SUMMARY:

• Confidential has worked in the healthcare industry over 30 years with 15 years of experience in Project/Program Management. She is skilled, from small to large, complex projects, and uses established project management methodologies, metrics, and processes to complete projects within time and budgetary constraints. Confidential has a strong background in project management with a focus on system implementations and the strategic planning and implementation of new products and processes. She is an excellent communicator, with well - developed written and presentation skills. Confidential has a demonstrated ability to develop positive relationships with project teams and all levels of leadership throughout the organization.
• Managed multi-year initiative to convert self-funded (ASO) business from a Legacy platform to Facets, overseeing a large team of project managers and business leaders.
• Managed configuration and IT teams to convert fully-funded business from a Legacy platform to Facets.
• Led a multi-location project team to implement electronic enrollment tool for large employer group, including integration of 31 interfaces and coordination with vendor.
• Led a company-wide implementation of HP Exstream as a replacement to the Facets Letter Server for management of system-generated communication.
• Led implementation of HealthMason for automated processing of high volume pended claims, resulting in a backlog reduction of over 14,000 claims and a workforce reduction of 3 FTEs.
• Worked with Business Development team to research and develop products that met regulatory guidelines and addressed market needs, and with Marketing team to develop collateral related to the release of new products.
• Successfully implemented three new products before competitors in the local market. New products resulted in rapid membership growth and membership retention.
• Participated in national industry work groups focused on Consumer Driven Health Care, representing payer concerns and issues.
• Constructed and maintained project documents including scope definition, project charter, project budget, and project plan.
• Identified business and technical resource requirements, led estimation efforts, and recruited multi-functional resources throughout the organization to serve on the project team.
• Facilitated business team members in identification and documentation of business and technical requirements and technical design.
• Developed testing strategy and led multi-faceted testing of configuration, custom development, and end-to-end administrative processes.
• Developed training strategy and worked with training team to develop workflows and procedures and to coordinate training of 400+ staff.

TECHNICAL SKILLS:

• Facets Implementations & Upgrades
• Facets HealthMason
• BenefitSolver
• HP Exstream
• Facets CDHP module; HSA; HRA; Wellness Incentives
• Trizetto Facets
• Trizetto CDHP module
• Trizetto HealthMason
• JIVA
• BenefitSolver
• HP Exstream
• Microsoft Project
• Microsoft Visio
• Microsoft Word
• Microsoft Excel
• Microsoft PowerPoint
• Microsoft Outlook
• Microsoft OneNote
• SharePoint

CORE COMPETENCIES:

• Project and Program Management
• System Implementations
• Test & Training Strategy Development
• Contract Management
• Requirements Identification
• Workflow Development
• System Development Lifecycles
• Budget and Resource Planning
• Deployment Planning & Execution

PROFESSIONAL EXPERIENCE:

Senior Project Manager

Confidential

Responsibilities:

• Led multi-location project team to implement a vendor supplied web-based enrollment application for large employer group use.
• Worked closely with client, employer group and vendor to configure eligibility rules and benefit options into the application and facilitated data integration between the application and the employer group systems.
• Coordinated development of 31 interfaces (imports/exports) with 13 carrier/vendors, and internal development of two export files to be sent to the application.
• Provided IT oversight in development of process to receive and automate processing of a daily 834 enrollment file, including rollout of upgrades to the infrastructure and supporting software.
• Accountable for test strategy for internal process testing and coordinated testing amongst application vendor and other carrier/vendors.
• Facilitated development of internal processes and developed training strategy for roll-out to over 400 agency administrators.

Senior Project Manager

Confidential

Responsibilities:

• Led implementation team to configure, test, and deploy HP Exstream as in-house replacement to Facets Letter Server for management of system-generated communication. Provided detailed requirements supporting vendor development of 24 letter headers and hundreds of letter formats and content.
• Worked closely with IT to add servers and build processes to support bringing the software in-house following development.
• Implementation included development of extension and storage of documents in OnBase. Provided guidance to QA Lead in issue management and defect resolution identified during QA testing.
• Facilitated end user training, and created deployment plan, executed by team with high quality results per the prescribed schedule.
• Led implementation of HealthMason to improve claims auto-adjudication using the health plan’s existing claims system. The automation eliminated the need for manual intervention for 3 sizable common reason for claims to pend < -- We should probably use terminology that would make sense to someone not in the industry.
• On the government side, it seems like the people who review the documents really have no clue about the inner workings and they don't understand the terminology such as "pends". It is clearer to them if we say "pended claims" or "reasons for claims to pend" -->within the system by duplicating user logic and keystrokes to re-adjudicate and release thousands of claims from a pended status to a payable status and significantly reduce the backlog of claims held in the system.
• Implementation included establishment of vendor connectivity and security, development of an extracts/interfaces, oversight of QA testing, and development of departmental procedures.
• Additionally, a workflow process was put into place for future expansion of the service to other high priority, high volume pended claims reasons and a recommendation made about using automation for non-claims process automation.

