SUMMARY

• Seeking an opportunity to function as an EMR/ICD - 10 Program Manager providing oversight and direction in a hospital delivery system environment utilizing 13 years of experience in the management and implementation of clinical, revenue cycle/ICD-10, cancer research, and health information management applications.

PROFESSIONAL EXPERIENCE

Confidential, Charlotte, NC

Sr. Project Manager

Responsibilities:

• Manage the Epic / ICD-10 Conversion Project, which involves the conversion of Epic to full ICD-10 capability following an Epic 2010/2012 upgrade. Holistically, the project will be centered around these initiatives:
• Managed the implementation of the Clinical Term Go-live with our Wave 1 rollout of Epic to the central Charlotte Market. The purpose of the Clinical Term Go-live is to have users begin the process of interacting with ICD-10 content before the ICD-10 transition date. Clinicians have the opportunity to use the Diagnosis Calculator and interact with new terminology that is specific enough for coding and billing in ICD-10. However, the preferred code set is ICD-9, meaning that the system still shows ICD-9 codes to users and sends ICD-9 codes on claims and in interface messages.
• Managed the ICD-10 build for Acute and Ambulatory that involved updating the masterfiles that were impacted by diagnosis procedure to ICD-10 standards (Billing, Clinical, Claims, Codesets, etc.). Following moved Build into POC and TST to prepare for Application and Integrated testing, and conduct process meetings with Acute and Ambulatory teams to review/modify test scripts necessary for unit and integrated testing. The consensus was to use the application test scripts from previous go-lives (with slight workflow modifications) to satisfy functional testing of the ICD-10 Build and current integrated test scripts for integrated testing with Epic’s ancillaries.
• Collaboration with Acute Test Manager to complete the Dimensions/ICD-10 test strategy document that outlined the scope, business requirements, testing prerequisites/deliverables, pointers to unit and integrated test scripts, testing activities, test cycles/schedule, impacted interfaces and ancillaries, role/responsibilities, and life cycle and defect management processes. In addition, we collaborated on the draft of the Business Justification document that was approved by VP of IT. The purpose of this document was to provide a Work Breakdown Structure (WBS) of ICD-10 associative upcoming testing events that will be executed in parallel with the Wave 2 Clinical Go-live period. This document identifies internal resource constraints with viable solutions; level of effort involved with deliverables and tasks, and cost breakdown/budget analysis of external resource support.
• Worked with integration and ancillary teams to update the vendor readiness tracker that identifies all impacted interfaces, interface type/description, inbound/outbound feeds, and downstream systems. There were 51 Epic-related impacted ancillaries and 69 interfaces. We performed discovery to verify the distribution, receiving, processing, or storage of a diagnosis code, and communicated with systems analysts of each affected ancillary to provide ICD-10 compliancy status related to software upgrade, remediation/configuration work, risks/issues, dependencies, test environments, and implementation schedule.
• Collaborated with Ambulatory RCS and Ambulatory Billing to recode 36 identified Epic-related outpatient claims in the MUT environment. We utilized these claims for testing with CMS and used dual coded claims for testing of Acute-related claims. Epic TS identified over 1,000 dual coded Medicare Acute accounts that we will utilize for testing. We were able to pull out 100 of them and generate 44 claims for these accounts with an ICD-10 code set in the SUP environment.
• Scheduled several collaborative meetings bringing together multiple teams (Integration, Acute Testing, ICD-10 Enterprise Program, Epic/ICD-10, Invision/ICD-10, & Reporting/FTP) to understand, plan, and assess the impact of the Cloverleaf upgrade and the use of Cloverleaf for multiple testing events and environments for Wave 2 (Preferred Code Set I-9) & ICD-10 testing (Preferred Code Set I-10) concurrent paths. The decision was made to upgrade Cloverleaf and include a build to point to multiple test environments.
• Arranged demo sessions of the impacted Acute and Ambulatory applications that trigger the Diagnosis Calculator. A follow up meeting was held to discuss the strategy for the training tool for physicians and clinicians. The CMIO led analysis to review the workflows from a clinician’s perspective regarding interaction with the calculator. Finally, he indicated that he would drive the physician training process for ICD-10, which were Tip Sheets sent out via memo. With respect to Ambulatory, the eLearning tool was developed for coders, physicians, and clinicians and uploaded with the disclaimer sent out to providers and managers. Acute coders were trained based on their specialty through AHIMA CBLs. We also provided classroom training in specialty areas.
• CAC solutions for Acute and Ambulatory were not in place for the Clinical Term Go-live due to a protracted full evaluation process due issues with the Optum product. On the other hand, Acute and PB Dual Coding were implemented. Acute Dual Coding is live at main Charlotte facility and the Ambulatory dual coding was initiated with the Clinical Term go-live. The build was migrated into PROD and collaborated with security to add security points to the templates for all of RCS to ensure the ICD-10 tab can be seen.
• Scheduled meetings with Acute/Ambulatory reporting teams to capture requirements and environment prep for ICD-10 preferred code set testing of reports and extracts. We decided to use the Meaningful Use environment (MUT) as our reports testing environment (as it is refreshed with a copy of PROD and contains real patient data) and run the Stage 2 Conversion during the integrated testing period.
• Manage the implementation of two revenue cycle applications:
• The implementation of Experian’s Healthcare solution, which is an end-to-end self-pay receivables management service that will assist Novant/RCS to optimize collections of patient’s out-of-pocket expense by determining their propensity to pay. The solution focused on Segmentation which is when the provider’s self-pay receivable is segmented to determine how to best route and treat each account to maximize liquidation, once the screening is complete and the AR cleansed. The product scored (Healthcare Payment Risk Score) each account to predict the likelihood that the patient will pay their healthcare debt by combining both a guarantor’s credit report characteristics along with their past healthcare payment behavior; and Routing which equated to routing data to the client’s system for segmentation delivery.
• To implement both full versions of Emdeon’s Patient Pay Online and eCashiering solutions. Patient Pay Online (Virtual Wallet) solution is an enterprise-wide online solution that provides self-pay patients the ability to save multiple payment options to their virtual wallet (Credit/Debit Card, eCheck/Bank Account), and allows quick one time and recurring payments. Emdeon’s eCashiering (full suite) enables any authorized Novant employee - whether in the back office, the call center, or at the point of service, the ability to accept any form of payment directly from the patient.

