Since beginning my healthcare career in 1994, I have worked with a cross-section
of research professionals in many settings to develop, measure and analyze new
and existing healthcare management strategies and quality improvement
initiatives. I have provided decision support both directly and indirectly to: 4
state health agencies, 6 state departments, 40 municipal and county governments,
2 state senates, 1 governor, 4 universities, 12 managed care organization and a
host of business partners and covered entities throughout the Healthcare
Industry.
SAS is my primary data management and analysis tool. My intermediate to expert
level SAS experience extends to both the mainframe and PC environments. As a
consultant I provide programming support to clients by developing programs,
processes and reports that automate data reporting. Data support activities
include management, manipulation, validations, transformations, audit,
statistical and ad-hoc analysis.
Above average proficiency in Microsoft Office (Word, Excel, Access, etc.),
excellent written and oral communication skills and advanced project management
experience makes me your ideal candidate. My accumulated experience has made me
proficient with the following data content, national codes and regulatory
guidelines: CPT, ICD-9, HCPS, NDC, HIPPA, NCQA, HEDIS, FDA, Utilization,
Authorization, Provider, Medical Claims, Eligibility, Enrollment/Membership,
Pharmacy, Dental/Vision, Behavioral, EPSDT
CONTENT AREAS
- Field Data Collection - HEDIS Audit/Analysis
- Project Management - Demographics Research
- Quality Improvement indicators - Predictive risk models
- Utilization Data Reporting - Pharmacy/Behavior
- Data management, collection & analysis - Program Evaluation
- Disease, Authorization and Case Management - Healthcare Compliance
- Provider network-support - Claims Billing/Coding
SAS HISTORY
Organization / Company Time (%) Start Year Duration Environment
Tennessee State University 20 1995 0.5 Mainframe Only
Metro-Nashville Schools 35 1997 2.0 Mainframe & PC
Bureau of TennCare 100 1999 3.0 PC & Mainframe
Independence Blue Cross 100 2002 2.5 PC Only
BCBS of Tennessee 100 2007 0.5 PC / Enterprise Guide
BLUE CROSS BLUE SHIELD OF TENNESSEE 2007
Industry: Healthcare
Department: Medical Information Management
Title: Information Project Analyst
Project Overview: 6-month project - Responsible for HEDIS audit and reporting
DATABASE MANAGEMENT/ANALYSIS
Access and format both internal and external administrative and hybrid data
using MedMeasure, MedCapture and XML to format, calculate and report the HEDIS
rates for both the Medicaid and Commercial products to NCQA and other
independent, state and federal auditors
Responsibilities include conducting CDC and NCQA pilot studies to assist in
the development of HEDIS measures and coordinate the collection reports from
various departments to prepare the company for multiple onsite audits
Identify multiple populations and routinely reporting on HEDIS various
measures using the NCQA HEDIS technical specifications
Identify and update links to the following data sources and coding systems:
Laboratory - LOINC codes
Pharmacy - NDC codes
Immunization - CVX codes
Claims - ICD-9, CPT codes
Medical Record
INDEPENDENCE BLUE CROSS - FAMILY OF COMPANIES 2003 2006
Industry: Healthcare
Department: Independence Healthcare Management, Department of Research and
Evaluation
Title: Research Analyst
Project Overview: Responsible for database management, utilization reporting and
analysis for 8 companies and 9 lines of business.
PROJECT MANAGEMENT/PROGRAM EVALUATION
Responsibilities: Develop and debug programming code to query corporate-wide
database systems to perform data management, validation, analysis and reporting
Meet with internal and external clients to meet business needs for ad-hoc
programming and reporting
Tools: SAS, Oracle/SQL Server, Visual Basics, MS Project 98, Word, Excel and
PowerPoint
REPORTING
Responsibilities: Produce various corporate reports for each of the 8 members
companies and 9 lines of business which covers a 4.3 million member population
which accesses a care network of over 300 hospitals throughout Pennsylvannia, New
Jersey, Delaware and several U.S. Territories. Report measures include
discrepancies, length of stay, bedtypes, admits, type of admits, denials, level
of care, beddays
Flash Report Standard monthly report designed to show inpatient utilization
data by product (lines of business). IBC contains nine lines of business
covering Pennsylvania, New Jersey and Delaware.
Utilization Data Report - Standard monthly report created to illustrate 14
inpatient utilization data measures by product and facility within product.
Tools: SAS, Visual Basics Macro, MS Excel, Access and PowerPoint
DATABASE MANAGEMENT/ANALYSIS
Responsibilities: Perform data/database warehouse design and support, validation
and analysis for the following database systems:
CDW (Corporate Data Warehouse) - Claims and Enrollment Data
Datamart 4 assist with an upgrade to the CDW, designed to more efficiently
blend various data content and sources that include claims, pharmacy, behavior
health, authorization, and medical cost data to meet corporate business reporting
requirements.