Senior Project Manager

Confidential

Responsibilities:

• Developed implementation approach for APC pricing, including coordination of provider communication and contract renegotiation.
• Facilitated collection and documentation of business requirements, and identified required resources needed to perform configuration, development, testing, training, and deployment.
• Coordinated system configuration efforts between departments, and facilitated development of test strategy.

Senior Project Manager

Confidential

Responsibilities:

• Led multi-departmental team, including other Project Managers, in the conversion of self-funded business from a Legacy platform to Facets.
• Responsible for all aspects of the conversion project, including Business and Technical Requirements, Technical Design and Development, System Configuration, Business Process Development, Testing, Training, and Deployment. Conversion was executed according to a multi-year schedule, with groups converting based on their renewal date.
• Facilitated issue resolution internally, and as needed, participated in meetings with employer groups to alleviate anxiety and coordinate efforts required of them to ensure an issue-free conversion. Managed project team resources, project schedule, and project budget throughout the course of the project, providing regular updates to Executive leadership in writing and presentations in weekly meetings.
• Led configuration and IT teams in the conversion of fully-funded business from a Legacy platform to Facets.
• Responsible for identification of business and technical requirements, and development of technical design. Managed IT team in interface, reporting, system-generated letter, and data warehouse development.
• Managed Configuration team in construction of business rules and benefit options to support claims payment and accumulator tracking.
• Participated in creation of Test Strategy and execution of testing.
• Participated in deployment planning; responsible for deployment of all IT deliverables.

Senior Project Manager/Project Manager

Confidential

Responsibilities:

• Worked closely with internal leadership and external consultants to develop strategy for large corporate initiatives, including CDHP and CRM Strategies. Managed Tactical Plan projects from planning through implementation.
• Notable projects included core application conversion and upgrades; new product implementations (HSA, HRA, Wellness programs); warehouse reporting; Pharmacy Patient Profiling; and Year 2000 Readiness.
• Developed Project Management and IS Methodology toolset and mentored IT staff on the use of Project Management tools.
• Participated in training of Project Management corporate education and participated in future planning for and implementation of Portfolio Management Office.

Provider Loading Team Leader

Confidential

Responsibilities:

• Delegated responsibility. Provided oversight of team responsibilities for maintenance of provider data, upholding 24-hour turnaround standards set by Statewide User Group.
• Role included interviewing/hiring process, coaching and staff development, disciplinary action, and performance reviews.

Business Systems Analyst

Confidential

Responsibilities:

• Liaison between the user community and the technical staff.
• Conducted system analysis process re-engineering and system training of all staff.
• Developed system test plan and developed and maintained system procedures.

Conversion Team Leader

Confidential

Responsibilities:

• Acted as the Provider Team Leader for all Michigan HMO/POS/Government Program conversions from Legacy system.
• Performed data analysis and documentation; system and process engineering; conversion mapping; software, prototype, and system testing; issue resolution; development and presentation of training programs; and leading, coaching, and performance reviews of team members.

Member Services Specialist

Confidential

Responsibilities:

• Provided telephone support and worked with medical, enrollment, and claims departments in resolving issues for membership and employer group representatives.
• Responded to written inquiries and concerns.
• Responsible for coordination of care and payment between statewide Confidential plans (“Reciprocity”) when members were hosted in the Confidential area or local members were hosted by another plan.

Preauthorization Technician

Confidential

Responsibilities:

• Responsible for collection and system entry of physician preauthorization of medical and outpatient care for members, validation of benefits, and mailing of information to physicians, facilities, and members.

Claims Specialist

Confidential

Responsibilities:

• Responsible for diagnosis and procedure coding of claims, validation and calculation of benefits, and accurate processing of claims payment.