Darryl Watkins Email & Phone Number

Camp Hill, Pennsylvania, United States

Provide Analytical support for Claims Operations. Manage daily pended claims inventory.Insure adjudication timeliness to satisfy regulatory compliance metrics. Implement and manage payment integrity in regards to overpayment identification and recovery.Oversight on encounters accuracy and rejections scrubs clean up efforts.Manage a team of business analysts who perform day to day activity of the department.Duties that align with staff management activities.

Camp Hill, Pennsylvania, United States

Engages directly with Claims Director and Senior Manager producing analytics for recovery efforts around claims payment integrity and coordination of benefits.Queries developed responsible for recouping $1 million in overpayments and have eliminated an average of $4,333 per month in sanctions, to date.Provides daily and weekly analytics updates on claims adjudication status and aging for suspended claims.Developed state mandated compliance report communicating Medicaid LTSS claims processing/turn around time using Teradata SQL Assistant.Produces other ad hoc reporting and analyses using Teradata SQL Assistant against company TD EDW and/or Golden6 against Oracle-based instance of AMISYS.

Harrisburg, Pennsylvania Area

SQL Server 2008 R2 reporting in SSRS. Leverages partner Cognos web-based reporting tool for advanced analytics of Pharmacy Utilization by members.

Buffalo/Niagara, New York Area

Client: Fidelis of NY ... Senior SQL Developer on team responsible for ACA Healthcare Exchange for the State of New York business process integration with FACETS. Meets with stakeholders and business analysts for process design solutions for FACETS Customer Service Inquiry (CSI) interface customized solutions. Meets with stakeholders for requirements gathering for above-stated projects. Assists in writing requirements for customized FACETS CSI solutions.  Develops stored procedures to customize Member Services and Retention teams to initiate customer outreach as specified by ACA legislation. Writes SQL stored procedures against Sybase Adaptive Enterprise Server –based FACETS 5.1 to run as nightly batch processes. Works alongside FACETS Configuration Analyst to assure configuration of fields meets stakeholder business process requirements as well as development specifications. Manages and maintains projects development requirements, goals, features and deadline using Visual Studio and Team Foundation Server as service to client. Travels to client site to fulfill Developer duties and to avail myself for face-to-face interaction with client invested parties Monday through Thursday of each week. Works remotely using Citrix Receiver to commit to client target dates and deadlines for solutions delivery.

Harrisburg, Pennsylvania Area

Served as a tester on the development of updated Davis Vision dot com website/web portal. Started by revising As-Is/To-Be requirements for the new site loaded into Microsoft TFS (Team Foundation Server). Filled the QA role on Scrum team in Agile Development environment responsible for overhaul of Member Portal. Revised As-Is/To-Be requirements to assure new (“To-Be”) website at a minimum delivered all functionality of current (“As-Is”) web presence and navigational structure. Served as lead in test design integrated with the use of Microsoft Test Manager (MTM). Authored training guide on how to successfully conduct testing with Microsoft Test Manager across multiple OS and mobile platforms to assure uniform testing.  Conducted training session to test team to deliver test plan, and to communicate testing execution for Davis Vision Dot Com project. Executed testing for web application using Microsoft Test Manager. Entered Defects into Microsoft Test Manager and linked them to cross-function features (if applicable) in Microsoft TFS.

Camp Hill, Pa

Serving as Sr. Business Analyst in support of QualityBLUE Provider Performance Assessment Web Application delivered by Truven Health (f.k.a. Thomson-Reuters). Developing test cases to validate application data is consistent with claims, membership and provider data in Highmark's Enterprise Data Warehouse. Using data analysis and presentation to influence decision-making around logical design elements of PPA web application. Implements requirements logic using SAS to perform Provider Profiling based on claims to validate application results. Conducts SQL Training to instruct other department analyst on how to leverage the use of SQL to create more independent testers in support of provider applications. Authored Understanding and Writing SQL, as it pertains to the Business Analyst and QualityBLUE training guide, along with SQL Quick Reference Guide.  Writes SQL using Teradata SQL Assistant to execute testing for validating application data of several clinical quality performance measures. Test release fixes for Enhancement Requests/Defects entered in ClearQuest and communicates results back to Technical Leads and Programmers, and updates CR. Extracts drug claims from Teradata and Oracle tables in order to analyze detail reports in comparison to summarized reports available to providers in Highmark's QualityBLUE network. Attends several project management weekly update status meetings to communicate progress of QualityBLUE testing.

