Khoa Do, Partner

Continued analysis of Medicare Advantage claims and Revenue for a Medicare Advantage client
Automated an annual financial projection process for a large health system client
Created various quality measure reports for a large health system client
Created and maintained a State-wide Global Budget Revenue rate setting model for HSCRC. Streamlined and automated the rate setting process so that rate information for all hospitals can be processed all at once. Created various reports for ad-hoc requests related to hospitals’ GBR revenues.
Created and maintained a State-wide Monthly Compliance model for HSCRC. The tool automates and speed up the calculation the revenue variance, price variance and penalties by hospital on a monthly basis.
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

Director with focus on clinical and financial analysis and reporting for Medicare Advantage and Medicaid managed care
Developed databases that provide all Medicare cost trending by market, including segmentation by provider types and member sub-populations; Created reference tables for Medicare FFS pricing methodologies including IPPS, OPPS, RUGs (SNF), HIPPS (Home Health), and Physician RVUs and ancillary professional fee schedules; Created tables and reporting for benchmarking against Medicare FFS using the CMS provider utilization files
Developed cost adjustment factors, HCC risk factors and reports that are used for Medicare Advantage bids and CMS rate setting process
Developed and performed revenue and cost modeling, analyzed impact of Medicare reimbursement and regulatory changes, and performed other complex modeling activities relative to Medicare segment
Led claims analysis and reporting, cost containment, risk adjustment and segmentation, and provider payment and incentives operations and analysis
Conceived, designed, and implemented sophisticated claims and cost analysis reporting.
Extensive work with HSCRC hospital reimbursement and reporting including experience reports, case-mix weight reports, GME Discounts and hospital inpatient and outpatient encounter data maintained by HSCRC
Worked with CRISP in providing member and demographic data, using ENS notifications, and in providing input into the development and use of CRISP’s payer portal
Annual HIPAA training

Consultant for one of the largest consulting firms in the country
Extensive experience in working with commercial, Medicare and Medicaid datasets
Extensive works in Medicare, Medicaid and commercial benchmark developments
Assisted with Medicaid rate setting processes for multiple states
Created dental pricing model to assist clients with employees benefit offering
Built drug cost sharing tool to help a large client with union contract negotiation
Assisted in the design of underwriting and contract valuations for facility and non-facility health providers
Assisted with both Medicare bid developing process and CMS bid reviews