SUMMARY:

Passionate IT professional with over 20 years of experience in Information Technology, Healthcare IT, Project Management, Data Warehouse, Clinical Informatics and Population Health with a remarkable track record of achievements. Capable of integrating all domains in Healthcare IT to produce outstanding results from EMR System Integration, automation and migrations, interoperability between Clinics, Lab, ER and HIE’s. Subject Matter Expert in ACO, MACRA, MIPS, EDI and value based payment, mixing Clinical analytics with costs and process improvement methodologies to comply with latest requirements of Quality Metrics and Practice Improvement Activities allowing organization to score high in Quality Payment Program and achieve savings for ACO’s. Moved hospital from EMRAM level 2 to level 6 using leadership and superb communications skills, building collaborative relationships with clinicians, management and ancillary departments. Artfully managed projects using SCRUM methodologies and Agile SDLC - Software Development Life Cycle, from design and development to optimization, maintained and customized Enterprise Hospital Information Systems and all applications: ADT-Admissions and scheduling, programmed and customized systems and trained physicians for CPOE, Order Entry for clinicians; clinical documentation improvement projects, and go-live of CDS- Clinical Decision Support Systems.

SKILLS:

Information Systems Integration Multi-platforms/ Languages EMR-EHR 5010 X12 EDI Meaningful Use Achievement Interoperability HITECH Networking Systems Architecture Cybersecurity HIE’s Enterprise Imaging Anti-Hacking Information Security Cloud Computing IaaS SaaS PaaS CPOE Process Automation Incident Command ITIL Data Governance HIPAA Compliance Policies & Procedures Hardware & Software Communicating & Selling Ideas Kaizen ETL LEAN Six Sigma HIT Active Directory Exchange Servers Firewalls Rule-Based Security Business Analysis Data Mining Databases Clinical Document Architecture Project Management HL7 Process Improvement Web E-Commerce Portals Change Agent Innovator Budgeting & Auditing Troubleshooting SQL Queries Reporting KPI’s Problem Solving Profitability Life Learner Flexible Mobile Computing VOIP Trainer Scrum and Agile Project Management MIPS & MACRA Clinical Process Improvement PQRS Quality Patient Resource and Utilization Analytics Revenue Cycle Process Improvement

TECHNOLOGY AND TOOLS:

EMR’s: CPSI, Epic, Cerner, Meditech, Touchworks, eClinicalWorks, CPOE, Athena Health, Greenway, Sure Scripts, Allscripts, Dr. First. Paragon, Health Land, EPIC, Dr. Chronos, Emdeon, Clinimax. OMNICEL, EKG systems, Sleep Lab- Nihon Kohden, CPAP, Respironics, Digital Radiology interfacing, PACS, ELR Lab Reportable, CART, Windcare, Exit Care, NQF- National Quality Reportable, Quaity Metrics, GPRO, INFOH- EOCCO and ACO reporting and 340B programs. Population Health- Explorys and Data warehouses- Strata and Midas. IBM Watson Health.

EDI / CLAIM MANAGEMENT: HSP, E-tracks, Plexus CVX, Gentran, ITXA, MoveIT Central Automation, Ultra Edit. FileZilla, Secure TransferPROJECT MANAGEMENT JIRA, Service Now, Samanage, Project Management Web App, Microsoft Project, Smart Sheets, TFS, ConfluenceINTEROPERABILITY HL-7 v.2.5 and 3.0, interfaces, CCDA- Consolidated Clinical Document Architecture. Interface engines -Extrahop, Mirth Connect, HIEs, FHIR, including ADT, ORM, ORU, and DFT

IMAGING: PACS Systems and interconnectivity. Pictzar for wound care. Enterprise Imaging, Photoshop CS6 PRO, Adobe Acrobat Suite, Cloud.

DATA MANAGEMENT: SQL Server, Access, ODBC, Crystal Reports, Cognos Impromptu, Oracle, SAS, SPSS, Data Mining, OLAP Excel Power Pivot, Power Query, Power BI- Business Intelligence. Tableau, Data Wrangler and Qlik.

OFFICE: MS Office 2013 and 365- Word, Access, Excel, PowerPoint, Outlook, Infopath, One Note, Publisher, MS Project

EXPERIENCE:

Confidential, Linthicum, MD

Responsibilities:

• Expert knowledge of Agile project management principles and practices and associated organizational management systems; Ability to maintain project team focus and structure; including the development of a strategic project management plan encompassing schedule, budgetary, contractual, human resource, and stakeholder elements
• Identify and analyze business needs; work with department members to ensure alignment on scope and requirements; create opportunities for innovation in process changes via technology enabled solutions; contribute to the strategic planning process and long-term direction for IT.
• Provide significant leadership in the development and maintenance of the Reporting Strategy and Healthcare Analytics and KPI’s. Including: defining initiatives, developing business case, high level estimates and guiding initiatives through the planning and execution process, expert at facilitating impasses between the technology and the business teams
• Scrum Master and Agile expert managing multiple mission critical IT projects simultaneously from new claims systems development, system migrations, integration and data analytics, infrastructure deployment and automation. Managed Claims cycle for major payors like Blue Cross Blue Shield, United Health Care. Medstar, Cigna, Aetna and Medicare and Medicaid for a population of 32 million beneficiaries.
• Successfully revamped EDI operations and projects for EDI HIPAA Claims Transactions- Electronic Data Interchange of 5010 X12 EDI transactions including: 834 Patient Eligibility, 270 and 271 Coverage inquiry and response; 837 Professional and Institutional Encounter Files, 999 and 997 acknowledgements, 277 healthcare notifications, 835 Payment Transactions.
• Developed new and improved existing process flows, for full automation of data and analytics of Claims payments, rejections, denials and reconciliations, including mapping, crosswalks, and full reconciliations of data files, reaching overall acceptance rates of 99.8% on first submission. Process improvements and automation of 5010 X12. Electronic Payment analytics. Review and validated data on claims to avoid issues with payors and avoid denials and rework.
• Follow up on Payments to Providers and verified cash disbursement journals and Clinical encounters for accuracy. Developed reports on revenue cycle performance and productivity rates and KPI’s.
• Developed and implemented SLA- Process mappings and Improved data and process flows professional and institutional claims. Developed system for keeping State, plans and Trading partners dashboards and KPI’s including Submission reporting, reconciliation and process for acknowledging, mapping and matching response files. End to end tracking, analytics and SQL queries development.

Data Scientist

Confidential, Hagerstown, MD\

Responsibilities:

• Developed and implemented Clinical/ Costs/Quality Metrics Data Warehouse for Tracking Patient utilization, cross reference data from hospital, clinics, labs, medications, high utilization of ER, readmissions, and patient risk modelling for ACO and Clinical Improvement processes and reengineering.
• Adept at preparing presentation that provides technical concepts clearly to a non-technical audience. Skillful at strategic and technical planning and experienced with tools supporting documentation and analysis of requirements, design and testing.
• Expert knowledge of Managed Care: Medicare, Medicaid, and Commercial Insurance (Group and Individual). Familiarity with Standard Medicare, Medical Supplements and Medicare Advantage Plans. Knowledge of HMO, PPO, POS Plans, etc. Experience with working with managed care enrollment and claims data, X12 5010.
• Managed Clinical Improvement and EMR optimization for quality processes by capturing data in data warehouse, provisioning data and creating data models and visualizations for leadership and interpret data and findings to improve outcomes from reducing costs and improving reimbursements.
• Integrated data to prevent over utilization, improving coordination of care and share of information among specialists, PCP, Inpatient, Outpatient, Health Information Exchange and Claims and Costs data from CMS/ Network through integration and interoperability of multiple EMR systems into Data Warehouse.
• Analyzed costs reduction, patient’s clinical risk factors and social determinants of health analytics using multiple data sources. By utilizing data modelling and risk management achieved reduced costs and ACO shared savings. Expert at CMS Claims data files (CCLF), CPT/HCPCS, LO INC codes, ICD 9 and 10 diagnostic and procedures codes, NPPES, HCC risk modelling. Creating complex reports and Power pivot tables, visualizations and trends for decision making.
• Managing Big Data systems, integration and trend analytics with longitudinal studies and population data.
• Experience with EMRs, Healthcare Data Warehouse and Healthcare Informatics: Population Health, Patient Access, Service Quality, Healthcare Outcomes, Patient/Family Satisfaction, Staff Productivity discovering patterns and trends, including Econometrical modelling and predictive statistics.
• T-tests, cluster analysis and correlation and regression, including building models for predictive analytics.
• Analyzing Readmissions, Average Length of Stay, Total discharged days not billed, Net Days on AR, AR aging.

Director Systems & Clinical Informatics

Confidential, Portland, OR

Responsibilities:

• Leader of clinical development data standards and governance by using emerging technologies to transform healthcare. Spearheading continuous improvements on clinical outcomes and ensuring compliance.
• Directed the Implementation of interoperability platforms for Laboratory interface for State reporting and connectivity with 17 different EMR systems. Radiology applications with connection to remote PACS system using DICOM and interfaced to E.H.R creating true end to end data flows for continuum of care.
• Expert at influencing senior leadership on strategic direction of Healthcare IT for the delivery system. Managing diverse and remote teams using SDLC and change controls process.
• Adept at reaching interoperability between stakeholders and gaining buy out from clinicians implementing CDA and CCDA exchanges between hospitals and clinics and HIE. Following the continuum of care for the patients and adapting systems and HIT to allow collaboration among practices, hospital, post-acute care and ACO. Master skills in Data Analytics allowed to prioritize implementation plans and deployments.
• Masterfully performed data ETL: Extracting from heterogeneous sources, Transforming and mapping then loaded for systems migration. Keeping critical data from legacy systems and integrating into new upgraded applications. Putting together reports for Business Intelligence and strategic purposes and quality metrics.
• Conducting statistical analysis and OLAP- Online Analytical Process through ODBC-Open Data Base Connectivity on different systems to integrate data for trends and business intelligence. Mining, managing and retrieving structured data and complex reporting. Arranging pivot tables and cubes of data for easier analytics. Scatter graphs and data presentation in 3D. Calculating Average Cost per patient/beneficiary, potential savings, and opportunity analysis, identifying top utilization of services, procedures and Emergency Department usage. Calculating Readmission rates and trending reports.
• Data Dashboards and Quality Measures both for Hospital side and Physician’s side PQRS and GPRO, KPI’s- Key Performance Indicators abstraction and reporting. Six Sigma and Lean projects data management and analysis. Work flow and data flow analysis, data repositories and correlations. DMAIC and DMAVD. Revamped multiple value based processes and improved quality outcomes 25%.

