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Business Systems Architect Resume

SUMMARY:

  • Creator of visionary product and process solutions. Excellent translator of healthcare, life science needs into innovative, lasting results.
  • Hands - on, enterprise technical business analysis, project leadership, data models and complex analytics.
  • High compliance. Great communicator. Amazing deliverables. Kind and ethical.
  • Delivered tens of millions for my clients/companies. Deep insight in provider networks, care management, claims adjudication, pricing, product development, health economics, outcomes research. Global enterprises, blue-sky & intrepreneurial start-ups.
  • Enterprise/PMO SDLCs including Agile/SCRUM, RSA, PMBOK. HIPAA, PII/PHI, other regulatory and internal compliance.
  • Hands-on PHP, MySQL & Oracle. Past Top Secret, PMP. Super Excel, Powerpoint, Visio, Project, many others.
  • For United Health/OptumRx, created architecture solution for a new Pharmacy Benefit Management client contract guarantees platform, with complex drug pricing models and algorithms, new data architecture model, upstream/downstream data flows, multi-year budget development and funding secured, Java with Oracle for performance
  • Served as solution architect for billion dollar PBM rebates integration and migration projects, integrating Catamaran acquisition, mapping operational processes/calculations, securing funding, migrating data platforms, estimating capacity scaling and planning hardware upgrade tasks, re-engineering data feeds into downstream systems, data warehouse integration
  • For a new CMS regulatory Medicaid mandate in provider credentialing, aligned all teams on business requirements, solution architecture & roadmap, created the ERD/data dictionary and wireframes, mapped new data flows across four systems, guided Java/SQL Server development, new mainframe adjudication algorithms, PII & CMS regulatory compliance artifacts
  • For Express Scripts as Business Systems Architect, worked PBM provider network pricing, member benefits and claims adjudication projects in Medco acquisition, mapping disparate business processes and system implications across multiple platforms including adjudication logic, ETL mapping and coding standardization, migrating data across platforms
  • Horizon Blue Cross New Jersey senior IT project manager, for a new Medicare Advantage PPO product launch, documented business requirements, developed strategy roadmap & project plan, HIPAA/PHI compliance artifacts, assisted CMS audit team
  • Juvenile Diabetes Research Foundation - senior project manager for master data management and data migration to enterprise Salesforce CRM, mapping business processes across groups, project plan development and tracking
  • Accenture - data warehouse/healthcare analytics proposal, RFP proposal development and compliance checklist, strategy development, competitor analysis
  • For DOD Air Force Surgeon General, led a great team integrating global military treatment facility data, operated monthly clinical & performance CQI processes, conducted system-wide monthly patient satisfaction surveys, and performed rapid turnaround health system analytics in medical personnel readiness/deployment and healthcare effectiveness, and placed MD advisor on medical innovation
  • Won CMS MEDIC pharmaco-vigilance compliance primary contract vehicle and task orders, leading eight partners
  • Established Traumatic Brain Injury (TBI) Service Center, establishing nurses, clinical and process guidelines, and tracking systems for wounded warriors
  • Developed population health data sets for FDA and CMS, conducted pharma population health, longitudinal patient, and clinical effectiveness studies
  • For CMS, developed new National Average Retail Price index for Medicaid drug prices, purchasing, and measured 50 states drug pricing performance, with new platform and data set
  • For DEA, developed new data analytics model to identify potentially fraudulent drugstore targets for field agents, synthesizing population data, sales/purchase data, and prescription data
  • For Zuellig Pharma, led design, development and deployment of AsiaRx®, an on-line pharmaceutical supply marketplace linking hospitals, drugstores, and clinics
  • Rebooted Zip-Online® enterprise pharma logistics business intelligence application, re-architected on Oracle/Discoverer and custom web development, cutting integration data load time by 90% across platforms in ten countries
  • For United Health/AIG, delivered a ground-up managed care turnkey business unit, growing over 70,000 lives, directing provider network build, medical management teams, claims processing, new product design & marketing, and internal operations
  • For Global Services Division, implemented operational efficiencies through PM and SDLC standards and restructuring, reducing expenses 50%
  • Engaged by the German national sickness funds alongside McKinsey to develop national strategy and implemented care management pilots in discharge planning, population health metrics and primary care relationship building, ran national pilots with German nurses and doctors, reducing average length of stay by 7%
  • Unified four care management application and data platforms (“Continuum”) from numerous acquisitions, in a three-tier distributed enterprise computing environment, developing new unified clinical care management data model
  • Founded, developed, and implemented the Episodes® product line, an innovative clinical care/disease management and complex care management product used by thousands of nurses and medical directors at hospitals, PPOs, and HMOs, which integrated multiple specialty Board, InterQual and Milliman clinical guidelines and workflow management (acquired by United Health)

TECHNOLOGY:

  • Multi-platform enterprise architectures, mainframe to web, batch & real-time
  • Data architectures, big data
  • Applications design & development
  • Systems integration, MDM, ETL and migration

PROFESSIONAL EXPERIENCE:

Confidential

Business Systems Architect

Responsibilities:

  • Provider network management, pricing, rebates, adjudication depth
  • UR, complex case management, discharge planning innovator
  • Health economics, population health, life science outcomes research
  • Complex internal/external industry standards, medical coding, guidelines
  • Government compliance, HIPAA, PHI/PII, accreditations, and audit architectures

Confidential

Business Systems Architect

Responsibilities:

  • Outstanding business results and project milestone accountable
  • Experienced with many SDLCs, including Agile, RSA and traditional waterfall
  • Well-honed executive, technology leadership and medical presentation skills
  • Mixed teams, vendor management, outsourcing
  • Uncovering the special and complex, getting business teams aligned
  • Process mapping and business requirements
  • Performance benchmarking & metrics development
  • Evidence-based roadmaps and strategic plans

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