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Sr. Consultant Resume

Boston, MA

SUMMARY:

  • 15 years’ experience leading and delivering high profile Information Technology and Business projects within Clinical, Healthcare, Retail, and Financial Services domains.
  • Experienced at creating, implementing and managing project plans and budgets.
  • Writing business and functional requirements, technical specifications, and complete SDLC documentation.
  • Managing vendors and business expectations as well as technical and functional teams.
  • Project Management style emphasizes communication throughout all levels of the organization while delivering a product that is requirements driven, on schedule, and within budget.
  • Implementations include Claims Adjudication applications, Data Ware house (Power BI), and Infrastructure upgrades.

TECHNICAL SKILLS:

Project Management Methodologies: PMI, RUP, Navigator, Waterfall, Agile (Scrum), Kanban, Six Sigma (Green Belt)

Technologies: MS Office 365 (MS - WORD, MS-PROJECT, EXCEL, POWER POINT, ACCESS), JIRA, SQL, ORACLE, JAVA, VISIO, C++, Plainview, SharePoint, Liquid Planner, Wrike, Rational Rose, TFS, DB2, TCP/IP. EDI, EDW, Relational Data Base, Migration, Extract Transform Load (ETL), Innotas, Cloud Computing IaaS, SaaS, Paas, HTML, XML, COBOL, JCL, File Management

CORE COMPETENCIES:

  • Project Portfolio Management
  • Global Matrix Team Management
  • Business Analysis
  • Business Transformation
  • Coach and Mentor
  • Resource Planning
  • Program Management
  • Enterprise Content Management
  • Cost Management
  • Relationship Management
  • Data Migration (ETL)
  • Product Implementation
  • Procurement Management (RFP, SOW)
  • SDLC
  • Scope Management
  • Contract Remediation
  • Vendor Management
  • Change Management
  • Stakeholder Management
  • Enterprise Communication
  • Conflict/Risk Management

PROFESSIONAL EXPERIENCE:

Confidential, BOSTON, MA

SR. CONSULTANT

Responsibilities:

  • Supported the procurement management process of a Dental Management System through RFP, evaluation, and selection for Confidential ’s dental line of business.
  • Directed vendor and Confidential departments through scoping, requirements gathering, configuration, test, training, and implementation resulting in more efficient workflow, processing, and organizational changes.
  • Directed/Managed several groups while supporting and representing project managers in the conversion of member enrollment/eligibility transactions from proprietary format to standard EDI transaction sets. Process also required coordination with the Vendor and EEOHS.
  • Redesigned the architecture for receiving, sending, migrating, and reconciliation of Member data.

Confidential, CHARLESTOWN, MA

PROGRAM MANAGER

Responsibilities:

  • Successful fast-tracked rollout of a new enterprise-level data security system, implementing Security Information and Event Management (SIEM) for continuous real-time security monitoring, a Data Loss & Prevention (DLP) System for discovery and prevention of data loss, a File Integrity Monitoring (FIM) and Data Classification system, and web filtering.
  • Project included: testing multiple levels (settings of the software to determine optimum performance, defect tracking, daily scrum with IT and Business, results reporting, rollout and support planning.
  • Managed multiple project teams to make changes necessary to enable the company to transmit Electronic Funds Transfer (EFT) data for enrolled providers.
  • Project was comprised of two teams adhering to an Agile based implementation approach. Project also involved a heavy vendor management component.
  • Project Manager for Power BI Proof of Concept/Implementation. Project involved the addition of Azure Cloud and Power BI capabilities into Confidential EDW environment for an integrated self-service reporting solution; along with current canned reports across the enterprise (SSRS). Actively managed, daily scrum of off shore vendor through deliverables and communication process. Project Management utilized Office 365 for documentation, process, and storage.

Confidential, WATERTOWN, MA

PROGRAM/SR. PROJECT MANAGER

Responsibilities:

  • Participated in the procurement management of the Rhode Island Medicaid contract for Confidential .
  • Primarily responsible for staffing and development of two major departments: Communications and Operations.
  • Business Project Manager Responsibilities include: building requirements for Member and Provider facing materials, member handbook, letters and forms, web site content, and provider manual.
  • Process required extensive communication and collaboration with respective Business Owners to identify content changes related to RI contract requirements and coordinating planning and technical requirements with IT.
  • Analysis to determine business processes, workflow, and dataflow to optimize efficiency and create repeatable processes for business departments.
  • Managed Business Requirements gathering and development, building of benefit packages, system configuration, enrolment criteria, and member/provider services responsibilities. Emphasis on process development, improvement, and repeatability.
  • Coordinated the effort to translate benefit packages into system configured tables as well as overseeing the test cases in the development of a User Acceptance Test Plan.
  • Developed Policies and Procedures (P&Ps) process based on contract and amendment requirements. Managed an iterative review process working with Compliance, NCQA, and Legal

Confidential, WORCESTER, MA

PROGRAM/SR. PROJECT MANAGER CONSULTANT

Responsibilities:

