SUMMARY:

• Over 15 years of total experience with extensive experience as Sr. Healthcare Project Manager in Commercial, Confidential / Confidential and FEP implementation programs.
• Project Manager, large scale electronic medical record and practice management system (Inpatient, Ambulatory & Revenue) upgrade. Maintain and coordinate all project related financial management, resource and project related coordination.
• Project Manager for large EDI ANSI X12 medical billing and government compliance filing
• Responsible for direct communication with senior staff, (CEO/CIO/VP), development of earned value management reporting on a monthly basis as well as weekly project related reporting and communication.
• Responsible for complete SDLC implementation including project estimates, project documentation, project planning, project status and earned value management.
• Manage critical and milestone activities and effective problem resolution.
• Excellent communication and interpersonal skills.
• Over 15+ years of experience with data modeling, datamart development with BI tools supporting commercial, state and federal reporting. State compliance reporting for state departments of insurance, CMS reporting for Confidential reporting parts A, B, C, D and Confidential state waiver program reporting.
• Development of analytical reporting tools providing drill down reporting capabilities for claims, membership, group, provider, network and pharmacy by various types of analysis (Line of Business, Region, Age, Sex, Diagnosis Codes etc.). Thorough knowledge of business reporting requirements and IT infrastructure capabilities for detailed analysis supporting all business silos (Group, Membership, Claims, Provider, Actuarial, Medical Management and Line of Business performance.

SKILL:

Platforms: Novell, DOS, Windows, Windows NT Back - Office, Unix

Languages: C, Visual C++, Pascal, Clipper, Visual Basic.

Databases: dBase, 4th Dimension, Microsoft Access, SQL Server, Oracle 8i, Btrieve, Xtrieve, DB2, SAS, Impromptu/PowerPlay, Informatica

Reporting: COGNOS-BI, Crystal Reports, HyperionOther: Primavera Enterprise Applications (Team Play, Project Planner, Expedition), MS Project, PMBOK Methodology, MS Office, Boomi, Sharepoint, EPIC Systems (Optime/ASAP/EpicRx/ClinDoc/Radiant), MS Project Web Server, ClearQuest, Clear Case, RUP, Agile, Visio, SAS Enterprise Guide, Toad, SVN, PlanView, Facets, Diamond.

PROFESSIONAL EXPERIENCE:

Confidential, Saint Louis, MO

Business Operations Manager

• Manage the operations of 9 existing properties and renovations of 2(properties) 60k and 75k respectively purchased out of foreclosure.
• Performed management of subcontractor during renovations.
• Building material procurement.
• Building permits and city code conformance.
• Advertising for new rental openings and walkthroughs for prospective renters including background checks, both financial and criminal.
• Tax preparation for delivery to CPA for filing.

Confidential, Saint Louis, MO

Sr. Program / Project Manager

Responsibilities:

• Manage the decommission of existing pharmacy data warehouse and integrate data into the Unified Data Warehouse from existing source systems: Manage four separate migration streams and PM’s for Provider, Member, Contract & Claims silos.
• Manage on-shore & off-shore internal resources within the different domain silos. All silos implementing data virtualization for future backend reporting and analytics supporting actuarial, finance and operations. Provide program level reporting communicating budgets, timelines, issues and risks and change control for corporate management and provide input to recurring weekly meetings.
• Allocate and manage all time charging and validating projected expenditures against actual progress to date utilizing Planview and MS Project. Monitor all matrixed resources across business and IT domains to effectively staff project and level work efforts.
• Assist with identifying gaps between the existing warehouse and target warehouse and develop plans for filling those gaps to ensure the solutions conform to HIPPA PHI regulations and standards.
• Ensure all impacted downstream applications were not affected by migration and whether existing schemas, tables and fields were still in use or legacy, which could be removed from scope.

Confidential, Saint Louis MO

Sr. Project Manager

Responsibilities:

• Manage the Integration of six major internal operational source systems using Fusion and C##. External feeds were processed through the Enterprise Data Warehouse.
• Manage on-shore internal resources within the different IT silos. All silos were in the process of implementing a HADOOP backend for streamlined reporting on a near real-time data access. Angular JS was the front-end access to the data which comprised of seven operational and additional analytic systems.
• Provide C level reporting for corporate management and drove recurring weekly meetings.
• Allocate and manage all time charging and validating projected expenditures against actual progress to date
• Assist with identifying gaps between the multiple warehouses, develop plan for filling those gaps and ensuring that the solutions conformed to HIPPA standards.
• Identify all downstream affected applications and analytics teams to determine whether existing fields were still in use or legacy, which could be removed from scope.
• Developed all mock-up claim and authorization data for the prototype system.

