High-performance Information Technology Professional with excellent analytical, communication, project management and interpersonal skills. Diverse technical, application and development experience derived from rapid learning and effective application of cutting-edge technologies. Team leader with fine-tuned multi-tasking capabilities, used to motivate, train and mentor people at all levels of technical expertise. Creative, very hands-on problem-solver who accurately assesses technical situational challenges and successfully transforms ideas into appropriate workable and make-sense solutions.
Manager Reporting and Analytics
Hi-Level, temporary position to fill in for outgoing Manager.Responsible for a staff of ten persons acting as analysts and technical participants in Business Intelligence gathering, analysis and presentation.Worked closely with management at director and VP levels on determinants for strategic and tactical planning/modeling and actioning implementation models and activities. Management areas were from all healthcare spaces i.e. provider, authorizations, claims, member, eligibility, etc. Also directed reporting of KPI and SLA measurements for vital customers top 2 of BCBSLA, including quality checks over data reported. Established project plan, schedule, risk and communication management plans for CMS Section 111 automation effort. My superior, senior VP acts wholeheartedly as a reference and has provided me a reference letter which can be supplied as required.
- Author and promulgate paradigm for data conversion efforts i.e. strategies of raw vis--vis derived.
- Establish and manage relationships with State and Legacy Vendor staff and Management members participating in effort.
- Determine source s of legacy data and ascertain formats, content, structures, attributes and availability of data
- Direct efforts to accurately Map Source to Target data Field/Column elements Files/Tables.
- Author Data Conversion Plan Paid deliverable to State 1.5 mill that documented policies, procedures documents and Project artifacts.
- Establish architecture for HIPAA compliance over all PHI related information being consumed by the data conversion process.
- Using MS Project, established multiple Project/Program plans to identify milestones and associated actions to accomplish them within budget and time frame allocated.
- Manage Data Conversion scope to Provider, Member, Authorizations, Claims and Reference areas MITA compliant .
- Evolve strategy for archive, older documents and images to a digital format for access to user community.
- Evolve strategy for paper document storage and retrieval.
- Manage Interfacing Inbound and Outbound to CNSI Partners Magellan, Noridian, etc. through design sessions utilizing existing vendor interfaces and those planned and specified in RFP.
- Specify ETL to populate Data Warehouse s with OLTP data.
- Evolve interfaces with CMS required reporting and data requirements inbound and outbound.
- Coordinate data conversion efforts to development efforts to assure data sets are populated for System Testing, UAT Testing and Go-Live.
Serve as Project Manager Consultant to Providers and Insurers affected by 4010/5010 and ICD-9/ICD-10 Compliance.
- Consulted with clients on remediation strategies for both 5010 ICD-10 initiatives moving them forward from their legacy positions and systems while satisfying HIPAA policy and standards
- Enabled the business communities in both Provider and Insurer sides of the claims process areas, to achieve more tangible success in claims processing and effective coding of their claims for maximum payment or qualification s
- Enabled clients to experience impact of GEMS and how it serves them in their practices and business acumen
- Consulted with clients on effective policy/procedure writing and implementations of same for their enterprise.
- Consulted with clients on Architecture concerns surrounding Database and Infrastructure elements in their compliance initiatives and actions.
- Using MS Project, established multiple Project/Program plans for clients to identify milestones and associated actions to accomplish them within budget and time frame allocated.
Serve as Project Manager Conversion Lead for activities associated with the conversion of Claims, Member, Provider, Eligibility and Accumulator history data housed in BCBSNJ QBlue systems Trizetto and others over to the NASCO platform. Supervision of Vendor IBM and NASCO Contractor personnel. Purpose of role was to stabilize conversion between waves of implementation. Each wave was defined by Groups or Plans participating in conversion at the time of the Wave cycle. 5010 compliance and ICD-10 implementation was being performed separately but with our knowledge and participation. Project involved HIPAA X12-837, 835, 834, 270/271, 276/277 and 278 transactions , NCPDP and ICD-10 methodology.