Optimed to MaxMC (authorization, case management, appeals database) -
Inpatient Utilization Data warehouse
Provide system transition support and development tools for the created
blended database management system that processes and incorporates Medical
Management data and business activities such as Utilization, Case and Appeals
Management
Finance and Health Services Datamarts Risk, Finance & Compliance Database
Coding Dictionary Management - maintenance includes importing of standard
dictionaries as well as client provided dictionaries to establish auto encoding
and setup processes to support and facilitate dictionary coding.
Risk, Finance and Compliance data program development and reporting
Tools: SAS (PC & Mainframe), Oracle/SQL Server, JCL, SQL, ODBC, MS Excel and
Access
COMPLIANCE
Quality Measures
Develop an administrative measures database reports that produces snapshot
reports for more than 75 specific health measure and analyze survey data from
various quality of care assessment tools
Provider Network analyze and publish provider assessment reporting tools
such as PQAS (HEDIS-based QI/UM survey tool) and VIPPS (performance-based cost
incentive program)
Tools: SAS (PC & Mainframe), SQL, ODBC, MS Excel and Access
STATE OF TENNESSEE - BUREAU OF TENNCARE 1999 - 2002
Industry: Healthcare
Division: Quality Oversight
Title: Biostatistician / Statisical Programmer
Project Overview: Oversee the continuous improving of the quality of health
services furnished by the nine contracted MCOs and their provider networks.
DATABASE MANAGEMENT
System/Database Administrator for Outcome Partners III (OPIII)ฎ an
internet-based database management system designed by Pfizer Health Solutionsฎ to
provide centralized and standard data collection, management and reporting
functions for EPSDT, High Risk Pregnancy and other quality oversight initiatives
Activities include monthly, quarterly and yearly surveys, on-site audits, case
management, database installation, configuration, upgrades and maintenance
analysis.
Tools: SAS (PC & Mainframe), SQL, ODBC, MS Excel and Access
REPORT AND ANALYSIS
Conspire with senior management to develop, measure, and analyze new and
existing healthcare management strategies and quality improvement initiatives
Develop systemic analysis tools applying measures of dispersion, variance and
association; Ongoing assessment of the reliability and validity of QI measures
through health monitors
Tools: SAS (PC & Mainframe), SQL, ODBC, MS Excel and Access
COMPLIANCE
Interact with contractors and consultants (EDS) to maintain EDI business
process rules, standards and consistency of application development; panel review
VAN logs and translator reports for the generation and tracking of functional
acknowledgements of EDI data
Monitor EDI transactions and HIPPA EDI standards for transaction sets (e.g.
835, 837, 276);
Identify and deliver cost-effective solutions that can meet the requirements
for ensuring HIPAA due diligence through advanced solutions for databases, and
document management
Tools: SAS (PC & Mainframe), SQL, ODBC, MS Excel and Access
METRO-NASHVILLE PUBLIC SCHOOLS 1997 - 1999
Industry: Education
Department: Research and Evaluation
Title: Program Evaluation
Project Overview: database development, collection, analysis and reporting to
measure and ensure compliance with Federal and State grant requirements
Responsible for data collection, storage and analysis, data model and design,
survey studies using SAS & SPSS and the development database of an application of
private and federal grant compliance reporting measure and results
Significant Grants: Title I, D.A.R.E, Gender Equity, Plans for the Future
TENNESSEE MANAGED CARE NETWORK 1994 - 1996
Industry: HealthCare
Department: Administrative Services / Transportation
Title: Mailroom Clerk / Transportation Project Coordination
Project Overview: Respond to and research requested appeals. Process
encounter/provider claims for billing and payment. Claims processing,
administrative appeals, case review and medical billing
Review encounter/provider claims and appeal cases for effective date issues,
access to insurance and billing code errors.
Process pending claims of encounter/provider data for provision of medical
services and/or reimbursement of same when paid by or billed to enrollee
EDUCATION
SCHOOL DEGREE MAJOR GRADUATED
Tennessee State University Bachelor of Science Social Sciences 1996
Tennessee State University Masters of Education Research/Adm.
1998
Nashville Technical State SQL/DB2/AutoCad Database Courses N/A
PROGRAMMING ENVIRONMENT
Products HMO POS PPO CHIP ADULT CHIP Medicare Uninsured Risk Panel
Content Medical Claims Enrollment Case
Management Provider Compliance Behavior Health Pharmacy Authorization
Documentation Code Logs Data Dictionaries Request Forms Reports
Data Tools SAS SQL Word Excel PowerPoint Access
Reporting SAS COGNOS Excel CRYSTAL Access
Communications Dedicated Line LAN TCP/IP
Extract / Transfer SAS Access Excel ODBC FTP
Data Source Interface DB2 ODBC Web Technology SQL Server Windows
Client & Server Type Windows AS/400 ASP Mainframe
PLATFORM APPLICATION PURPOSE
IBM Mainframe OS/390 R2.10 Oracle 8i/DB2 V 7 Mainframe
Sun Servers Unix\Sun OS V 5.8/SQL Server/SAS V 8.2 Database Processing
Corp. Data Warehouse AIX V4.3.3/Oracle 8i/DB2 V7.2 Data Staging/modeling
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