Confidential, Saint Louis MO

Sr. Project Manager

Responsibilities:

• Manage the Decommission of two major platforms:
• Dental (3.5MM) - Combine multiple legacy data warehouses into single Enterprise Data Warehouse (Edward)
• ISG (2.5MM) - Individual Small Group; Goal was the same as Dental
• Confidential was migrating to a single data warehouse (source of truth) for the entire organization
• Manage on-shore and off-shore resources (roughly 50+ resources)
• Worked closely with other major vendors ( Confidential, Confidential ) as part of their contracts included the premium and rates silos, which crossed all projects including other organizational efforts.
• Develop project schedules and resource forecasts required to meet ICD10 October 2014 CMS deadline
• Allocate and manage all time charging and validating projected expenditures against actual progress to date
• Conduct and perform daily project status meetings and report those results to a weekly management meeting. Prepare management dashboards for high level project views of schedule, risks, issues and any change requests that might impact budget.
• Assist with identifying gaps between the multiple warehouses, develop plan for filling those gaps and ensuring that the solutions conformed to Edward standards. Work with existing source systems to identify legacy data no longer required by the organization.
• Identify all downstream affected applications and work with those teams to determine whether those fields were still in use or legacy, which could be removed from scope
• Worked with all teams (Sourcing, Development, Edward, Downstream) i.e. Analysis, Development andTesting. There were multiple transactional systems feeding both Dental and ISG with different development teams in addition to those of the source data warehouses
• Project estimates were developed using the feedback from the transactional, legacy warehouses, Edward & downstream systems
• Communicate with other projects with cross functional requirements to insure no duplicate efforts were being performed

Confidential, Saint Louis MO

Sr. Project Manager

Responsibilities:

• Manage the rationalization and migration of 6000+ client custom reports from ESI’s legacy systems to the surviving MEDCO platforms
• Daily & weekly project reviews with business, IT and program management
• Provide monthly program reviews to senior management and reporting using Earned Value Management
• Develop and update all project schedules and funding forecasts. This migration was on a 14 tier effort (monthly) grouping clients progressively from commercial plans, DoD and its largest private insurer Confidential .
• The Confidential initiative was started early due to the complexity of daily feeds to their data warehouse which comprised of a 2500 byte customized file with the first 1700 bytes consisting of enrollment/billing data with the last 800 bytes consisting of claims specific data. Weekly, ESI would send and amend billing file to adjust the daily billing portions of daily files for validation. Confidential was started early due to the high visibility and need for client end to end testing.
• Manage and communicate project schedules and budgets and work with external consulting firms for project planning and resource allocations. Both onshore and offshore resources were utilized for this effort. Identify and manage all project risks, issues and change management.
• The customized reports were rationalized from 6000+ to 3500+ reports and deliverables were either re-written or slightly modified for specific client requirements.
• Customized reports were a combination of commercial, Confidential Part D, Medicaid & DEA. Reports varied from claims summary, claims detail, diagnosis code and drug utilization by member, product, line of business & diagnosis codes.

Confidential, Baton Rouge LA

Functional Lead

Responsibilities:

• Execute all migration of existing mainframe & MS SQL environments to new Datawarehouse environments. Applications are supported by Oracle 11i, DataStage & Cognos BI
• Weekly project reviews with business, IT and program management
• Provide monthly program reviews to senior management and reporting using Earned Value Management
• Develop and update all project schedules and funding forecasts
• Manage and communicate project schedules and budgets and work with external consulting firms for project planning and resource allocations. Confidential will be the fiscal intermediary for DHH and is the prime contractor for the project working with Magellan, Noridian, Siebel and Pitney-Bowes.
• Communicate all data-warehouse project status reports at the project and program level and coordinate project goals to the Department of Health and Hospitals.
• Identify and manage all project risks, issues and change management.
• Identification and rationalization of all internal and external reports for DHH. Operational reports, state waiver programs detailed reports, type & place of service utilization reports (Home Health, Skilled Nursing Facilities, Drug Utilization, and CMS reports i.e CMS 64, CMS 21 CHIP etc.)

