Description
PROFESSIONAL SUMMARY: Extensive experience working with internal and external clients and users. Medical loss ratio reports, provider score cards, pay for performance, risk analysis of members for intervention, government reporting requirements for the healthcare industry. Reporting to actuarial, sales, marketing, membership, federal and state requirments. Reconciliation and auditing of Medicare Part D claims and eligibility in a Six Sigma environment. Familiar with project life cycle. and Designed and managed a Medicare Part D Broker database. This was created as per senior management. Performed weekly audits per CMS requirements against the Broker database. Created loading processes from an IBM mainframe into the Broker database. Accompanied senior management on CMS audits to answer all questions pertaining to data management. Created SOP's for the maintenance and daily loading and auditing of the Broker database. Express Scripts FACETS database. Analyzed outcomes for sales campaigns for the marketing dept. using SAS. Designed and developed database reporting interfaces using SAS EG and Excel/VBA in a Teradata environment to support marketing actuarial and Medicare D enrollment and eligibility. Creation of base SAS and SAS macro programs. Implementation of Teradata based analytic solutions via Teradata SQL stored procedures. Interfaced with users to determine requirements for data reports and training. Designed processes to map extract transform cleanse and load data. Maintained updated and tested SQL on IBM mainframe using BTEQ. Documented processes by creating SOP's and flow charts. Designed and provided training sessions for Medco employees on Teradata and SAS.
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