SUMMARY:

• Analytical, highly adaptable professional with extensive experience enhancing IT operations across enterprise.
• Skilled in aligning end - user needs with long-term resolutions to complex IT challenges related to health care administration.
• Track record of success developing, deploying and evaluating systems aimed at improving quality and efficiency.
• Advanced expertise in solutioning, project management, global deployments, and integrated software applications.
• Skilled troubleshooter continually focused on identifying, isolating and resolving technical issues.
• Strong knowledge and comfort within a variety of technical and business environments, along with all procedural processes.
• Accomplished communicator skilled in building and strengthening relationships across functions to drive cohesive, strategic operations.

TECHNICAL PROFICIENCY:

• Program Management
• Solution architecture
• IT Management
• Software Engineering
• Solutions Architecture
• Program Management
• Project Management
• Regulatory Compliance
• Budgeting
• IT Management
• Engagement Management
• Change Management
• Cross - Team Collaboration
• Regulatory Compliance

TECHNOLOGY PROFICIENCIES:

Microsoft Office: Microsoft 2010 Suite, Microsoft Project 2010

Databases: SQL, Oracle, Sybase, Teradata, DB2 OS/390 v6/5/4, Microsoft Access 97/2000,2003,2007,2010, MDMS, Informatica, Data stage, TIBCO, ODS, DataLake

Test Tools: Load Runner; Win Runner, QTP, Mercury Quality Center Suite

BI Delivery Tools: Cognos, Hyperion and Web Focus

PMO Software/Methods: Innotas, Clarity, Microsoft Project Server, Waterfall, Agile, Scrum, RUP, Sprint

Salesforce Summer 15: PeopleSoft 8 -- Maintenance Upgrades, Project Implementations, and Structure Content Changes

ICD-10 Software: LEAP 10

Health Care Claims/Provider Systems: NASCO, Facets (v4.6,4.7,5.0), ITS, MHS, Medco, McKesson, Blue Exchange, PEGA, NETWORKX, AE2,CDWF, Contract Gen, CDW,XML, Aerial, Allscripts, MACESS

Infrastructure /Languages: LDAP, NOVELL, Active Directory, Microsoft .Net Framework 2.0, SailPoint IAM tool C#, .NET, SQL, COBOL

Digital Landscape: Adobe Enterprise Manager, Jira, Drupal

CAREER PROGRESSION:

Confidential

Program Manager

Responsibilities:

• Performed Six Sigma Process Improvements for Medicare and Retirement products across Confidential Group and Confidential
• Analyzed, Designed and Implemented Digital Product Enhancements across Medicare and Retirement groups

Program Manager

Confidential

Responsibilities:

• Cradle to grave implementation working with Marketing to design, develop and implement Confidential Product worked throughout product lifecycle including legal to implement for go live October 2019
• Led Analysis Only phase for Re - Architecture of legal forms for Confidential Advancement Strategy for both Confidential and United HealthCare
• Designed, developed and implemented high level monthly and executive summaries regarding Analysis Only findings
• Implemented touch points across Confidential and Confidential regarding the Legal Re-Architecture Process
• Designed, developed, analysis findings for over 35 system impacts throughout Confidential and Confidential
• Created Best Practice opportunities to interact with Legal across both Confidential and Confidential

Solutions Architect / Director Systems Integration

Confidential

Responsibilities:

• Lead JAD sessions in Claims, Benefits, Authorizations, Provider, Portal, Data Lake, NVHI, EODs, HCE, HEDIS
• Participated and Interacted with Scrum Team and Train Engineer on Agile Concepts
• Assisted in the development of Features, User Stories and Release Plans for Sprint Sessions
• SharePoint Admin for Architectural Team
• Directly responsible for the oversight, hands on participation and delivery of large scale projects/programs.
• Large scale programs are defined as high cost, high complexity and/or high risk.
• Ensured utilization rate and billable revenues are attained annually.
• Facilitated development of business segment and enterprise level planning and program objective setting.
• Participated in senior level program funding and prioritization decision processes.
• Provided strategic input to the development of program roadmap and timelines.
• Participated in senior level program funding and prioritization decision processes.

Confidential, Boston, MA

Solutions Architect

Responsibilities:

• Directed the implementation of Edifecs ICD - 10 Financial Impact Analytics Tool on behalf of Blue Cross of Massachusetts using Waterfall Technology
• Primary Point of Contact for Confidential of Massachusetts EPMO and Data Warehouse, Claims, Operations and Actuarial for the implementation of the Edifecs tool for prospective review of ICD-10 Claims
• Responsible for coordination and ensuring compliance within Confidential Application Assessment Team, Solutions Architecture, Production Readiness Assessment, Security Assessment, and Technical Review of the Edifecs tool on behalf of Confidential

Confidential, Boston, MA

Solutions Architect

Responsibilities:

• Directed the daily multi - channel delivery of predictive analytics and behavior-based programming using a combination of Waterfall and Agile technology of the Confidential Engine for engagement, measurement, and reporting within the Salesforce Summer 15 platform for European and U.S. colleagues
• Primary point-of-contact for French, German, and Gulf Cooperation Council on real-world therapy options.
• Manage and mentor a team of 8 Salesforce Developers to maintain timelines, deliverables, and testing protocols.
• Ensure Interface and ISO compliance matrices with pharmaceutical clients.

