SUMMARY

• 17 Years Experience in the Healthcare Industry
• Deputy Project Leadership
• Mayor & Executive DHS Liaison
• Certified Scrum Master
• .NET Web Based User Portals
• Proficiency in Business Analytics Methodologies / Requirements Deposition
• Project Management XLC& Oversight of Commercial and Government Contracts/Agencies
• Offshore Contracting Oversight Implementation and Deliverables
• Budget Review & Staffing Requirements
• Provider Management & Commercial Insurance
• Contract Performance Review/ IV & V/Change Management
• Understanding Government Policy & Federal Policy Mandates
• Full Lifecycle IT Release Management
• IT Help Desk Tier 1 - 3 Analysis and Resolution
• Test case development, UAT Testing, User Manuals
• Joint Application Design Session/ Functional & Technical Design (JAD)
• EDI (Electronic Data Interchange) knowledge
• Certified Scrum Master /Agile Methodology
• Extensive experience with billing/rebilling, appeals, third party billing and coding
• Curam IBM System OOB experience
• HP Quality Center
• JIRA Defect Tracking/Issues Logging
• Business Process Modeling
• Business Process Flow and Streamlining
• Call Center Management and T raining
• SharePoint& Website documentation management

PROFESSIONAL EXPERIENCE

Confidential

Project Manager

Responsibilities:

• Work with Stakeholders, Business Owners, Project Manager (PM), development and quality assurance teams, infrastructure, and operations teams, for the planning, managing, and implementation of projects in addition to adhering to timeline constraints.
• Implemented the DHS Systems Helpdesk from Conception to Realization
• Helpdesk Technical Manager Tier 2 DHS Internal Helpdesk Oversee (15) Agents
• Medicaid Release Lead Implementation of the new Eligibility System including Federal and Local Policy
• Joint Application Development Strategies. Medicaid/SNAP/TANF
• Provide cost effective contact resolutions and contract performance review
• Technical documentation preparation FDD/TDD
• Hospital/Provider Management & Onsite Provider Enrollment
• EHR Records Hospital Admission and Claims Payment
• Provider Relations and Escalation of Issues on Fee Schedules and re-enrollment criteria
• DCHL Medicaid Eligibility Requirements and Validation Rules
• Support Independent Verification and Validation ( IV& V - Accenture)
• Release Deployment and Change Management
• System Defect & Workarounds Oversight
• Provider and Recipient Marketing Analysis
• Federal and State Level Tracking Dashboard Tracking using Micro strategy
• On-site and offshore contractor development for system coding
• Utilized JIRA for tracking of test cases, defects, and release management
• Provide weekly status reports on various HHS projects
• Broad understanding of Business Processes, Business Rules in the As- Is & To Be functional design
• Assisted District Legal team in program research and federal justification

Confidential

Business Analyst

Responsibilities:

• Provide leadership and guidance to a team of 9 Business Analyst, 3 Technical Writers and 2 Subject Matter Experts
• Interview, hire and maintain reasonable staffing levels across the agencies MMIS area
• Designate appropriate teams for SCRUM sprints
• Develop project plans in an XLC Life Cycle and technical documentation
• Assign and track analytic workloads throughout teams
• Maintain project risk and issues within the project charter
• Develop strategic implementation process for aligning the agency with the project schedule
• Design look and feel of the Requirements and Business Rules Repository system
• Oversee various system implementation under the MMIS project in terms of complexity, cost, software and hardware
• Coordinate and participated in all stages of project development including research, design, programming, testing and implementation.
• Provide requirements for the SC MMIS System including verbiage for the RFP
• SC Medicaid Eligibility Structure As Is ~ To Be
• Key Liaison across all functional areas, including business units, information technology and outside vendors
• Create, refine, and enforce a structured process for the design, development, testing and deployment of all systems
• Oversee the development of the state’s BI (Business Intelligent) including system and federal reporting mandates
• Prepare technical solutions for RFI, Acquisitions Strategies and RFP for vendor
• Provide creative solutions to unique business area functions
• Provide lead oversight and analysis on the T-MSIS project for the Center of Medicaid and Medicare Services.
• Evaluate project, communication plans and technical documentation for quality assurance and technical relevance.
• Develop training documentation and guidelines for the states to adhere to during design and implementation phases.
• Traveled to various state sites to monitor the progress of the system implementations and upgrades.
• Reported and tracked the states progress, project dates, conversion plans and implementations for CMS.
• Participate in the on boarding process of 40 states to assist with the integration efforts.
• Develop project plans to assist with technical interface requirements, migration and test plans.
• Identify, refine and augment acceleration strategies for the State Medicaid CHIP agencies.
• Collaborate and identify best practices, lessons learned from the states and disseminate the information to the states.
• Maintained the project SharePoint site and the contractor to state website information which included the Frequently Asked Questions (FAQ) list.
• Created and maintained the Project Toolkit which provided project guidance, inventory of resources, case studies and reports

Confidential

Lead Senior Business Analyst

Responsibilities:

• Lead the Business Analytics for the development of the business rules and functional requirements for Maryland Medicaid System.
• Validate and provide system software solutions to various areas of Maryland Medicaid such as claims, TPL, Pharmacy, Provider, POS and Recipient areas.
• Visualize the overall concept for the recipient and provider as it related to the MMIS and the eCAMS system
• Facilitate MITA requirement and Business Process Sessions
• Construct and document business rules and Use Cases for the design, UAT and implementation phase
• Preliminary test interfaces, data exchanges, regression testing, stress testing and end to end results
• Provide leadership to mid and junior analyst by delegation of assignments and overseeing work teams
• Track and maintain implementation dates and mid checkpoint sprints
• Report and track team stats and project completions and accomplishment
• Oversight of Independent Verification & Validation (IV&V - Deloitte)

