Ajith Reddy

About Ajith Reddy

Over 8 years of extensive experience as a Senior Data/HEDIS Analyst, with a strong history of collaborating with technical teams to convert business requirements into software applications within the healthcare domain.• In-depth knowledge of project life cycle and SDLC methodologies, including RUP, RAD, Waterfall, and Agile.• Skilled in designing and executing SQL queries for Oracle, Sybase, and SQL Server databases.• Extensive expertise in integrating, validating, and optimizing healthcare quality data within Inovalon and Cotiviti platforms.• Proficient in analyzing health plan billing, claims, and clinical data to support HEDIS quality reporting and regulatory compliance.• Strong analytical, technical, and problem-solving abilities, combined with excellent communication skills.• Experienced in extracting, transforming, and validating claims, encounter, and EHR/EMR data to ensure accurate HEDIS submissions in compliance with NCQA, CMS, and state regulations.• Well-versed in HEDIS measures, annual reporting, medical record reviews, and HEDIS auditing, with advanced proficiency in Microsoft Excel, Access, Word, PowerPoint, and Visio.• Skilled in utilizing Visual Studio for developing, automating, and enhancing data analysis workflows.• Proficient in using SQL Server Management Studio to write complex SQL queries for data retrieval.• Hands-on experience with Teradata Enterprise Data Warehouse (EDW) and Data Marts.• Expertise in designing ETL pipelines, optimizing Delta Lake storage, and automating HEDIS measure calculations using Databricks workflows.• Knowledgeable in a diverse set of technologies, including business process tools such as MS Project, Primavera, Promote, MS Excel, MS Access, and MS Visio, as well as data warehousing concepts and web development.• Adept at developing Use Case Models, Analysis Models, Design Models, Implementation Models, and various UML diagrams (Use Case, Sequence, Collaboration, State Chart, and Activity Diagrams) using Rational Rose.• Experienced in creating Unit Test Plans (UTP) and Integrated Test Plans (ITP), with extensive expertise in conducting User Acceptance Testing (UAT).

Experience

1. Sr Data Hedis Analyst

   Centene Corporation

   Jun 2021 — Present · St Louis, MO, US

   Led research and document gathering efforts for the HEDIS project, including preparation and execution of HEDIS Onsite Audits.• Managed the end-to-end HEDIS project lifecycle, from planning and measure selection to final submission to the National Committee for Quality Assurance (NCQA).• Extracted and analyzed claims, encounter, and billing data from diverse sources, including Medicare, Medicaid, and Commercial plans, to ensure adherence to HEDIS compliance requirements.• Performed data validation and integrity assessments on claims and billing records to identify discrepancies impacting HEDIS reporting accuracy.• Reviewed claims adjudication processes to verify the correct use of CPT, ICD-10, HCPCS, and revenue codes in HEDIS measure evaluations.• Collaborated with finance and reimbursement teams to ensure health plan billing aligns with HEDIS and NCQA compliance standards.• Designed ETL workflows for extracting, transforming, and loading data into Inovalon and Cotiviti HEDIS engines, ensuring data accuracy and completeness.• Created technical documentation and delivered training sessions on best practices for integrating Inovalon and Cotiviti systems.• Developed and optimized automated data pipelines to facilitate the ingestion of clinical, claims, and provider data into Inovalon and Cotiviti, enhancing efficiency in HEDIS reporting.• Conducted data reconciliation between internal databases and Inovalon/Cotiviti outputs to ensure compliance reporting accuracy.• Researched and evaluated software solutions for case management, predictive modeling, NCQA HEDIS reporting, and provider profiling.• Performed comparative analysis of clinical and claims data to assess quality measure performance and detect inconsistencies.

Education

• California State University - East Bay

  Master's degree, Business Analytics