Confidential, Chattanooga TN

Sr. Project Manager

Responsibilities:

• Stratification and Identification of all impacted data warehouse and business and medical informatics reports, applications, third party vendors affected by the Centers for Confidential and Medicaid (CMS) October 2013 mandate for ICD10 implementation.
• Communicate all project status reports at the project and program level.
• Provide weekly project reviews with business, IT and program management
• Provide monthly program reviews to senior management
• Develop and update all project schedules an funding forecasts
• Manage and communicate project schedules and budgets and work with external consulting firms for project planning and resource allocations

Confidential

Sr. Project Manager

Responsibilities:

• Implementation of new strategic data warehouse (Member/Product/Plan/Claims - Coordinate all project resources including external(India), internal and Confidential consulting. The project budgets were 6.7 MM.
• Communicate all project status reports
• Provide weekly project reviews with management
• Provide monthly program reviews to senior management
• Develop and update all project schedules an funding forecasts
• Interact with differing business and IT silos to ensure requirements were met and deliverables were defined

Confidential

Sr. Project Manager

Responsibilities:

• Implementation of large customer reporting datamart project - Implement overall project including infrastructure upgrade, data architecture and coordination of resources with the necessary product silos. The project consisted of the addition of over fifteen critical subject fact tables and utilized SAS as the ETL engine to build out the datamart. Tables consisted anywhere from small reference tables to fact tables that had in excess of four billion rows. Existing reporting methodologies were used to facilitate the requirements analysis and gap analysis was performed in each business segment. The end state user base for the project was in excess of 250 resources.
• Enhancement to existing case & disease management reporting - The project’s primary goal was enhance existing clinical methodology to add additional disease & care management definitions and value monetization reporting for external customer renewal reporting.
• Manage relationships and communication with the business team, senior management, and a wide range of cross functional project contributors. Prepare monthly program review documentation for presentation to executive steering committees.
• Communicate project status, achievements, and issues to senior management.

Confidential

Project Manager

Responsibilities:

• Implement overall project including infrastructure upgrade, table re-partitioning, improve existing indexing, implement configuration management strategies and improve Informatica ETL processes.
• Automate processes to extract and scrub “good claims” data for training, sales & marketing purposes. Protected Health Information (PHI) was scrubbed in data marts and images incorporated into the claims. The enhancement rolled forward historical data so that dashboard reporting was current and the system was not dependent on internet connectivity issues in remote settings.
• Migration of Hyperion reporting system to new architecture and version upgrade from 8.3 to 11. Migrate and validate 700+ BQY & SQR’s and communicate to remote clients steps to validate new version. Establish training materials for 200+ users for new functionality and GUI enhancements.
• Implement additional system functionality to streamline claim representatives internal audits. Modify existing system to provide a more stable and robust environment.
• Manage relationships and communication with the business team, senior management, and a wide range of cross functional project contributors. Prepare monthly program review documentation for presentation to executive steering committees.
• Communicate project status, achievements, and issues to senior management.

Confidential

Project Manager, Software Engineering

Responsibilities:

• Manage, develop and retain staff, allocate resources in an efficient/optimal manner, and maintain a cooperative, motivated and successful team.
• Manage relationships and communication with the business team, senior management, and a wide range of cross functional project contributors.
• Communicate project status, achievements, and issues to senior management.
• Elicit and define project requirements.
• Source projects, create RFP’s & SOW’s, negotiate and manage outside vendors.
• Develop in conjunction with the business sponsor, project definition and ensure that projects are delivered on time, to budget, and to the required and defined standard of quality.
• Manage of multiple projects. Develop and manage overall project plans, incorporating costs and tasks from the various components.
• Currently managing a team of 5 Senior Developers, and 25 contract developers in St. Louis, Chennai, and Brussels working on multiple projects within the core business application systems, as well as new business and technological ventures throughout all functional business units of the organization.
• Accountable for multi-million dollar budget allocation and adherence via MasterCard Proprietary Process. (Similar to “Waterfall” Project Management Methodology).
• Responsible for Managing Core Systems Development and Application Support. Consistently achieving target system availability of 99.9999%.

Confidential

Project Management Consultant

Responsibilities:

• Maintain and coordinate all project related financial management, resource and project related coordination. Communicate with senior staff, (CIO/EVP), development of earned value management reporting on a monthly basis as well as weekly project related reporting and communication (Phase related punch-list and issues management reporting).
• Manage critical milestone activities and effective problem resolution. Management of resource utilization and align to forecast budgets and cost estimates.
• Project includes over 450 clinical resources in a specialty specific environment. Coordination between systems vendor (EPIC) & Mercy for all major schedule activities, issues lists and Sr. management reporting (EVM/Program review).
• Maintain project plan (MS Project Server, 15000+ activities & 450+resources both clinical & IT) and coordinate with other internal IT initiatives.

