Richard Langseth
170
Budlong Farm Road
Warwick, RI 02886
860-415-0500 (cell)
401-480-9001
richard@langseth.com
PROFESSIONAL
SUMMARY
To apply managed
care and data experience to address provider groups' and payers'
Affordable Care Act data warehouse and data mart strategic and
technical needs.
This includes the integration of several
code sets including: the diagnosis and procedures ICD-10 set, CPT
with pharmacy NCD along with drug compounding, and lab LOINC coding.
Membership and coverage data must also be tied in to complete the
picture. Complexity comes up at the state level when various payers'
data is brought together. The need to build longitudinal data sets
for outcomes analysis will be especially challenging as health care
reform moves forward.
I have modeled many of these issues and
look forward to new and exciting challenges. I am an expert data
architect with payer and provider experience and am a proven ETL
resource.
SPECIALTIES
Managed
Care Data Exchange Modeling
Encounter Analysis ICD CPT matchups
with NDC and LOINC
Data Warehouse Setups
Data Modeler
(Powerdesigner, Erwin)
OLAP MicroStrategy - Cognos, SQL Server
ETL Data Stage TimesTen Bulk Copy SSIS
Health Claims
Processing Systems - HIPAA ICD-10
o Project management
of health claims - HIPAA HEDIS TPA setups, provider networking.
o
X.12 HIPAA EDI trading partner datasets, conversions to HIPAA
837 standards.
o ICD-9 to ICD-10 federal health coding
working group, conversions and crosswalks.
o Managed care
PMPM models and calculations for HMO filings.
o Physician
office automation and transmissions.
o ETL loads and
replication log extracts including massively parallel data loads.
o
Agile and traditional project management techniques.
o
Offshore team building experiences.
o SQL Server
Resource - SQL Server 2008 - 2005 - 2000
o High speed
equity trading system data architect and proof of concept testing
resource.
o Changed Data Capture - InfoStage Resource IBM
DataStage
o Data warehouse setups, transaction systems
modeling, very large databases.
o Data modeler and
architect, Erwin and PowerDesigner ( Power Designer )
Consultant
- Alternative Health Systems 1986 – Present
Native
American Business Enterprises (Mashantucket Pequot
Tribe) 11/11-01/12
·
Assisted
in the development of a federal application for a new HL7 (XML)
component development project integrating with tribe's PrxN Pharmacy
Benefits Management (PBM) program. This was a follow on to previous
work I did for the tribe.
Studied impact of Affordable Care Act provisions on healthcare
delivery systems.
·
The following date by date engagement list details my
consulting jobs. I have built upon then to get to the level of
technical and business experience that I apply to my current tasks.
Given the size of the data bases that need to be built to meet the
new federal health reform requirements and the technical complexity
involved I draw on this experience daily. I have federal managed care
experience.
IBM
Changed Data Capture and Data Stage - Capgemini
02/11-07/11
·
Lead data architect and data modeler. Transformations of
Guidewire Policy Center data on SQL Server to IBM mainframe via
InfoSphere. My main tasks were the building and maintaining of the
PowerDesigner data models, direction for the execution of the proof
of concept using SQL Server replication logs and the building of the
DB2 receiving database as well as MicroStrategy datamarts.
Responsible for maintaining SQL Server DDL for the transformation
stages.
BASEL
Transmissions - RBS Americas and Citizens Bank -
1/08-8/10
·
My primary function was to oversee the daily transmission of
credit derivative positions and bank treasury instrument positions to
the Royal Bank of Scotland's central facility for the calculation of
positions and other credit risk data.
Data
Architect - Fidelity Investments -
1/07-12/07
·
I served as the data architect for a team developing an equity
trading system for Fidelity. The mission was to build a data model
for a Java/data cache based transaction system, employing an
in-memory, high-speed data store (Oracle's TimesTen).
Senior
Data Analyst - Verispan -
4/06-11/06
·
My basic responsibility was the data modeling and mapping of
pharmacy scripts and medical (CPT procedure) data collected from
switches and pharmacy chains into
X-12 and XML formats for data
exchange with pharmaceutical companies. Included ICD-9 / CPT
crosswalk planning to ICD-10. NCD and LOINC integration setups. This
included normative calculations to determine relevance of data coming
in from very large pharmacy and medical provider feeds.
·
I also studied the X-12-based adjudication of medical savings
accounts and the autoadjudication of claims through point of sale
networks bypassing the traditional Per-Se NDC and Caremark PCS
switches.
