Arjun S. Patel
Placentia,CA
Summary
Senior Healthcare Data & Analytics Professional with 10+ years of experience leading enterprise analytics, regulatory reporting and performance improvement initiatives in managed care environments. Subject matter expert in HEDIS, STARS, QRS, PQA, and MCAS measure analytics with extensive experience designing scalable ETL pipelines, governed data marts, and executive BI solutions. Proven ability to translate complex regulatory specifications into production-ready analytic systems and products that drive measurable performance improvement. Demonstrated ability to manage staff and lead complex strategic and cross-functional projects to completion.
Overview
8
8
years of professional experience
Work History
Technical Analyst & Business Intelligence Developer III
L.A. CARE HEALTH PLAN
01.2025 - Current
- Serve as the technical subject matter expert (SME) for HEDIS, STARS, QRS, PQA and MCAS analytics, owning end-to-end measure logic, technical interpretation, and BI implementation.
- Led development of audit-ready BI dashboards and reporting solutions, translating complex regulatory specifications and value sets into validated SQL and SAS code compliant with NCQA and CMS standards.
- Mentor analysts and developers on measure logic interpretation, SQL optimization, and governed BI development practices.
- Partnered with IT, data governance, and business teams to enforce data quality, lineage, and performance standards, mentoring developers and ensuring reliable analytics across Medi-Cal, Medicare, and Marketplace lines of business.
- Architected and maintained scalable BI and data warehouse solutions using SQL Server and SSIS to support clinical, operational, executive, and regulatory reporting.
- Designed and optimized dimensional data models, ETL pipelines, and stored procedures integrating claims, encounters, enrollment, and supplemental clinical data across enterprise source systems.
Clinical Data Analyst III
L.A. CARE HEALTH PLAN
01.2024 - 12.2024
- Lead all data activities that include but are not limited to data exploration, statistical modeling and data mining to provide business insights that enable leadership to make critical business decisions.
- Identify solutions and project manage all quality and process improvement initiatives to enhance clinical, operational and strategic outcomes. Research and implement best practices to improve population health, quality of life and evaluate impact.
- Monitor/track enterprise wide quality intervention and analytical strategies that elevate quality of care and enhance satisfaction for LAC members.
- Provide support to senior leadership by serving as a liaison to inter/intradepartmental teams to ensure efforts align with Quality Improvement goals.
- Effectively collaborate with and support QI/QPM staff in their efforts around various QIP’s, PIP’s and PDSA’s by assisting the team during the planning, implementation and evaluation phases of Quality/Process improvement projects.
- Design, develop and maintain complex ongoing data projects. Design, develop, and generate ad hoc/production reports. Produce automatic, robust, timely and accurate results based on required specifications.
- Develop automatic, robust, and sharable Statistical Analysis System (SAS) or Structured Query Language (SQL) stored procedures and programs using SAS and SSMS to build a comprehensive clinical data repository known as the Stars DataMart.
- Utilize basic SSIS packages to load data into dev environments which is internally referred to as the Stars DataMart.
STARS Program Manager
L.A. CARE HEALTH PLAN
01.2022 - 01.2024
- Actively screened and interviewed candidates for the stars core team positions, which lead to the staffing of the Senior Director, Stars Administrative assistant and program manager positions.
- Manage cross functional projects to implement monitoring and process improvement initiatives for STARS measures in preparation of CMC to D-SNP transition in 2023. Develop and maintain work plans, convene committees and workgroups, and assist Stars Core Team by leveraging technology and tools to streamline processes, enhance synergy, promote data sharing, and improve transparency across clinical and operational areas.
- Design, develop and maintain complex ongoing data projects. Design, develop, and generate ad hoc/production reports. Produce automatic, robust, timely and accurate results based on required specifications.
- Provide support to senior leadership by serving as a liaison to inter/intradepartmental teams to ensure efforts align with Quality Improvement goals.
- Drive collaboration to maintain working relationships across the Stars Core team and with multiple departments throughout LAC including but not limited to QI, Pharmacy, Care Management, Utilization Management, Risk Adjustment, Products, Appeals and Grievances and the provider network.
- Identify solutions and project manage all quality and process improvement initiatives to enhance clinical, operational and strategic outcomes. Research and implement best practices to improve population health, quality of life and evaluate impact.
- Monitor/track enterprise wide quality intervention and analytical strategies that elevate quality of care and enhance satisfaction for LAC members.
Clinical Data Analyst II
L.A. CARE HEALTH PLAN
08.2019 - 01.2022
- Served as the lead analyst within the QPM team to provide guidance on data sources, business rules to team members, communicated with management and external parties to provide updates or deliver finalized reporting. Led a team of three clinical data analysts responsible for monthly HEDIS data refreshes, data optimization, and implementation of new HEDIS data feeds and ad-hoc analysis.
- Supervised a team of clinical data analysts responsible for deliverables throughout the annual HEDIS audit in support of 2 HEDIS submissions including a NCQA Commendable Medi-Cal plan: HEDIS roadmap, PSV, Rate Review, and communications with auditors as needed.
- Assisted in screening and interviewing new candidates. Supervised three new hires and provided one on one guidance and training to help team members come up to speed and get past the probation period after hire.