Confidential, Florida

Project Management Consultant

Responsibilities:

• Maintain and coordinate all project related financial, management, resource and project related coordination. Responsible for direct communication with senior staff, (CEO/CIO/VP), development of earned value management reporting on a monthly basis as well as weekly project related reporting and communication.
• This project implemented strict RUP development methodologies. This included business use cases, development use cases, system use cases, software requirement specifications, system & business test plans, maintenance plans (warranty work) and lessons learned.
• Each artifact was tracked in Clear Case and specific deliverables (milestones) tracked in the master project schedule.
• Project included over 100 resources in a matrix environment coordinating between five consulting firms. There were a total of 9 value packs that contained 21 specific capabilities that could be traced back to each business use case. Capabilities that shared common deliverables were closely coordinated between the development teams to insure that duplicate efforts were not being performed. These capabilities included predictive modeling, Care Management operational capabilities that encompassed silos such as delivery systems, enabling, operational and informatics.
• Each silo had a Six Sigma Black belt assigned as a customer information expert.
• The projects were driven by a sophisticated Enterprise Data Warehouse utilizing DB2 and AbInitio software as the ETL tool.
• Claims data was driven by multiple source administration systems.
• Diamond was used for commercial business and LRSP was utilized for Federal Employee Plan (FEP).
• Care Management utilized a custom CM application, as well as the base Provider & Network applications.
• Significant gap analysis was performed to insure business models were carried forward due to variances in business rules between the multiple systems

Confidential

Project Management Consultant

Responsibilities:

• Duties include analysis and design of complex healthcare ANSI X12 837 transaction sets. Management and resource allocation of 4 IS and 3 business project staff. Provide weekly project status and earned value reporting and schedule updates to Sr. management.
• Data was mapped and extracted via SQL Server from the company’s base Operational Data Store.
• MSC utilized SEI/CMM with specific deliverables tracked through Primavera Project Planner and rolled up into the PMO master integrated plan. Corporate reporting both SPI & CPI was reviewed monthly as project priority was re-aligned as needed.
• After requirements, alternative analysis, data specifications, coding & implementation the project was turned over to the QA department and tracked through Mercury & the system test plan and after defects were completed the projects would ultimately be promoted into the production environment.

Confidential

Project Manager

Responsibilities:

• Routinely update senior management with regards to project status, issue escalation & resolution, change requests and resource allocation. The project consisted of 6 IS and 6 business resources and required vendor management of contracts ranging from 1MM to 1.5MM respectively.
• All information was provided via customized data warehouse feeds in an Oracle/Cognos environment. The organization was matrix modeled and required working with resource managers to augment staffing. The staffing processed was managed through Planview. Project Manage CORE system replacement Ingenix implementation.
• Ingenix is a 3rd party claims bundling/unbundling system. This project required coordination between Ingenix and QCSI (New Claims System) for an API interface between the two applications using XML. The project consisted of resource management of 3 IS and 9 business individuals and vendor management of the two vendors. This project ran in parallel with P4P.
• Confidential utilizes a “Gate” methodology which was developed internally by the IT PMO organization. It consisted of starting with an RFP from the business, approval from steering committee to complete a Rough Order of Magnitude (ROM). After approval, the project would follow each gate process (specific artifacts for each phase, rqts, design, test plan etc.) and a review was performed after the completion of each phase with a decision process as to whether to proceed or table the project until further need or priority was escalated.

Confidential

Management Consultant

Responsibilities:

• Management Consultant responsible for development of current and future business model, provide cost estimates and provide contract schedules as needed.
• Development of internal process controls. This included an inventory management process for internal cost controls.
• Analyze, streamline and implement new and existing Management Information Systems.
• Provide oversight and direction of internal cost estimates and develop comparison modules for competitors bid estimates.
• Implement a new scheduling infrastructure and provide schedules for awarded contracts.
• Developed and implemented company business plan to obtain outside investment capital.

