RICHARD LANGSETH
170 Budlong Farm Rd.
Warwick, RI 02886-8362

(401) 738-4347

(401) 480-9001 cell phone

mailto:

MANAGED CARE OBJECTIVE

To apply my health plan and medical claims processing-focused data downloading, exchange, validation and testing skills to help clients focus on managed care topics including data warehouse requirements and HIPAA data issues. My business analysis, data architecture, data modeling, programming, and project management skills that I have built over twenty years of health care and managed care data consulting experience bring into perspective the unique requirements that many entities now face. I have experience with data handling planning, SQL loading, and the testing techniques that the Centers for Medicare and Medicaid (formerly HCFA) require for the phasing in of HIPAA X.12N transmissions.

HEALTH CARE AUTOMATION FOCUS

Many of my activities have been in a managed care, clinical or provider-to-payer data interchange settings. These experiences include data base and networking planning at the managed care and physician office levels, setting up HMOs and other managed care networks from scratch, TPA development, PC-based on-line claims capture and exposure to clinical trials and Department of Health and Human Services-funded grant work. HIPAA data and data security activities are very detail oriented. My data architecture experiences using such tools as Visio Data Architect and Power Designer as well as my experience with data loading and validation are key items.

TECHNOLOGY DETAILS -- SKILLS INVENTORY

  • Project Management specializing in health care planning and automation
  • Data Architecture (ER/Win, PowerDesigner, ER/Studio and Visio Database data modeling) to assist with the presentation of HIPAA issues to end users.
  • SQL as a language (T-SQL, PL/SQL and SQL*Plus triggers, stored procedures) to access health care data, etc. often used in a setting to monitor and maintain the downloading of data into data warehouses.
  • Turbo XML and Visual Studio.net XML tools for future health data interchange.
  • Object Access to SQL (DTS – Data Transformation Services, ADO – ActiveX Tools, BCP 2000) to transform data from one form to another.
  • Database support programming (Visual Interdev 6, Visual Basic 3, 5, and 6, VBA including Excel 5, 97 and 2000, ADO, Delphi, Cold Fusion and UltraDev) which can assist in reviewing details of health care automation issues.
  • OLAP (MicroStrategy 7, Excel & Access 2000 OLE DB, COGNOS, some XML) for "futuristic" presentation of health care data.
  • DBA (SQL Server 6.5, 7.0 and SQL 2000 DBA including tuning strategies and restoration plans) a skill that helps gain the confidence of data production people.
ENGAGEMENTS by YEAR

I have been engaged as a consultant/contractor for over ten years. During this time I have worked as a programmer, business analyst, data base developer, project manager and web designer. My experiences ranged from managed care, clinical trials, international logistics, electric utility power slot trading, insurance distribution, physician networking, clinical trials, and internet consulting in general. Here is an engagement list.

2003Keane, Inc. (HIPAA)

2002Keane, Inc. (HIPAA), ERW Systems (HIPAA), Providence Washington Insurance (DSS), United Healthcare (DSS, Managed Care), IndianPath (Web)

2001Merrill Clark (Clinical), John Hancock (PM), Demos Consulting (VB), GIGA (DSS)

2000PAREXEL (Clinical), Behavioral Healthcare (Clinical, Managed Care, Web), John Hancock (PM), Strategy.com (Web), GIGA (DSS)

1998-99PAREXEL (Clinical), Behavioral Healthcare Partners (Clinical, Managed Care, Web), Polaroid (DSS)

1997PAREXEL (Clinical), Polaroid (DSS), Northeast Utilities (VB, Web)

1996PAREXEL (Clinical), Consolidated Group (DSS, Managed Care, Insurance Processing), Northeast Utilities (VB, Web)

1995HMO Blue – BCBSMA (Clinical, Managed Care), Consolidated Group (DSS, Managed Care, Insurance Processing), EMC (DSS)

1993-94HMO Blue – BCBSMA (Clinical, Managed Care), Fleet Bank (DSS), R. I. Pharmacy Assn. (Clinical, Managed Care)

1991-92Fleet Bank (DSS), R. I. Pharmacy Assn. (Clinical, Managed Care)

1986-90Mashantucket Pequot and other health planning activities (Clinical, Managed Care)

Note: DSS = Decision Support, Clinical = Pharmaceutical or health care provider, Managed Care = HMO, PM = Project Management, VB = Visual BASIC which includes Visual BASIC for Applications and VB.net; WEB = Web programming or design.