Confidential, Worcester, MA

EMR Program Manager / Director

Responsibilities:

• Functioned as the ICD-10 Business Unit Director responsible for delivering a full range of services to clients such as project management, interim project staffing, software application optimization, healthcare reform initiatives including 5010 and ICD-10, and support analysis. Worked work with clients to define needs or problems, gather data and perform analysis to advise or recommend solutions. Responsible for ensuring that resources assigned to each project perform satisfactorily by communicating with client and providing feedback to team and will be responsible for the overall success of the program.
• Manage ICD-10 implementation program for Confidential Information Systems and Johns Hopkins Medical Center. Collaborate with Price Waterhouse Coopers (PWC) to build ICD-10 Impact Survey outlining affected applications, interfaces, and work effort estimation. Provide direction and close oversight of day-to-day operations of each individual work stream and project involving an upgrade or remediation effort. Lead Integrated Work Group that is comprised of 28 project managers, 15 application managers, 12 application analysts, and 10 business and QA analysts for specific ICD-10 impacted areas to develop, track, and report on milestones, cross-functional assignments, risks, and dependencies.
• Project Management Governance/Methodology: Utilized the PMI Project Delivery Life Cycle (PDLC) project management methodology which details the phases, activities, tasks, and deliverables for successful project delivery of the ICD-10 Remediation Program. PDLC consists of four main phases: Initiating (Involves defining the project objectives, high level requirements, and success criteria); Planning (Involves developing the project’s schedule, detailed budget determined, and all facets of the project are planned); Execution and Monitoring & Control (To assure that the quality of project delivery meets business objectives, requirements, and success criteria, rigorous application of project change management and regular monitoring of project schedule, budget and status for successful completion), and Closing (Allows for a proper end to the project, releasing the team from any future delivery requirements and providing the time to reflect on the project to determine what should be improved and avoided).
• Budget/Finance Development: Estimated 2-year project budget (2013/2014) including project team, support, and costs for key impact areas broken out by fiscal year totaling 5 million. Assisted Finance to review and update both capital and operating budgets items (e.g., IT system remediation/upgrade, physician and staff training, resource costs, and backfill staffing needs) identified throughout the transition and duration of the ICD-10 remediation period.
• Vendor/External Business (Trading) Partners Management: Due to the majority of hospital internal systems being vendor-supported applications, coordinated with vendors regarding GA release of ICD-10 compliant versions and remediation efforts to configure ICD-10 impacted applications to receive, send, and store ICD-10 diagnosis codes. Created a centralized vendor management initiative to track vendor readiness as well as to understand changes and updates to systems. As changes to each application can potentially affect interfaces, reports, and other downstream applications, a clearer understanding of vendor readiness and anticipated changes is necessary. Collaborated with Business to track readiness of Clearinghouses and Payors.
• Interface Modification Work: Collaborated with Integration Team to develop a comprehensive inventory of HL7 and batch interfaces, and flat/text files requiring modification or customization work to facilitate processing of ICD-10 data formats. In addition, identify files that are exported to external agencies/databases requiring ICD-10 related modifications.
