Prateek Mahajan

Sr Informatics Analyst @Aetna, A Cvs Health Company

Led the plan wide process change, collaborating with systems analysts and IT team to migrate three plans to a new encounters system. Initiated new processes in other departments for existing data cleanups and new data verification and validations.Lead and manage various Medicaid and Medicare plans, submitting the healthcare information to State agencies and CMS to be processed, currently handling 3 Medicare advantage and Duals plans.Perform analysis of varied healthcare data to evaluate programs and product solutions using healthcare medical, pharmacy, lab, survey and utilization data to increase the submission accuracy and timeliness to 99%.Collaborated with the validation and claims analysts to increase the process efficiency and avoided losses in form of sanctions across the plans.Develop and implement various weekly/ monthly recurrent reports and processes to support and shape management decisions. This has led to additional reimbursement of more than $20 million from the state and CMS till date.Develop, validate and execute algorithms and predictive models to solve business problems. Execute univariate and multivariate statistical analyses and interprets results in the context of the business problems or questions.Develop and implement various ad-hoc reports to evaluate accuracy and timeliness of data.Participate in presentations and consultations to constituents on information services, capabilities and performance results.Create and evaluate the data needs of assigned projects and assure the integrity of the data.