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Owner Resume

SUMMARY

  • He has over 24 years’ experience in Information Technology spending the last 18 years in the Healthcare Industry.
  • He possesses a unique perspective in working on ‘both sides of the fence’ holding a senior position on the client and vendor side of operations.

TECHNICAL SKILLS

Healthcare Payer Platforms: TriZetto QNXT Medical (all versions from QMACS 4.10 to QNXT 5.1)/Health Rules Payer 19.6

Dental Payer Platforms: TriZetto QNXT Dental (all versions from aQDen 4.10 to QNXT Dental 4.7)

Clinical Editing: McKesson ClaimCheck (integrated with QNXT via ClaimCheck Wizard; integrated with internally developed systems)

EDI/HIPAA Admin Simp: QNXT Connect (all versions from QConnect 2.6 to QNXT 5.01), ClarEDI, Microsoft BizTalk (2006 w/HIPAA Accelerator, 2009, 2010)

Provider Credentialing: VisualCACTUS 3.10

Pricing Components: Micro - Dyn DRGActive (integrated with QNXT and stand-alone)

EDI transaction sets: 834/835/837I/837P

Data Warehouse Solutions: VIPS McSource

Database Software: SQL Server 4.21a/ 7.0/2000/2005/2008/2014/2016 , Oracle 10.x/11.x

Server Software: Windows 2000/2003/2008 , Oracle Application Server, Apache

Business Intelligence Stack: SSIS/SSAS/SSRS

Languages: T-SQL, PL/SQL

High Availability options: Oracle RAC, Microsoft SQL Clustering (Active/Passive), NLB, Log Shipping

Project/Document Management: MS Project, Basecamp, Daptiv, Ace, Sharepoint

Integration Software: Biztalk 2002/2006/2009/2010

Programming tools: SQL Management Studio, Toad, PL/SQL Developer

Database Monitoring tools: Quest Spotlight for SQL Server and Oracle, Quest Foglight for SQL Server and Oracle, SQL Profiler.

PROFESSIONAL EXPERIENCE

Owner

Confidential

Responsibilities:

  • Led development efforts for provider and CSI conversions into HealthRules Payer using HE’s connector services.
  • Designed and coded 028 extract for EOBs out of HE’s data warehouse.
  • Assisted in QNXT technical and business design requirements, configuration, and implementation for the 834 Import using QNXT Connect for multiple lines of business.
  • Designed and coded interfaces to third party vendor for inbound/outbound benefit and MOOP accumulators.

Confidential

Solutions Architect

Responsibilities:

  • Responsible for QNXT technical and business requirements development focused on payment processing and eligibility output interfaces.
  • Designed QNXT global eligibility interface to accept source files from multiple employers in proprietary formats and load into core claim system.
  • Setup and deployed custom EDM solution for claim submission to CMS.
  • Validated and corrected QNXT import into Data Warehouse for both Phase 1 and 2 of the implementation.

Confidential

Solutions Architect

Responsibilities:

  • Developed QNXT Claim and Payment reports for new line of business using SSRS for deployment.
  • Designed and developed QNXT claim workflow interface to extract data elements from core system based upon vendor mapping.

Confidential

Solutions Architect

Responsibilities:

  • Primary developer for QNXT reporting and interface inventory spanning UM, Claim, Financial, Membership and EDI Process Logging modules resulting in 100+ Production reports and 25 Production interfaces.
  • Lead conversion architect for following subsystems:
  • Developed custom claim encounter extract for new trading partners as well as submission to CMS.

Confidential

Solutions Architect

Responsibilities:

  • Led QNXT technical and business design requirements, configuration, and implementation for the following transactions: 834/835/837I/837P including testing and any related troubleshooting within BizTalk applications.
  • Created custom training classes for EDI environment and architected relationships.

Confidential

Senior Manager

Responsibilities:

  • Medical
  • Legacy System to QNXT Medical/Connect 2.6
  • QNXT Medical/Connect 2.6 to QNXT Medical/Connect 3.4
  • Eligibility
  • Legacy System to Vitech’s V3
  • Dental
  • Legacy System to aQDen 2.4. aQDen 4.14 to QNXT Dental 2.6
  • QNXT Dental 2.6 to QNXT Dental 3.4.
  • Provider Credentialing
  • Legacy System to Visual Cactus 3.10
  • Successfully incorporated virtualization into the system architecture which has created much more options in cost savings, Disaster Recovery, and environment duplication for all Execution Units, Distribution Hubs and Biztalk servers.
  • Created custom QNXT extract into VIPS MCSource Data Warehouse with successful integration for Production use.
  • Reporting regularly with C - level executives on operational direction while providing strategic and cost savings initiatives to business owners.

Confidential

President/Founder

Responsibilities:

  • As President and Founder, Confidential . Confidential was personally tasked with the responsibility of building the corporation from the ground up. Company grew in both employee size and revenue generation during the course of Confidential . Confidential ’s tenure.
  • Oversaw the hiring and future mentoring of 8 fulltime employees which was a mixture of Project Managers, Business Analysts, Developers, and Administrative Assistants.
  • Built strong vendor and offshore relationships to provide our client base with the most economical solution without compromising our customer satisfaction.
  • Was elected to board of Performance Series User’s Group which met to determine various application goals including: reviewing current application direction, review of outstanding defects, and how to improve overall customer satisfaction. Primary role was to act as a voice for Confidential Inc’s client base.

Confidential

Senior Consultant

Responsibilities:

  • Met leadership’s goals each year of generating over $1 million dollars in new revenue yearly and maintaining a minimum of 80 percent chargeability rates.
  • Hired, trained and deployed newly hired consultants along with conducting yearly performance evaluations and establishing personal goals.
  • Presenter each year for Performance Series conference on a variety of technical topics including: database performance, ‘What does the future hold?’, and data integration.
  • Lead technical resource for post-production issues and sales presentations.

Confidential

Consultant

Responsibilities:

  • Met leadership’s goals each year of generating over $500,000 dollars in new revenue yearly and maintaining a minimum of 80 percent chargeability rates.
  • Designed technical training program geared towards assisting technical resources with troubleshooting Performance Series complexities.
  • Promoted within first year of employment.

Confidential

Systems Analyst

Responsibilities:

  • Designed a curriculum for an MCSE boot camp roadmap for Managing Partner of Public Services sector who was overseeing the partnership developed between Microsoft and Confidential .
  • Program had a successful graduation rate of 95 percent at its inception.

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