Here is a chronological overview of activities related to health care systems:

Keane, Inc. – I have just finished the project managership of a Companion Guide and Test Plan Project for an HMO (November 2002 through February 2003). This included 837 and 835 test planning as well as data mapping for other transaction sets.

ERW Systems- This was a data gap analysis and strategy study for a large medical billing company converting NSR-2 to 837 Professional. This task was completed in October 2002. My role was that of an overall consultant.

Unicom, Inc. Data conversions from AS400 to SQL Server. (June 2002 – September 2002) I was engaged as a project lead extracting and testing claims data that was built into COGNOS cubes. One of my roles was to test and validate results.

UnitedHealth –Uniprise- Project Management Systems / Database Consulting. April – June 2002: I worked in the project management area on database issues associated with the management and control of several hundred IS projects.

Merrill Clark - I worked with Merrill Clark from September 2001 to December 2001. My task was to enhance a LIMS system in an FDA 21 CFR 11 setting for the FDA.

Behavioral Healthcare Partners, Inc.- is a mental health carve out MSO (Managed Care Service Organization) that I contracted with from 1998 to 2001. My responsibilities included managing the practice management package including payer feeds and developing the managed care/triage system under the guidelines then being proposed by the Department of Health and Human Services as draft and proposed HIPAA regulations as well as health care X12 protocols.

PAREXEL International- (1997 to 2000) This is a leading Clinical Trials Research Organization (CRO). Responsibilities included data management support for a major AIDs study and a Web-based hospital emergency room study of acute cardiovascular incidents. Both studies had HIPAA implications and I participated in HIPAA planning. A key item here was the planning for pharmaceutical company review of 21 CFR 11 type concerns.

Consolidated Group/Allied Community Health Project- (1995 and 1996) Gathered data from multiple HMOs, into Sybase database, developed remote query/reporting downloading capability of UB92 institutional claims for use by MSOs (physician-based Management Service Organizations) in building physician profiles.

HMO Blue- (1993 through 1995) Built physician profiles and other performance measurements from HMO institutional and professional data, and quality measurement & case management systems for quality management teams as well as HEDIS runs.

Rhode Island Pharmacy Association- (1991 to 1994) Developed an EDI-based on-line pharmacy link for the adjudication of third party claims through x.25 links to a Novel server. Also provided data base analysis support to a primary care physician spillover study that looked at the effect of formularies on primary care physicians when they were prescribing to patients who were not in the formulary group.

Other Health System Activities- Contract-based engagements during the period of 1986 through 1994 included the establishment of an HMO qualification filing for HCFA review, entity coding work with the federal Agency on Health Policy Research coding team, building a pharmacy data analysis system for Indian Health Service use under Indian Health Service Research grants for use at Mashantucket, an employee and dependent TPA claims processing system for Foxwoods Casino, data gathering for a home care network, various health data planning studies for the Wampanoag Tribe of Gay Head, and studies for GTE, Bard, Leviton Corp, The Rhode Island Health Care Coalition, Rhode Island Group Health, The Connecticut Business Coalition, several school boards and hospitals. Served as a consultant to Rhode Island Group Health (Harvard-Pilgrim Health Care) focusing on their approach to ERISA plans as a full-service third party administrator.

Chronological review of other activities:

IndianPath, Inc. During the winter of 2001-2002 I built an Indian Country Web Site for a tribe located in Connecticut. The primary tools were Macromedia Ultradev 4 accessing a SQL Server data base using JavaScript active server pages.

Demos Consulting- I was engaged by Demos Consulting from June 2001 to August 2001. The mission was to convert one of their major products to SQL Server 7 using ADO links and temporary stored procedures running under Access 2000. Programming language was VBA.

John Hancock Financial Services-I worked with John Hancock from October 2000 to May 2001. I focused on SalesLogix implementations including conversions from other Contact Relationship Management (CRM) systems. I used the Visio database tool as my primary business planning analysis and presentation tool to get user buy in and production acceptance. Serving as project manager and business analyst, the process of staging to production took on the highest priority. Accomplishments included the project to combine the Banking and the Broker/Dealer channels into a combined SalesLogix database. I also served as the Project Manager of the Group Insurance Channel implementation project that added eGroup to the combined SalesLogix database.

