Sunday Adesina Director, Healthcare Analytics & AI Strategy at Apparent Health

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Director, Healthcare Analytics & AI Strategy

Apparent Health

Mar 2025 - Current (1 year 8 months)

• Manage teams that leverage the latest Gen AI/ML tools in solving healthcare business challenges. • Assist in simplifying data analytics findings and AI/ML concepts for non-technical stakeholders • Lead AI/ML analytics in RCM, reducing claim denials by 25% & recovered $50M in missed charges. • Leverage knowledge of data standards, ICD_10, SNOMED, LOINC, NCPDP, NDC, X12-EDI, FHIR/HL7, OMOP-CDM in (REST-API)-EHR integrations mapping and handling of sensitive data. • Lead tactical strategies on Gen AI/ML roadmaping, Go-to-Market strategy & QA testing using PDLC/SDLC, Lean/Agile and Design thinking frameworks that reduced time to market by 25%. • Deployed AI claims scrubbing tool, cutting processing time by 30% and enhancing cash flow. •

Sr. Manager, Data Science & Analytics Studies

Gdit

Jan 2025 - Feb 2025 (2 months)

• Directed and supervised data scientists, clinicians, developers and SME investigators • Set strategic direction for Healthcare Fraud Prevention Partners (HFPP) CMS-TTP analytics. • Managed workload using modern tools such as Snowflakes, Bitbucket, Jira, AWS, Python, & SQL • Participated in CMS-DFPP/ HFPP-TTP meetings & HHS-OIG law enforcement briefings

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Advisor, Payment & Revenue Integrity Solutions

Apparent Health

Jun 2023 - Mar 2025 (1 year 10 months)

• Leveraged in-depth knowledge of health data engineering, and proficiency in Python, SQL, IBM, Snowflakes, Databricks, Jira, Tableau in leading, and simplifying analytics and AI solutions. • Oversaw revenue & payment analytics strategy, data engineering ETL and integrations of AI/ML. • Safeguard data assets, API endpoints and ensure seamless integrations of AI/ML with legacy systems • Provided guidance on AI/ML data readiness, ETL QA, preprocessing and feature engineering • Led teams that leverage AI/ML algorithms in Medical, Pharmacy and RCM claims data analytics. • Managed stakeholders' engagement and team dependencies, translating requirements to get buy-in.

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Assistant Director, Payment Integrity Analytics Strategy.

ClaimInformatics.

Oct 2022 - May 2023 (8 months)

• Supervised and mentored data analytics and directed cross-functional AI/MLOps team operations. • Provided strategic direction based on best-in-class payment integrity and FWA audit solutions • Led EDA, ETL QA testing on 837 EDI data and CMS tables updates to ensure data integrity.

Payment Accuracy Value Consultant

Changehealthcare

Jun 2019 - Oct 2022 (3 years 5 months)

• Led analytics studies team using in-depth knowledge of healthcare coding to generate insights. • Engaged with clients in understanding data issues, created detailed UX for solutions design • Served as (SME) on payment integrity analytics model evaluations and reporting metrics. • Leverage lean/agile methodologies in release planning and backlogs grooming refinement. • Combined design thinking, SDLC/ PDLC framework in leading data products development • Led cross-functional team in resolving defects, change requests and acceptance criteria.

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Sr. Consultant Healthcare Payment Integrity Ideation

Optum.

Jan 2017 - May 2019 (2 years 5 months)

• Served as lead SME on payment and revenue integrity analytics strategy that saved over $200M. • Provided advisories on ETL data pipeline-HL7/FHIR integrations, and implementations. • Harnessed in-depth knowledge of health data in scripting (BRD) using PL/SQL, Python, Excel. • Performed ad- hoc agile/scrum ceremonies that facilitate prompt resolution of issues in JIRA.

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Manager, Fraud Investigations Unit

Magellan Healthcare

Feb 2015 - Dec 2016 (1 year 11 months)

• Supervised 12 FTE in FWA and payment integrity , achieving 1.5% reduction in costs of care • Led advanced analytics initiatives and developed pharmacy analytics to detect anomalies • Managed operational oversight, staff development, including hiring and mentoring

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Manager SIU

Simply Healthcare Plans,

Nov 2013 - Dec 2014 (1 year 2 months)

• Directed talents (Data analyst, Nurses, Coders, and Auditors) in payment integrity analytics. • Leveraged knowledge of health data literacy in leading payment integrity and FWA projects. • Hired, trained, and mentored new SIU talent on various data analytics and Investigations.

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Sr. Healthcare Fraud Investigator

Simply Healthcare Plans

Sep 2013 - Nov 2013 (3 months)

• Successfully completed various fraud analytics that resulted in high profile cases referrals. • Conducted Pharmacy audits with PBMs, promoted to SIU manager within 3 months of hire.

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Medical Malpractice Investigator

Florida Dept of Health

Feb 2012 - Sep 2013 (1 year 8 months)

• Completed complex healthcare frauds cases using medical and Pharmacy data analytics. • Led statewide projects on pain management clinics, Pharmacy inspections and invoice auditing.

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Adjunct Professor

Broward College.

Sep 2008 - Dec 2018 (10 years 4 months)

• Served on faculty board as adjunct Professor and taught assigned courses for 10 years.

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Environmental Specialist II

Florida Department of Health.

Mar 2008 - Feb 2012 (4 years)

• Led investigations team on Vector Borne Diseases Epidemiology Surveillance project for CDC. • Built and prepared epidemiological reports and database for Florida health department

Sunday Adesina

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Sunday Adesina

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