- Supervision of 5 direct, 12 indirect vendor reports IBM offshore and onshore and several NASCO participants. BCBSNJ SMEs added another 10 indirect reports to project
- Conducted due diligence over JAD sessions, Impact Analysis and Gap Analysis and resolutions and direction of/to them and approval responsibility for BRD and TRD documents
- Direction/authority over design documents including cross-walk, transformation, business rule and mapping strategies and documents
- Daily review and assessment of CSR documents Scope creep items from published requirements documents and coordination of them through wave implementation process or Change Management disciplines
- Guide and direct code base migrations/promotions though Unit Test and into SIT/UAT/Production environments
- Standard architectures used with some NASCO nuance to enable multiple platform/vendor conversions
- Authored Project Plans and Portfolios associated with each wave Planview
Executive-Level Project Manager of over 5 million dollar Encounters Project Phases 4 5. Activities managed were related to encounters Claims Paid/Denied and submitted via EDI using HIPAA Transaction, UB92, UB04 and HCFA 1500 formats and Member, Eligibility, Provider and accumulator history. Implementing PMO and Project Management disciplines within Organization. Performed Executive and Director management, coordination, assignment and oversight of budgets, contracts and tasks associated with Encounters conversion to bring transactions into 5010 compliance and ICD-10 implementation. Project heavily involved with 5010 Initiative X12-837, 835, 834, 270/271, 276/277 and 278 transactions , NCPDP and ICD-10 conversion.
- Supervision of 11 vendor Accenture offshore and onshore and 15 Wellcare direct personnel. SMEs added another 30 indirect reports to project
- Conducted due diligence over JAD sessions, Impact Analysis and Gap Analysis and resolutions and direction of/to them
- Approval responsibility for BRD and TRD documents
- Participated with Architecture groups on hardware, database models, Informatica configuration, Cognos and network structures and topologies
- Authored and managed Project Plan MS Project consisting of over 5000 tasks
- Approval authority of design documents including cross-walk, transformation, business rule and mapping strategies and documents
- Prepared Executive and Director level management documents on status and progress of project Red/Yellow/green Assessment/Rating . Performed necessary communication of this information to these management groups weekly.
- Conducted Stage Gate reviews and preparation of materials associated with completion of each step in the SDLC 10 step
- Assisted in reviews of Excelys, EDI and EDS softwares and implementations/conversions.
- Assisted PMO on Policy/Procedure documents and associates improvements
- Assisted in evaluations of Scrubber, XML, EDI and HIPAA transaction tool solicitation and approval for purchase
Executive-Level Manager over largest contract in Company History 3.5 Million . Implementing PMO and Project Management disciplines within Organization. Performed coordination, assignment and oversight of budgets, contracts and tasks associated with CMS Project State of Florida. Project heavily involved with 5010 Initiative X12-837, 835, 834, 270/271, 276/277 and 278 transactions , NCPDP and ICD-10 conversion.
- Establish PMO principles and begin implementation of Policy/Procedures for all Projects underway and to be undertaken
- Complete AS-IS to TO-BE Requirements gathering, etc. including Gap Analysis
- Complete Project Management Planning including all essential Project plans Communications, HR, QA, Procurement, Risk Mgmt, etc.
- Complete Authorship of State of Florida, MED3000 and IT Project Management Plans using Project 2007
- Evaluation of software products to be used for various phases of software and establishment of procurement budgets
- Coordination of all Project Plans with Vendors and State of Florida
- Establish and Direct Steering and Senior Project Committees
- Coordinate project activities with State and employer Senior Management to satisfy requirements and expectations
- Coordinate IT infrastructure elements with Third-Parties Trizetto/Facets/COTS and internals
Conversion/Interfaces Manager Contract Position
Performed coordination, assignment and oversight of TRA and ETL teams for development and implementation of Conversion and Interface programming of Medicaid legacy data MMIS-Maine to Unisys solution Trizetto/QNXT/COTS .
- Oversight of Conversion of major datasets Provider, Member, Eligibility, Claims and Prior Authorizations for SIT, UAT and Production environments. This included schema update guidance, GAP analysis, ETL development guidance, Test Case creation and execution, and defect resolution
- Oversight of Interface development for external partners and agencies. This included establishing transformation rules, ETL developer guides, Test Case creation and execution, and defect resolution
- Staffing and work assignments within On-shore and Off-Shore Development teams
- Led SCRUM sessions in morning for Progress Teams and late afternoon for Progress Team Leaders
- Weekly Issues/Actions reporting and updating for management reporting
- Detailed guidance to DBA and ETL developers on planning and priority of assignments
- Coordination with infrastructure teams on environment availability and expectations
- Coordination of Project Plan updates on a weekly basis for PMO status reporting
- Coordination with Configuration teams on reference tables, structure and population
- Personal contact with State, Partner Third-Party and Agency SMEs and management supplying data or expecting data from MMIS as well as conducting weekly status meetings with Project Managers or Leaders of these groups
- Coordination of Conversions and Interfaces with Implementation team and promotion of programming into SIT, UAT and Production environments
- Initiated JADs and Requirements Gathering sessions as required