Summary

• Confidential is a seasoned Senior Healthcare Systems IT Development consultant with 28 years of Medicaid MMIS claims processing, CMS mandated federal reporting and State Healthcare Decision Support System Implementation experience in the State Healthcare industry. She is a proven leader in designing, developing and implementing large scale systems t support state healthcare claims processing, federal reporting mandates, data analytics, healthcare performance measures, as well as fraud detection methodologies for State Medicaid agencies.
• She possesses strong management, effective communication, and proven organization skills which enable her t build and lead large project development teams, relate requirements and solutions t end user State Healthcare clients and successfully demonstrate compliance with acceptance criteria, in order t consistently develop, manage and implement high quality product solutions.
• Project Development and Implementation: Experienced in developing and implementing MMIS Medicaid Management and Administrative Reporting MAR , Surveillance, Utilization and Review SUR and AdHoc Decision Support Systems DSS Data Warehouse solutions, using the Software Development Lifecycle, for state Medicaid programs. Incorporated deep operational experience and knowledge of Medicaid int the DSS Ad Hoc, SUR and MAR products through a combination of leadership, business knowledge, and technical competency. Managed development and testing, including coordination and monitoring of testing, defect tracking and results. Anticipated delays and initiated plans for alternative solutions. Managed project with specific focus on deliverables, tasks and due dates. Performed independently with minimal supervision and worked with others t develop trusting relationships, and user acceptance. Participated in planning and preparation for the successful District of Columbia MMIS CMS certification utilizing the Medicaid Enterprise Certification Toolkit MECT for Program Management, garnering a CMS Best Practices recommendation for the CMS64 design. Strong organizational and problem solving skills with excellent written and verbal communication skills. Ability t multi-task. Possesses long term and extensive CMS Knowledge and experience, especially as related t Federal Reporting requirements for State Healthcare agencies, including T-MSIS Transformed Medicaid Statistical Information Systems . Heavy customer interaction experience with both State based end users as well as other contracting agencies, leading t successful and profitable project relationship experiences.
• Project Manager: Experienced in overall project management, which includes: developing Project Charters, Work Breakdown Structures, Project Plans, and Test Plans estimating task efforts and durations managing project work plans ensuring compliance with project standards and methodologies working through approval process leading meetings reporting project status and mediating priorities between business units. Respected for interpersonal skills, integrity, leadership, and team building

PROFESSIONAL EXPERIENCE

Confidential

Project Implementation Lead

• Served as Project Lead in developing large-scale Medicaid Ad Hoc and EMAR Solutions for AK, DC, MO, MT, OR, and ND which included:
• Assessment of contracts and defining Statements of Work
• Identifying data and business requirements to design MMIS based DSS, MAR and SUR decision support business intelligence solutions
• Successfully funning client site Requirement and Design Joint Application Development JAD Sessions to accurately and clearly define scope
• Leading project teams in the transformation of system requirements into a design
• Verifying data warehouse data validity, credibility and integrity
• Developing Source-to-target Mapping documents outlining data elements from legacy system and new systems to database models, with respect to Federal and State requirements and mandates
• Developing ETL Business Rule documents along with controlled end-user lookup tables that can be easily updated and maintained
• Developing extensive and innovative automated system test scripts, use cases, and scenarios
• Overseeing Development and Testing technical and analyst Teams over multiple large scale projects at a time
• Providing clear, concise and timely communication and support to clients throughout the development lifecycle
• Assisting in development of user documentation and online help
• Developing and facilitating end-user training
• Ensuring product, departmental and CMS standards were followed
• Mentoring Technical, Development and Business Analyst team members
• Developing/overseeing the creation of project deliverables reflective of the system development lifecycle, specifically: Requirements Analysis Document RAD , Detailed System Design DSD Document, Requirements Traceability Matrix RTM , Unit Data Validation Test Plan/Results, System Test Plan/Results, User Acceptance Test Plan/Results, System Documentation, Operations Manual, and Data Dictionary
• Developing/overseeing the creation of miscellaneous project documentation, such as: Agendas, Status Reports, Meeting Minutes, Defect Tracking, and user training materials.

Confidential

Implementation Project Manager

• Served as Team Lead for the analysis and development of Enterprise Operational reports which included:
• Performed analysis of all State Medicaid Operational Reports
• Facilitated Design sessions with Enterprise team
• Designed and Developed Enterprise reports in Cognos for ORR
• Ensured all ORR reports were tested
• Identified areas for improvement
• Tracked and managed issues and progress
• Mentored/coached Associate Business Analyst and Business Analyst team members

Confidential

Implementation Manager

• Served as Project Implementation Manager in designing and developing large-scale Medicaid Data Warehouse Decision Support Solutions for Missouri, Montana, Oregon, and the District of Columbia, which included:
• Assessed contracts
• Performed on request program integrity audits and analytical studies for State Medicaid Agencies
• Identified business flows, business requirements, data and metadata requirements
• Facilitated Requirement and Design Joint Application Development JAD Sessions
• Lead project team in the transformation of system requirements into a design
• Verified data warehouse data validity and integrity
• Developed system test scripts, use cases, and scenarios
• Tracked and managed issues
• Provided clear, concise and timely communication and support to clients throughout the development lifecycle
• Developed user documentation and online help
• Developed and facilitated end-user training
• Ensured both departmental and CMS standards were followed
• Mentored/coached Developers and Business Analyst and Business Analyst team members
• Developed project deliverables reflective of the system development lifecycle, specifically: Requirements Analysis Document RAD , Detailed System Design DSD Document, Source-to-target Mapping Documents outlining data elements from legacy system to database model, Transformation Business Rule Document, Requirements Traceability Matrix, Unit Data Validation Test Plan/Results, System Test Plan/Results, User Acceptance Test Plan/Results, System Documentation, Data Dictionary

Confidential

Senior Fraud Analyst

• Served as Project Team Lead in implementing and support the OmniAlert Product.
• Performed requirements analysis for client customization of OmniAlert.
• Provided training and documentation.
• Evaluated client requirements and designs solutions.
• Ensures SURS CMS compliance.
• Coordinated OmniAlert data requirements using MMIS source files.
• Applies knowledge of Medicaid Policies t the development of Fraud Studies.
• Performs detailed unit and system testing for prior to production implementation