CAREER SUMMARY:

• Over 15 years of experience in the healthcare industry including Health Information Systems, Project Management & Client Implementation, Business Analysis with expert knowledge of HIPAA regulations, ANSI electronic standards and Health Information Technology, Revenue Cycle Management and Electronic Medical Records.
• Diverse background in software development life cycle in several medium to large scale healthcare IT and business solutions environments.
• A creative problem solver, self - starter and accomplished leader experienced in bridging the gap between business functional needs and implementing innovative solutions to streamline business processes to bring about e ective cost and quality health outcomes.

CORE COMPETENCIES:

• Extensive knowledge in healthcare revenue cycle practices
• Advanced skills in business requirements gathering, business & technical documentation Expert in System Development Life Cycle methodology
• Advanced knowledge of business analyst/project management methodologies Knowledge of HITECH Act and Meaningful Use
• Healthcare compliance knowledge (HIPAA, The Joint Commission, CMS, OCR, ONC, DNV, OSHA, NCQA)
• Great knowledge of healthcare clearinghouse and Claims adjudication system architecture, knowledge of HIPAA electronic transaction formats and code sets, security of healthcare information systems and privacy of personal health information
• Excellent knowledge of EDI operations & transactions and code sets
• Excellent at building customer and client relationship as it relates to physicians, software vendors, hospital executive members, project teams and all software/system stakeholders
• Exceptional technical, business and communication skills
• Exceptional knowledge of hospital operations as it relates to health information management, patient accounting and patient access business processes
• Detail oriented with excellent multi-tasking and organizational skills Creative problem-solving skills
• Extensive experience in business process improvement consulting

PROFESSIONAL EXPERIENCE:

Confidential, Tampa, FL

Product Manager

Responsibilities:

• Confidential is a leader in managing care to the home. Headquartered in Hartford, Connecticut
• Confidential connects patients with the care they need at home, through a national network of over 8,000 credentialed providers, with customer care centers located across the United States.
• Confidential provides optimal access to quality home care for more than 23 million lives by connecting providers with patients and helping them navigate the complex home care system. Confidential ’s extensive range of services provides support and coordination for patients and their families in every step of the healing process, including home health, durable medical equipment (DME), home infusion, sleep management and care management services, which ultimately improve care transitions and reduce unnecessary readmissions and emergency room visits.
• Effectively work collaboratively as a member of the revenue cycle multi-disciplinary team to implement new or enhanced business system processes as it relates to 837, 276/277, 270/271 and 835 healthcare EDI transactions in support of physician billing and accounts receivable operations.
• Matrix manage project resources including technical, business and operations stakeholders to ensure project tasks, timelines stay within overall project scope.
• Serve as contact between software vendors, health plans and end users to successfully translate business needs into functional requirements.
• Successfully build strategic relationships with internal RCM clients, assuring that they are fully leveraging all of the technical capabilities, products and services to improve cash flow.
• Identify areas of operational inefficiencies and translate process improvement strategies into system functionality.

Confidential, Franklin, TN

Product Manager

Responsibilities:

• Manage project stakeholders and project resources to ensure that all project tasks, deliverables, timelines and milestones are met.
• Conduct joint application design (JAD) sessions.
• Matrix manage project resources including technical, business and operations stakeholders to ensure project tasks, timelines and budgets stay within overall project scope.
• Work with hospital executive leadership to establish effective strategic communication plans to ensure maximum end-user and physician adoption.
• Develop comprehensive training plans to align with corporate standards and business best practices.
• Manage and facilitate complex health data conversion projects including both MPI (Master Patient Index) and image data conversions.
• Coordinate testing efforts to include: user acceptance testing (UAT), unit testing, integration testing, regression and parallel testing.
• Serve as a consulting resource to the HIM, Patient Financial Services and Registration departments in finding innovative ways to use workflow to automate and enhance operations or to resolve operational issues/barriers to performance.
• Conduct process reengineering and business requirement sessions to build workflow system to automate and streamline business processes within the Health Information Management, Patient Financial Services and Patient Registration departments.
• Work with third party software vendors to integrate system interfaces with Horizon Patient folder EMR. Provide ongoing system maintenance and support of both the applications and related business process flow. Troubleshoot and resolve system issues and coordinate resolutions where applicable.
• Establish interoperability measures as it relates to EMR (Electronic Medical Record) adoption.

Environment: SQL 2008, Microsoft Server 2008, VMWare, HL7, XML, ANSI X12N, BDI (Binary Data Interface), MS Visio, MS PowerPoint, MS Word, MS Project, MS Excel, Citrix Metaframe, Project Insight, Postscript ASCII, Citrix XenApp, Client/server and Web Applications, EDI HIPAA 5010, ICD-10, Confidential Horizon, Cerner Millennium

Confidential, Alpharetta, GA

Business Application Consultant

Responsibilities:

• Worked collaboratively as a member of the implementation team to plan, build, test and implement the Horizon Patient Folder, Horizon Business Folder & Imaging Link Engine suite of products.
• Designed and build work ow system solutions to automate and streamline business processes within the customer’s Health Information Management, Patient Financial Services and Patient Registration departments.
• Conducted and lead master table builds, interface and workflow design sessions. Provided consultative guidance on industry best practices and business process reengineering to streamline and bring efficiency to future state workflow.
• Successfully implemented single facilities and large integrated healthcare systems by meeting both customer satisfaction and internal Confidential implementation timelines.
• Establish system design and operational best practices to support future state work ow and internal consulting best practices

Confidential, Jacksonville, FL

Systems Analyst Consultant

Responsibilities:

• Coordinated the HIPAA X12N testing e orts for the Florida Medicare provider network to ensure provider compliance and readiness as it related to Florida Medicare claims submission utilizing the PC-ACE Pro32 application. Developed test scenarios and test scripts to support HIPAA Transactions and Code Set testing initiatives.
• Consulted with trading partners to provide testing guidelines, HIPAA industry standards and best practices and business requirements to ensure HIPAA compliance.
• Successfully tested over 60 Florida Medicare trading partners that have passed the testing process and have been cleared to submit electronically through the Medicare provider network.

Confidential, Tallahassee, FL

Lead Business Analyst (EDI)

Responsibilities:

• Performed gap analysis, created test plans, traceability matrices, and heavy conversion of electronic media claims data into text and various formats.
• Created Crosswalks or mapping speci cations using Interface Record Layout (IRL) that documented host system operations against Federal and State laws and mapping for Mercator bridges.
• Created and maintained software/change con guration management (SCM) tools, requirements analysis documents, design speci cation documents, business speci cation documents, HIPAA Speci cation (Companion Guides), technical specification documents and other SDLC deliverables.
• Participated in Capability Maturity Model for Software (SW-CMM) Maturity Level 2 certi cation assessment process governed by Software Engineering Institute.
• Coordinated and performed integration, regression and user acceptance testing against developed test cases and conditions for web portal, clearinghouse and Medicaid Management Information System (MMIS) environments and documented and analyzed test results.
• Acted as project point of contact for Medicaid clients, intermediaries, switch vendors, software vendors, provider community, and trading partners throughout the project lifecycle.
• Provided leadership and guidance to a team of junior Business Analyst throughout the project and software development lifecycle.

Environment: Mercator, RUMBA Mainframe, MS Visio, MMIS, WINASAP 2003, EDIFECS, Java, XML, DB2, IBM AIX, NIKU Workbench, Interactive Voice Response System (IVRS), Oracle