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Data Management

Location:
Dallas, Texas, United States
Salary:
Open
Posted:
October 30, 2018

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Resume:

Roderick Waddle

Medical Records Clerk

972-***-**** E-Mail:ac7j3a@r.postjobfree.com

PROFESSIONAL SUMMARY

10+ years functional and technical experience for meeting healthcare-IT strategic initiatives.

Reduced ongoing and potential threats by performing risk assessments with impact analysis.

Created efficient SQL queries in reporting to support operational and C-Suites decision making.

Managed updates to benefit grids to reduce claim edits and service errors in claims processing.

Leveraged key management functions for achieving operational-based and project-based goals.

Decreased operational threats to business continuity using contingency planning strategies.

Performed system assessments in clinical and ancillary systems for integrating clinical data.

Composed UML conceptual and logical diagrams to define business entities with business keys.

Executed packages mapped to workflows and tasks for meeting data integration milestones.

Facilitated projects using management functions for data, technical and application tracks

Forged team building initiatives for managing change and galvanizing organizational efficiency.

Ensured the handling of ePHI to comply with legal, social, and ethical compliance standards.

Merged and purged of EHR/EMR records in CHR and Mychart during peak and off-peak hours.

Composed root cause analysis in SWOT for meeting project milestones aligned to Six Sigma. .

FUNCTIONAL AND TECHNICAL SKILLS

Business Requirements: Development and Management, Forward/Backward Tracing,RMF

Project Management: CPM, Pert/Ganitt,Outsource,Operational Budgets,CMMI-ACQ, Schedule

Healthcare Management: EPB,Health Policies/Programs/Ethics/Systems,Informatics,Anaytics.

Test Management: Burndown reports, Defect Mgmt., Test Execution,Automation,Regression

Databases: SQL Server, Oracle 12g/Iseries(MongoDB), HiveQL,Redshift,OODBMS, ORDBMS

BI and EDW/ETL:Redshift, SSRS/SSIS,SSAS,Jitterbit, SSDT,Tableau, Quipu, BiReady Pentaho

Enterprise Data Management: MDM,ECM,Hub Integration, Data Governance, Data Cleansing

Business Management: Capacity Management,Change Management,Management functions

Data Manipulation/Visualization- Tableau(Geonomics), Excel(V-Look-up,H-Looks,Pivot)

EDI/HL7; 837,834,835,999,TA1,Pull/Push,Connect Direct,FHIR,ONC,HIO,Mirth,HIE-Gateway.

Clinical Systems: Meditech,EPIC,HIE/NHIN,HL7,Mirth,CPOE,EHR/CDS,PACS,MARS,RCM

Payer Systems: NASCO,ITS,EPIC, Facets 5.5, QNXT 5.4, Xcelys,IDX,EzCap,Amisys3000

Certifications/Awards

EPIC Tapestry Core/AP Claims NVT, Epic 2015

Trizetto Software Upgrade Team – Recognition for Service Excellence,2013

ICD10 – Compliance – 2012

ICD-9,Medical Terminology – Regional Occupational Program(ROP/C) 1990

EDUCATION

Master of Science in Healthcare Management 2018

Colorado Technical University Colorado Springs, CO

Concentration: Healthcare Informatics

INDUSTRY EXPERIENCE

Developer/Analyst Internship 02/2017 – Present

SWF Datafeeds(Start-up) Dallas, TX

Increased provider reimbursements using best-fit scoring logic to set up Medicare benefits.

Created efficient SQL queries in reporting to support operational and C-Suites decision making.

Leverage Micro-services, JSON, and Web-services with managing real-time data in IoT devices.

Optimization of real-time and manual batch processing for database transactional query tuning.

Discovered ways to lower expenditures using regression analytical tools built in Excel and SAS

Automated Mirth and Cloverleaf HIO using HIE/Gateway for meeting Stage 3 MU objectives.

QNXT Benefits Configuration 10/2016 – 12/2016

Catholic Health Initiatives(Merger with PMC) Remote, CA

Increased provider reimbursements using best-fit scoring logic to set up Medicare benefits.

Created efficient SQL queries in reporting to support operational and C-Suites decision making.

Managed updates to benefit grids to reduce claim edits and service errors in claims processing.

Reduced claims overpayments and recouped funds caused by benefit restriction errors.

Identified failed segment Id/elements for each HIPAA rules to meet coverage benefits,

Leveraged knowledge bases and training material to ensure accuracy during setting up benefits.

QNXT SSRS Reports Analyst 01/2016 – 7/2016

Santa Clara Valley Health San Jose, CA

Achieved successful requirement gathering work-sessions with users for defining provider and claims reporting data criteria.

Used synthesis, analysis, and evaluation to transformed requirements into viable reporting solution by calling out benefit plan tables in QNXT.

Used T-SQL and SSRS to create dynamic claims aging reports in Trizetto QNXT with multi-parameter-valued functionality in analytical tools.

Elicited user’s requirements for analysis to develop performance reports from extracted provider and claims operational data.

Lead Configuration Analyst ((Contract) ) 08/2014 -04/2015

Kaiser/EPIC Denver,Co

Achieved certification to configure Carriers, Benefit Groups, Networks,Billing, and Providers modules in EPIC Tapestry Core.

Created pricing mechanisms in EPIC to match service related or claim level events for payouts.

Reduced threats in EPIC by strengthening security posture via access controls and permissions.

Gathered high-level requirements for configuring provider’s information in EPIC Tap110 and Tap112.

