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I worked in health insurance. The code is supposed to make it easy to pay. It doesn't. We could do away with the codes. In addition to having to look up the co

I worked in health insurance. The code is supposed to make it easy to pay. It doesn't. We could do away with the codes. In addition to having to look up the codes, I read records all day, called and wrote providers for additional info, consulted my technical lead regularly to see if it was covered and once had to print the entire file and get it reviewed by the retired surgeon who came in once a week to read surgical reports on difficult cases. I'm underwhelmed with the value they provide and I paid claims as my job for 5+ years.

swalsh 3y ago
I'm in healthcare analytics, the codes are for me.
- DoreenMichele 3y ago
  We were drowning in data. It was a Fortune 200 company and every few years they completely overhauled their system for looking up state exceptions etc, which meant longstanding employees could no longer use it efficiently and new people still didn't magically get it instantaneously and inevitably some important thing could no longer be accessed at all. It was all in-house, homegrown software, I tried more than once to suggest moving to GIS -- a map-based system -- for some things and was ignored. I'm curious how that works for you because I just have trouble imagining that actually works. Like what value does that provide that you cannot do some other way and which justifies the systemic cost burden? Please edify me a smidgen.
  - swalsh 3y ago
    We're one of the guys who are creating all that work for you lol. We too have been through a number of systems. Since i've been with the company, we've gone from SQL Server, to an on-prem Hadoop cluster, to Databricks on the cloud, and plenty of home grown software. The cloud has been a real game changer for us from the simple fact that we finally have enough compute to start running some machine learning models. We have this standard data model with something like 300 columns, but every clients data is so different, some of them have around 400 columns in the data.... We're in theory using the medallian architecture, but there's so many legacy business processes we're not anywhere close to an ideal implementation. We've also recently started using AI in a big way as well. My email is in my bio, we should chat sometime i'd be facinated to hear more of your perspective.

swalsh 3y ago

I'm in healthcare analytics, the codes are for me.

DoreenMichele 3y ago
We were drowning in data. It was a Fortune 200 company and every few years they completely overhauled their system for looking up state exceptions etc, which meant longstanding employees could no longer use it efficiently and new people still didn't magically get it instantaneously and inevitably some important thing could no longer be accessed at all. It was all in-house, homegrown software, I tried more than once to suggest moving to GIS -- a map-based system -- for some things and was ignored. I'm curious how that works for you because I just have trouble imagining that actually works. Like what value does that provide that you cannot do some other way and which justifies the systemic cost burden? Please edify me a smidgen.
- swalsh 3y ago
  We're one of the guys who are creating all that work for you lol. We too have been through a number of systems. Since i've been with the company, we've gone from SQL Server, to an on-prem Hadoop cluster, to Databricks on the cloud, and plenty of home grown software. The cloud has been a real game changer for us from the simple fact that we finally have enough compute to start running some machine learning models. We have this standard data model with something like 300 columns, but every clients data is so different, some of them have around 400 columns in the data.... We're in theory using the medallian architecture, but there's so many legacy business processes we're not anywhere close to an ideal implementation. We've also recently started using AI in a big way as well. My email is in my bio, we should chat sometime i'd be facinated to hear more of your perspective.