SUMMARY:

• Accomplished professional with more than 18 years of Information Technology experience within the Healthcare industry, specializing in support and management of Electronic Data Interchange (EDI) transactions implemented under Health Insurance Portability and Accountability Act (HIPAA), including 13 years of leadership and project management experience
• Project Manager for several implementation and projects
• Responsible for all aspects of new business development (Ownership of sales pipeline, contractual historical and project performance, solution requirements evaluation and solution definition, contract negotiations and service definition, technical product/service planning and development, and Partner/vendor governance and management)
• Educated peers and clients by organizing and presenting training classes on EDI claims processing
• Played an essential role in all phases of the software life cycle, including requirements analysis and definition, Pre and Post sales, solution architecture, solution design, implementation, integration, training, testing, and maintenance
• Experience focused on EDI processing and data mapping
• Participated as a subject matter expert for several State Medicaid HIPAA implementations
• Served on EHNAC Criteria Committee that meets periodically to review and update EHNAC accreditation criteria
• Served on the HL7 Attachments Work Group
• Provided support and project management oversight of multiple implementations that leveraged the following EDI products: EDIFECS Suite, Foresight Automator, Foresight Studio, Foresight Instream, Foresight Translation, WTX, BizTalk, Move - It Central (SFTP, DMZ), SQL Server, and Informatica

PROFESSIONAL EXPERIENCE:

Confidential

Technical Project Manager

• Support and project management oversight for Infrastructure Rationalization for acquisitions.
• Project Manager for Telecom/Networking, IT Operations/Management, DBA/Storage, DevOps/IT Enterprise Applications, IT Security, Data Center Hosting and Migration, and Disaster Recovery
• Develop Test Plans and Test Cases.
• Develop Project Plans.
• Manager Budget.

Confidential

Senior Consultant

• Serve on the HL7 Attachments Work Group.
• Develop Test Plans and Test Cases.
• Develop Project Plans.
• Develop content for RFPs.
• Support and project management oversight for TIBCO on the esMD project is various roles, including: testing of EDI validation and translation, developing custom esMD edits in EDISIM, development involving EDI Translation, Defect Tracking, and configuration updates.
• Served as EDI Subject Matter Expert (SME) for various projects and proposals.
• Drive development of demonstrations based on solution needs and go - to market presentation.
• Support and provide oversight of all phases of the design, development and implementation of an Enrollment Resolution and Reconciliation process for health insurance exchanges.
• Participate in design sessions, report on project progress and identify potential risks and issues.
• Responsible for analysis of discrepancies in the eligibility reconciliation process for multiple stakeholders and continuous process improvement of the reconciliation process.
• Provide content to and for collaboration with training staff on training stakeholders on the transactions and the reconciliation process.

Confidential, Tallahassee, FL

System Development Manager/EDI Solutions Architect/Project Manager

• Project oversight support, of Pre/Post Sales activities including ROI analyzes, design, development, and implementation of EDI solutions for State Based Marketplace under the Affordable Care Act (ACA)
• Performed assessments for health plans and hospitals for HIPAA Operating Rules readiness as well as sales of solutions based on results
• New Hampshire Medicaid T-MSIS Project Manager.
• Mapped and maintained EDI validator/translation using: Foresight Automator, Foresight Studio, Foresight Instream, Foresight Translation, Mercator 6.5-8/WebSphere in UNIX AIX and Windows environments
• Performed equipment and software design, engineering, and development for commercial and medical uses
• Performed engineering evaluation and testing of hardware or software components, products, and systems
• Participated in development and preparation of documentation for procedural, program, and user documentation
• Designed, developed, installed, implemented, and polished documents and maintain databases and database dictionaries
• Monitored standards and procedures and integrate systems through database design and administration
• Performed associated process studies, research investigations, and requirements analyses of all aspects of communications and telecommunications system, by applying statistical/analytical and modeling or engineering techniques, procedures, and criteria in specialized areas

Confidential

Consultant/EDI Analyst

• Created companion guides from the implementation guide to simplify the EDI submission process
• Worked with Medicaid Encounter Data System (MEDS) on EDI and claims analysis
• Provided consultation and expert advice to management or other groups on technical, systems-related, or process-related topics
• Identified information received by making estimates or categorizations, recognizing differences or similarities, or sensing changes in circumstances or events
• Performed equipment and software design, engineering, and development for medical uses. Engineering evaluation and testing of hardware and/or software components, products, and systems
• Trained new staff on X12 transactions, tools, and general EDI processes

Confidential, Tallahassee, FL

System Development Manager

• Managed an EDI call center, SA unit, and PA unit
• Pre/Post-Sales Support, designs, develops, and implements EDI solutions
• Mapped and maintained the EDI validator/translation using Mercator 6.5-8/WebSphere in UNIX AIX and Windows environments
• Trained new staff on X12 transactions, tools, and general EDI processes

Confidential

EDI Consultant/QA Team Lead

• Mapped and maintained the EDI validator using EDISIM for West Virginia Medicaid
• Trained site staff on X12 transactions, tools, and general testing process for WV and LA Medicaid accounts
• Performed X12N and EDI format and parallel testing through the adjudication process for West Virginia Medicaid vendors, billing agents, and clearinghouses, as well as Medicare intermediaries
• Researched and documented errors in BizTalk/aQTrans data mapping for West Virginia Medicaid
• Trainer/speaker for the West Virginia Healthcare Association

Confidential, Tallahassee, FL

EDI Business Analyst Manager/Eligibility Product Salesperson

• Technical implementation of new EDI clients
• Sales and marketing of eligibility products
• Implemented EDI process for several Health Maintenance Organization (HMO)/Managed Care Organization (MCO) organizations for the submission of encounter data
• Stayed current on EDI national formats/changes in industry