Project Test Coordinator (Contract) 01/2014-04/2014

Deloitte/HCTEC/Catholic Health Initiatives (CHI) Denver,CO

Prepared and conducted WebEx with stakeholders to capture high-level EPIC Test Scenarios.

Participated in high-level requirement sessions for client specific functionality in EHR-systems.

Validated messaging and interoperability in Meditech 5.66/6.0 for meeting EHR-MU’s objectives.

Achieved 100% functional testing goals for validating interfaces and messages in Epic systems

This Area Denotes Multiple Contracts from 2012- 2014 for the Enactment of the ICD10 Mandate

SSRS Reporting Analyst/Test Lead 01/2013- 09/2013

Multiple Trizetto Proprietary End-Clients Multiple Locations

Conducted work-sessions with Stakeholders to elicit requirement high level Test Scenarios.

Validated HL7 ADT Workflow along with Meditech applications, interfaces, and Reporting.

Used MS Access and Rapid SQL to validate Facets SEPY groups along with products services.

Queried multi parameterized reports in MS SSRS 2008 to allow end users to generate dynamic QNXT 4.81 claims aging reports.

Resolved Claim Edits mapped to service groups, revenue, and CPT codes for claim payments.

Business Analyst Manager (Contract) 04/2012-07/2012

OTSI/Trizetto Group Kansas City, MO

Orchestrated multiple work-sessions with departments to elicit requirements for a security build.

Created mocked test data for configuring items in a Facets 4.8 SMT security build.

Reduced threat agents risk by configuring access controls and security controls in To-be system.

Increased workflow efficiency using key management and project-based functions during build.

ICD10 Project Test Lead (Contract) 12/2011-04/2012

S3/Cigna Hartford, CT

Tracked defects and created queries to extract daily test case execution results in Quality Center.

Leveraged functional baseline to define inbound/outbound messages that interface with Mckesson and ClaimCheck.

Orchestrated data summits and requirements gathering work-sessions to define functional flow in over 25 down-stream applications during a healthcare-IT system ICD10upgrade.

Facilitated Test planning phase along with data requirements and project management activities.

Test Lead(Contract with extensions) 07/2011-12/2011

Kforce/Think Finance Fort Worth, TX

Validated scorecard from decision engine along with transported messages for business rules, mapping and formatting in Biztalk Server 2008.

Reduced errors in scoring logic using synthesis, analysis, and evaluation during software testing.

Increased workflow efficiency using key management functions and project-based functions for meeting daily operational tasks.

Managed offshore teams task related to defects, schedule, and tasks during software testing.

ICD10 Test Lead (Contract) 02/2011-07/2011

S3/BCBS Detroit, MI

Leveraged key management functions for pre-live ICD10 integration and functional testing.

Augmented testing approach to meet projected test schedule, cost, and time constraints

Collaborated with cross-functional teams on SLA’s to meet test criteria for over 550 test cases.

Leveraged TR3 and TP companion guides specification for validating throughput of 837 files.

Increased workflow efficiency using key management functions and project-based functions for meeting daily operational tasks.

EDI Analyst(Contract Worked Concurrently) 10/2010-12/2010

Mercer/Beacon Technology Dallas, TX

Identified failed segment Id/elements for each HIPAA rules using editors and compliance tools

Designed Test plans with open enrollment and ongoing scenarios during testing 834 testing

Created ad-hoc SQL statements to manipulate and extract data for end-to-end test scenarios.

Used TR3/TP companion guides for validating 834 formatting and mapping EDI requirements.

Automation Test Lead (Contract Work Concurrently) 08/2010-02/2011

Zeva Technology/ Nokia Siemens Irving, TX

Managed broken builds and merged code from main trunk/object tree in sandbox/Dev environment using CL Hudson and ANT.

Automated web-based, Mainframe, and Window application using keyword, Object Spy, Data table parameters, and Expert View functionality in QTP.

Designed VBScripts to execute splitting actions functionality for single test scripts or scripts belonging to a suite using QTP 10.

Created VBscript functions in QTP 10 to capture Flex 3 objects in QTP 10 for automating events.

EHR/EMR Senior QA Analyst (Contract) 06/2009-09/2009

Gebbs Healthcare/MedPlus Mason, OH

Created test plans and test cases for validating throughput of HL7 messaging throughput in Epic.

Performed test case reviews and demonstrations involving stakeholders before product releases.

Created SQL statements to extract data for end-to-end test scenarios for Pharmacy CDSS build

Achieved testing of backlog scenarios in Care360 EHR/EMR portal

Pharmacy QA Analyst/Automation (FTE) 02/2008-02/2009

DaVita RX (Fulltime Employee) Coppell, TX

Achieved testing of 270,271,277,278,835, and 837 EDI files for a web-portal build using Axway.

Set-up data sources connectivity and batch schedules bulk loads to staging during ETL testing.

Performed data analysis, transformation, and merges using source data for data warehousing.

Created test scripts in QTP 8.5 for the automating of web-based and mainframe applications.

Validated XML messages throughput mapped to business rules and logic to Biztalk 2005 target.

Perot Systems (FTE) 2/1996 – 02/2008

Project Lead(BPO Fulltime-Employee) Dallas, TX

Performed System testing, Functional testing using baseline requirements in EPIC EHR/EMR core systems and ancillary subsystems during a system conversion.

Resolved QNXT claim edits and warning messages mapped to benefits services groups.

Validated inbound 837i and 837p messages during SIT testing of QNXT 3.2 at WEA in 2007

Processed of 200 CMS 1500 and UB04 claims in Facets 4.1 – 4.5, QMACS/QNXT 3.2.

Increased workflow efficiency using key management functions and project-based functions for meeting daily operational tasks.



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