DNJ Solutions, LLC is an IT Consulting/Outsourcing firm with an emphasis on Business Analysis, Data Analytics and Systems Testing and Integration. We provide access to more streamlined and targeted business processes using the following model:• Identify an organization’s business needs by asking the right questions.• Making the right talent accessible to an organization to analyze business goals and objectives. This step can include implementing a team of Business and Data Analysts to determine the organization’s technology gaps and provide data visualization to offer solutions for business optimization.• Advise decision-makers on which tools will drive the organization toward achieving their goals.• Install a team of developers and testers to interpret the business need into a business process that directly reflects the goals of the organization. This step can include following new systems integration from design through to user acceptance and training.For outsourcing needs, DNJ places individuals with a background best geared toward the job roles and responsibilities. DNJ covers the majority of human resource management functionality required in locating and hiring talent. Following the hiring process, DNJ employs the consultant 100% and manages benefits, enforces labor laws and best practices, manages invoicing and billing, and covers incentives and rewards programs.DNJ can place talent for the following projects:• Applications Development• Business Analysis• Data Analysis• Data Management• Project Management• QA and Testing Services• Statistical Analysis and Reporting

Harrisburg, Pennsylvania Area

Consulted with PA Department of Revenue on testing Modernized e-File system implemented by Revenue Solutions, Inc. Managed inventory of business-use test cases for personal and corporate tax systems. Developed a dashboard to communicate testing status and completion rates to client. Served as liaison between staff testers and developers to effectively communicate and report application errors and bugs detected during testing session.  Loads test case XML files for new tax system via web service to SQL Server 2005 DBMS in preparation for each test session. Schedules testing sessions, organizes testing personnel (DoR staff members), and manages client resources during Integration Testing and Participant Acceptance Testing in order to achieve completion rate goals and keeping client on target in regards to budget and schedule. Coordinates and conducts daily summary sessions with developers to discuss bugs and communicate client design and functionality requirements. Writes SQL SELECT scripts to confirm web service functionality and test data integrity to provide technical support.

Served as primary consulting contact for Capital Blue Cross' annual Healthcare Effectiveness and Data Information Sets (HEDIS) audit conducted by NCQA. Key in providing statistics for categorical utilization data to determine if client met quality care standards in order to service Medicare/Medicaid coverage. Achieved low percentage of errant reporting by performing the following: Converted stored Teradata claims data into vendor-specified flat text file formats using SAS to export to vendor's SQL Server 2000 DBMS.Analyzed data using SQL Query Analyzer and SAS to produce key HEDIS statistical data.Provided non-compliant membership listing to marketing department with the result of increasing preventative screening utilization initiatives.Extracted membership from client enrollment system and prepared all enrollment segments in preparation for import to vendor's SQL Server-based system according to vendor specifications and NCQA continuous enrollment guidelines.Successfully provided HEDIS measure data that accounted for utilization anomalies and/or inconsistencies based on strategic data analysis and research.Supports auditing vendor by constructing and supplying SQL queries for the purpose of sampling client utilization data.

Solely responsible for the conversion and automation of all military contract utilization and metric performance production reports. Improving report generation process to one stop/one step cut department cost allotted for data retrieval by 20%. Was able to provide accurate reporting and exceed deadline expectations by achieving the following: Constructed complex SQL queries and SAS programs against Oracle, DB2 and Teradata DBMS to lower query requests for each respective DBMS.Used PC SAS to merge multiple DBMS SQL necessities into one program to improve processing time for reporting requirements.Delivered monthly, quarterly, semi-annual and annual production reports and Metric Performance reports by meeting 100% of deadline and accuracy requirements which avoided government fines and penalties.Interfaced with TDP Marketing and Quality Improvement departments to gather requirements, design and implement key tools used in tracking Military Contract Performance.Led the implementation of Data Extraction revisions for reporting Claims Statistics and Enrollment Status.Project Lead for claims system conversion to dental reporting interface.

