Warning: This is more important to do than to write about! Not much in terms of warm fuzzies though with headlines like:
In terms of healthcare experience, we've done just about everything - HIPAA, Medicare, Medicaid, 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, Medicare, Medicaid, 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:
- Provided subject matter expertise (SME) for the RDS/ADM (representative marketing activity/compensation reporting system) redesign efforts. The design involved supporting alignment decisions, improving the system refresh rate, supplying management and representative dashboards, and incorporating pharmaceutical data feeds (payer, physician and facility, prescription, and anonymous patient-level data). Handled logical, physical, and semantic data modeling. Provided solution architecture and application DBA support. Worked with offshore development team.
- 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.
- 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.
- Performed the business operations, workflow, optimization, and needs analysis. Performed the data analysis, modeling, and mapping. Integrated data from multiple platform prototypes and hard-copy patient records. Designed system to be scalable and expandable (breadth and depth). Identified issues to be resolved in future modules and scope expansions.
- Identified date and volume manageability 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.
- 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.
- 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 migrations, including impact analysis and data-mapping. This led to smoother transitions and pro-active enhancements.
- Evolved 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.