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Setting Up of Cloud Environment

Helped in setting up a data warehouse for the combined entity and report generation

Challenges

  • Helped in setting up a data warehouse for the combined entity and report generation. Also, helped in setting up the cloud environments and servers with best practices.
  • The client does not have a robust reporting module for their Medicaid and Alliance lines of business
  • Their business is handled by multiple vendors in bits and pieces which hinders the reporting capabilities and data integrations
  • They needed to migrate the data from multiple vendors and create a data warehouse for reporting
  • To move from existing Azure cloud to Soft Layer
  • To create multiple environments and set up multiple servers in the cloud.
  • To create HEDIS reports for state Medicaid
  • As the client merged with another leading health plan, they needed to maintain the same vendor database for both the entities which required mapping of data from existing SQL DB to new proposed Oracle DB

Solutions

  • Migrated client systems from Azure to Soft Layer
  • Built reporting capabilities using Tableau for various reports including HEDIS reporting
  • Used ETL jobs to dump data into the data warehouse by converting the data extracts from different vendors
  • Designed a single source data warehouse system using SQL to process member and claims information for generating reports
  • Developed reports using extracts received from Optum DB for pregnancy-related claims and Dental vendor for enrollment and claims
  • Mapped existing database with medical vendors’ new database and identified multiple gaps in the new DB Mapped the data elements between two different data sources for an acquired health plan with a current health plan

Tools & Technologies

Microsoft SQL Server, Microsoft SSRS, tableau

Key benefits

  • Centralized data warehouse enabled a single source for reporting
  • In house reporting system helped in meeting the deadlines for submission of mandatory reports to the state system
  • Speed up the encounter submissions to state thereby increased the acceptance rate
  • Created customizable reports to be scheduled and fetched on demand
  • Made reconciliation process easy by tracking all encounter submissions and responses from state
  • Readily consumable reports on claims, enrollment business at each lower granular level
  • Adhered to regulatory compliance
  • Improved process efficiency and accuracy and reduced manual effort