Case Management Database Administrator

Education:

University of Maryland at College Park – Bachelor’s in General Studies (1978-1983)

Work History

Ross Innovations : IT Healthcare Consulting

(1994 to Present)(Cordova, TN)

Collect Requirements and create Process Documentation

Collect User, System, and End Result data and create detailed Process Documentation.

Process Automation for data transfers & System Operations

Create automation of data extraction and transfer to ensure up-to-date information for vendors.

ERISA, HIPAA, EDI & PHI Compliance Security.

CMS Compliance MMSEA Section 111.

Collect and implement process and exchange with client vendors.

Reinsurance Tracking Systems Reporting

Aggregate and Specific plan years to ensure correct reimbursement.

Trend Analysis Reports Reporting

Rolling months and years to assess trends within benefit plan.

Trigger Reports for Case Management Reporting

Specific diagnosis for illnesses that can benefit from case management.

TPA Insurance Analysis & Data Exchanges

X12 Exchanges, Modifications - 834, 835, 837

Cognizant (formerly Trizetto / formerly RIMS) QicLink Versions 2 – 6 / DataPiction SQL Expert

Microsoft Access & SQL Database Administrator - SSMS

Microsoft Office - Windows – UNIX – FTP &VPN Vendor Exchanges

Data & Process Governance

IT Application Development & Management Senior Specialist:

MSAG/CIGNA (2005 to 2007)(Memphis, TN)

Develop and maintain all IT systems and applications.

Txen PowerSTEPP & InfoSTEPP liaison, SQL DBA.

Develop and process data/reporting exchanges with clients and vendors.

HIPAA Compliance Officer.

Senior Consultant: Resource Information Management Systems (RIMS/TriZetto/Cognizant)

(then Trizetto now Cognizant) (1987 to 1994)(Naperville, IL)

Developed and maintained Intelligent Query (IQ versions 2 & 3) for COBOL relational database.

QicLink & DataPiction

Develop data/reporting exchanges with clients and vendors.

Implement new clients to QicClaim II and QicLink versions 2 & 5

Taught Classes for ALL QicClaim & QicLink Modules

Skills

QicLink Versions 2 – 6 (Expert)

Windows Operations/Scripting (Advanced)

UNIX (Familiar)

SQL/SSMS (Advanced)

Database Management (Advanced)

Data Processing/Automation (Advanced)

Data Mapping (Expert)

Data Governance (Advanced)

Process Governance (Advanced)

MS Access (Expert)

Excel (Advanced)

Word (Advanced)

Microsoft VBA (Familiar)

X12 Manipulation/Processing (Expert)

FTP Processing (Expert)

UltraEdit (Advanced)

AutoHotey (Advanced)

Power BI (Beginner)

HTML (Familiar)

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