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In terms of healthcare experience, we've done just about everything - HIPAA, Medi-Care, Medic-Aid, Medi-Cal, CHAMPUS,
Share-of-cost (SoC/SC), Ability-to-pay (ATP), State-subsidized care, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), private insurance, membership services, eligibility
determination, BCBS, patient flow, billing systems, decision support systems (DSS), laboratory services, claims processing, government regulation compliance efforts, APC, APG, OPPS, etc.
NOTE: Our experience also covers compliance with government regulations involving: HIPAA, Medi-Care, Medic-Aid, Medi-Cal, CHAMPUS,
Share-of-cost (SC), ability-to-pay (ATP), and Eligibility determination. Please see the related pages for additional information.
Some of our healthcare experience includes:
- ViPS Inc. for CMS, Woodlawn/Windsor Mill, MD 2006–2007
Responsibilities: Participated in the Drug Data Processing System/Integrated Data Repository
& Drug Benefit Calculator (DDPS/IDR & DBC) for Centers for Medicare & Medicaid Services (CMS) Medicare Part D Prescription Drug Program. Led the ETL/BI Reporting Team. Handled project planning
and priority management.
- Blue Cross Blue Shield of Texas, Richardson, TX 2003-2004
Responsibilities: Set up the actuarial data mart. Developed the Decision Support Services
(DSS) for the statistical control/actuarial efforts. Analyzed the membership and claims to support pricing determinations. Handled requests in this area by internal and external customers. Areas
requiring further study were identified and presented to the actuaries. Developed and administered catalogs, cubes, on-demand and scheduled reports, user classes, and security.
- UCLA MedicalCenter, Sylmar,CA 2000
Responsibilities: Accepted the Aftercare OB/GYN project on a fixed-bid basis. Designed and developed
Aftercare in Oracle. Performed the business operations, workflow, optimization, and needs analysis. Performed the data analysis, modeling, and mapping using Designer and Developer 2000, as well as Platinum
ERWin. The data entry screens were Oracle Forms. The reports were Oracle Reports and SQL*Plus. Integrated data from Access prototypes and hard-copy patient records. Designed aftercare
to be scalable and expandable (breadth and depth). Identified issues to be resolved in future modules and scope expansions.
- Medi-Consult, Palm Springs,CA 1997-1999
Responsibilities: Identify Y2K issues with regards to patient eligibility. Set up date windows for
eligibility data imported from health maintenance organizations, preferred provider networks, and private insurance. Set up reconciliation / correction procedures among these organizations. Set up
"universal" import system for data mining/warehousing. Identified core information in mission-critical systems for disaster recovery and/or system migration between platforms, data analysis and
data-mapping.
- Laboratory Corporation of America,Burlington, NC 1997-1998
Responsibilities: Participated in the merging of National Health Laboratories and La-Roche
business into the existing LabCorp systems. Enhanced the HMO eligibility system in order to reduce the redundancy of efforts and staffing, centralize eligibility processing, produce more timely and
accurate billing, lower processing costs, and raise client satisfaction levels.
- Blue Cross Blue Shield of South Carolina, Columbia, SC 1997
Responsibilities: Participated in the blending of IT streams to handle data processing for
other Blue Cross Blue Shield organizations. Interpreted and implemented top priority changes to comply with HIPAA. Identified core issues in system integration for expanded business area and database
migration from TOTL to DB2, including impact analysis and data-mapping. This led to smoother transitions and pro-active enhancements.
- Medi-Group, Los Angeles, CA 1987-1989
Responsibilities: Evolve a heavy-volume, state-subsidized care facility from the pen-and-ink world into the
computer-age. Converted from a paper system to an automated patient database. Dramatically cut waiting time and increased patient flow. Converted the paper accounts receivable system to a computerized
system that aged accounts and generated appropriate collection notices. As a result, collections were increased by nearly 30%, average age of accounts was reduced to 3 months from 8.7 months, and small claims court
filings were increased 43%. Designed a patient recall system that resulted in a 13% increase in sales during first month of implementation. Streamlined the data-flow for MediCare, MedicAid, and Medi-Cal
processing.
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