Alex Oliphant is a member of BRG’s Health Analytics practice. He has provided analytical and strategic insight for litigation and management consulting matters for more than ten years. He has wide-ranging experience managing teams tasked with designing custom algorithms to analyze medical and pharmaceutical claims for engagements involving commercial health insurers, pharmaceutical manufacturers, federal health agencies, state regulatory entities, hospital systems, and state worker-compensation agencies. His work involves assessing the accuracy of reimbursement of medical and pharmaceutical claims, conducting financial analysis on the impact of potential inaccurate claims submissions, designing statistically valid sampling methodologies for auditing claim submissions, and developing customizable front-end applications for streamlining the claim audit process.
Mr. Oliphant has extensive experience with risk adjustment in the context of Medicare Advantage–related engagements and strong understanding of the mechanics of the CMS-HCC model. He has applied his understanding of CMS MRA data, claims data, and membership data when leading teams that have analyzed large datasets to investigate provider diagnosing behavior. He has also designed statistically valid sampling methodologies for conducting medical record reviews and has developed sophisticated front-end applications that record, run quality checks on, and summarize medical record review results.
Mr. Oliphant has served as the technical lead on engagements involving 340B compliance monitoring for large pharmaceutical manufacturers. He has constructed models based on pharmaceutical pricing and utilization datasets, Office of Pharmacy Affairs–related datasets, hospital cost report data, CMS claims data, and state Medicaid claims data to identify entities that may be diverting 340B product or creating duplicate discounts.
University of Virginia B.A., Mathematics and Economics, 2004
LECG Senior associate 2005 - 2010
Primus Telecommunications Systems Analyst 2004 - 2005