170 Budlong Farm Road ? Warwick, RI 02886 ? (401) 738-4347
(401) 480-9001 (cell)
o ICD-9 to ICD-10 Working Group and conversion studies – Meaningful Use
o Health Claims Processing Systems – HIPAA 837-I and 837-P and 5030
o X.12 and XML Healthcare Data Sets
o Clinical and Pharmaceutical Research Studies – HEDIS NDC CPT ICD
o Data Warehouse Setups
o Data Modeler and Architect
o Data Dictionaries and Corporate Data Conformance
Consultant - Alternative Health Systems – Health Claims
Senior Data Analyst - Verispan – NDC ICD-10 and HIPAA Trans Sets
HIPAA & HEDIS Resource - NEMC - New England Quality Care Alliance
( EMR Meaningful Use Studies – Pay for Performance )
Data Architect - Pfizer
PBM & HMO Consultant - Mashantucket Pequot Tribe
Consultant (Project Management) - United Healthcare
Consultant (Adverse Events, AIDS) - PAREXEL International
HIPAA Trans Sets - Keane, Inc.
HEDIS - HMO Blue (Massachusetts)
PROFESSIONAL EXPERIENCE DETAILED: 1986 - 2010
I have been engaged in health plan data studies under the name Alternative Health Systems and have worked with several employers dealing with SQL and data modeling / data architecture issues. See the list of clients on the following pages. They include RBS Citizens, Fidelity, Pfizer, and several others. This base of operations allows me to continue to work on healthcare data issues while staying current with mainstream database toolsets. Typically I use PowerDesigner as a data architecture tool to generate conceptual and physical maps and Erwin to build SQL database generation code. I have current experience with On Line Transaction Processing (OLTP) as well as with data warehousing structures.
Here is a review of healthcare acronyms that I work with: I am reviewing Health Information Technology
for Economic and Clinical Health ( HITECH ) Act and Electronic Health Record ( EHR / EMR 21 CFR 11 )
strategies. I have built Pay for Performance architectures and am now studying Meaningful Use and PQRI
rules as they relate to HEDIS measures and generalized contextual search tools. (See Clarabridge for
details on this toolset.) I have mapped ICD-9 CM, CPT, and NDC to ICD-10 and have worked extensively with HIPAA 837 transactions. I have served on Agency on Healthcare Research AHRQ working
groups studying ICD coding and HIPAA privacy requirements.
RBS Americas and Citizens Bank - 01/08 – 07/10
My primary function was to oversee the daily transmission of credit risk management data to the Royal Bank of Scotland’s central facility for the calculation of positions and other credit risk data.
I also built a data model of the existing credit risk database and performed some SQL Server stored procedure and trigger modifications as required.
Data Architect – Fidelity Investments - 01/07 - 12/07
I served as the data architect for a team developing an equity trading system for Fidelity Management Company. 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). I used
PowerDesigner to convert a conceptual/logical model to a full machine-level physical model.
Senior Data Analyst - Verispan - 04/06 - 11/06
My basic responsibility was the data modeling and mapping of pharmacy scripts and medical (physician) procedure data ( NDC HIPAA 837 and ICD 9 CPT and ICD 10 data ) collected from switches and pharmacy chains into X-12 and XML formats for data exchange with pharmaceutical companies. The medical encounter data ties to the Verispan pharmacy script database to allow for longitudinal studies combining medical encounters with pharmacy scripts to link to whar are now called Meaningful Use datasets for outcomes and pharmaceutical studies.
New England Medical Center - New England Quality Care Alliance 01/05 - 04/06
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. This is a web-based reporting system to help physicians meet their Harvard-Pilgrim, Tufts Health Plan, and Blue Cross quality objectives under Federal guidelines. Meaningful Use issues addressed.
Pfizer 08/04 - 09/05
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. Casewise Corporate Modeler used for conceptual data modeling and process modeling including case studies.
Other Consulting Engagements 1986 - 2004
Mashantucket Pequot Tribe - PBM & HMO Consultant
United Healthcare - Consultant ( Project Management )
PAREXEL International - Consultant ( Adverse Events, AIDS )
Keane, Inc. - Consultant ( HIPAA Transaction Sets )
HMO Blue (Massachusetts) - Concurrent Review, Physician Profiles, HEDIS
RI Business Group on Health - Large employer group data analytics
Consolidated Group Trust - Alternative Provider Networks
Rhode Island Pharmacy Assn - On-Line Pharmacy Claims System
MicroStrategy - Claims Analytics
GIGA Information Group - Web/Database Strategy
Data Architecture and Business Analysis: PowerDesigner, Corporate Modeler, and ERwin data
modeling. Zachman Framework, and other business analysis tools. Skilled at architecture views including "swim lanes." Entity Relationship diagrams. Patch complex SQL views and queries back into data modeling tools.
OLAP Data Warehouse: MicroStrategy, Excel & Access, Cognos. Major database platforms include Oracle and SQL Server. OLAP examples include HEDIS outcomes, managed care, physician prescribing patterns, clinical trial adverse event analysis and insurance buyer behavior analysis models.
OLTP: Mainframe and Oracle TimesTen in memory, object-based equity trading systems. Mainframe and networked transaction systems including equity trading, swaps, health claims processing including TPA setups, and life insurance administration systems.
SQL: (As a language) Microsoft T-SQL, Oracle PL/SQL triggers, stored procedures and SQL*Plus. Some Oracle data warehouse petition architecture experience. Experience with Oracle TimesTen in memory database setups.
DBA: SQL Server DBA including tuning strategies and restoration plans, various ETL (Extract Transform Load) data loading tools. Team building experience in large database clusters with multiple DBAs engaged in the integration of UNIX systems and mainframes.
University of Connecticut, School of Insurance, Hartford, CT - Bachelor of Business Administration in Insurance - Research Paper: Impact of Medicare on Insurance Industry.
Son Justin is co-founder of Strategy.com and Clarabridge ( Voice of the Customer – Contextual
Search – Meaningful Use studies )
WEB SITE: http://www.langseth.com
THIS DOCUMENT LOCATION: http://www.langseth.com/Richard_Langseth_bio.doc