PROFESSIONAL PROFILE

State health care programs development and operations professional with proven Medicaid systems development, fiscal agent operations, and state operations, and management expertise. Over twenty-four years of experience in state government environments. Proactively able to strategize and execute positive, forward-thinking solutions, both within organizations and in collaboration with clients.

PROFESSIONAL EXPERIENCE

Confidential

Senior Business Analyst and Medicaid Subject Matter Expert

• Resource and consultation to a state Medicaid Program for implementation of International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Code System ICD-10 CM/PCS
• Research and identify business, operational, and system impacts resulting from the implementation of ICD-10. Develop Impact Analysis document and supporting matrix
• Analyze financial impacts of ICD-10 implementation
• Analyze vendor solution vs. internal system modification for ICD-10 system remediation
• Develop Risk and Issues Management Plan and manage risk and issues process for ICD-10 transition project
• Analyze system-generated reports to determine modification requirements and develop Report Remediation Management Plan
• Develop Implementation Plan, including Contingency Management
• Prepare and present project deliverables to customer and respond to customer comments Perform internal review on deliverable documents

Confidential

Senior Consultant/Medicaid Subject Matter Expert

• Independent Verification and Validation IV V consultant/resource to North Dakota state users for development of Medicaid Management Information System MMIS
• Manage IV V UAT monitoring activities, including planning, preparation, execution, and defect resolution
• Review and evaluate deliverable products and artifacts from vendor to state client
• Manage the development of user acceptance testing UAT methodology and data
• Identify core MMIS and state-specific business scenarios to comprehensively test the MMIS prior to implementation
• Provide observations, evaluations, and recommendations for product and project improvement
• Manage Functional Test including the design, development, and execution of functional test for the Claims Processing components of the North Dakota MMIS
• Develop, author, and present White Papers on topics pertinent to projects
• Write sections of proposals and participate in oral presentations

Confidential

Senior Business Consultant Independent Consultant

• Developed Data Mining and Program Evaluation Services proposal for non-profit organization for services to Arkansas Medicaid program

Confidential

Senior Business Consultant Independent Consultant

• Consultant to project leadership for MMIS development
• Reviewed deliverables for content accuracy
• Project terminated early and contract ended

Confidential

Senior Business Consultant Independent Consultant

• Managed the development of as-is business processes and functional mapping for Ohio Medicaid Program
• Advised State of Ohio in areas of Organizational Structure and Staff Management and Redeployment to functional vs. programmatic construct
• Performed QC on team deliverable products
• Developed Ohio Business Process to MITA business process crosswalk
• Identified desk-level procedure documentation needs and state staff training needs for transition to new MMIS environment

Confidential

• Ensured compliance with Federal and State requirements
• Responsible for the integrity of the CNSI proposal and contract in the areas of Claims and Encounters Processing, Customer relationship Management and Managed Care
• Maintained Requirements Traceability Matrix
• Developed Use Case Packages for system development and testing
• Development and Execution of Test Plans and Scenarios
• Developed and validated documentation presented to State of Michigan client
• Advised project team in areas of Reference/Data Management, Benefits Administration, and Prior Authorization
• Managed CNSI participation in the preparation of Federal Certification documentation

Confidential

Medicaid Subject Matter Expert Independent Consultant

• Provided Medicaid expertise to nine contractors and State Medicaid staff
• Managed the development and publication of as-is business processes and functional mapping for operational business units and system maintenance functions
• Managed, evaluated, and refined day-to-day operational procedures for all operational units
• Developed Fiscal Agent financial procedures including:
• Management and reconciliation of bank accounts
• Financial recovery processing
• Claims payment processing
• Performed IV V on contractor deliverables
• Managed the development of best practices scorecards for operational business units
• Managed the preparation of presentations and certification checklists for successful Federal MMIS certification

Confidential

Medicaid Subject Matter Expert/Primary Writer Independent Consultant

• Developed a plan to consolidate four proprietary systems to interface with and enhance operations within the MA MMIS, and to replace two customer service vendors with a single cross-trained, coordinated staff
• Developed detailed outreach and training plan for providers, members, internal staff, and client staff
• Presented strategies for recruitment of providers in underserved geographic and specialty practice areas and expansion of member enrollment in underrepresented geographic and ethnic areas

Confidential

Senior Business Analyst Independent Consultant

• Medicaid/MMIS resource for project staff, including hands-on training
• Developed requirements, formats, and styles for project-related publications led requirements sessions, and designed and maintained issues tracking logs
• Managed the development and publication of system documentation, online user manuals, Power Point information and training presentations prepared updates to provider billing manuals
• Developed test plans and executed system testing and user acceptance testing for HIPAA-compliance changes
• Managed and directed the implementation of three significant system enhancements:
• Standardization of Local Procedure Codes to HCPCS Codes
• Automation of Medicare Crossover claims
• Automation of adjustment and void transactions

Confidential

Provider Enrollment Supervisor

• Managed Provider Enrollment Unit, Provider Publications Unit, and Special Projects:
• All provider enrollment and update functions, including full file update
• All provider publications
• All Medical Policy functions, including annual HCPCS file update
• All Primary Care Provider Program functions
• Federal Certification Coordinator
• Designed Federal Certification Guide, Handbook, and Process documentation
• Business Analyst Managed Care, Provider, SURS, QC
• Managed the successful Federal onsite review of Colorado MMIS
• Developed and executed system test plans for provider, reference and managed care system areas
• Researched problems, updated system files, maintained managed care rates and rate cells, defined requirements, tested system enhancements, corrected deficiencies
• Developed enhancements for automated enrollment, capitation payment, and correction processing
• Monitored and balanced claims processing financial cycle
• Documentation Team Lead
• Participated in requirements sessions, designed and maintained issues tracking logs
• Developed requirements, formats, and styles for all project publications
• Managed team of four technical writers to develop, test and publish:
• Requirements Definition Document
• Detailed System Design Document
• MMIS System Documentation
• Online User Manuals
• Detailed MMIS Operations Manual
• Disaster/Recovery Plan
• Proposal Writer
• Authored sections of Colorado MMIS proposal, including provider management, reference/data management, and quality assurance

Confidential

User Liaison

• Managed team of six technical writers to develop test and publish:
• User documentation
• Provider billing instructions
• Interim and final MMIS System Documentation
• Operations Documentation
• Other Specialized documentation
• Managed the development and provision of training to 300 State MMIS user staff
• Midwest Regional Office Administrative Manager
• Managed all administrative functions of the project office and Midwest Regional Office, including:
• Human resources
• Accounting
• Physical facility
• Work audits

Confidential

Research and Training Specialist

• Managed the planning, development, delivery, and evaluation of annual Medicaid provider training at 14 sites, statewide
• Maintained 29 provider policy and billing manuals
• Performed research into publicly-funded health care in several states for Medicaid Director and Florida Legislature
• Senior Human Services Program Specialist
• Maintained Florida Administrative Rules for nursing homes and prior authorization
• Maintained and refined Hospital Disproportionate Share Program
• Authored and published modifications to State Medicaid Manual
• Monitored compliance with federal audit requirements

TECHNICAL EXPERIENCE

• Mainframe Applications
• MMIS Florida, Minnesota, Colorado, South Dakota, Iowa, Michigan, Ohio, Nebraska, North Dakota
• PC Applications
• Microsoft Windows XP, Vista, and 7
• Microsoft Office Suite and Visio through Office 365