Annette Lindemann, Partner

Analysis of Medicare Advantage and Medicaid claims and Revenue for a Medicare Advantage/Medicaid client
Risk score analysis for a Medicare Shared Savings Program MSSP Accountable Care Organization ACO client
Experienced user/programmer in SAS, SQL, MS Office and Visual Basic for Applications within Office for more efficient workflow development and creation of business intelligence tools

Manager with focus on clinical and financial analysis and reporting for Medicaid managed care; responsible for serving as an expert in data analysis, reporting and formulating recommendations and providing guidance to other data analysts. Performed complex data queries using SAS and SQL
Led a team of six analysts and medical coders to conduct reporting and provider medical record audits
Develop and analyze business performance reports (e.g. for claims data, provider data, utilization data) and provide notations of performance deviations and anomalies
Developed reporting and databases to analyze Medicaid revenue trending by product, including segmentation by provider types and member sub-populations
Automated and developed reporting used in provider engagement incentive programs – Patient Centered Medical Home PCMH-based models – including patient utilization, cost, and HEDIS-based quality measures
Coordinated with provider relations and member engagement staff to identify high risk populations to ensure effective patient outcomes on HEDIS and Value Based Purchasing measures
Met regularly with key stakeholders including internal executive team, provider practice (including hospital, FQHC, and large health systems) executive and staff members
Developed and performed revenue and cost modeling, analyzed impact of Medicaid reimbursement and regulatory changes, and performed other complex modeling activities relative to Medicaid segment

Team leader supporting the Healthcare Informatics team on ad-hoc requests, data analysis, reporting and database development, serving as an expert in data analysis, reporting and formulating recommendations and providing guidance to other data analysts. Performed complex data queries using SAS and SQL
Developed reporting used in provider engagement shared savings program – CareFirst Patient Centered Medical Home PCMH model – including patient utilization, cost, and HEDIS-based quality measures, shared savings calculations, and patient panel risk scores
Provided analytic consultation to leadership or external customers including provider groups
Trained PCMH provider consultants on the suite of provider reporting – made recommendations to consultants on how to spot trends and data anomalies
Developed database to assist Care Coordination team to identify high risk patients for ensuring patients with the greatest need receive care plans

Assist development of Health Risk Assessment database and provider forms to ensure accurate HCC risk factors – Report revenue results of the HRA and provide feedback to key stakeholders including the provider community
Developed medical record and HRA audit process to ensure HCC accuracy
Part D – Ensure PBM contractual obligations met including AWP guarantees, timely filing, invoice to claim feed to PDE reconciliation and ensuring administrative and subrogation fee accuracy
Part D – Developed and automated coordination of benefits (plan to plan) process to including reporting and reconciling payables/liabilities