Sr. Project Manager Resume Rancho Cordova, CA - Hire IT People

PROFESSIONAL SUMMARY:

Collaborative contract Project Manager that emphasizes on - time project deliverables within the project allocated budget.
A dedicated team player that is skilled at mediation and conflict resolution.
25+ years of experience in Information Technology, including advanced working knowledge of the Software Development Life Cycle (SDLC).
Clear understanding of Portfolio, Program and Project level management using Project Management Office (PMO) and Project Body of Knowledge (PMBOK) principals.
9+ years of experience directing projects valued from $609 thousand to $208 million.
Works extremely well with people at all levels of the organization; including customers, stakeholders, vendors and onshore/offshore project resources.
Multiple company award winner for exceeding business goals and customer expectations.

SKILL:

WORK HISTORY:

Sr. Project Manager

Confidential, Rancho Cordova, CA

Responsibilities:

Created and managed Program Management schedule of 8 sub-projects:
Completed 2 burn-down phases of corrective action claims, generating $50+ million in revenue.
Completed corrective clean-up of Provider data.
Completed financial reconciliation between VA, Clearinghouses (banks), Providers and Confidential .
Generated CAP scheduling for Claims Invoicing, Voids, Program Finance (835 Bank Reconciliation), Finance Accounting (Solicited/Unsolicited Refund Checks), Bad Address Log, Claims Adjudication (Duplicate Claims Logic), EDI Inventory Management.
Completed non-documented work flow processes for above.
Completed review, update and sign-off of 29 business internal controls with business owners.
Scheduled and tracking within VA compliance timeline.
New Fees scheduled.
Responsible for weekly Executive Program Management Dashboard updates and presentation.

Sr. Project Manager (contractor)

Confidential, Rancho Cordova, CA

Responsibilities:

Overlapping SDLC phased quarterly releases, with multiple System Enhancement Requests (SERS), Change Requests (CRs), and Workflow paths.
Bi-weekly Executive presentations: Steering Committee, Provider Relations and Enterprise Operations.
Statistical analysis and presentations for actual/projected cost savings, claim volume and workflow queues staffing levels.
Adjusted claim volume releases based upon statistical analysis, to ensure exceeding the $10.1 million annualized cost savings goal.

Sr. Project Manager

Confidential, El Dorado Hills, CA

Responsibilities:

Department of Managed Health Care ( Confidential ) All Plan Letter, Insurance Nondiscrimination Act ( Confidential ) Compliance. Successfully implemented within budget and the 5/5/15 compliance date. Changes affected:
Evidences of Coverage ( Confidential ) and Riders for fully insured Confidential, CDI and Confidential Plans.
Medical Policy - Cosmetic/Reconstructive surgery definitions, omit lists of excluded surgeries and replace with medical necessity verbiage, omit artificial limitations of surgeries.
Claims Processing - Eliminate Plan General Exclusions (PGEs) auto-denials.
Clinical Review - Review all cosmetic/reconstructive claims for medical necessity.
Training - Internal/External Medical Directors, Doctors and Nurses of the changes.
Operations - Benefit narratives and collateral documentation changes.
California Department of Insurance (CDI) Emergency Regulations on Network Adequacy. Successfully implemented within budget and the 6/1/15 compliance date.
Total of 14 CDI Network Adequacy compliance reports filed electronically within California’s System for Electronic Rate and Form Filing (SERFF).
Confidential Member Touchpoint Measures (MTM) internal audit for claims. Successfully gathered all statistics (stratums) for newly “branded” core health benefits as defined by the Federal Affordable Care Act within the allotted timeframe and budget.

Sr. Project Manager

Confidential, Olympia, WA

Responsibilities:

Completed Requirements, Design, and Development phases, generating $3.4 million in net revenue within 7 months for this deliverable-based project; meeting all 15 deliverables time frames, with no incurred contractual penalties.
Directed and managed a diverse cross-functional team of 68 resources, across 3 time zones, including an onshore/offshore model.
Responsible for project scope, schedule, cost control, quality, personnel, deliverables and client relationships.
Use of Earned Value Management (EVM) for collecting and reporting on measures of progress (metrics), including monthly reporting to the State of Washington Governor liaison and monthly reporting of revenue projections to Confidential executive management.
Prepared and distributed accurate project status reports, deliverables and artifacts, according to State-specific format(s) and frequencies, adhering to contractual obligations.
Managed Change Requests (CRs) and contractual amendments.

Project Manager

Confidential, Sacramento, CA

Responsibilities:

Managed 27 resources (onsite/offsite), across 3 concurrent projects, with joint vendor Hewlett Packard for the State of Nevada Department of Health and Human Services (DHHS). Responsible for all 3 projects scope, schedule, cost control, quality, deliverables and client relationships.
Decision Support System (DSS)
Medicaid Data Warehouse Project (DW)
Java Surveillance and Utilization Review System (J-SURS)

Project Manager/Technical Lead

Confidential, Sacramento, CA

Responsibilities:

Project successfully implemented within the 11/2011 time frame.
Responsible for the schedule, tasks, resources and QA.
First point of contact for team members and ACS business partners.
Trained team members in the use of Confidential MQ FTF and RJE/NJE file transfers.
Author of the Production Support Unit ( Confidential ) Implementation Plan