Healthcare analyst with a decade of experience designing, procuring, implementing and using decision support and reporting systems to manage Medicaid and other healthcare programs. Analytic skills include fraud and abuse detection and investigation, Surveillance and Utilization Review (SURS), budget forecasting, managed care rate setting, cost benefit analysis and benefit modeling. Excellent written and oral presentation skills, leadership, team building, time management, training and testing.

Education

1990-1992 Indiana University, School of Public and Environmental Affairs, Bloomington
Masters of Public Affairs in Policy Analysis/Public Finance

1986-1990 University of Miami, Miami, Florida
Bachelor of Arts in Public Affairs and Economics

Experience

2001-Present Mathias Consulting, Santa Rosa, CA
Executive Consultant
Founded Mathias Consulting in January 2001. Performed healthcare fraud analysis and created fraud algorithms for Medicaid clients. Created http://www.MathiasConsulting.com, a website that provides news and other resources for healthcare fraud control. Mathias Consulting is a leader in healthcare fraud and abuse control practices.
2005-2006 FourThoughtGroup, Phoenix, AZ
Executive Consultant
I just started in this position. My responsibilities will be defined as we move forward. The position will draw heavily on my experiences in Medicaid, data analysis and fraud control.

1999-2001 The MEDSTAT Group, Ann Arbor, MI
Product Designer
Designed standard reports shipped with MEDSTAT’s state of the art decision support system, including fraud and abuse detection algorithms and reports. Completed QA testing of ad hoc report writing capabilities. Trained clients to use MEDSTAT products for fraud and abuse detection and investigation. Specified and analyzed reports to estimate the extent of fraud and abuse for Medicaid and Medicare clients. Supported the sales team by creating demo reports and helping with proposal writing.

1996-1998 Indiana Office of Medicaid Policy & Planning, Indianapolis, IN
Director, Data Management and Analysis
Managed implementation of new decision support system and EIS to improve data retrieval and analysis. This included specifying Indiana’s business requirements, participatingn in JAD sessions, approving the mapping of data to the new system, approving system design, user acceptance testing (UAT) and managing the project and contractors. Managed program budget forecasting, including supervising actuaries, making budget recommendations, and preparing the budget forecast. Explained and documented the estimation process in a way that allowed decision makers to participate in a more sophisticated manner, and created a relationship with the legislative analysts that built trust in the estimates.

1995-1996 Indiana Office of Medicaid Policy & Planning, Indianapolis, IN
Policy Analyst 1
Lead effort to procure a data analysis system that needed to be both powerful and easy to use. Worked with a management consultant to prepare the DSS RFP and evaluation plan. Prepared and monitored Medicaid’s $2.5 billion annual program budget. Led the evaluation effort of procuring actuarial services. Acted as OMPP’s Data Coordinator, working with other agency representatives. Expanded Trends and Perspectives to monitor the growing managed care program and the performance of the new claims processing system. These initiatives formed the foundation of institutional accountability still in use today.

1992-1995 Indiana Office of Medicaid Policy & Planning, Indianapolis, IN
Policy Analyst 2
Collected, organized and analyzed data to help make $500 million in budget cuts needed to balance the State budget. Started to institutionalize data analysis for the Medicaid program. Became the State employee in charge of all Medicaid data systems and analysis. Worked with EDS to redesign the Management and Administrative Reports (MARS) from printed reports to online reports. Supervised implementation of EDS’s ad hoc query tool that was delivered as part of the MMIS procurement. This tool allowed State staff to query a copy of the MMIS production data. Querying this way was very time consuming and too difficult for all but the most sophisticated users. Conducted user acceptance testing (UAT) of MARS and DSS.

1990-1992 School of Public and Environmental Affairs, Bloomington, IN
Graduate Assistant
Assistant Instructor: Management Science and Urban Structure & Policy
Research Assistant: Tax Policy

1991 City of Bloomington Controller’s Office, Bloomington, IN
Summer Intern
Analyzed the City’s accounting and reporting needs. Flowcharted City’s accounting process. Helped prepare Certified Annual Financial Report.