Consulting Project Experience:
Managed Care System enhancement, data analysis for claims, UM and capitation accounting, P4P and ICE
compliance reporting; using Health Trio, SQL Server stored procedure programming, Crystal Reports.
Point-of-care P4P monitoring web application design, QA and implementation.
HIPAA X12 EDI implementation, using TIBCO BusinessWorks.
Medical Case Management system design, QA and implementation.
Managed Care Claims System Interface, using IRP Software's Medicare DRG and APC grouper/pricer software products.
Managed Care Claims Processing Review, auto-adjudication rate analysis, executive summary and
EDI Translator Software Evaluation, Selection and Implementation, using Mercator software.
Managed Care System Conversion - from EZ-CAP to AS400-based ASP vendor.
Managed Care Claims Scanning/OCR Interface Design and Implementation, using EZ-CAP and Captiva
HIPAA X12 Data Repository Design and Implementation, using SQL Server and Sybase (NEON) ECMap EDI Translator.
Programming with various tools including VB, C/C++, SQL, proprietary/embedded scripting tools as required.
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