JOHN FRIAS MORALES, Dr.BA, MSSACRAMENTO, CA JOHNFMORALES@GMAIL.COM408.914.5765 CELL HTTPS://WWW.LINKEDIN.COM/IN/JOHN-FRIAS-MORALES

SUMMARYAnalytics leader optimizing clinical & operational services with high integrity partnerships, frictionless processes and shared data. Tactful engineering manager (five years) delivering self-service automated BI/data applications and analyses that drives service transformation towards benchmarked quality and efficiency outcomes, often across multiple delivery modes (inpatient, ASC, medical group, pharmacy, lab) and insurance contracts (providers, groups, products, ACOs). Expert (16 years) in developing data services into actionable/modifiable descriptive trends/variances, predictive, and prescriptive analytics to optimize healthcare service decision making.

Program management Consultative problem solving EMR/EHR Cerner & EPICOperational improvementAnalytic decision support

Value driver performanceClinical & health research

Facets, TapAP, IDX, MeditechTeam commitment & empowerment

PROFESSIONAL EXPERIENCE

Kaiser Permanente, Oakland, CA (3 years) 2013 – currentHealth plan program offices, benefits administration

Executive Dashboard & Analytics Lead Consistently measured member/patient coverage cost-sharing/accumulations, variances and transactional throughput in support of operational service quality and productivity across regional claim and benefit systems (EPIC EMR/TapestryAP, Diamond, & Xcelys). Reduced over accumulation backlog by 22% and increased error resolution productivity by

18%, in partnership with shared service managers (claims/encounters, batch data exchange, benefits, and SOX auditors), by using Agile change management, PMP methodologies, and SOX report automation (SAP Business Objects XI Crystal Reports & Web Intelligence).

Blue Shield of California, San Francisco, CA (8 years) 2006 – 2013Self-insured, fully-ensured groups/individuals, and government carrier.

Business Intelligence Manager Managed developers to solve ad hoc problems and value-oriented use cases with data analytic applications while satisfying resource constraints. Developed measurement models for variation reduction, min/max decision optimization (capacity, staffing, scheduling, queue waiting lines), utilization variance, work flow productivity simulation, clinical risk adjustment, Markov risk state prediction, chronic disease/service outcomes, managed care/ACO risk share, provider and group utilization trends, and actuarial product forecasting. $4 million dollar ROI from a billing delinquency and auto adjudication software application

(SAP Business Objects XI universe & Web Intelligence) by using Agile development, Lean Six Sigma gap analysis, and PMP delivery methodologies across systems (Trizetto Facets) and workflow queues (claims/encounters operations, customer service); and trained/mentored underwriters, actuaries, provider contract analyst, and medical informaticists on eligibility & claims analytic toolsets (base SAS & EG info map, Web Repot Studio, stored process, query builder, ProcSQL statements, and Oracle SQL Developer).

John Frias Morales, Dr.BA, MS (408.914.5765) Page twoStanford Children’s Hospital, Lucile Packard, Palo Alto, CA (1 year) 2005 – 2006Health plan program offices, benefits administration

Business Intelligence ManagerManaged a cross-functional finance team of SMEs and engineers to improve the speed and quality of charge capture from systems (scheduling, registration, eligibility/benefits verification, authorization/referral, charge master accuracy, HIM coding, clinical acuity/census, and AR-to-GL flows). Increased total inpatient charges by 8% from reprogramming 5% of system failed batch load

data exchange errors (Cerner EHR, Meditech claims, ADP FTE labor, TSI/TII Eclipses Decision Support Manager budget, Lawson GL revenue expenses), recovered capitation from termed patients resulted in $560,000 dollars savings, and benchmarked revenue cycle and clinical quality against HFMA Map Keys, CAHPS, and NCQA using Lean Six Sigma and PMP methodologies.

Sutter Health/Palo Alto Medical Foundation, Sacramento, CA (5 years) 2001 – 2005Health plan program offices, benefits administration

Lead BI/Data Solutions DeveloperDeveloped data warehouse and business intelligence applications for self-service access to clinical, claims, strategic and financial analysis; accountable for all data warehouse and BI use cases, business rules, mappings, and audits/testing. Developed a SQL Server & Excel-linked application that identified contractual and

claim/service line detail variations to recover $7 million dollars from in underpayments from insurance carriers using a CMMI-Service methodology.

Contributed to Sutter Health’s # 1 quality ranking (Lewin Group) by developing warehouse and analytic applications (IBM Cognos Impromptu reports and PowerPlay Cubes) for reporting of Myocardial Infarction Data Acquisition System (MIDAS), 3M All Patient Refined DRG (APR DRG) Classification System, and Joint Commission core measures, while standardizing ETL load mappings of TSI/TII Eclipses Decision Support Manager, IDX (BAR, MCA, Sched, Reg), Meditech financial data and clinical code sets (ICD-9/10, CPT, APC, MS-DRG, APG, RVUs/RBRVS) using Agile methodologies.

EDUCATION/TRAINING

Fellow, Health for All, School of Medicine, Stanford University, Palo Alto, CADoctorate in Business Administration, Golden Gate University, San Francisco, CAMaster of Science, Computer Science, Golden Gate University, San Francisco, CA

PROFESSIONAL DEVELOPMENT

Data science methods and techniques that have been consistently applied to healthcare problems: Medical coding: CPT-5 & ICD-10CM diagnosis and procedure coding certificate, UC

Davis Health System, 2003. Forecasting/ predictive multivariable modeling summer school, Keele University (UK)

Prognosis Research Strategy Partnership, Summer 2014 EPIC electronic medical record (Clarity) inpatient, outpatient and pharmacy data analysis

training. Kaiser Permanente, 2015. Insurance claim/encounter & enrollment/eligibility processing software, Trizetto Facets

certification, 2009.