  • Managed Business and Functional Requirements development working with Claims, Actuarial, and IT to create selection criteria for the purpose of database extraction and subsequent loading to EDGE cloud server supported by Amazon Web Services. Process required frequent correspondence with CMS to understand and implement numerous software updates as well as manage schedule delays/changes.
  • Project utilized Cloud services (Vendor - Amazon Web Services) for infrastructure, processing, and reporting.
  • Completed 2014 with a return of $2.5 million dollars in reinsurance funds.
  • The Cost Share Reduction program subsidizes Essential Health Benefits (EHB) for eligible individuals with low and moderate household incomes, who are enrolled in a silver level QHP.
  • Managed business requirement sessions to develop a process that arrives at Fed and State reconciliation money amount owed back to the Payer.
  • Project required re-adjudication of eligible individual’s annual claims comparing results of out of pocket costs of the variant and base plans to arrive at the amount to be reconciled with the Feds and State.
  • Identify Infrastructure components - new instance/new hardware, new instance/same hardware or same instance/same hardware. Enhanced Data Warehouse to include meaningful data as well as improved data reporting capabilities.
  • Facilitate weekly meetings with ACA project stakeholders, CMS, and project team members
  • Facilitate Bi weekly stand-ups/scrum meetings with technical resources and functional managers for environment build
  • Bi monthly reporting/presentations to CIO and Senior Management
  • Managed vendor for deliverables and general monitoring and project control
  • Responsible for project planning and management: Scope, Time, Quality, Communications, Risk, Control, Deployment, and Closing.

Confidential, BOSTON, MA

PROGRAM/SR. PROJECT MANAGER CONSULTANT

Responsibilities:

  • Managed the automation of medical device equipment data collection and population of an acute care electronic medical record, implementing industry best connectivity solutions at hospitals throughout the Confidential network. Workflow, process updates, and organizational change had an overall positive impact on patient care.
  • Managed the research and development of a medical device supervisor program with the intent of creating interoperability processes and communication to programmatically respond to alerts and adjustments.
  • Vendor procurement and management included: Solicitation through award and contract negotiations. Assessment of Medical Device Connectivity solutions that leverage the strengths of EPIC (EMR) and the PHS expertise in informatics, knowledge management, and systems architecture.
  • Worked with Human Resources to identify positions for hiring and the ultimate building of an enterprise level department for Partners Biomed.
  • Research and development to evaluate the effectiveness/accuracy with which piloted RTLS, hardware and software solutions can locate and track IT and Biomedical equipment in various situations (e.g. closed spaces, open spaces, spaces with irregular dimensions, multiple floors, etc.).
  • Evaluated the ability of piloted RTLS solutions to produce data outputs that are compatible and interoperable with impacted current MGH systems.
  • Managed multiple vendors and all teams associated with projects: Infrastructure, Networking, Software Development, Clinicians, Infection Control, and Biomed.
  • Responsible for complete project planning and management: Scope, Time, Cost, Quality, Communications, Risk, Control, Deployment, and Closing.
  • Specific responsibilities include: project communication, schedule development, risk assessment, process development, and full SLDC tactical support.

Confidential, BOSTON, MA

SR. PROJECT MANAGER CONSULTANT

Responsibilities:

  • Multiple projects - notably the successful implementation of a Hospital Clinical Editing Code Review Web enabled Java application loosely coupled with the Facets Claims adjudication system.
  • Application allowed for members to view processed claims and explanations via WEB interface. Infrastructure enhanced to house the new Code Review application. Application written in Java.
  • Captured member ‘Race, Ethnicity, and Language’ data to ensure equitable treatment across groups. The data was captured and weighted through three separate sources: Case Management system, State EDI feed, and entry into the Customer Services module of Facets.
  • Project included WEB application development for case managers.
  • Managed multiple vendors and all teams associated with projects
  • Responsible for the requirements gathering, quality assurance, and integration phases of the project.
  • Assisted PMO Director with the development and acceptance of a new Project Management Office and Portfolio Management.

Confidential, WELLESLEY, MA

PROJECT MANAGER CONSULTANT

Responsibilities:

  • Vendor management, procurement, requirements, quality, integration, and complete management of teams associated with projects. The application enhances the rules development process and produces a savings of over four million dollars annually.
  • Consolidated COLD storage application from DataWatch to FileNet. Project included extract from DataWatch, conversion of documents to FileNet and successful data migration of data spanning ten years.
  • Successful implementation of a web enabled Ingenix iCES Code Review application into the Claims adjudication system.
  • Infrastructure enhancement to multi thread to two Windows Intel servers housing the new Code Review application.

Confidential, PROVIDENCE, RI

PROJECT MANAGER/SWAT LEAD CONSULTANT

Responsibilities:

  • Analysis, development and implementation of fifteen high priority, mandated projects for client Confidential . Projects included EDI transaction updates, creation of new Provider Termination Letters, new process for incoming RX drug files resulting in Data Warehouse updates, updated EOB statements spanning separate platforms, and the loading of Relative Value changes that contain pricing and rules for Asst Surgery, Global days, Confidential, Co Surgery, Team Surgery, Multiple procedures, and diagnostic family imaging. Applications written in Cobol and Java. Responsibilities include full project planning and management: Scope, Time, Cost, Quality, Communications, Risk, Control, Deployment, and Closing.

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