PROFESSIONAL SUMMARY:

• Over 15 years of experience as a business and information technology consultant, specializing in program and project management throughout the full project life cycle, strategy, financial analysis and planning, joint planning with sales and delivery executives, application development and integration, business and requirements analysis, business process management (BPM), and electronic data interchange (EDI) implementations.
• Held officer positions at ANSI Accredited Standards Committee X12, developing traditional and XML based standards in healthcare.

PROFESSIONAL EXPERIENCE

Confidential

Program Director

Responsibilities:

• Managed a $30 million healthcare claim pre - adjudication system migration to a server-SOA-based solution for a large healthcare insurance company. The migration had multiple concurrent work and testing streams. Utilized an iterative methodology.
• Overall lead for the HIPAA 5010 and ICD-10 assessment remediation programs
• Led a new group and benefits account business process management implementation for a large healthcare insurance company.
• Instituted and monitored business controls, processes and collaboration among different areas. Interfaced with and reported to the client’s executive management on design, development, testing and financials.

Confidential

Senior Consultant/Managing Consultant/Senior Project Manager/PMO Director

Responsibilities:

• Led engagements that implemented front and back-end healthcare transaction processing consolidations, including claims, claim status, acknowledgement, eligibility, service review, enrollment, premium payment, as well as response transactions, internal and external reporting for national and regional health care insurance organizations. Responsible for financials, project staffing and client relationship management.
• Engagement Leader and Project Manager for IT strategy and gap analysis of a claim processing system for a multi-million dollar health insurance organization. Analysis included process workflow, functional and infrastructure gaps, and detailed investigation of the system capabilities. Utilized IBM’s Global Services Method, use cases, context and process flow diagrams for the process and data analysis.
• Managed the implementation of a complex benefits open enrollment system that included configuration, customization, and integration of commercial off-the-shelf software for a large national insurance organization. Utilized Rational Unified Process (RUP) throughout the full project life cycle.
• Technical Lead in the design and implementation of healthcare insurance electronic remittance advice, claims processing, and claims acknowledgement projects; implementation included build, and all testing phases.
• Used in depth knowledge of healthcare industry and standards, such as X12 and HL7, to develop functional and non-functional requirements, and to re-engineer healthcare transactions and processes. Facilitated information gathering through JAD sessions.
• Developed and conducted EDI and healthcare systems training to client and internal IBM staff.
• Used Sybase/ECGateway and ECMap for translations of various electronic transactions, such as claims and remittance.
• Responsible for global financials, business controls, contract negotiations, new business management, asset management oversight, and project management office reviews ensuring account profitability, compliance with IBM corporate directives, and compliance with audit readiness for a strategic outsourcing account that provided data center support, desk side support, network services, and telecommunications infrastructure services, to a global pharmaceutical company.
• Led several proposal teams on complex opportunities ranging from $2 million to $350 million in contract value, thereby generating significant additional service revenue. Responsible for negotiating with client and multiple subcontractors, writing and finalizing subsequent statements of work. Complex proposals included integrated state and federal tax systems, transaction processing systems, imaging solutions involving content management, federal and commercial lab information systems, state government motor vehicle systems, and operational and financial strategy engagements.

Confidential - St Louis, MO

Senior Project Manager

Responsibilities:

• Managed healthcare related projects, including HIPAA assessments and gap analyses.
• Developed interfaces and related databases, procedures, mapping and testing for healthcare electronic transactions.
• Developed documentation and training for implementation of healthcare X12 electronic transactions.

Confidential - Nashville, TN

Senior Systems Manager

Responsibilities:

• Managed acquisition related integration and Y2K projects.
• Prepared budgets to forecast and track costs related to company-wide integration projects.
• Enforced EDI healthcare standards for corporate business transactions.
• Developed, managed and documented corporate procedures for implementing an electronic remittance advice. Increased volume and revenue by 200% in less than a year.

Confidential - Nashville, TN

Healthcare Systems and Finance Manager

Responsibilities:

• Responsible for preparation, analysis, and Board of Directors presentation of multi-million dollar quarterly and annual budgets. Contributed to a 40% overall reduction of division cost of operations over a two year period.
• Developed a claim processing and analysis system, including design and code, and led its implementation. Purchased, installed, configured, maintained, and administered a client/server network to support the claim system. Oversaw tracking and projecting of financial data, training of supervisors and staff in using the data collection system. Chaired contract negotiations with vendors.
• Prepared encounter data for reporting to the State, including necessary data conversions.
• Served on the company’s Publication Board.

Confidential - Portland, TN

Financial Systems Analyst

Responsibilities:

• Designed and coded automated accounts payable, purchase order and invoice systems that tied to the G/L.
• Developed multiple other applications in a client/server database environment.

Confidential - Nashville, TN

Accountant and Financial Systems Analyst

• Prepared and analyzed budgets. Developed financial systems and generated reports using database-programming tools.

Confidential - Knoxville, TN

Systems Analyst and Programmer

• Designed and coded computerized billing and inventory system.