Confidential

Project Manager

Responsibilities:

• Responsibilities include the development and maintenance of project plans for large-scale HR/Payroll PeopleSoft implementation and conversion projects totaling $3M and $18M respectively. Resource allocation was implemented in a matrix organizational structure. Projects utilize SEI/CMM development lifecycle principles and are managed through earned value reporting. Other duties include:
• Developing and monitoring project controls for measurement of key project deliverables.
• Maintain positive working relationships between interdependent IS and business teams.
• Management of over 100 resources spanning 1000+ detailed activities.
• Assessment and development of mitigation plans of key deliverables and change requests.
• Tracking project metrics to identify and manage project risks and issues.
• Coordinate actual project costs and estimate at completions with finance and in corporate baseline change requests as necessary.
• In corporation of milestone activities into PMO integrated schedule managing 500MM in total organizational projects.
• The project not only include the Peoplesoft & Oracle upgrade but also business driven enhancements to the HR/PR and Employee Self Service modules within Peoplesoft tailored for customized requirements by Confidential delivery factories.
• At the time, Confidential ’s Employee Benefit Management Services (EBMS) organization was level II SEI/CMM. All required artifacts from each phase were tracked in Primavera Enterprise and each project rolled up into a master integrated schedule. All projects reported individual SPI/CPI results and integrated into the entire EBMS portfolio.

Confidential

Project Management Consultant

Responsibilities:

• Conversion Manager for Firstar/US Bank Corp 1.5 million dollar data warehouse integration project.
• Responsibilities include the coordination of various business and information technology organizations for the implementation, integration and conversion of 15 existing and 30 new Data Warehouse interface modules.
• Communicated project status to senior management, maintain positive working relationships between the Data Warehouse group and interdependent application organizations.
• Prepared and maintained project schedule using MS project with over 400 activities and 60 resources. The project manager was responsible for the management of all SQA test metrics and coordination of integrated and user acceptance testing activities. All lifecycle artifacts were previously identified through the initial warehouse implementation and all systems that retired were managed through conversion plans specific to each legacy system.
• Implementation of pilot project using Informatica as an additional tool used to quickly implement interim interfaces. Prepared capital expenditure proposal for $200K procurement of hardware, software and consulting services.
• The Data Warehouse was built on a three-tier architecture with Oracle 8i as the database management system. Actuate and Cognos are the primary end user reporting tools.

Confidential

Project Manager

Responsibilities:

• Management of health plan Data Warehouses in St. Louis, Pittsburgh and Washington DC including a staff of seven full time database and business analysts with a budget of $500,000+ per year. Warehouse platforms included MS SQL Server 7.0, Informix and Oracle 8i with approximate sizes of 90 to 700 GB.
• Responsible for monthly data feeds to third party HCFA, HIPPA and HEDIS vendors with annualized contracts surpassing 2 million dollars per year.
• Provide senior management weekly development, production and crisis management status.
• Coventry followed SEI/CMM SDLC methodology and tracked specific artifacts and deliverables in the project plan. Milestones were routinely reviewed with the project steering committee to insure scope was intact and scheduled deliverables were being met.
• Project deliverables included business use cases, development use cases, system use cases, software requirement specifications, system & business test plans, maintenance plans (warranty work) and lessons learned.

Confidential

Vice President MIS

Responsibilities:

• Responsible for the analysis, design and programming of a two tier claims administration system written in MS SQL Server and Visual c++. Implemented significant system enhancements for compliance with state and federal government and IRS requirements. Utilization of advanced project management and control systems (Primavera) to monitor project deadlines and projected financial impacts. Managed sales and implementation process of claims system (EASI-Win) to clients throughout the US.
• Implemented network architecture migration from DOS/Novell local area network to Windows NT Back-Office. Solution included providing database, claims system portal via a virtual private network using the internet as a data carrier.
• Consultant to Chapter 11 Physicians group to provide reversal back end claims analysis to determine what each of the practices would receive for unpaid claims. This required extensive data mapping from Confidential & Confidential data files into our claims system for auto-adjudication. Hard copy claims that were unprocessed were outsourced to GTESS for electronic conversion and processed in parallel with data files received from Confidential & Confidential .
• Provided Information Systems consulting services to First Physicians Management Corporation, a physician owned management services organization. Responsibilities included analysis and procurement of hardware and software systems with a budget of 1.2 million dollars. This practice management system was .ASP based and was fully compatible with EDI sets 276/277 & 835/837 and provided consulting services to the software vendor, Electronic Healthcare Systems, with mapping their data sets to the Texas Health Information Network. Provided Information Systems recommendations and proposals to the Board of Directors.

Confidential

Systems Engineer

Responsibilities:

• Programmed custom database applications for internal claims analysis of large-scale claims litigation for the construction industry.
• Licensed training instructor for the State of Hawaii and Pacific Rim in Primavera Systems project management and control software.
• Provided claims analysis and preparation for Harbert International vs. US Army Corps of Engineers Space Defense Initiative (SDI) testing facility, Meck Island.

Confidential

Systems programmer

Responsibilities:

• Developed municipal bond tracking system for the Department of Finance.