OBJECTIVE

Health Care IT project management or consulting opportunity related to an MMIS, HIX, or Service-Oriented Architecture SOA Enterprise-Scale IT Development Project.Specifically,providing oversight and leadership of planning, design, development, testing, evaluation, training, and implementation or maintenance of healthcare delivery systems,focusing on liaison skills between the internal/external business community and the IT development team.

QUALIFICATIONS

• 20 years' experience with both private and public-sector healthcare IT delivery systems
• 3 years recent 2010-2014 experience working in an advisory capacity on a day to day basis with State MMIS, HIX, and IV V staff
• Highly skilled in translating business requirements into functional requirements and specifications
• Excellent current leadership skills in web-based healthcare IT methodology architecture
• Experience in identifying risks, issues, and risk mitigation recommendations on enterprise projects
• 20 years' experience planning, developing, and implementing MMIS and HIX business processes
• Managedbudget and actual costs, project schedule, and verification and validation of project's activities and requirementson numerous projects
• Understands technological trends and communicates effectively with IT developers
• Experience interviewing and selecting project staff for required roles
• Led and completed RV/JAD sessions with SD State staff for the new SD MMIS
• 10 years' experience in staffing level assessment on large-scale projects
• Experience managing Requirements Traceability Matrix RTM updating Verification/Validation Plans
• 20 years' presentation and demonstration experience
• Excellent health care business process modeling skills MS Visio 2013
• 11 years' IT project management Experienced in all phases of SDLC testing
• Exceptional skill of facilitating internal and external communications between client, stakeholders, vendors, and solutions team
• Multi-task ability on parallel components
• Microsoft Project 2013 Proficiency
• Strong requirementsmanagement/requirements elicitation skills
• Proficient in Use Case development, User Stories, MS Excel, MS Word, MS Outlook, MS PowerPoint, Experienced with MS SharePoint for SDLC project library artifacts
• Proven leadership abilities Self-starter with excellent written and verbal communications skills Experience establishing and presenting formal communication plan for all project stakeholders

PROFESSIONAL EXPERIENCE

Senior Medicaid Program Advisor

Confidential

• Provided recommendations directly to Maryland Medicaid Executive Staff in managing the Medicaid Program-related business and IT activities of the Maryland Health Benefit Exchange MHBE from concept through operational readiness. Worked collaboratively with stakeholders of the MHBE, Maryland Dept. of Health and Mental Hygiene DHMH , MD Department of Human Resources DHR , and MD HIX IV V staff to facilitate/resolve program design and development issues.
• Produced and received approvals for CMS/CCIIO grants and Advanced Planning Documents APDs for additional funding for the Maryland Health Benefit Exchange MHBE . Served as CMS liaison throughout the MHBE budget cycles.

Senior Business Analyst

Confidential

• Senior Business Analyst/Medicaid SME on a Master Data Management MDM contract with the Centers for Medicare and Medicaid Services CMS to provide enterprise data services, identity resolution for Medicare and Medicaid beneficiaries and providers to support the agency's information systems.
• Developed and presented CMS stakeholder presentation to share MDM solution before deployment to production.
• Developed project WBS structure in Microsoft Project to build the schedule for each MDM release.
• Responsible for writing technical specifications documentation, presenting technical solutions to CMS stakeholders, creating MDM test plans, test case scenarios, and performing testing prior to production deployment. Also responsible for delivery of Detailed Design Documents DDD , test summary reports, and release management artifacts.