Confidential, Baltimore, MD

Solutions Architect / Technical Delivery Manager

Responsibilities:

• Facilitated deployments across multiple platforms and led a team of architects, delivery managers using a combination of Waterfall and Agile technology to meet organizational protocols on delivery/release/change management. Held oversight of an $8M development and testing budget.
• Managed deployment of Consumer Direct and small to mid - size group-related activities
• Facilitated Coordinating on and Off Exchange Enrollment Operations Support and Coordinating Enrollment/Defect Resolution across FACETS, PEGA, CDWF, and AE2.
• Led the development of Consumer Direct and SHOP business requested reports.
• Responsible for organization of the daily handling of enrollment Electronic Data Interchange (EDI) files associated with Open Enrollment and the Affordable Care Act.

Senior Manager

Confidential

Responsibilities:

• Directed the delivery of required projects using a combination of Waterfall and Agile technology for the Confidential & Confidential program and 2015 Consumer Direct open enrollment season, with responsibilities ranging from planning and integration of technical and business solutions. Managed the Project Management Office and held oversight of budgets and overall governance.
• Implemented over 400 new products for Consumer Direct and SHOP and realized a $300K profit on an $8M Statement of Work (SOW).
• Planned and executed operations - wide support across enterprise and server-based VM servers.
• Recognized for implementing processes that transmitted over 115K 834 transactions, resulting in a near 100% rate, and delivered over 300K State and Federal Mandated letters to Consumer Direct enrollees.
• Identify and quantify Confidential & Confidential scope requests in accordance with regulatory/compliance protocols.

Confidential

Program Manager

Responsibilities:

• Served as Program Manager for Regional Blue Plan ICD - 10 Conversions with oversight of a +$2M budget using a combination of Waterfall and Agile technology.
• Directed vendor teams in ICD-10 conversion activities, with responsibilities including budget management, scheduling deliverables, resource planning, and integration with FACETS 5.0 team.
• Engaged with executive management on developing strategies to implement initiatives to overcome ICD-10 delays.
• Maintained compliance with a variety of states department of public assistance for ICD-10.
• Coordinated staffing across a variety of enterprise-wide solutions including Infrastructure Delivery, Finance, Claims, and Operations.
• Managed all aspects of third-party vendor services and administration of Pharmaceutical and Mental Health Provider ICD-10 Remediation.

Confidential, Philadelphia, PA

Program Manager

Responsibilities:

• Responsible for projects related to ICD - 10 implementation and conversion activities for eight states (PA, IN, SC, LA, NJ, MI, NE, FL) with estimated yearly budgets over $8M using a combination of Waterfall and Agile technology. Engaged with hosted solution vendors for Medicare Special Needs Program. Managed staffing, vendor deliverables and performance, and ICD-10 governance related to payor disease and utilization management, HIN, ICD-10 business processes, technology assessment, planning, remediation, and compliance.
• Interfaced with executives at key clients to facilitate the proposal development process and pricing strategies.
• Led the redesign and implementation of electronic funds transfer of HIPAA 5010 (835) in accordance with the Affordable Care Act.
• Administered the RBM (Radiology Benefit Manager) for the states of Confidential with an estimated savings forecasted at $12M.

Confidential, Philadelphia, PA

Senior IT Consultant/Technical Architect

Responsibilities:

• Managed the implementation and redesign of the electronic funds transfer of HIPAA 5010 (835) to comply with Affordable Care Act of 2014 stipulations.
• Executed the RBM (Radiology Benefit Manager) platform for the states of Confidential, resulting in savings of $12M using a combination of Waterfall and Agile technology.

Confidential, Baltimore, MD

Senior IT Consultant/Senior Project Manager

Responsibilities:

• Held responsibility for all facets of the PCMH Program using a combination of Waterfall and Agile technology, including, but not limited to, FACETS configuration, NASCO coordination, provider configuration, network pricer fee schedules, benefit setup/configuration, budget planning, and issues mitigation.
• Served as subject matter expert for ICD - 10 remediation on claims, provider contracts, and medical management.
• Managed program/project budget totaling over $10M per year.
• Directed a 10-member staff to ensure all initiatives met project objectives and expectations of the executive leadership team.
• Developed a comprehensive Risk Management Plan at the program level within the CMMI Framework.
• Ensured resources were properly allocated to meet project, budget, and time changes and constraints.

Confidential, Uniontown, PA

Senior IT Consultant/Director

Responsibilities:

• Established a Project Management Office using a combination of Waterfall and Agile technology and held accountability for a variety of business, operational, and IT project deliverables. Developed business/functional requirement methodologies. Ensured adherence to established standards and methodologies to increase efficiencies related to the QA process. Developed templates used for business/functional requirements, test plans/scripts, project charters/scopes, ITIL Help Desk Formats, and RTM.
• Key contributor in the Rest of World requirements gathering for the Power Vista Web Application and SCADA Xchange rewrite, and was accountable for implementing their respective software development methodologies.