Nedim Husrefovic

As a dynamic leader with over 17 years of experience, Nedim uses his subject matter expertise to help clients apply data driven insights to mitigate risks and drive measurable outcomes. His modern approach balances the use of technology with business strategy to build operational models that proactively anticipate outcomes and prevent business disruptions.

Throughout his career, Nedim has led large departments and assisted organizations in navigating complex processes and legacy data environments with issues related to operations, analytics, compliance, audits, forensics, disputes, SOX controls, financial investigations, automation, SaaS, analytics, data mining, vendor management, and health system modernization.

Nedim’s professional experience includes:

Healthcare Risk Adjustment

• Led all aspects of risk adjustment operations, data management, and compliance processes for Medicare Advantage and ACA markets for a large payer/provider (IDFS) organization.
• Scaled a small function into a high performing team to successfully manage unpredictable ACA market demands and transition of RAPS to EDPS. The department grew eight-fold over a three-year period.
• Redesigned processes to ingest, curate, submit, and reconcile risk adjustment claims and supplemental data improvements which resulted in around $74 million additional revenues over a two-year period.
• Led automation of predictive processes to achieve 22% quicker assessment of risk scores, revenue valuation, and bid calculation.
• Responsible for managing all aspects of compliance, including translation of government mandates into concrete program strategy and tactical plan while ensuring compliance with regulatory standards.

Healthcare Data & Analytics

• Responsible for delivering a curated data health model using in-house and external data to enable real time, proactive, actionable information for a large payer/provider (IDFS) organization.
• Collaborated with clinical, provider, and product divisions to deliver data driven solutions that reduce PMPM costs and move care and intervention upstream in order to improve clinical outcomes and member experiences.
• Developed large scale data and analytics solutions and business platforms, including vendor selection and redesign of underlying workflows of impacted processes related to API management, interoperability, master data management, data governance, and enterprise data hub.

Life Sciences Clinical Trials and Data Management

• Responsible for digital data transformation and delivery of data services and technology models to proactively monitor and protect the health of studies via data driven insights for one of the top three largest clinical trial software companies in the world.
• Led the design and development of scalable data tools and services to support compliance, integrity, reporting, and analysis across cloud infrastructure for clinical trials.
• Redesigned end-to-end clinical study implementation process with focus on efficiency (speed) and quality (accuracy and completeness), resulting in reduction of overall cycle time by 34% and decrease of client UAT findings by 52%.
• Scaled the data services department by partnering with sponsors and CRO’s to design a service model driven by data insights. This resulted in a 140% increase of clinical trial bookings over a 12-month period.

Financial Services Production and Data Management

• Managed the execution of operational governance, design, and maintenance of financial master data for all corporate finance systems for one of the top 10 largest investment and wealth management firms in the world.
• Led cross-functional teams as a consultant on data trends and designs across Oracle and IBM data platforms.
• Reengineered the master data governance process, including a complete redesign of Oracle DRM system flows, procedures, and communication channels, resulting in a clean-up of more than 40,000 data discrepancies and processing improvement by 35%.

Information Technology Internal Audit and SOX Controls

• Enforced SOX policies and procedures to improve the overall operation of one of the top 10 largest investment and wealth management firms in the world.
• Operated as a key driver in development of the annual Sarbanes Oxley (SOX) risk assessment program by evaluating information technology controls for high-risk applications and financial processes. This included monitoring of company-wide risk exposure to platforms and systems via continuous monitoring processes.
• Lead information technology audits across large payer/provider (IDFS) organization to determine adherence with policies, procedures, and regulatory requirements.
• Delivered information technology and business process audits to ensure business risks were recognized and appropriately managed. This included analysis, forensics, and data mining support for fraud driven investigations.
• Designed and developed an automated process to review individuals and vendors against sanctioned lists.