Reshmi Mandal

30+ years of analytics experience in consultant, advisor, and manager roles in the healthcare industry. Companies consulted for include HMOs, PBM, DMO, ACO, FQHC, hospitals, providers, GPO, and academia. Passion for improving patient outcomes and reducing medical costs through strategic and analytical approaches.

Communicate data-driven insight into healthcare costs, utilization, reimbursement, quality, and performance. Present complex findings as clear, decision-ready insights that articulate the "what", "why", and "so what". Ability to lead nuanced SDOH analyses across Medicare, Medicaid, and Commercial populations.

Experienced in end-to-end data functions from data acquisition, migration, to ETLs and ELTs to visualizations.

Experience with nearly all major BI tools such as Power BI, Cognos, Crystal Reports, Business Objects and Tableau. Manage health information data and ensure its quality, accuracy, accessibility, and security. Skilled in analysis of EHR/EMR data such as Epic, Allscripts, eClinicalWorks, Cerner, NextGen, Meditech.

Strong proficiency in managed care terminology, concepts, and acronyms as a healthcare data SME. Advanced knowledge of claims codes such as ICD, CPT, HCPCS, NDC, DRG, LOINC, and SNOMED. Thoroughly versed in standard healthcare metrics such as PMPM, utilization per 1000, ALOS.

Experience with FHIR, HL7, Mirth, APIs, XML, JSON in support of EMR and EHR analytics and data integration. Expert skills in SQL and Excel from utilization across all projects completed over long career. Strong experience in staff, project, and process management.

Highly enthusiastic with a love of lifelong professional learning. Knowledge of industry best practices and work to drive innovation. Exceptional writing, communication, and organizational skills. Ability to manage multiple priorities under tight deadlines.

High emotional intelligence, discretion, and professionalism. Ability to manage and work with large teams onshore, offshore, and nearshore. Extremely comfortable handling challenges of all types – large and small.

Self-motivated with the ability to work successfully independently and remotely. Proven team player with strong communication and problem-solving skills. Consistent, on-time delivery of high-quality deliverables.

Medical Record Review Consultant - United Health Group

(2026-01 - 2026-02)

Performed medical record review for HEDIS LTSS measures and abstracted and verified data in multiple systems.

Consultant - United Health Group/WIPRO - Remote

(2025-01)

Built models for automation of prior authorizations for UM/CM and analyzed historical data to build and validate models.

Consultant - AllyGPO - Tempe, AZ (Remote)

(2023-01 - 2024-12)

Data ingestion, monitoring, and reporting of healthcare products and data for GPO.

Consultant - OMNI Healthcare - Melbourne, FL (Remote)

(2024-05 - 2024-06)

Generated provider reimbursement and revenue reconciliation reports for monetary recovery for provider group.

Consultant - OMNI Healthcare - Melbourne, FL (Remote)

(2022-11 - 2023-03)

Generated provider reimbursement and revenue reconciliation reports for monetary recovery for provider group.

Temporary Team Lead - Florida Blue - Jacksonville, FL (Remote)

Served as temporary Team Lead for all Power BI reporting needs.

Consultant - Orlando Health - Orlando, FL (Remote)

(2022-01 - 2023-12)

Support for project to assist in multiple migrations of EHR data from Allscripts to Epic, including MPI data.

BI Developer - Urban Health Plan - New York, NY

(2017-01 - 2018-12)

Served as a BI developer for internal reporting and HEDIS for FQHC utilizing SQL, Cognos, and eClinicalWorks.

Manager - Primaris - Columbus, Missouri (Remote)

(2016-01 - 2021-12)

Managed 7 remote employees to manually abstract data from multiple EMRs for ACOs seasonally.

Consultant - Services for the Underserved - New York, NY

(2016-01 - 2016-12)

Helped to configure Relias employee training system properly.

Consultant - CareCentrix - Stamford, CT

(2015-01 - 2015-12)

Helped build KPIs necessary to support internal dashboards and reporting.

Consultant - P&R Dental Strategies, Inc. - New York, NY

(2014-01 - 2015-12)

Ad hoc analysis for DMO to answer various specific business questions.

Report Writer - Columbia University in the City of New York - New York, NY

(2014-01 - 2014-12)

Report writer for Office of Alumni and Development utilizing Oracle PL/SQL and Crystal Reports.

Consultant - Queens-Long Island Medical Group/AdvantageCare Physicians - Garden City, NY

(2013-01 - 2013-12)

Clinical data analyses to support the Revenue Integrity Unit (RIU) program.

Consultant - Healthfirst - New York, NY

(2012-01 - 2013-12)

Analysis in support of successful PBM implementation utilizing SQL and SAS.

Consultant - Allscripts Healthcare Solutions for North Shore-Long Island Jewish Hospital System - Lake Success, NY

(2012-01 - 2012-12)

Reporting in support of Meaningful Use utilizing Sunrise Clinical Analytics and Sunrise Clinical Manager systems.

Consultant - Horizon Blue Cross Blue Shield - Newark, NJ

(2011-01 - 2011-12)

Investigated data transfer issues between disparate Blues systems through drill down to point of failure.

Consultant - Medco Health Solutions - Franklin Lakes, NJ

(2011-01 - 2011-12)

Benefits installations for employer groups for client Coventry Health Plan.

Consultant - Hudson Health Plan - Tarrytown, NY

(2009-01 - 2010-12)

Medical management reconciliation work for CMO for ALL HEDIS / QARR data measures.

Consultant - Affinity Health Plan - Bronx, NY

(2008-01 - 2008-12)

Completed analytics projects for Finance and Medical Management to optimize medical cost ratios.

Manager, Operational Analysis and Reporting / Manager, Data Quality and Reporting - ParadigmHealth (now Alere) - Upper Saddle River, NJ

(2006-01 - 2008-12)

Created ad hoc analyses, reports and dashboards for data quality and operations.

Manager, Data Acquisition and Integration - Medco Health Solutions - Franklin Lakes, NJ

(2002-01 - 2006-12)

Automated QA of incoming data in client-facing role to great satisfaction of internal and external stakeholders.

Sr. Business Analyst, Pharmacy Audit - Medco Health Solutions - Franklin Lakes, NJ

(2002-01 - 2006-12)

Created reports in support of PBM for Fraud, Waste, and Abuse and selection of pharmacies for on-site audits.

Consultant - Healthfirst - New York, NY

(2001-01 - 2002-12)

Conducted ad hoc quantitative analyses to optimize profitability in negotiations.

Supervisor - Health Net - Shelton, CT

(2000-01 - 2001-12)

Supervised and mentored junior analysts in delivering and optimizing medical economics reports and analyses.

Manager, Medicare - HIP Health Plans - New York, NY

(1998-01 - 2000-12)

Managed staff recovery of roughly $20 million in Medicare capitation and claims through data reconciliation.

Manager, Enrollment - CarePlus Health Plan - New York, NY

(1996-01 - 1998-12)

Implemented reporting and analysis for Medicaid and Child Health Plus LOB enrollment.

Graduate - Public Health - University of Massachusetts - Amherst (2002-01 - 2004-12)

Undergraduate - Biology major/Management minor - SUNY Buffalo (1991-01 - 1996-12)

High School - Stuyvesant High School (1987-01 - 1991-12)