Worked with case management in HIV services for high-risk members that qualify for SNP (Special Needs Plan) in Medicare and Medicaid.
• I learned skills such as data entry and consolidation by preparing for an upcoming Medicare audit in the fall, verifying the current members' statuses to see whether they still qualify for Medicare. I worked in a team with two other interns as we reviewed cases for each of MetroPlus's thousands of members under the SNP. I learned how to navigate large data sets with programs such as PowerSTEPP and DCMS, which involved cooperating with other departments such as Claims, MIS, and Network Relations.
• One of my biggest projects entailed data analysis of various pharmacies, prescribers, and Rx drugs. Given my unique background in statistics, I proposed strategies on predictive modeling of the high-risk population and defining that threshold based on different variables. At the end, we were able to develop a system to sort through over a million prescriptions and immediately identify frequent abusers and fraudulent prescribers with the help of Access, which I used to model the data into relevant information.