Analytics · 2022–2025
Sentara Healthcare
Most people only see one side of the claim. This was the insurance side — markets, rates, leakage, and the math that settles an argument.
Subject-matter expert for underpayment and overpayment root cause. I found discrepancies on both the hospital and the payer side, then led settlements that recovered substantial lost revenue. The work lived in Databricks, NetworX Modeler, QNXT, and a lot of SQL.
Day to day: state market comparisons, price and rate modeling, charge capture, contract renewal and repricing, fee schedules, DRG rates, Medicare / Medicaid / Medicare Advantage / commercial compliance. Segmentation by service type, product, and ownership — so leadership could see where money was actually moving.
This is why I can sit in a provider ops meeting and still hear the payer's version of the same claim. Both sides tell a different truth. Evidence has to travel with the action.
Full title history is on LinkedIn.