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Director Payer Implementation Healthcare Analytics / Healthcare Solutions Architect Resume

SUMMARY:

RESULTS ORIENTED IT CONSULTANT with more than 25 years Payer Systems implementations. Demonstrated expertise in all aspects of design, development, testing and quality assurance related to healthcare systems implementation. Broad range of experience includes executive management, internal and external consulting, organizational growth, restructuring and vendor management. Healthcare Systems integrations, using ETL functions & Data Warehouse Design & Development.

TECHNICAL SKILLS:

FACETS

AMISYS

HEALTHRULES

PowerMHS

MONUMENT SYSTEMS

Proficient in Office Suite, including Visio, MS Project and MS Access, SharePoint

Informatica, Alteryx, SAP, Tableau

PROFESSIONAL EXPERIENCE:

Confidential

Director Payer Implementation HealthCare Analytics / HealthCare Solutions Architect

Responsibilities:

  • Health Plan Business Requirements and Design Development
  • Development and Creation of Roadmap & Portfolio Design
  • Health Plan Analytics / KPI planning
  • Strategic Analytics Planning
  • Conversion & Interface Design as the Healthcare Business Solution Architect responsible to create solution for Healthcare Payer solutions
  • Hands - on experience professional leading business and technology strategy projects and experience with complex business systems integration, technology transformation in the Healthcare Payer space
  • Led HealthCare consulting team & practice developing go to market strategy
  • Mentored and manage teams of consultants to ensure quality of delivery and to keep projects on time and budget
  • Served as engagement leadership and quality assurance across client portfolio
  • Provided value for consulting engagements and meaningful thought leadership
  • Participated and led engagements by communicating and reporting project status to C-level executives and IT management, including budget, risks, issues, etc.

Confidential

Senior Principal Consultant / HealthCare Solutions Architect

Responsibilities:

  • Healthcare Business Architect, responsible for Enterprise implementation of HealthRules preparing for the Accountable Care Act product.
  • Comprehensive knowledge of healthcare reform and effect on HealthPlan operations & offerings to individuals on/off healthcare exchanges
  • Responsible for business architectural review, program guidance, system gap resolution and enhancement design
  • Designed interface strategy resulting in significant reduction of number interfaces developed comprehensive interface plan including effort, priority and complexity levels using local, remote and offshore resources
  • Lead Scrum and project meeting communicating within the entire enterprise in a multi-tier matrix organization
  • Lead healthcare Payer solutions from Concept to Discovery through Implementation process
  • Provided guidance for a major Confidential Plan, for implementation of TriZetto Facets, EDW, ITS, and accumulator efforts
  • Knowledge of complete Payer Value chain, Including Claims, Enrollment, Provider, Product, Customer Service, including Medicare/Medicaid product lines
  • Accountable for engagement artifacts, support of architecture and solution management for Payer system solutions
  • Delivered conceptual and logical system designs while identifying alternative design approaches. Recommended solutions to align with corporate strategies and standards. Managed and gained approval on solution design reviews
  • Provided Application Rationalization and Enterprise Architecture projects reviewing all levels of Payer applications & surround systems, Collecting, Analyzing and making recommendations for each product and system
  • Created topology of infrastructure and technical scope and guidance to clients for Payer & System Engineering Frameworks. Delivered data strategy meeting the needs for future analytics and reporting
  • Recommended tactical and strategic reporting needs based on interaction with other Healthcare Payers to help manage and reduce cost.
  • Prepared HealthCare Payers to make the transition to ICD-10
  • In-depth knowledge of Payer Business Process and supporting technologies
  • Trained internal technical resources on Payer processes and future direction of HealthCare Payers & Medicare/Medicaid mandates

Project Manager/Implementation Lead

Confidential

Responsibilities:

  • Produced estimates and work plan schedule for Interface & Reporting needs during for Health Plan System Implementation
  • Developed Gap Analysis for all Interface & Reporting components as related to ICD10 implementation issues.
  • Identified Integration points and coordinated with other team members to meet development and configuration milestones
  • Worked with management and client executive level Health plan contacts to bring high priority issues to quick resolution
  • Aided in resolving several critical BPO transition issues in a timely manner in a persistent but patient manor
  • Facilitated trouble-shooting phone calls with clients; researched errors to resolve issues, escalating to and working with various vendor personnel
  • Provided governance of client projects, engaged regularly with project executives in support of TriZetto Facets implementation and interface activities, including accumulator synchronization with other vendors

Project Manager

Confidential

Responsibilities:

  • Developed Gap Analysis for all Interface & Reporting components as related to ICD10 implementation
  • Primary contact for issue tracking and version control function in a multi-site web environment
  • Developed detailed project plans & managed scope to ensure deadlines met with a high level of quality
  • Ability to act effectively and communicate in a high paced environment
  • Work closely with engineers to specify and scope, features and enhancements associated with custom client development

