Joe Cerniglia Email and Phone Number

Coordinated testing plans from business areas for a company-wide effort to add a non-binary self-identified gender identity (SIGI) to all data tables, applications and reports that use gender.Wrote Python auditing script packages in Jupyter Notebook to ensure data integrity for monthly company submissions to the Blue Cross Blue Shield Association’s National Data Warehouse. Surfaced aberrancies can be corrected before the Association receives the data, thus preventing failure notifications and rework.

Improved U.S. HEDIS results for Aetna by engineering the necessary data for mailing and electronic outreach campaigns to thousands of Aetna members, and by measuring the effectiveness of these campaigns with monthly HEDIS rate trending reports, predictive analytical trending reports, and specialized trend reports in HEDIS behavioral health rates.

• Expanded, developed, automated customized ETG reports, smoking rate reports, industry reports, detailing regional and industry comparisons for largest clients’ rates of immunization, pregnancy, joint degeneration, coronary artery disease, diabetes, obesity, and others.

2013: Designed, built, and trained team to use the Hedis Hybrid Measure Database (HHD), which captures clinical results from medical charts from physicians’ offices. Data collected is used to improve HEDIS measure results, to compare health plans nationwide, and to calculate compliance rates. Produced documentation for the processes in the HEDIS Hybrid Measure Database. As of 2019, the HHD is still in use.• Achieved 99.8% medical record return rate, exceeding best-practice benchmark (95%).• We filed our chart review results with HEDIS auditors on time and passed the validation with no error.2009: Created the first version of the report production process for the Alternative Quality Contract Provider Practice Variation Analysis program. Reports to provider groups detailed comparative information on rates and cost of treatment for such procedures and diagnoses as knee surgery, depression, coronary artery disease, and others. Reports were used to help provider groups measure quality of care.

Conceptualized and developed a SAS ETL and statistical outlier detection system for all surfaced aberrant spending patterns among hospitals providing Medicare services. System became the basis for comprehensive statistical analysis reports to providers on proper submission and coding of claims eligible for state and federal payment.