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marcellus darby

@marcellusdarby

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Payer Insight Analyst at Conifer Health Solutions analyzing payer performance and reimbursement opportunities.

United States

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At Conifer Health Solutions, I analyze payer performance, reimbursement methodologies, and revenue-cycle metrics to identify financial opportunities and risks. I evaluate payer contracts and translate findings into recommendations for performance improvement.

Previously, at Ensemble Health Partners, I used Epic, SQL, Microsoft Access, and parsed 835 claims data to investigate denial trends and prevention opportunities. Across my healthcare revenue-cycle work, I’ve also supported pharmacy financial analysis, 340B compliance, and claims billing and appeals.

Experience

Work history, roles, and key accomplishments

Current

Payer Insight Analyst

Current

Conifer Health Solutions

May 2024 - Present (2 years 5 months)

Analyze complex payer performance data and reimbursement methodologies to identify financial opportunities and revenue risks. Evaluate payer contracts to validate reimbursement accuracy and support payment integrity initiatives.

SQL MS Access Power BI Excel Epic Payer Analytics Reimbursement Analysis Revenue Cycle Management Denial Prevention Payment Integrity Healthcare Data Analysis Contract Analysis KPI and Trend Analysis Stakeholder Management

Denial Prevention Advisor

Ensemble Health Partners

May 2021 - Apr 2024 (2 years 11 months)

Performed advanced denial analytics using Epic, SQL, and parsed 835 claims data to identify denial trends. Conducted root-cause analysis and developed executive reporting packages to support reimbursement preservation.

Epic SQL MS Access Denial Management Analytics Root Cause Analysis Claims Analysis Executive Reporting Data Visualization Process Improvement Training Healthcare Compliance

Senior Business Analyst, Pharmacy Revenue Cycle

Augusta University Medical Center

Mar 2020 - Apr 2021 (1 year 1 month)

Directed financial and operational analysis supporting pharmacy cost centers and revenue-generating operations. Developed executive reports and dashboards to support management decision-making.

Financial Analysis Operational Analysis Pharmacy Revenue Cycle Reimbursement Analysis Executive Reporting Dashboard Development Quality Assurance Process Improvement Excel Power BI

340B Program Analyst

Augusta University Health System

Dec 2018 - Mar 2020 (1 year 3 months)

Supported 340B compliance, auditing, and financial analysis. Conducted Medicaid claim audits and developed financial reports detailing program performance and compliance.

340B Compliance Audit Financial Analysis Medicaid Claims Data Analysis Reporting Contract Pharmacy Healthcare Compliance

Billing Specialist / Denials Management Specialist

Augusta University Health System

Nov 2013 - Dec 2018 (5 years 1 month)

Managed hospital claim processing for government and commercial payer portfolios. Investigated denied claims and conducted reimbursement analysis using payer contracts and EOB documentation.

Medical Billing Denials Management Claims Processing Reimbursement Analysis Appeals Coordination Of Benefits Medicaid Commercial Insurance Compliance Process Improvement

Patient Account Representative

The Regional Medical Center

Nov 2009 - Nov 2013 (4 years)

Managed patient accounting, collections, and revenue-cycle activities. Resolved complex payment issues and supported accounts-receivable recovery initiatives.

Patient Accounting Collections Accounts Receivable Reporting Database Development Audit Customer Service