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Mmis Consultant/subject Matter Expert Resume

Salem, OR

SUMMARY:

  • Experienced business and IT executive with exceptional background building and managing teams to implement systems and processes that increase revenue and improve service.
  • In - depth knowledge of healthcare organization operations including Medicaid/MMIS, including Confidential ; HIPAA; health insurance; and outsourced operations. Outstanding project management skills to implement projects on schedule and within budget.
  • Ability to use business process reengineering skills to improve manual and automated systems.
  • Excellent consultative skill to analyze complex situations and recommend management and technical solutions. Innate ability to quickly learn complex technology and operations, understand the business value, translate and explain to diverse audiences.
  • Ability to evaluate software packages, determine appropriate operational solutions, and successfully implement new / revised business processes.

PROFESSIONAL EXPERIENCE:

MMIS Consultant/Subject Matter Expert

Confidential, Salem, OR

Responsibilities:

  • As the MMIS Consultant/SME for the Confidential Medicaid Assessment Project, I developed and presented training to Confidential staff on Medicaid and Confidential 3.0.
  • I led nearly all business process sessions with State staff, authors sections in seven deliverables. I reviewed all seven deliverables to ensure compliance with Medicaid rules and Confidential .
  • I also conducted final editing to ensure consistency across the sections developed by all team members.

Confidential,

Certification Manager, Calverton, Maryland

Responsibilities:

  • I developed and presented training to Confidential staff on Medicaid and Confidential 3.0.
  • I reviewed project progress for the Financial Management Module and reviewed this module for compliance with Confidential and Medicaid.
  • Developed a plan to ensure the Financial Management Module would become Confidential compliant.

Project Manager

Confidential, Williston, VT

Responsibilities:

  • Served as both the Project Manager for the MMIS IV&V and as the Project Manager for the Pharmacy Benefits Management (PBM) program.
  • Developed the processes and tracking mechanisms for the review of documents and the interactions of system integration vendors, State reviewers, and the Quality Assurance/Independent Validation and Verification (QA/IV&V) teams.
  • This process was used for both the PBM and Care Management projects.
  • As the project manager for the PBM, I coordinated, tracked, and reported on project activities.
  • Assisted in the development of the process for developing, monitoring, and evaluating vendor Corrective Action Plans; in the development of the Vendor Manager process.
  • Served as the Project Manager for the MMIS Core project during the procurement process until the State placed this effort on hold.
  • Ensured the business analysts proceeded to document the current business processes, business rules and clarified the business requirements.
  • Served as an independent advisor to the State Procurement Review Teams for the MMIS QA/IV&V procurement and the MMIS Core/Contact Center procurement activities.

Confidential

Project Manager

Responsibilities:

  • Managing an IV&V-type assessment for Confidential in Washington State.
  • I managed the periodic IV&V and source code review activities for an electronic toll road system in Texas; this involved working with client and vendor staff in the US and Spain and ensuring adherence to standards and requirements As part of this effort, I negotiated a contract extension to cover subsequent phases of the project. Developed the UAT Plan for the Confidential.
  • Prepared and lead staff in their User Acceptance Test activities for their new Medicaid program and provided Confidential expertise for the State of Iowa MMIS development project and the Iowa Eligibility Exchange project.
  • Conducted Confidential training to SLI staff. Participating member of the Confidential 3.0 sub-workgroup. Managed the assessment of the Confidential program against the requirements of the Center for Medicare and Medicaid Services (CMS) Medicaid Information Technology Architecture ( Confidential ) ensuring all work deliverables were completed as scheduled and within budget such that the State received their federal funding.
  • Trained company staff and state staff in the Confidential State Self-Assessment.

Confidential

Project Manager

Responsibilities:

  • Reorganized the project plan so that positive revenue was realized in 2009. Developed and maintained the project plan tasks and activities to deliver all items ahead of contract schedule. Trained company staff and state staff in the Confidential State Self-Assessment. Led client meetings to obtain the current-state and the desired to-be state for the Indiana Medicaid program.

Confidential

Sr. Consultant/Project Manager

Responsibilities:

  • Managed the Confidential Technical Assessment of the MMIS to accurately determine its Confidential maturity. Conducted Confidential Business Process Self-Assessment with Confidential staff to determine the current Confidential Maturity and the desired Confidential Maturity.
  • Led the technical quality assurance reviews for independent validation and verification (IV&V) of the new MMIS for the Confidential: Concord, NH, including the design and interfaces among components.
  • Led the quality assurance reviews and documented the pricing algorithms, report specifications, and system edits against the Confidential policy and administrative rules in preparation for the development of the new Medicaid system.
  • Managed the development of a business and cost proposal for the operation of the assignment of Confidential to CMS and coordinated the proposal development among two entities, Confidential Systems and Noridian Administrative Services, which resulted in this winning proposal.

Confidential

Project Manager

Responsibilities:

  • Managed the on-time renovation and quality assurance of the State of MMIS for HIPAA 4010 compliance.
  • This project was also completed under budget.
  • Managed the off-shore conversion of all financial applications for Confidential Electronics such that it completed early and under budget.
  • Managed the development of a business and cost proposal for the Confidential (Rockville, MD) MMIS and coordinated the proposal development among four independent entities, including prime and subcontractor.

Confidential

Sr. Manager

Responsibilities:

  • Sent in under emergency situations to manage the quality assurance reviews on the health care systems for Independence Confidential Association (Chicago, IL)ensuring their compliance with the HIPAA regulations resulting in both clients signing additional work orders.
  • Managed the on-site technical team for the Year 2000 renovations for two clients; no problems were reported because of the renovations.
  • Managed the migration of Confidential ’s (Ford Auto Parts) financial applications to off-shore accounts.

Confidential

Project Manager

Responsibilities:

  • Managed the on-site technical team for the Year 2000 renovations for all Confidential
  • Reduced change order backlog from over 150 requested changes to less than 10 without impacting the on-going operations and by eliminating unproductive staff.
  • Improved client relations by instituting quarterly on-site meetings with the client. Developed the FHS MS Project training class.

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