GIGA Information Group- I worked with GIGA's Web site gigaweb.com from June 2000 to January 2001. GIGA is a leading e-business advisor that helps companies deal with e-business issues. My task as a DBA was to assist in the conversion of the GIGA Web Site's ONYX-based back end to SQL Server 7. I have also set up programs in Visual Basic to analyze Bulk Copy (BCP) and OSQL utility log files as well as scheduled task completion logs and some Web traffic analysis. The GIGA data base server is attached to a 7 by 24 Web site under IIS and Site Server.

Strategy.com- Prior to the GIGA engagement, I contracted with MicroStrategy's consumer Web site from January 2000 to June 2000. This site has over 200 affiliates including leading wireless and content companies. Over 400,000 registered users can connect to the Financial Channel, News Channel, Traffic Channel and Weather Channel. My task was to research the offering of additional financial services for users of desktop and wireless devices.

Polaroid Worldwide Supply Chain- (Contract - September 1996 to January 1998) Responsibilities included domain-level security and worldwide access via TCP/ip. Most processes ran as SQL stored procedures, bulk copy operations and FTP links. A major objective was the rapid updating of data due to the small window available after nightly SAP programs are run. Also linked to data base through Visual Basic for Applications {VBA) using the Microsoft Data Access Objects (DAO) and Microsoft Query. Data base design tool was PowerDesigner.

Northeast Utilities Power Management- (Contract - September 1996 to March 1997) Upgraded existing Paradox/BBS and Excel systems to build in automatic feeds from OASIS, an Internet FTP and Web source established by several dozen utilities on the World Wide Web to meet new Federal requirements for the open purchase of power. Major language was Visual Basic. (This is the methodology used by the California power companies to push its energy crisis out from 1998 to 2001!)

EMC Board Yield Project- (Contract - May 1995 through October 1995) This was a study of circuit board test results. Database was MS SQL Server. Access was through Paradox with embedded Sybase SQL Links, Excel with embedded SQL and some MS Access. Graphics and reports in Visual Basic for Applications (VBA). Total Quality Management (TGM) procedures and ISO 9000 documentation standards were met.

Fleet Bank- (Contract 1991 - 1994) Quality Measurement, Pipe Line (marketing system) and Plan and Migration systems. Programming language was Paradox and R&R Reports.

DATA BASE DEVELOPMENT SKILLS DETAILED

MS SQL Server 4.2, 6.0, 6.5, 7.0 and SQL 2000 SQL development and DBA activities including cursors, triggers, stored procedures, DTS and ADO. Extensive experience with Transact SQL, BCP (Microsoft Bulk Copy Program) and SQL Data Transformation Services (DTS) for automatic data warehouse loading and high-speed denormalization processes. Also ER/Win, PowerDesigner, ER/Studio and Visio Database data modeling, Delphi SQL tools, some Oracle 8 PL/SQL and SQL*Plus application development. Development of XML-based data loads and queries. Programming skills include VB, VBA, and Delphi using ODBC and ADO. GUI interfaces to data base using VB and VBA. SQL-Windows experience: seven years.

Windows NT 3.50, 3.51, 4.0 and Windows 2000 Server setups, conversions, and general administration including monitoring and problem resolution. Installation and maintenance of Microsoft Internet Information Server. Develop and support Web-accessed SQL Server sites. Maintain remotely administered Web tool via Gothamweb as a hosting service and provider of SQL Server and e-commerce solutions using Dreamweaver and ColdFusion. NT platform experience: seven years.

WEB TOOLS

I have worked with HTML, Dreamweaver and UltraDev templates, ColdFusion imbedded in Dreamweaver, FrontPage 2000 for advanced navigation and theme development, Microsoft Office 2000 ADO in a Web environment for data grid deployment attaching to SQL Server, and several XML tools. Experience with MicroStrategy 7, DSS Web, Architect, and Agent, Sybase PowerDesigner for the Web, English Wizard (Easy Ask), JBuilder, and Visual Interdev. Some client-side Java. Some PhotoShop. Web experience: three years plus.

ADDITIONAL DETAILS

Several Web pages are available on including this resume, a Medicare backgrounder, a sample systems flow diagram, and a sample screen mapping diagram.

Downloadable Microsoft Word documents are: programmers resume, HIPAA, Medicare, systems flow and screen map.

EDUCATION

BS The University of Connecticut, School of Insurance

CLU, Chartered Life Underwriter

WEB SITE

Feb 7, 2002 rel/HIPAA

Created using: Lightning HTML Editor Version 2.20.1997