Senior Consultant

Confidential

• Served as a Senior Business Analyst on the DDI of the Colorado Health Benefit Exchange project conducted Requirements Validation sessions and JAD sessions to define and clarify the system specifications for the CO
• Implemented communication management process comprised of status meetings, defined deliverable schedules, Webex presentations.
• Served as the project's CMS SME, keeping team apprised of CMS developments,providing guidance and direction on CMS policies and procedures, and participating in preparation and execution of establishment/Gate Reviews. Established risk and issue management process pertaining to CMS Gate Reviews.
• Served as a senior consultant for CGI in an effort to procure HIX and MMIS contracts throughout the United States assisted in the writing, development, review, and approval of HIX and MMIS proposals

Medicaid Health IT Specialist

Confidential

Worked as a CMS Federal employee performing reviews on State Medicaid Health Information Technology Plans SMHP's and Implementation Advanced Planning Documents IAPD's from State Medicaid programs for completeness and accuracy to approve/deny requests for CMS funding for Electronic Healthcare Provider Incentive Payment program. Wrote impact analysis for State Medicaid programs to implement T-MSIS reporting requirements to CMS. Provided CMS updates and policy clarification by delivered presentations at various HI-TECH and MMIS conferences.

Senior Business Analyst

Confidential

Responsible for the drafting, developing, and delivering ofthe State of Illinois' Medicaid Health Information Technology Plan SMHP .

Medicaid Subject Matter Expert

Confidential

• Team Lead for the Provider Management and Prior Authorization teams consisting of business analysts, technical developers, and testers associated with the analysis, design, testing and
• Implementation of the transfer from the legacy MMIS to the new web-based South Dakota MMIS.
• MITA Experience 1 Analyzed and completed an assessment of the As-Is and To-Be capabilities of South Dakota's MITA Business Objectives for the Provider Management and Prior Authorization functional areas, 2 Mapped the MITA process areas to Use Cases for the Provider Management and Prior Authorization functional areas, 3 Analyzed and defined the quality measures for MITA levels 1-5 for each Business Process within Provider Management and Prior Authorization, 4 Determined the As-Is and To-Be MITA Maturity Levels for the business process areas within Provider Management and Prior Authorization.
• Successfully conducted the Requirements Validation sessions and JAD sessions with the State staff of South Dakota and IV V staff and effectively met all requirements requested for the new South Dakota MMIS.
• Accountable for writing, overseeing, and delivering the formal Requirements Validation Documents and Requirements Traceability Matrices for Provider Management and Prior Authorization for the new SDMMIS received sign-off from the State on these Requirements Validation Document deliverables.

Team Lead/Senior Business Analyst

Confidential

Project Lead for Enterprise and divisional projects dealing with AR Blue Cross/Blue Shield's claims processing system private business side of BCBS defined at the corporate level managed projects from initial specifications through implementation insuring accuracy, timeliness, and budgetary responsiveness.

Project Manager

Confidential

• Successfully managed numerous IT projects related to Medicare and Medicaid billing and collections for
• Beverly's 400 nursing facilities using RUP methodology and Microsoft Project software supervised technical/operations staff. Established project governance, risk management process, issue management process, communications management process and deliverable management process.
• Effectively streamlined Beverly's Therapy Interface Project billing and collection process of therapy services which resulted in enhancing company bottom line by 15 million.
• Served as overall Y2K project manager for Beverly's Home Care division. Involved inventory, assessment, risk, and remediation of all hardware and software products for Beverly Home Care's 62 agencies - 03/1998-01/2000.

Operations Development Consultant/Provider Relations Manager

Confidential

• Managed and conducted provider outreach and statewide provider training sessions shortly before the new NM MMIS was implemented.Instrumental in winning MMIS proposal for the MS Medicaid RFP participated in requirements analysis with the State, developed sections of the GSD and DSD.
• Hired and trained the MS MMIS Provider Relations Department staff of 37 prior to go live of the new MS MMIS. Responsible for all contract requirements of provider training, provider communications, provider manuals, and provider publications.

Provider Relations Manager

Confidential

• Managed the provider relations department for the Massachusetts MMIS fiscal agent - a staff of 25 individuals.
• Responsible for all contractual requirements related to provider enrollment and credentialing, provider file maintenance, provider inquiry, provider publications, and provider training.

Product Administrator/Provider Relations Manager

Confidential

• Wrote and presented MMIS technical proposals for claims processing contract procurements throughout
• the U.S.Wrote the provider subsystem sections of the AR MMIS technical proposal and participated in GTE's
• team oral presentation to the State related to the procurement of the AR MMIS contract.