- Serve as a subject matter expert on NCQA HEDIS, DHS MCAS and CMS STAR quality measures. Serve as the point of contact for all data related efforts among the QI workgroups and HEDIS data integration efforts.
- Identified opportunities for acquiring new HEDIS data sources and optimized data mappings that lead to year over year performance improvements for various Children, Behavioral Health and Pharmacy HEDIS measures.
- Serve on the Member Health Equity Counsel as a statistician and primary analyst in all efforts addressing Health Disparities in Los Angeles County.
- Collaborate cross functionally to improve various HEDIS measure rates by integrating new data sources for HEDIS reporting. Work with stakeholders to develop OBIEE reports as needed. Was successfully able to demonstrate that the eManagement depression/alcohol abuse screening and/or the CCA depression screening data has been integrated into the HEDIS engine for MY2020 final reporting.
- Effectively collaborate with and support QI/QPM staff in their efforts around various QIP’s, PIP’s and PDSA’s by assisting the team during the planning, implementation and evaluation phases of Quality/Process improvement projects. Utilize SSMS to develop scripts for monthly tasks and for ad hoc analysis as needed.
- Identified solutions and project managed all quality and process improvement initiatives to enhance clinical, operational and strategic outcomes.
- Provide support to senior leadership on a continuous basis by serving as a liaison to inter/intradepartmental teams to ensure efforts align with QPM goals. Continuously analyze data and generate useful descriptive statistic reports and visual aids to promote the mission of L.A. Care Health Plan.
- Work with the HEDIS Analytics Manager to write SSIS packages for clinical data integration (CDI) adoption for ingesting claims, encounters, enrollment, 837 EDI files, supplemental data and more into the HEDIS engine for HEDIS reporting.
- Develop automatic, robust, and sharable Statistical Analysis System (SAS) or Structured Query Language (SQL) stored procedures and programs using SAS and SSMS.
Program Planning & Evaluation Consultant
PRACTICAL CONNECTIONS ST. VINCENT MEALS ON WHEELS
05.2021 - 12.2021
- Serve as the point of contact for all data related efforts among the executive leadership team, administration and program managers.
- Assist leadership to develop survey tools that are in line with the requirements outlined within the program RFP’s. Work with the project team to plan, implement and evaluate the different phases of the project.
- Identify the volume of surveys needed to establish credible findings per statistical significance as outlined within the program requirements.
- Obtain, compile and analyze survey data for all active projects to monitor performance and when necessary, make changes to the intervention.
Data Analyst Specialist
FAMILY SERVICE ASSOCIATION
07.2018 - 10.2018
- Use statistical methods to analyze data and generate useful business reports to promote the mission of Family Service Association including, but not limited to, agency impact and annual reports.
- Responsible for devising, gathering, compiling and reporting on all agency statistics including provisions of required survey amounts per year and per quarter to each department based on previous year’s client statistics.
- Serve as the point of contact for all data related efforts among the executive leadership team, administration and program managers throughout the organization.
- Prepare ad hoc descriptive statistic reports and visual aids for leadership members to supplement meetings with stakeholders.
Education
Master of Public Health - Biostatistics
LOMA LINDA UNIVERSITY, SCHOOL OF PUBLIC HEALTH
Loma Linda, CA08.2018
Bachelor of Science - Applied Mathematics
UNIVERSITY OF CALIFORNIA, RIVERSIDE
Riverside, CA06.2015
Bachelor of Science - Biology
UNIVERSITY OF CALIFORNIA, RIVERSIDE
Riverside, CA06.2015
Skills
- Healthcare Quality Outcomes Analytics (HEDIS, CMS Stars, QRS, PQA, MCAS)
- Dimensional Data Modeling & ETL Architecture
- Advanced SQL Development (SSRS, SSIS, SSAS, SSMS)
- Statistical Modeling (SAS, R, Python, R-Studio, Python)
- Executive-Level Reporting & Stakeholder Engagement
- Cross-Functional Leadership & Mentorship
- Problem-Solving & Critical Thinking
- Quality & Process Improvement w/ Lean Principles
- Robust Data Visualization and Dashboarding (Tableau, Power BI, R-Studio)
- Visual Studio, Visual Studio Code, Informatica, Cloudera
Timeline
Technical Analyst & Business Intelligence Developer III
L.A. CARE HEALTH PLAN
01.2025 - Current
Clinical Data Analyst III
L.A. CARE HEALTH PLAN
01.2024 - 12.2024
STARS Program Manager
L.A. CARE HEALTH PLAN
01.2022 - 01.2024
Program Planning & Evaluation Consultant
PRACTICAL CONNECTIONS ST. VINCENT MEALS ON WHEELS
05.2021 - 12.2021
Clinical Data Analyst II
L.A. CARE HEALTH PLAN
08.2019 - 01.2022
Data Analyst Specialist
FAMILY SERVICE ASSOCIATION
07.2018 - 10.2018
Bachelor of Science - Applied Mathematics
UNIVERSITY OF CALIFORNIA, RIVERSIDE
Bachelor of Science - Biology
UNIVERSITY OF CALIFORNIA, RIVERSIDE
Master of Public Health - Biostatistics
LOMA LINDA UNIVERSITY, SCHOOL OF PUBLIC HEALTH