Experience

Blue Health Intelligence
• United States
• IT Services and IT Consulting
• 100 - 200 Employee
• Senior SQL Developer

  • Jul 2017 - Present


IT Consultant - HCSC / Emdeon

• Senior Consultant

  • Feb 2014 - Jul 2017

  Providing architectural design, technical expertise and project management experience to various health care related initiatives. • Using Agile framework and Scrum development strategy to migrate millions Teradata stored claims to Big Data Hadoop technology to facilitate the data analysis of corporate and governmental claims. Also consolidating the data into episodes facilitate reporting of true cost analysis. • Application upgrades for conversion of ICD9 / ICD10 diagnostic codes and procedures. • Implementation of on-line data migration process of network claim reimbursement rules. • Redesign post-payment healthcare database for screening financial recovery claim candidates. Show less



MultiPlan / Viant Inc

• EDI manager / Client Service Liaison / System Architect

  • Jan 2003 - Nov 2013

  Managed EDI operations and development for Viant, a division of MultiPlan; maintaining and updating as required 200+ feeds for multiple clients utilizing X12 standards (837.997,999) and proprietary formats.Manage upgrades from 4010 to 5010 and ICD9 to ICD10 coordinating with client and business schedules.Responsible for IT budget through effective project planning, software procurement and licensing, as well as monitoring; including the attraction, development, motivation and retention of staffing. Ensure documents and procedures have been implemented for all applications as part of the Standards for Attestation Engagements (SSAE) audit process. -Architected and managed conversion/upgrade of single node EDI system for handling medical claims, images, reporting and acknowledgements to state-of-the art multi-node clustered system with built in fail-over; providing 24/7 availability to clients. -Designed, developed, implemented and manage a HIPAA compliant EDI system for handling medical claims. Included in the system is a fully encapsulated paradigm for claim information management, data validation, electronic acknowledgements, process automation, error notification and security handling claims with total billed charges exceeding $11 billion dollars annually. -Architected, developed and managed enterprise system for the Recovery Audit Contractor (RAC) program pilot using Rapid Application Development (RAD) for the recoupment of Medicare payments mandated by the Tax Relief and Health Care Act of 2006 in excess of $115 million dollars. Performed: data analysis and validation for executive summary, hardware capacity planning and procurement, and claim flow communication interfaces between CMS, Medicare fiscal intermediaries and other recovery audit providers. -Developed healthcare post payment common repository database to integrate multiple client medical claim payment information for data mining, analysis and identification of possible improper claim payment. Show less



Knowledge Works

• Architecture and Planning
• 1 - 100 Employee

• System Architect / Database Administrator/Senior Developer

  • Mar 2001 - Feb 2002

  Accomplished many roles in a small, start-up company that was a client of the Revere Group. Responsibilities included; Hiring and training personnel in business and technical processes. Designing and implementing enterprise wide systems and procedures. Generating capacity plans and future resource needs. Integration of multiple, divergent sources of raw data into the existing architecture. Designing and implementing adaptations to existing business processes and technologies to accommodate new, dynamic business requirements. Documentation and version control of database schema, stored procedures, database triggers, process libraries, and web pages. Show less



The Revere Group

• United States
• IT Services and IT Consulting
• 1 - 100 Employee

• Managing Consultant

  • Sep 1995 - Mar 2001

  Resolved scheduling, resource, and technical conflicts across teams. Assessed clients’ technical environments and cultures and influence key technical decisions to deliver optimal solution.Worked at all levels within client organizations to communicate critical technical choices specify technical requirements and constraints for design and implementation.Developed and implement project design standards in all work products, including complete development life cycle, project charters, project plans, technical specifications, testing, and QA Proficiency while properly managing client expectations. Work with the developers, business analysts, and database administrators, to resolve emerging issues or to design new solutions.Developed integrated systems architecture including databases and other system components in a distributed, on-demand environment National Transportation Exchange(NTE)– Project Manager Analyzed and advised changes to project managers MS Project plans for the utilization in third party software integrated at the database and the macro-level of MS Project to provide reporting capabilities across multiple projects. Leveraged existing software to provide added value to the company’s transportation brokerage business HUB Group Inc– Database Architect Analyzed, designed, and developed database tables, stored procedures and triggers for web and EDI applications. EDI application used XML formatted documents to input new package delivery requests as well as making changes to existing package deliveries. Triggers updated business related fields in other tables, not directly modified by package delivery updates Northern Trust Bank– Technical Specialist / Project Manager Managed team to design, create and implement a 3-tier architecture application to schedule reports/client statements. The stored procedures executed remote procedure calls that allowed it to access data from multiple distributed Sybase databases as well as an IBM mainframe DB2 database Show less