Edward C. Email & Phone Number

Bethesda, MD, US

Dallas, TX, US

• Team lead establishing incoming EDI connections to accept x-12 5010 834 files from various payroll vendors. Responsibilities include testing new 834 EDI connections, communication with vendor business analysts to.
• Partnered with Aetna Insurance Corporation and DC Healthlink to manage x-12 5010 834 and 820 file processes. This included custom reporting to both parties as well as reconciliation of enrollment and payment information
• Partnered with the Benefitmall EDI team to develop, troubleshoot and document Aetna/DC HealthLink (exchange operations) as well as vendor connections
• Regression testing of custom Benefitmall applications, including reporting potential bugs via JIRA to offsite IT resources
• System analysis lead, with SaaS vendor, that included testing and design of complete vendor file processing dashboard, processing reports, customer error reporting and handling of new group setup and maintenance.
• Transmission of 834 based enrollment files via Centerprise Data Integrator and TIBCO to various insurance carriers. Includes mappings for local source data to carrier data elements

Acting consultant dealing with provider and health plan data. My role encompasses both data management, as it related to maintenance and upgrading, to be in line with NCQA ans HEDIS guidelines and customer adhoc needs. This extends to commercial and non-commercial products.Role has a strong focus on back-end (or basement level) data analysis and quality.

• Served as a data consultant and business analyst for disease management vendors with focus on Return on Investment (ROI) analysis.
• Investigated and developed a revised data dictionary covering flat file source systems as well as existing data marts to improve Return on Investment analysis accuracy and efficacy for all stakeholders.
• Highlighted key metrics and business rules key to ROI and general ad hoc report production. This was accomplished within required timespans set by client customers and for executive, data governance and business stake.
• Delivered both concise dashboards and detailed reports spanning the varied intake data sources and data marts key to accurate outputs for customers. Snap shot and trending techniques used to capture data states year.
• Upgraded the efficiency of data intake and reporting by guiding the development of improved SQL scripts used in automated reporting and data transformation. Partnered with key stakeholders in data governance and.

US

• Lead business consultant for analysis and quality assurance of health risk clinical and economics data. Managed production and presentation of vendor specific Return on Investment analyses and health management.
• Delivered an average 15 ROI analyses per year, with a very high percentage surpassing client expectations as to outcomes and contracted incentive targets. Recovered incentive fees at risk with a value of $100,000 to.
• Executed onsite presentations of ROI analyses for customers and internal stakeholders. Maintained consultative contact with customer and hired consultants after each presentation guaranteeing timely maintenance and.
• Demonstrated additional product value and outcomes feasibility through use of HEDIS aligned metrics and risk analysis software.
• Designed automated dashboard reports detailing disease and risk markers coupled with drilldown analyses using multiyear period trending. Business Objects and custom applications on a Netezza backbone were leveraged to.
• Tested pharmacy risk and abuse software for a major pharmaceutical company by partnering with internal medical directors and business analyses subject matter experts. Developed downstream reports and dashboards.

• Detailed analysis of claims data sourced from End Stage Renal Disease clinics to determine if costly over-payments exist.
• Mining of claims data, UB92 and other data to establish the existence of an over-payment
• Interpretation of payer/provider contract language to help determine recovery opportunities
• Analysis of data sources to determine extent of payor error and to determine reason for error
• Communication of findings to company officers along with payer/provider contacts for approval
• Development of dashboard reports to summarize findings for internal staff and officers

Bachelor Of Science (Bs), Computer Information Systems

Continued Education, Biostatistics