New
England Medical Ctr - New Eng Quality Care Alliance
1/05-4/06
·
I project managed a SQL Server/dot net project to develop
federal HEDIS measures and a patient registry. I served as the data
architect, data modeler and query writer and C# ADO dataset-bound
forms in C# for administrative pages and data conversions.
·
ICD-9 and CPT coding conversion planning to ICD-10. NDC and
LOINC integration.
·
Included extensive data transformations of claims, enrollment,
and provider data into a SQL Server 2005 database and data feeds to
DB2-based mainframe setups.
Pfizer
8/04-9/05
·
I worked with the drug discovery area on chemistry- and
biology-based enterprise entities that reach across the corporation.
21 CFR 11 compliance was sometimes required.
·
I also reviewed data models across Pfizer to determine if they
meet the corporate standards. ERWin and ModelMart were used in this
mostly Oracle activity.
Delta
Dental of Rhode Island
5/04-8/04
·
Data modeling of self-administration system using ERWin, SQL
Server administration.
Textron
Financial
11/03-5/04
·
Completed data map of eight feeds from commercial loan and
lease transaction systems into SAS data sets associated with the data
warehouse.
Teknor
Apex Company
6/03 10/03
·
Microsoft Data Transformation Service - AS/400 feeds to the SQL
Server data base.
Neighborhood
Health Plan of Massachusetts
10/02-3/03
·
Finalized their HIPAA EDI X12n 837 Companion Guides and reject
(997) planning including data feeds from Oracle and mainframe data.
Extensive ICD-9 / CPT code crosswalks as required by data switches to
line up with HIPAA 837 requirements. Conversions of in hospital claim
submitted by paper into claims processing system.
·
Designed SQL Server feeds to their data warehouse and EDI
responses back to hospitals and physician groups as well as
laboratories and pharmacies using such X12 data sets as the 276 / 277
sets, the 278 set, and the 835 set.
Providence
Washington Insurance
7/02-9/02
·
Used Microsoft Data Transformation Service to build complex a
premium/loss reserve metrics model in Cognos Impromptu/Power Play.
Built reports from the Cognos cubes.
United
Healthcare
3/02-6/02
·
Served as project management system business analyst while
building new ways to track projects, and measure project performance
metrics.
Merrill
Clark
10/01-1/02
·
Conversion to SQL Server of chemical and hazardous material
laboratory inventory system written in VB 6 COM objects. Client was
the FDA.
John
Hancock Financial Services
2000
– 2001
·
Served as a project manager and DBA consultant to focus on
their SalesLogix CRM implementation to solve database performance
issues within the structure of their SQL Server 2000 database feeding
mainframe database ( DB2-based).
GIGA
Information Group
2000 – 2001
·
Served as SQL Server DBA for this clustered computer
site.
Strategy.com
(MicroStrategy)
2000
– 2001
·
Managed a project to research the offering of additional
financial services for users of desktop and wireless devices for this
MicroStrategy consumer marketing operation.
·
Developed SQL Server and Teradata approaches to optimizing
stock market database
Behavioral
Healthcare Partners, Inc.
1998 – 2001
·
Built practice management bridges to capitation plans. Worked
extensive with medical billing companies to automate billing
submissions to claims processing system.
·
Managed the practice management package and developed the
managed care/triage system with feeds to other providers. Covered the
HIPAA planning issue.
PAREXEL
International
1996 - 2000
·
Project managed Cleveland Clinic cardiac intervention data
project.
·
Project managed and built AIDS adverse event collection and
analysis system.
Blue
Cross Blue Shield of Massachusetts (HMO Blue)
1992 - 1996
·
Developed SQL queries to be passed against various UNIX-based
databases to study claims data and create HEDIS data sets. (These are
the same data sets that I worked on at New England Medical Center for
physicians contracted with Blue Cross, Harvard-Pilgrim, and Tufts
Health Plan.)
·
Created physician profile reports and other performance
measurements from data, quality measurement, and case management
systems.
Fleet
Bank
1991 – 1994
·
Developed nonperforming loan migration models for commercial
loans and supported the implementation of the same in all operating
banks.
Mashantucket
Pequot Tribe - Pharmacy Network and HMO 1986 - 1991
·
Project Managed federal Department of Health and Human Services
projects for several tribes moving forward with managed care
initiatives.
EDUCATION
University
of Connecticut School of Insurance, BS
The
American College
Chartered
Life Underwriter (CLU)
Activities
and Societies: Allstate
Insurance Scholar, Research Paper on Medicare Impact, CLU Journal
"Personalized Data Processing Services" (an early paper on
the use of personalized computers)
Rel
01/30/2012 web