SUMMARY:
Healthcare professional with extensive leadership experience in strategic Project and People Management, specializing in the areas of Healthcare, Finance, for IT and Business areas. Possess a deep understanding of off - shore models. Comprehensive experience in claims systems, provider,, benefits, new products, multistate senior/technical leadership, EHR, and multiple clinical systems. Technical Skills Practice PMI/PMP methodology, according to PMBOK Risk Analysis/Management and Mitigation, Budgeting, and full project life cycle. Comprehensive experience with MS Project/Office. SDLC practices followed. Waterfall/AGILE SAFe/Hybrid Methodologies. Currently in process of obtaining PMP and ACP s.
PROFESSIONAL EXPERIENCE:
Confidential, Los Angeles, CA
Sr. Project Manager
Responsibilities:
- Created a WBS from the requirements documents
- Created a project schedule in MS Project
- Implemented the project with a kickoffs (Internal and external)
- Regular weekly team and Separate stokehold status
- Delivered the implementation of the transition of a OH state system
- Used All the MS office suite, including Visio.
- Coordinating Services with government initiatives
- Projects requirement scope, kickoffs, WBS, Workplans, state projects.
Confidential, Los Angeles, CA
Project Manager
Responsibilities:
- Team oversight of renewal letters ACA
- Filling in for an ill employee, managed the multidata project for the affordable Care Act Confidential mailing or renewal letters with data merge of member data.
Confidential, CA
Project Manager
Responsibilities:
- Oversight of SSI/SSDI Program
- Responsible for the day to day management of Medicaid participating in the SSI/SSDI benefit including reporting, liaison to region leads and vendor management who assisted obtain the benefit. Created an analysis of Kaiser Telemedicine for all regions.
Confidential, Santa Barbara, CA
Sr. Project Manager
Responsibilities:
- Implemented the conversion of Utilization Management System, Case Manage Management System and Credentialing System for Medical population in the Santa Barbara and St. Louis Obispo region California- Integrated Claims/Provider.
- California State Medicaid interfacing with State regulations
Confidential, CA
Sr Program Manager
Responsibilities:
- Developed a Program, with 3 projects, Charter/ Project Plans, for the PMO to improve 25 clinic processes.
- Transitioned to staff.
Confidential, Monterey Park, CA
Sr. Project Manager
Responsibilities:
- for Medicare/MediCal State and Federal Mandated projects December Delivery
- Use of Planview for Resource and timesheet management and Project Tracking
Confidential, Ontario, and Irvine, CA
Sr. Program Manager
Responsibilities:
- Delivered integrated solutions supporting Claims, Provider, EDI, Reporting and EHRs.
- Completed the evaluation and solution for improvement of complex Encounters processing, for Trizetto QNXT System, interfaces with EHR with Health Information Exchanges (HIE).
- Served as a Release Train Engineer (RTE) and developed / maintained resource and budget tracking for a $16M Provider and Patient portals initiative for 5 Agile Scrum teams
- SDLC used in the upgrade and development for ther Managed Care NAMM and Monarch.
Confidential, Monterey Park, CA
Sr. Project Manager
Responsibilities:
- Oversaw implementation/ of a Call Center Application Provider/Member support
- Completed multiple initiatives for Managed Care Medicare and Medicaid (Medi-Cal)
- Delivered Data and Applications Projects - related to Claims, Provider Contracting/ Credentialing, Member/Provider Web Portals using AGILE. Over $2M budget per project.
- Implemented corporate wide projects using SDLC.
- Project and Portfolio Management System to manage resources and project priority.
- Implemented Data and Process Initiatives including a Clinical Repository and Shared Medical Records for the Inland Empire Health Information Exchange (IEHIE).
Confidential, Indianapolis, IN
Sr. Project Manager
Responsibilities:
- Project Managed a Complex multi-disciplined initiative to upgrade, claims adjudication consolidating Vision/Dental ID Cards, EDI, Data Warehouse, and Reporting.
- Interfaced with the leadership, stakeholders and business areas as the IT PM monitoring Budget Off-Shore Development managing new development and regression testing.
- Followed ITIL practices, strict SDLC guidelines and successfully implemented a major release supporting a new enhanced administrative process to provide better service to and streamlined internal processes. Substantial use of SharePoint. MS Project 2013, Project Server and using the Waterfall Methodology.
Confidential, Long Beach, CA
Sr. Project Manager Claims and Business (Contract)
- Worked for Primarily Medicare/Medicaid business in 14 states related to encounter and fee for service claims, eligibility, Data Warehouse, Analytics and EDI with vendor management.
- Worked directly with the State plans and local state regulations
- Implemented 5010 EDI upgrade with Paper to Electronic claims processing with Emdeon. Implemented new multi-state processes, with State Plan Presidents. Trizetto - QNXT integration.
- Assumed responsibility and completed implementation of a failed major multi-state NDS reporting system experiencing state penalties effecting State reimbursement. A pilot led to implementation. Implemented with the coordination in the state of Texas.
Confidential - Woodland Hills, CA
Sr. Project Manager
Responsibilities:
- Managed Center for Medicare and Medicaid Service Critical Compliance deliverable
- Implemented EOB Part C Medicare - of the mandated EOB for the Medicare Advantage plan in California.
- Using HP PPM software, SDLC, /Print Vendor oversight $1.5 Million Budget.
Confidential, Las Vegas, NV
Sr. Project Manager
Responsibilities:
- Managed $25 Million Claims Track for the Affordable Care Act Implementation Project
- Delivered the Health Insurance Exchange for Claims, Project Manager with resources (on an off-shore), on Plainview, artifacts on SharePoint, MS Project, and other MS Office tools.
- Managed $25 Million planning and tracking in Planview.
Confidential, Minneapolis, MN
Delivery Manager Claims Systems
Responsibilities:
- Formulated IT/Business processes, led initiatives transitioning from legacy to new claims systems.
- Delivered functional tracks for system transition and operational readiness processes for a complex Confidential claims system.
- Managed incoming system requests and SDLC.
- Facilitated/completed a new common process, integrating MN BCBS and Confidential Systems
- Worked with claims system and State of MN for the plans serving there.
Confidential, Thousand Oaks CA
Project Manager
Responsibilities:
- Exchange implementation, Claims Track
- 25 Million Budget and all aspects of the claim’s requirements for multiple states
