SUMMERY

• Highly experienced with Healthcare Systems design: primarily Claims Processing MMIS .
• Claims Processing Systems SME, Medicaid, Medicare and Commercial.
• PeopleSoft Certified V8 Technical Consultant with a Financial focus.
• Developed Systems tools needed for ICD-10 Conversion/implementation APR-MS-DRGs .
• Significant experience working with Public Sector Clients including State Governments and Departments, Counties, Cities, School Districts and Utilities.
• Comprehensive knowledge of mainframe, client/server, and PC applications.
• Worked in multiple SDLC Agile methodologies, work flow, gap/fit analysis and JAD sessions.

SKILL

Hardware: HPs, DEC UNIX , Mainframes, IBM PCs, Unisys, Honeywell

Software: COBOL, CICS, OS/390, MicroFocus Cobol, Basic Assembler Language BAL , Ideal 4GL , C

Databases: ORACLE, MS SQL, INFORMIX, DB2, IMS, IDS, SQLBase, ADR/Datacom, MS Access.

PC Related: MS-DOS, Windows, Novell, Visual Basic, MS Word, Excel, PowerPoint, Visio, MS Project

Professional Experience:

Senior Business Analyst

Confidential

• Defined how to adapt the CMS GEMs to Convert Paid Inpatient Claims from ICD-9 to ICD-10 and minimize 'DRG drift' when passed through v30 IDC-10 grouper. I developed a version of CMS GEM file to eliminate 1 to many relationships with minimal impact on DRG assignment.

Senior Business Analyst Consultant

Confidential

• Analyzed the 2011 CMS General Equivalency Mappings GEMs for the ICD9 to ICD10 HIPPA compliance. As a Senior Business Analyst/ Subject Matter Expert I developed a variety of tools that can assist in the conversion of existing tools, policy and other Diagnosis based capabilities.

Senior Healthcare Systems Analyst

Confidential

• Lead Technical analyst for CSC's bid to win the Medi-Cal Procurement. Formulated questions and developed the methodology for the Takeover of the Legacy System Cobol and CICS and a series of required modifications and enhancements i.e. HIPPA 5010 and ICD-10 compliance, to be made over a five year period to the Legacy System prior to implementation of new generation MITA compliant MMIS in 2015.

Business Systems Analyst / PeopleSoft Certified Technical Consultant

Confidential

• Worked with many clients and on various projects as a Senior Analyst and PeopleSoft Technical Technician:
• City of Kansas City, Mo - Kansas City, Missouri - Provided Fin/SCM technical support. I wrote interfaces for BAI Bank Recon Treasury , Document Express check writing and ACH Output file generation.
• Chelan County Public Utility District Washington State 8.4 Financials, Novel, Oracle, Unix, HCM 8.8 I provided Fin/SCM technical support.
• State of Oklahoma This was a State-wide implementation of - 8.4 Financials, NT, Oracle, Unix, HCM 8.3. I worked both sides of the implementation focused on the Financial conversions, interfaces and Mods.
• King County Washington The County had made over 300 customized mods to their HR system that needed to be upgraded to a new release. California Secretary Of State The Department had not applied patches or fixes for nearly 2 years. During this assignment I re-wrote the existing Claim Schedule process and decreased run time by over 90 .
• Niagara County, N.Y. Helped identify and overcome some of the unique problems associated with an INFORMIX/NOVELL implementation
• City of Cambridge, Massachusetts Technical Lead/ Business Analyst for the Fastrack five months Implementation of the Financial Modules GL, AP PO . Mr. Holland provided training to the City's technical staff.
• City of Des Moines Technical Lead for financials Phase II GL, AP, PO, AR BI . Mr. Holland was responsible for providing training to the City's technical staff.
• LA County Museum of Arts Technical Business Analyst - I developed the data conversion process from the Museum's legacy system.
• California Secretary of State Technical Analyst and trainer for SQR, conversions, Crystal reports, nVision and troubleshooting to SOS technical staff.
• San Diego County Water Authority Technical Business Analyst
• Health Welfare Data Center Technical Business Analyst - I developed Claims Schedule Mods

Health Care Systems Analyst / CEO and President

Confidential

• Projects typically included a full MMIS Design, Development and Implementation DD I .
• Deloitte, Haskins Sells Claims Processing manager for Arizona Healthcare Cost Containment System AHCCS, the first fully managed care MMIS in the county .
• Foundation Health Care Developed the Corrective Action Plan CAP to eliminate the deficiencies identified in a HCFA audit of the Foundation Medicare business.
• New Jersey MMIS Business Analyst for State's Managed Care Policy, regulations, HMO contracts, and administrative procedures for converting the Medicaid Management Information System MMIS system from fee-for-service to a capitated managed care process.
• Maricopa County Designed and managed the development and modifications to a series of programs for the Maricopa County Health Plan County Hospital's billing system.
• California Dental Services Participated in the design, development, and implementation of the risk contract for dental services under Denti-Cal.
• Santa Barbara County Served as the technical consultant and advisor to the Santa Barbara County Health Authority for the procurement, design and monitoring of the Federal/State demonstration project to provide capitated services Managed Care on a countywide basis to Medicaid recipients.
• Computer Sciences Corporation I managed Design Development and Implementation of the Claims Processing Subsystem of Medi-Cal CA-MMIS . I managed five of the six subsystems after the system went into production. This system is still running today.