PROFESSIONAL SUMMARY:

• 15 years of experience as a programmer and data analyst performing claims reconciliation, auditing, medical and financial data extraction and reporting in a mainframe and client server environment. Strong background in Medicare and Medicaid compliance in a regulated environment.
• Medicare part D and Medicaid compliance background
• Medical loss ratio reports, provider score cards, pay for performance, risk analysis of members for intervention, government reporting requirements for the healthcare industry. Reporting to actuarial, sales, marketing, membership, external clients. Reconciliation and auditing of Medicare Part D claims and eligibility in a Six Sigma environment. Familiar with project life cycle.
• Knowledge of accounting finance, medical terminology and coding ICD9 and ICD10 diagnosis and procedure coding, pharmaceutical drug classifications, HEDIS, QARR, MEDS II, ANSI X12 834 EDI reporting, HL7 v2,v3
• Reporting tools: Quadramed, Misys, Facets, Medstat Decision Analyst, ViPS, McKesson CRMS, Business Objects, SQL, SSRS, SSIS, Cognos, Oracle Reports, Crystal Reports, Excel templates/macros, Access
• MVS environment, OS 390, z OS, strong JCL and IBM utilities i.e. sync sort, GDG, VSAM, TSO ISPF, SPUFI for DB2.
• Unix shell scripting, Awk, Sed,Grep,Perl
• Oracle SQL Developer, Toad, PL SQL, stored procedures, Oracle Reports
• Interfacing SAS batch programs with Teradata, Oracle, web pages, Perl cgi.
• Taught a course in SAS at Bergen County Community College Fall 2005 as a SAS authorized training provider. Design of course from the ground up by myself.
• Pharmaceutical research background including c-GMP, c-GLP training. LIMS exp.

WORK HISTORY

Confidential

• Project: Participated in creation of a web based information system based on Quadramed for use by physicians and health care workers in a hospital setting.
• The system has an Oracle 12c back end and asp.net front end.
• I worked with the webpage developers by creating stored procedures used to load the web pages. The stored procedures are used to bring in data and images on a Unix system.
• This involved the use of SQL and regular expressions to extract medical data from electronic medical records for presentation in the web based system. BFILES were used to load image data such as X-rays etc.
• In addition, I did research on New York state DSRIP which included the most suitable projects for HHC to participate in. This included cost and utilization analysis of hospital claims data.

Confidential

• Designed and developed database software on a Teradata environment to support marketing, actuarial and Medicare D enrollment and eligibility.
• Broad knowledge of data sources, data integration and data flow.
• Extensive experience interfacing SAS and Excel with Teradata information warehouse. Implementation of teradata based analytic solutions via Teradata macros and Teradata SQL stored procedures.
• Interfaced with users to determine requirements for data, reports and training.
• Design of processes to extract, transform, cleanse and load data. Maintenance, updating and testing of SQL on IBM mainframe using BTEQ.
• Excellent documentation skills including writing of SOP's.
• Training of Medco employees on Teradata and SAS.

Confidential

Position: Sr. Data Analyst

• Medical, financial and risk analysis reporting using Medstat, ViPS, Business Objects, SQL Server 2008 and Microsoft reporting tools. Database used was FACETS.
• Medical loss ratio reporting, benchmarking of primary care physicians, PCPs, pay per performance measures for PCPs, member utilization and cost monitoring, over billing monitoring, relative risk comparisons vs. cost of providers and for early intervention for members.
• QARR HEDIS formatted reporting to New York State SSRS.
• PCP report cards and pay for performance SSRS.
• Scheduled loading of daily inpatient data from Excel into SQL Server warehouse SSIS.
• Readmissions project identify readmission rate among members having COPD, asthma, pneumonia, CAD, CHF. Identify as high risk, medium risk or low risk. Provide demographic information to Readmission committee to improve aftercare and readmissions rates.
• HIV project identify new members having HIV including level of illness. Provide medical, pharmacy and demographic information on new members.
• Behavioral Health committee identify new candidates for QARR HEDIS studies and report to the committee on the status of these members.

Confidential

Position: Sr. Data Analyst Programmer

• Data extraction and reporting as per user and government requirements such as QARR HEDIS MEDS II.
• Design and implementation of production and ad-hoc reports per user and government requirements using McKesson CRMS, SAS, SSRS Report Designer and Report Builder against a SQL Server back end.
• Claims analysis and reporting using SSRS for marketing sales such as enrollment rates and rates of renewal.
• Reports were created for internal and external customers.
• Design and creation of user interfaces such as ASP.NET web pages, Perl cgi, and SAS AF screens for user report generation.
• Scheduled data loading using SSIS from Excel, Access and flat file delimited formats into SQL Server warehouses.
• Government reporting MEDS II, QARR, HEDIS, ANSI X12 834 EDI, HL7 reporting.
• Visiting Nurse Service May 2007-July 2007
• Position: Programmer contract through TNT Technologies
• Project: Migration of SAS DB2 jobs from IBM mainframe to an Oracle server environment. Interface SAS Enterprise Guide with Oracle data bases. Parallel testing was performed on the new and legacy system. Validation programs were written to examine the integrity of data tables and output report data of the new system.

Confidential

Position: Database Manager

• Management, maintenance and update of demographics, trending and historical databases and automated reporting software for membership, marketing sales and actuarial depts.
• Maintenance of sales department data base and website.
• The databases were on an IBM mainframe in DB2, VSAM, SAS and flat file format.
• Create reports for actuarial, marketing sales and membership depts. such as enrollment rates and renewal rates.
• Production and ad-hoc reporting using Business Objects, SAS, Excel VBA macros to produce custom reports for users.
• Manage monthly, daily, hourly job streams on mainframe.
• Assist in HEDIS audits of information practices and control procedures, data integrity.

Confidential

Position: Programmer analyst

• Design, building, testing and debugging of programs and processes related to EDI reporting on IBM mainframe.
• Use of utilities such as Quikjobs, SAS, SQL and Report Writer.
• Assist with issue tracking, data investigation, root cause analysis and problem resolution.
• Analysis of data and output reports as specified by HIPAA using ANSI X12 834 EDI standards. Output reports were tested for government compliance using Claredi a web based testing facility.
• All data mapping and data dependencies were examined using proc freq, proc tabulate and in house testing programs.
• Parallel testing was performed on test programs using production programs. A validation program was written to examine the integrity of output report data. Ad-hoc programs to examine files and data.
• Mainframe using SAS programming position using the OS 390 TSO ISPF facility, JCL, base SAS and SAS macros.

Confidential

Position: Mainframe Unix Programmer

Writing and testing of batch and CICS programs written in COBOL and Natural. Reporting using base SAS, SAS macros on Unix Red Hat . Use of Expediter, Intertest and SPUFI. Syncsort, generation of GDG and VSAM data sets. Unix shell, Awk, Perl, SAS, Proc Report., Proc Plot, Proc Chart, Proc CPORT CIMPORT. Creation of VSAM files, repro of flat files into VSAM files and verifying them. Testing of programs against Adabase.