
2013.01 - 2015.01
- Interprets, administers, and verifies contracts and associated paperwork to prepare complete contract package
- Maintains and retrieves contract documents and ensures compliance with company policy as well as relative laws/regulations
- Monitors existing contracts and associated paperwork to ensure timely renewals
- Responsible of contract termination requests ensuring contract clauses.
Programmer and Data Analyst
MSO of Puerto Rico, LLC
2020.11 - 2022.11
- Responsible to design, create and maintain complex programming algorithms using business datasets and programming tools to acquire, manage, manipulate, and analyze data and reports results
- Support analytical staff and projects generating results of internal or external business needs and translate complex analytical needs into reports for management in summarized or in detailed fashion
- Responsible for new projects, income opportunities and processes improvements
- Implement routine and complex database extraction programs to generate necessary reports as requested by management and end users
- Evaluate quality of information entered into healthcare information systems and develops mechanisms from improvement
- Determine ramification of poor-quality information and develop mechanisms for localizing and minimizing its impact
- Detects and resolve problems related to performance and reliability of application and databases
- Recommends and oversees application changes required to resolve these problems by application and technical staff
- Provides support as required to ensure proper operation of database and file structures
- Data management using Structured Query Language (SQL) from medical, pharmacy data sources and provider information, or other services claims databases
- Utilized data visualization techniques to present and explain complex data sets.
- Generated ad-hoc reports to evaluate specific business requirements.
- Implemented business intelligence solutions to increase operational efficiency.
- Deployed predictive analytics models to forecast future trends.
- Prepares reports in Crystal Reports, MS Reporting Services or other reporting tool using technical, statistical and descriptive techniques
- Analyzes plan information and data collection for beneficiaries, network and providers
- Maintains accurate reporting of variances and trends of health care spend and utilization costs with recommended adjustments to controls and models.
- Identified, analyzed and interpreted trends or patterns in complex data sets.
- Utilized data visualization tools to effectively communicate business insights.
- Participated in requirements meetings to understand business needs.
- Used statistical methods to analyze data and generate useful business reports.
- Extracted and interpreted data patterns to translate findings into actionable outcomes.
- Designed and implemented tools to support strategic value chain optimization initiatives.
- Implemented code solutions to answer analytic questions and test and assess new methods.
- Analyzed data to identify root causes of problems and recommend corrective actions.
- Developed customized reports, summarizing and presenting data in visually appealing format.
Education
MBA - Finance
Interamerican University of Puerto Rico
San Juan Puerto Rico02.2017
Bachelor Degree - Computer Programming
EDP University of Puerto Rico
San Juan08.2015
Skills
- Ability to work independently or without direct supervision.
- Ability to organize and prioritize multiple projects, frequently with conflicting deadlines.
- Strong problem solving and critical analysis skills.
- Strong healthcare expertise and medical terminology knowledge.
- Self-motivation and reliability with attention to detail.
- Oral and written communication skills.
- Strong healthcare expertise and medical terminology knowledge.
- Advance Software knowledge in: Microsoft (Excel, Access, Power Point), SAS, SQL and Tableau, SnowFlake Schema along with Statistical Software Solutions.
- Programming Languages VBA, C+, C#, Java Script, HTML
Languages
Spanish
Native language
English
Proficient
C2
Timeline
Programmer and Data Analyst
MSO of Puerto Rico, LLC
2020.11 - 2022.11
Financial Analyst
MSO of Puerto Rico, LLC
2019.09 - 2020.11
Senior Reconciliation Analyst
MSO of Puerto Rico, LLC
2018.07 - 2019.07
Reconciliation Analyst
MSO of Puerto Rico, LLC
2015.01 - 2018.07
Contracting Clerk
MSO of Puerto Rico, LLC
2013.01 - 2015.01
MBA - Finance
Interamerican University of Puerto Rico
Bachelor Degree - Computer Programming
EDP University of Puerto Rico
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