IT Director & Information Security Officer

Confidential, Lakeview, OR

Responsibilities:

• Demonstrated ability to lead all IT areas Hardware, Software, Network and Clinical Informatics Data. Expert performing analysis and make recommendations to improve project design and performance, including the ability to identify and analyze requirements, dependencies, risks, critical paths, and needed resources. Unified data flows for Healthcare system comprising Hospital, Long Term Care, 3 Clinics, FQHC and HIE. Implementing and supporting reference lab interfaces and maintaining revenue cycle management interfaces.
• Achieved hospital moving from EMRAM level 2 to level 6 using leadership and superb communications skills and building collaborative relationships with clinicians, management and ancillary departments. Artfully managed systems, physicians, training and optimizing EMR adoption of CPOE, e-prescribing and electronic documentation. Implemented Systems Interoperability between Financial Systems, Revenue cycle, Clinical and Resource management and procurement systems. Control all cybersecurity for hospital.
• Achieved Meaningful Use I and 2 by successfully improving infrastructure and hardware, migrating systems, updating LO INC, SNOMED, ICD-10 and CPT codes. Deploying and optimizing patient portal using web and digital background, created connections and interfaces with State for reportable and syndromic surveillance. Created bases for safe electronic transfer of CDA’s direct messaging and connectivity with other hospitals, including the electronic transmission of structured lab results directly to doctors. All while keeping policies and procedures, while updating required ones according to the times.
• Moved organization to value based payments by using analytics and reviewing payment cycles, denials and claims rejections analysis. Reviewed trends of reimbursements and optimized IT functions to provide KPI’s and comparisons to benchmarks and other metrics to monitor payor contracts and optimize reimbursements through Clinical documentation improvements.
• Upheld optimal balance between Technology, Clinical, Costs, Provider’s needs & Patient outcomes/metrics.

Network & E-Commerce Director

Confidential

Responsibilities:

• Proven ability to solve problems using data analytics and identifying best tactical moves and strategies based on data analytics. Developed multi-platform E-Commerce and Secured connection system.
• Managed and overseen interdisciplinary ventures integrating Lean Six Sigma projects with disciplined project management methodologies and ITIL. Using API technology and A/B testing determined critical option for E-commerce algorithms.
• Kept projects on check by maintaining costs, resources, managing stakeholder’s expectations and monitoring tasks skillfully. Keep track using latest technology. Managed projects in 17 countries.
• Manage, review and monitor data traffic throughout the network to prevent potential problems and threats. Constantly training personnel to improve the weakest link of the security equation. Reviewing data flows and monitoring for potential intrusions and vulnerabilities. Monitoring updates and fixes.
• Established secured data backup procedures and business continuity plan, developed disaster recovery plans. Developed procedures for proper data and devices disposal through degaussing and sanitation. Conducted annual risk analysis for compliance. Established incident response plan and portal for reporting

Executive VP Marketing

Confidential, Brandon, FL

Responsibilities:

• Member of strategic leadership team, advisor and consultant for C Level for Information, data and technical issues affecting the organization. Can relate IT strategy to key performance metrics and long-term goals and develop recommendations for operational courses of action and accessing new markets (new systems, integrations, software purchase or other innovations) that could save money, time or other resources.
• Provide leadership, direction, mentoring and guidance to staff to foster a strong business outcome focused team atmosphere, understanding of requirements and reducing risks.
• Managed Marketing and Contracts, SLA- Service Level Agreement with vendors, setup BAA-Business Associate Agreements and coordinated sub-contractors. Managed new market development activities.
• Effective communicator leading and engaging public with topic at hand, delivering state of the art presentations with multiple technologies to persuade and motivate audiences, can pick what drives and motivate people and adjust accordingly. Prepared and delivered Newsflash, websites content and reports.

Measurement & Evaluation Program Mgr.

Confidential, Clearwater, FL

Responsibilities:

• Work with the IT Data Management to develop potential solutions that match the business strategy with the technology strategy. Coordinate stakeholder involvement in the deployment of technology to include requirements definition, business cases with cost benefit analysis, design sessions, QA and user acceptance testing
• Masterfully performed data extracting from heterogeneous sources and created compiled and edited annual Corporate report and reporting for the State.
• Conducting statistical analysis and business intelligence to review root cause of problems and provide prescriptive measures for improvement. Mining, managing and retrieving structured data and complex reporting. Managed budgets and reviewed trends.
• Evaluated center’s outcomes and recidivism against State guidelines and proposed improvements for processes and data gathering.