SUMMARY:

• Self - motivated leading industry professional with many years of proven experience in all aspects of the project life cycle including, managing, planning, analysis, and development.
• Special expertise in many diverse advanced technological areas. Recognized for Excellent problem-solving and analytical skills, including an ability to effectively communicate with peers, customers and management. Works well both independently and as part of a team in an aggressive, deadline-driven environment.
• Experience on Multi-Million infrastructure programs/projects, SDLC, PDLC, SOX requirements, vendor management analysis, with resource allocation to enable better management of the infrastructure services portfolio and client-facing project demand.
• Experience in Budget Forecasts and manage assigned projects through implementation.
• Experienced in controlling and requesting project/program, financials, planned vs actual project schedule, and resource utilization
• Proficiency working with MS Excel calculations, charts, graphs, Word, Power Point, Microsoft Project, Visio
• Experienced in Scrum master, Agile, waterfall, and SOX requirements
• Experienced in Project Portfolio implementation starting initiation, Planning, Design, End Testing, Implementation Matrix, and communicating risk/issue with project team and resources
• Sufficient team management and resource oversight throughout the project life cycle
• Operational Analysis on process improvement, Strategic process Planning with impacted Business departments and resources
• Self-starter and work efficiently under pressure, excel as an organizer and can easily accomplish complex assignments while working independently or as part of a team

PROFESSIONAL EXPERIENCE:

Lead Project Manager

Confidential

Responsibilities:

• Monitor and oversee the planning and execution of the new mandate products, vendors and system transitions by creating detailed project plan
• Experience in project implementation planning, communication, End testing, post implementation matrix, and snow ticket.
• Creates Work Breakdown Structures and resource allocation
• Program/Project Finance Budget and Forecasting. Balance and maintain Estimate budget with Actual
• Identify Project risk, issues, action, and decision (RAID log) throughout the Project development life cycle (PDLC)
• Assist the project team to define the scope changes and gap analysis
• Work and communicate with Business and Development team on project to ensure the process is streamlined
• Adhere to project development life cycle (PDLC) and communicated work on IS Project Delivery group.
• Define and identify project risks, issues, action, and development throughout different project phases.
• Create project artifacts (Project Charter, Business Requirement BRD, and Test Plan / Metrics) based to each project phase
• Responsible for gathering and analyzing project data and requirements, defining business specifications, Compliance regulatory, and analyzing and documenting business processes.
• Researching, planning, preparing status reports, and writing project documentation.

Confidential, California

Senior Project Manager

Responsibilities:

• Monitored and oversaw enterprise migration program/projects starting initiation through execution of the new products and systems transition
• Experience in project implementation planning, communication, End testing, post implementation matrix by creating project plan.
• Identify Project resources and Represent as Business specialty liaison on formal project team
• Assist the project team to define the platform changes from another internal application
• Work and communicate with Business and Development team on project to ensure the process is streamlined
• Adhere to project development life cycle (PDLC) and work on IS Project Delivery group.
• Define and identify project risks, issues, action, and development throughout different project phases.
• Create project artifacts (Project Charter, Business Requirement BRD, and Test Plan / Metrics) based to each project phase
• Responsible for gathering and analyzing project data and requirements, defining business specifications, Compliance regulatory, and analyzing and documenting business processes.
• Researching, planning, preparing status reports, and writing project documentation.

Confidential

Manager

Responsibilities:

• Managed, Oversaw, and developed staff on the assigned Confidential RAF strategies per CMS guideline
• Educated Physicians on Medical necessity documentation, compliance, and risk adjust regulatory
• Direct report to Operational and Financial executives on operational improvement
• Created an educational strategy for the Confidential team on data collection and an effective Confidential /RAF coding methodology
• Lead strategic planning and managed projects to meet organizational initiatives.
• Oversaw daily operations including developing, training, and monitoring the productivity and performance of auditing and other assigned staff.
• Managed and resolved human resource, labor relations, employee and department safety, and risk management issues.
• Provided on-boarding and orientation for new employees.
• Managed and ensured continuous improvement of services and operations by designing and implementing systems, processes and methods to evaluate and improve effectiveness.

Confidential

Project Manager and SR. Analyst

Responsibilities:

• Plan, Organize, Direct, and Control projects throughout the Development life cycle.
• Deployed enterprise level multi-million system and business projects (Info Security, system Migration, Business process Migration)
• Experience in project implementation planning, communication, End (UAT) test, post implementation matrix, and snow ticket.
• Identified Project resource allocation and communication within project team
• Communicated with Business and Development team on project scope, risk, issues, and implementation planning
• Adhered to project development life cycle (PDLC) and work on IS Project Delivery Group Define and identify project risks, Action, and Development throughout different project phases
• Created project artifacts (Project Charter, Business Requirement BRD, and Test Plan / Metrics) based to each project phase
• Responsible for gathering and analyzing project data and requirements, defining business specifications, Compliance regulatory, and analyzing and documenting business processes
• Maintaining repository of performance metrics, and generates management reports illustrating statistical data, text and graphics.
• Knowledge of functional area policies, procedures, processes, and standards.
• Complying with guidelines and compliance on all the mandated regulations
• Experienced and adhere to PDLC, SDLC, BARR, Lead test, test cycles (SIT, UAT testing), and data dashboard creation.
• Involved in Number of compliance and non-compliance projects
• Creating the Weekly status report, project mapping/plan, Traceability Matrix, Risk/Issue logs

Confidential, California

Compliance Audit Project Management and Risk adjust Auditor

Responsibilities:

• Performed account Confidential and RAC audits and regular reviews of vendor’s collection practices to learn best practices and communicate back to hospitals.
• Designed and built Access databases for vendor claims inventories, fees charged and collections received to produce analytical reports, dashboard reporting, collection and fee projections, and comparative analysis between business lines for vendors
• Conducted risk adjust audit on Physicians and provided educational seminars on medical necessity documentation
• Met with Medicare Representative for improving the working force and task.
• Worked extensively with managed care contracts and analyzes contract terms to compare actual payments to expected reimbursement under those contracts
• Recapture of revenue, reducing purchased services costs and assisting in the development of policies and practices to make improvements along the revenue cycle.
• Confidential audit and reviewing the pertaining medical records

Confidential, California/New York

Director of Worker’s Compensation MSA/FMCP Operational

Responsibilities:

• Managed multiple departments
• Educated Auditors for Recovery Audits.
• Trained staff on new CMS regulation and Medicare Set aside allocation for Future Projection Treatment on Workers' Compensation regulations Nationwide.
• Implemented company's policy and expectation to all units.
• Quality control on all the Workers' Compensation and Medicare claims and cases to adhere with all MSA workers' compensation compliance.

Confidential, California

Manager of Worker’s Compensation

Responsibilities:

• Supervisor of 18 staff Nurses and Pharmacy Technicians.
• Created revenue cycle reports
• Created department Policy and Procedure for MSA Specialists, Drug Utilization and coding Unit.
• Arranging surgical presentation for staff education purposes.
• Drafted and updated department guidelines and reports

Confidential, California

Nurse Auditor/Medical Reviewer

Responsibilities:

• Conducted an Audit on Nursing documentation, procedures, and claims based on state compliance
• In charge of Educational process for Directors and Managers of
• Analyzed claims, Pharmacy, and general Healthcare issues
• Processed the Confidential (Ambulatory Patients Classification) rejections.