By Timm Tobin
- Aegeus team charged with investigating and designing this data and EDI intensive effort. Responsible for submitting complete and accurate RAPS and EDPS files from this legacy claim adjudication system via an Enterprise Date Warehouse and associated Operational Data Stores. Worked with the Centers for Medicare and Medicaid Services (CMS), to develop the business process and technical plan.
- Led Claim Payment software implementations, conversions, and migrations for Managed Healthcare clients including Marketplace, Medicare, Duals, and Medicaid products. Implemented add-on software such as Market Prominence, Customer Service, Grievance/Appeals, Optum pricers for Medicare payments, Claim editing software ICES, ClaimCheck, ClaimsXten, and Cotiviti.
- For a major regional third-party payer, create and roll-out an Enterprise Data Warehouse and associated Operational Data Stores (ODS) and Data Marts. Providing key analytics to improve healthcare delivery and this insurer’s bottom line.
- Development of a Wellness Incentives Program, comprised of an Operational Data store (ODS), custom reward calculations, administrative UI, Single Sign On integration with WebMD (for user reward management).
- Clinical Implementation to transition from disparate legacy UM/CM/DM applications, to a web based distributed integrated platform reducing manual processes, and delivering a complete view of care. Create processes and configuration that is scalable for future growth and shared across lines of business. Enhance clinical data management and analytic core competencies.
- Provide Project Management for the Council on Accountable Quality Healthcare (CAQH) initiatives. Quickly come up to speed on new requirements and work with all stakeholders to design and implement the solution. Develop project management plans and schedules for all phases of this initiative.
- Responsible for coordinating Trading Partner testing for this national payer. Project consisted of developing scenarios, performing data mining, building the EDI transactions, and handling all defect management. Extensive use of Quality Center to drive results. Coordinate all players in end to end testing including Trading Partners, third parties, developers, test and business resources.