SUMMARY

• Training and Development - Created and led business administration program for seven years, largest student enrollment of all. Developed curriculum, lessons plans, and assessments.
• Portfolio/Program Management - Organized and controlled departmental budget, contracts, and projects through close collaboration with personnel implementing project management methodologies. Continually looking for ways to improve process.
• Leadership - Successfully trained and led multiple co - located SWAT teams during ACA implementation. Teams investigated enrollments through FFM and off exchange and reconciled enrollments, premiums, and subsidies (APTC) with little to no member abrasion.
• Operations - Managed all aspects of business office to drive growth, cost containment, and profitability.
• Regulatory - Investigated, analyzed and led various healthcare related regulatory projects from Healthcare Reform to the Mega Reg.

PROFESSIONAL EXPERIENCE

Confidential

Sr Project Manager

Responsibilities:

• Committee Lead for WISE (Women Inspire to Support and Empower) Employee Resource Group (ERG)
• Received EPMO Certificate of Appreciation first quarter 2019
• Received multiple recognitions: Care Crew Volunteer work (2018), Focus on Customer (2018), Accountable/Gets Results (2019), and Makes a Difference (2019)
• Worked with multiple business areas for implementing new Managed Care Organization (MCO) Line of Business (LOB): Provider Network Management, Provider Network Operations, Care Management, Quality Management, Utilization Management and Population
• Managed implementation and created process flows for the following projects during implementation of the new MCO LOB program: Long Term Support Services and Personal Care Services (LTSS and PCS), Electronic Visit Verification (EVV), Optum Tobacco Cessation Program, Value Added Services (VAS), Data Sharing, and Provider Grievances and Appeals
• Identifies opportunities for continual improvement
• Develops interdepartmental partnerships
• Ensures relevant SDLC standards, process and regulations are upheld
• Manages forecasting and reporting on allocated budget
• Recognizes, anticipates, and resolves organizational, operational or process problems
• Assesses and effectively manages all of the risks associated with business objectives and activities

Confidential

Project Manager

Responsibilities:

• A hybrid of Waterfall and Agile was used for most of my projects
• Solve issues; identify, manage and/or mitigate risks, and exploit opportunities to maximize productivity and efficiency
• Communicate project status, update, and details to team members, stakeholders and other parties as needed for milestones, capabilities, requirements, deliverables, finances and timelines
• Set priority for and develop detailed work plans for project activities and allocate resources to activities
• Provide information and offer guidance to business to allow them to make informed decisions
• Ensure communication and messages are in alignment with the vision and goals of the project/organization
• Model values and behaviors including excellent customer service, open communication, teamwork, collaboration, trust and respect for diversity
• Set up files to ensure that all project information is appropriately documented and secured in Clarity
• Collaborate with others to set goals, resolve problems, and make decisions that enhance organizational effectiveness
• Determine and communicate any system or business improvements to consider as part of future process or as new opportunities
• Implement and manage project changes and interventions to achieve project outputs
• Communicate project evaluations, lessons learned and assessment of results project team and stakeholders

Confidential

Project Manager

Responsibilities:

• Communicate progress, issues/risks/contingency or mitigation plans, expectations, timelines, milestones and other key project metrics through weekly status updates in Clarity, dashboards and decks with all levels of management and leadership
• Track progress against timeline, scope and budget
• Lead interns on AHNJ SBC review; create instruction document and log for research/results
• Prepare and provide support for (AHNJ) Audit by CMS (Centers for Medicare/Medicaid Services)
• Develop policies and procedures where needed
• Complete forms and records to document project activities
• Work w/Finance on monthly “temporary” Payment Process - in lieu of the 820 financial CMS payment reporting
• Perform v-look ups, run Pivot Tables, and other excel formulas to investigate discrepancies and resolve fall out
• Lead enrollment research/solution team for records for Orphans for Enrollment Data Baseline (reconciliation w/CMS records)
• Lead enrollment research team/solution for reconciling billing issues for members in order to send accurate invoices
• SME on ACA regulations and guidance for ACA Implementation team
• Requirements/Regulations: identify, analyze, manage (including traceability), analysis and documentation (including communication) and verification of business compliance with requirements set by CMS in Final Rules
• Guidance: identified, analyzed, validated, and recommended viable business solutions w/options for implementation

Confidential

Project Manager

Responsibilities:

• Built 2007 Project SharePoint Site and maintained all project documentation (later transitioned 2007 to 2010)
• Created and managed projects and resources in Project Server 2010 for all projects in Program
• Planned, wrote, edited, and managed development of communication plan, timeline, and messaging for stakeholders
• Modified/Created business procedures/processes
• Documented various departments business process and workflows in Visio to identify and plan all aspects of the member experience for site build on route 202
• Communicated activities and progress on each of the cross-functional projects: Risk & Contingency, Training, Coding, Testing, Crosswalks/Mapping, Software Compatibility/Upgrades, Business Process, and Computer Assisted Coding (CAC)
• Performed business analysis, documented processes, and workflow for current state and future state for various operational areas
• Establish and maintain project performance metrics
• Created and document change control and escalation processes
• Partnered with vendors for product demos with multiple vendors, create surveys on demos and report back results and give recommendation on software purchase (from Optum Insight)

Confidential

Project Manager

Responsibilities:

• Interviewed, hired, and trained administrative staff on roles and responsibilities
• Used MS Project to track on average 30-50 concurrent clinical trial or drug development projects
• Complete Accountability for departmental and project budget: approved spend and reconcile expenses against SOWs/deliverables
• Handle Request for Proposal (RFPs); negotiate terms, create and process contracts, Statement of Work (SOWs) and Personnel Requisitions in SAP to include set up new suppliers, contractors, and employees
• Primary Records Management resource for dept, including: maintenance, tracking, policies, and procedures