Richard Poeling Email & Phone Number

Greater St. Louis Area

Greater St. Louis Area

• Manage team of healthcare data analysts responsible for handling routine and ad hoc requests for multiple Medicare Advantage health plans from both internal and external clients including regulatory agencies.
• Create and maintain SQL data stores for collecting and submitting HEDIS data based on NCQA specifications.
• Created SQL stored procedures to perform risk score ROI calculations on diagnosis information from enhanced encounters, chart audits, and what-if scenarios.
• Responsible for training staff on the technical aspects of the CMS EDS (EDPS), including process flows and data file formats (837, TA1, 999, 277, MAO-002, MAO-004).
• Responsible for proper submission of CMS RAPS data and monitoring of differences in HCCs between RAPS and EDS.
• Assist Director of Claims department in EDS oversight, ensuring that all claims are properly handled.

Greater St. Louis Area

• Designed and wrote the SQL processes responsible for accurate creation of CMS Encounter Data and processing of CMS return files.
• Created custom reports to monitor data integrity issues within the data warehouse and to identify data entry issues in the billing system.
• Created stored procedures to simplify the consumption of data in the data warehouse and to ensure referential integrity for downstream processes.
• Wrote stored procedures and functions to create standardized algorithms that simplify ad hoc queries.
• Created ad hoc queries using SQL Server Management Studio 2008 for Corporate Analytics, Finance, Enrollment, Medical Management, and Provider Networks.
• Created SSRS reports using Visual Studio 2008.

Elgin, IL

• Remotely managed team of five healthcare EDI developers and two system operators (approximately 33% travel).
• Communicated with insurance companies to develop and enhance payer connections.
• Developed systems involving various ANSI X12 standards (837, 835, 997, 276, and 277).
• Re-engineered payer file processing from 246 unique programs to a single program used by all payer connections.
• Migrated several FoxPro systems to SQL Server in order to provide better security and control.
• Responsible for application development in multiple languages (FoxPro, VB.Net, C#.Net).

Greater St. Louis Area

• Per-Se Technologies was acquired by McKesson in Nov. 2006.
• Developed direct payer connections for claim and report processing.
• Responsible for system architecture of a health insurance claim billing system.
• Designed and implemented system changes based on regulatory changes and business needs.
• Created various interfaces (HL7 and proprietary) between clients’ systems and the claim billing system.
• Wrote DTS packages to port existing Clipper databases into SQL Server 2000.

Greater St. Louis Area

• Promoted to Programming Manager in May 1995 when programming staff was increased to 12.
• Reported directly to business owners and communicated programming status on a continual basis.
• Reviewed each developer’s code on a regular basis.
• Held weekly programming status meetings.
• Responsible for hiring and firing of programming staff.
• Worked on a team of four FoxBase programmers on a software package sold to nursing homes for maintaining electronic patient records and filing UB92 claims.