MITALI S. CHAUHAN
Baton Rouge
Summary
Dynamic Senior Healthcare Economics Consultant with a proven track record at Optum, leveraging advanced SQL and Tableau skills to drive cost optimization and enhance patient care. Expert in forging strategic partnerships and delivering actionable insights, resulting in improved healthcare outcomes and operational efficiency. Adept at mentoring teams and implementing innovative analytics solutions.
Overview
17
17
years of professional experience
Work History
Senior Healthcare Economics Consultant
Optum
Baton Rouge
07.2021 - Current
- Conducted comprehensive quantitative analysis for the Care Delivery Organization (CDO) on medical utilization trends and cost optimization opportunities.
- Established and nurtured strategic partnerships with CDO stakeholders to identify areas for improving patient care, leveraging Population Health analytics and advanced machine learning.
- Developed program initiatives targeting high-cost patient cohorts, focusing on attributes such as chronic disease type and risk, to optimize patient care delivery and reduce costs.
- Assisted operations team in stratifying outreach efforts by creating member prioritization lists based on insights derived from analytics.
- Created a consolidated KPI dashboard, providing executive and operational stakeholders with insights into utilization trends and performance metrics compared to target goals.
- Ensured seamless integration and display of data analytics by troubleshooting and integrating various data types from disparate data silos.
- Forecasted, estimated, and tracked program initiatives impacting medical utilization and cost trends, aligning with the Office of Affordability, Finance, and Actuary.
- Analyzed and verified vendor proforma and ROI estimates to support decision-making.
Senior Healthcare Consultant, Business Relations Manager
Blue Cross Blue Shield of Louisiana
Baton Rouge
12.2016 - 07.2021
- Served as facilitator between businesses and teams on clinical/population health projects.
- Acted as Subject Matter Expert for healthcare claims, working with external vendors on new analytical software implementation and guiding data scientists in predictive model creation.
- Orchestrated thorough 'Provider Profiling' analysis for participating and non-participating providers, enhancing quality and utilization metrics for external vendor benchmarking.
- Increased member adherence to vital clinical procedures by assessing member care gaps using Healthcare Effectiveness Data & Information Set/Care Analyzer and Truven IBM database.
- Executed new case/disease management strategy through 'Monthly Member Referral Source,' integrating it with existing JIVA clinical software database.
- Identified major operational gaps in advanced Predictive Analytical Models implementation, driving significant improvements by developing a responsive scorecard.
- Created routine and ad-hoc group reports, ensuring accuracy in new processes, data structures, and integrity through rigorous User Acceptance Testing.
- Mentored interns and guided external vendors on comprehending claims, healthcare terminology, data structures, and internal business operations.
- Guided strategic choices, strengthening 'Louisiana Healthy's' organizational aim.
- Implemented AI-based Blue Models for business utilization.
Financial Operations Analyst II
Our Lady of The Lake Regional Medical Center
Baton Rouge
11.2008 - 11.2016
- Collaborated closely with McKinsey Consulting Firm on a 5-year strategic initiative, reducing length of stay and improving coding documentation.
- Fostered strategic goals by aiding managers with financial/clinical research through Crystal report tool, identifying wasteful expenses and monitoring revenue effectively.
- Led execution of EPSi data audits, producing executive dashboards for overtime, productivity, case mix index, readmission rates, and profitability reports.
- Guided experienced nurse managers and directors in strategic budgeting and staffing needs analysis, enhancing healthcare financial operations.
- Automated Capital proforma creation process to minimize manual effort in collecting and disseminating capital requests replacing existing software.
- Mastered the development and maintenance of a capital budget database, providing essential files and documents to middle and upper management.
- Trained middle level management and senior executives in financial reporting while educating finance staff on budgeting software usage.
- Resolved finance report issues for efficient performance monitoring by service line managers.
- Served as Subject Matter Expert in financial/clinical reporting with EPSi and Allscripts.
Education
Masters - Psychology
University of Mumbai
Mumbai, MaharashtraBachelors - Psychology
University of Mumbai
Mumbai, MaharashtraSkills
- Microsoft SQL Server
- SQL
- Microsoft Teams
- Alteryx
- Crystal reports
- Tableau
- Excel
- Teradata
- Snowflake
- Dbeaver
Timeline
Senior Healthcare Economics Consultant
Optum
07.2021 - Current
Senior Healthcare Consultant, Business Relations Manager
Blue Cross Blue Shield of Louisiana
12.2016 - 07.2021
Financial Operations Analyst II
Our Lady of The Lake Regional Medical Center
11.2008 - 11.2016
Masters - Psychology
University of Mumbai
Bachelors - Psychology
University of Mumbai