Served as key contact for Administrative Services Only (ASO) customers to receive weekly and monthly financial reports. Business Process Improvement resulted in eliminating monthly data extraction costs from department expenses. Maintained rapport with external customers to increase client service value. Supported customer claims reimbursement transactions by meeting all deadlines and providing accurate financial reports by:Delivered 1,350 production and ad-hoc reports, annually, with 100% timeliness and within 1.5% error tolerance.Integrated Teradata and DB2 SQL queries with SAS procedures to generate monthly claims detail files to justify reimbursement from ASO Customers.Balanced monthly claims detail reports to UCCI Finance ASO Invoice with zero (0) variance from finance on a weekly and monthly basis.Project lead on converting large weekly claims file from multiple legacy system processes to an all-in-one PC SAS process.Coordinate mainframe file management with Highmark ISG to successfully migrate data from Highmark network to external key customer networks.Project Manager and Lead Developer working with UCCI Underwriting to launch an automated workload application that populated ERISA Schedule A 5500 tax forms which met new insurance department regulations and avoided fines and penalties.Utilized Visual Basic for Applications Object Model to automate the importation of data to MS Excel spreadsheets to improve underwriting process for generating Schedule-A tax forms.

Solely responsible for supplying customer account experience (claims, premium and membership) data to Underwriting Department for the purpose of generating renewal rates. Generated application which automated the process of extracting and reporting experience data for accounts that are up for renewal, in addition to calculating renewal rates based off of supplied data. Directly impacted increased revenue by achieving the following:Integrated the ad-hoc renewal rate calculation process with the current workload process to automate rate calculations using the Visual Basic for Applications, VBA, Object Model (MS Access, MS Excel).In 2006 UCCI achieved first $1 billion dollars in revenue which CEO attributed to Underwriting Department following the implementation of automated rate calculation application.Reduced rate calculation errors to zero (0) percent by automating rate calculation process.Produced Claim vs. Premium, Network Analysis and Class Utilization reports.Tracked statistics for large accounts to focus UCCI on meeting operational Performance Guarantees.

Provide technical support to consumers with ADSL / Cable Broadband ServiceWalk customers through basic troubleshooting.Hardcode TCP/IP configurations across multiple operating system platforms.Uninstall and reinstall communication components for multiple operating systems.

Devised a UML schema for modifying existing tables and developing new tables for the Department's reporting tool. As a result, more efficient queries could be run and return accurate and complete records.Designed and developed database reporting utility that allowed for the exportation of graphical reports to MS Word using OLE Automation, VBA, Access Forms, Reports and various MS Office Object Models. Solely responsible for the full analysis, design, development and implementation of an online catalog matching utility built using an MS Access 97 project (.mde) along with the Access Basic Object Model.

Updated and maintained the online FAQ of the company's top-selling ActiveX control (TrueDB Grid). Software samples were developed using COM objects with company products to provide "Tips and Tricks" for customers. Developed database front-end applications (VB6, ADO, TrueDB Grid and MS Access) to track and update online knowledgebase.Generated tutorials for Visual Basic 6.0 on use of company's data-bound ActiveX controls. A directory style structure was used to group and categorize support topics and file items.Developed screen-shots for top-selling reporting tool (VSVIEW RE) for use on marketing website by generating actual reports and developing applications for users to sample.MS Visual Studio .NET Beta Tester.

Facilitate usage of software programs (MS Visual Studio 6, MS Office 2000, Mulberry, and Windows 98b).Involved in setup and networking of computers.Troubleshoot user and equipment errors.

Bs, Computer Science

Activities and Societies: Order of Omega, Alpha Phi Alpha Fraternity, Inc., Men's Bible Study, Some of God's Children Gospel ChoirReceived.

Education record