Confidential

Project/Implementation Manager

Responsibilities:

  • Served as primary contact and managed overall interface relationships within defined scope of work to ensure responsiveness to customer needs
  • Install, configure, test, and optimize of enterprise applications remotely and on site
  • Coordinate and managed solution implementation with partner, consultant, and client resources
  • Work closely with engineers to specify and scope, features and enhancements associated with custom client development
  • Troubleshoot and resolve client and product issues; Document issues and resolutions in enterprise knowledge base
  • Identifies and resolves problems in a timely manner; gathers and analyzes information with attention to detail
  • Develop technical materials, documentation and conduct technically oriented
  • Expert individual contributor working independently with initiative and self-sufficiency, with strong team and collaboration skills

Confidential

Project/Program Manager

Responsibilities:

  • Directed and managed the implementation of Microsoft Active Directory solution including +700 servers and 2000 workstations for local & remote users.
  • Led the evaluation of all user desktop applications during the AD upgrade process,
  • Headed up the MS Exchange 5.5 to Exchange 2003 upgrades including the OWA integration.
  • Formed a collaborative work environment using Microsoft SharePoint solution resulting in increased information sharing and project success rates while providing a lower cost solution.
  • Developed ITIL Scope and Project Plan which defined the implementation of the framework with payback in less than one year
  • Improved the IT asset management & tracking system, reduced the losses, improved accounting processes, and proactively managed asset lifecycles.
  • Managed a $1 million core switch upgrade; implementing a high availability dual core solution and moved all without any down time.

Confidential

Sr. Consultant/Project Manager

Responsibilities:

  • Developed multi-departmental process, making using State of Montana EDI data for COB and creditable coverage information including all Medicare/Medicaid transactions
  • Designed methodology and user utilities to support group billing reconciliation processes.
  • Created file and content structure for corporate SharePoint employee portal.

Confidential

Senior Project Manager

Responsibilities:

  • Responsible for planning, controlling, team leadership, cost management and status reporting to stakeholders.
  • Provided effective communication, issue resolution, project deliverable and project review. Position included directing BA personnel developing requirements, functional design, testing, and client communication.
  • Effectively build strength and team practices.
  • Communicated with management both oral & written and developed effective build team practices.
  • Applied critical thinking, analytical decision making and participated in solving issues in results-oriented environment while maintaining excellent interpersonal skills.
  • Developed results-oriented wprocess & Project Management for configuration team methodology.
  • Coordinated with Model Office and other analysts’ technical tasks.

Confidential

IT Manager

Responsibilities:

  • Bridged the gap between exiting IT Manager while Regional IT Vice President position was being filled.
  • Responsible for 28 Technology Professionals, including Application Analysts, Computer Help Desk Personnel, Computer Operations (24/7), Network Administrators, Telecom Analysts.
  • Single point of contact for communications with staff, requesting services of IS, requesting information, problem resolution, and day-to-day operations of the Information Services Department to include 7/24 access.
  • Managed multiple projects and directed staff resulting in timely completion and resolution of issues.
  • Managed the consolidation of 4 Data Centers to one primary location.

Confidential

Senior Consultant/Project Manager

Responsibilities:

  • Performed Scope Plan & Definition Project Phase Planning for conversion of 2M member HMO to FACETS software system using MS Project.
  • Developed Needs Assessment & Resource Planning with user community and Management insure positive project outcomes
  • Prepared client for changes in Medicaid lines of business specifically to EDI transactions
  • Developed Project Plan guidelines and objectives, including Project Budgeting, Project Charter, Change Management, and Risk Assessment/Management and Project Lifecycle activities.
  • Conducted formal Project & Administrative closure, resolved open items and distributed project completion documents.
  • Designed and Scoped Claims, and Accumulator interfaces on several Facets implementation projects.

Confidential

Senior Consultant

Responsibilities:

  • In collaboration with client and external resources, designed unique Claims Performance Management system, focusing on the daily activities of claims processors.
  • Managed transition of IT operations during Health Plan shut down and run-out of health plan while providing uninterrupted support to current employees and member services.
  • Negotiated termination of hardware leases and equipment disposal significantly saving run-out expenditures.
  • Planned and implemented dissolution strategy, developed procedures for health plan run-out phase.

Confidential

Director of Systems Development & Programming

Responsibilities:

  • Managed installation of corporate wide LAN/WAN network on a Microsoft Server Platform.
  • Software development Manager in HP3000 AMISYS environment using SDLC techniques.
  • Developed reporting system in support of services for HAI case management data, claims information.

Confidential

Lead Programming and Systems Analyst

Responsibilities:

  • Designed and authored EDI claims system increasing throughput of claims by 50% within six months.
  • Designed/developed proprietary hospital procedure-based cost accounting system.
  • Designed and implemented knowledge base for Clinical Decision Support System.
  • Developed provider network analyses and physician/hospital report cards.

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