- 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.
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
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
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
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
- 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
- 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.