Confidential

Senior Project Manager

Responsibilities:

• Utilized Project Management skills to run EDI/HIPAA implementation project and Call Center
• Produced Business Requirements and Requirements Traceability Matrix
• Serve as a liaison between the business and I/T organizations in the development of new I/T solutions and enhancements to existing applications.
• Establish Use Cases and User Manuals
• EHR as relates to Nurses and Case Management notes.
• Suggest areas for improvement in internal processes along with possible solutions.
• Interface with appropriate technical personnel for hands on problem solving and support
• Trading Partner Management
• Assisted with claim production from 4010 to 5010
• Medicaid and Commercial Provider Enrollment based on 5010 modification and companion guides
• Updates to Provider Enrollment Interface and PQRS Requirements for participating providers
• Produced Business Process Models and Scope Statement
• Wrote SOW (statements of work) for new projects
• Facilitated the discussion and planning of Project Life Cycles
• Maintained 49 States Companion Guides
• Tracked and maintained EDI issues/ Supervised Tier 1- 3 Helpdesk Assistance
• Conversion of ICD 9 to ICD 10 Implementation

Data Analyst

Confidential

Responsibilities:

• Produced Business Requirements and Requirements Traceability Matrix
• Understanding of The Physician Quality Reporting Systems (PQRS) Provider Enrollment
• Established Requirements surrounding the (EHR) Electronic Health Records incentive payments and measures
• Processing of (RCR) Requirements Change Request through the Change Management Process.
• Utilized the Change Management for Data Enterprise Architecture to update the system environment.
• Integrate evolving requirements into the production support environment, working with development staff to understand implications and impact of proposed and upcoming system changes
• Interface with appropriate technical personnel for hands on problem solving and support
• Utilized Quality Center for reporting incidents in the database, maintain an accountability and assign ownership
• Serve as a liaison between the business and I/T organizations in the development of new I/T solutions and enhancements to existing applications.
• Facilitate meetings and discussion as needed during the project lifecycle.
• Created/update documents required as part of the system development lifecycle (SOW, business & functional requirements, detail functional design, technical design input.
• Utilized Excel to document requirements and the traceability matrix
• Establish Use Cases and User Manuals
• Research and Analyze system development and provide Gap Analysis
• Medicare Fraud Waste and Abuse for the HEAT project with Department of Justice (DOJ)
• Verifying and Clearing Provider Management and Program Enrollment system flags
• Data Mining using Business Intelligence tools such as Cognos and SAS, Lexus Nexus
• Prepared Power Point presentations reports based on the data collected and presented it to DOJ and CMS

Confidential

Project Manager

Responsibilities:

• Implementation of Healthcare Federal Mandates including ICD9 to 10 and 4010 to 5010 conversions.
• Conducted Town Hall Meetings for Providers
• Assisted with verbiage for CMS Final Rule regarding EHR Incentive Program
• Provided direction to providers for advancing HHS efforts of Electronic Health Records (EHR)
• Worked with CMS Medicaid in the advance planning and development of upcoming structural changes
• Project Management Dashboards
• Setting guidelines for the new HIM regulations
• Processing of (RCR) Requirements Change Request through the Change Management Process.
• Designed Dashboards, Flight Tracking, Project Plans and Implementation schedules
• Work on the 5010 HIPAA implementation of Version 5010, D.0, and 3.0
• Maintain project budget spreadsheets, and correspond with various contractors across the regions
• Development of White Papers and testing criteria
• Submit written requirements including budget needs for various contract proposals within CMS
• Business Requirements, Budget Reports, and Budget Tracking
• Assist and actively strategizing with workgroups on overall product/project development
• Worked on the implementation of new J Codes for the new billing system
• Record and maintain the Issues Log for the 5010 Project

Confidential

Project Manager

Responsibilities:

• Provider Outreach for current changes in the Medicaid Business requirements and software
• Guided providers through the NPI implementation and new DC Medicaid processes
• Analyze and provide best business practices for claims adjudication and processes
• Facilitate provider training in EDI through provider enrollment and software packages
• Worked closely with providers and staff through enrollment and EDI issues
• Process Change Management (CM) requirement processes.
• Responsible for overseeing escalating issues from Provider Relations Department
• Provided pharmacy management for the set up of the Medicaid Pharmacy Call Center
• Report all finding to the District Government through various reports.
• Troubleshoot provider payment, retractions, adjustments and voids
• Oversee Call Center Inquires & Help Desk Tickets
• Supervised and lead two separate departments Data Entry and Document Control in daily operations.
• Mandated the Business Requirements for the Batch Control Specialist
• Worked all claim rejection reports based on the Incorrect ICD code classification and billing structure.
• Performed daily Quality Assurance on each staff member
• Ensured that the department upheld time constraints set by MMA for the Medicaid project
• Facilitated training workshops based on team strengths and weakness
• Developed various forms and protocols that are designed for maintaining daily operations
• Created proposals for revamping of Claims Department
• Worked on the MMIS system in conjunction with the claims adjudication for optimal payment reimbursement