• Analysis and Design: Led the requirements management process whereby technical design/whiteboard sessions are conducted with Application Managers/Leads and Integration Team members to capture end-to-end ICD-10 scenarios to be documented in a Technical Design Specification (TDS) for the ICD-10 Program. This deliverable will encapsulate: Scenario Summary and Scope, Release Notes, Business Rules, Pre/Post-conditions, Process Workflows, and Interfaces/FTP Traffic.
• IT Infrastructure Work: Lead the necessary associated work for upgrading Servers, Networks, Processors, Databases, IT Security, Licensing, and Desktop Services related to ICD-10 remediation.
• Testing: The objective of this initiative is to facilitate and support the testing of ICD-10 code propagation following the remediation of Hospital Delivery System’s IT systems and external business partners to achieve the ICD-10 Remediation Program’s successful adoption of ICD-10 standards and requirements per government mandate of October 1, 2014. Furthermore, to define the testing phases that will be conducted and document the processes for test cases development, test execution, defect management, risk management, risk mitigation through test completion and metrics.
• Training: Coordinate the development and delivery of ICD-10 training and education for the Delivery System. Training will be structured using a four-level model - Level 1: Basic ICD-10 Awareness training will be delivered to clinical non-provider and administrative employees; Level 2: Intermediate ICD-10 Awareness and Data Analytics training will deliver a more detailed review of the changes between ICD-9 and ICD-10 for Patient Accounting staff and Charge Posters. Level 3: ICD-10 Clinical Documentation training content will be developed and delivered by the Clinical Documentation Quality Assurance (CDQA) team in partnership with physician champions. Level 4: ICD-10 Code Selection training will be provided by AHIMA-certified ICD-10 training contractors and delivered to HIM, Home Health and Ambulance coders, CDQA auditors and the Clinical Documentation Improvement (CDI) team.
• Reporting: Remediation of Soarian Financials, Soarian Analytics (Clinicals and Pharmacy feeds), and EPSi (extracts) reporting requiring identifying those reports impacted by the move from ICD-9 to ICD-10, adjusting report fields to accommodate the larger ICD-10 code, and integrated testing with data source systems. The ICD-10 codes selected for the mapping effort will be validated against the ICD-10 codes produced by HIM’s dual coding initiative (if applicable), and the data produced by the crosswalk’s mapping logic will have to be tested for accuracy. Furthermore, the upgrade of DSS (Soarian Analytics decision support module) to its 7.01 version and conduct a WBS on the reports generated from queries out of CEP/Informatica.

Confidential

EMR Program Manager / Director

Responsibilities:

• Managed the Central New Mexico EMR Acute/Ambulatory rollout of Epic 2010 into Presbyterian Healthcare Service environment - replacing the McKesson Medipac 16.0 EMR environment. The scope of this project included: Facilities/Entities, Epic Applications, Reporting, Interfaces, Batch/Data Transfer Jobs, Third Parties, Meaningful Use, ICD-10, Data Conversions, Information Technology, Training, Change Management, Scope Changes and Assumptions and Dependencies, including the Denali upgrade and Epic SUs performed on a regularly scheduled basis during the life of the project.
• Epic Enterprise presented a fully electronic solution for the automation of patient care and revenue cycle for all identified in-scope facilities and departments. The Epic applications were designed to ensure that care delivery is seamless for patients and the clinical teams who serve them and that revenue operations are efficiently integrated with the clinical applications. The system was intuitive and support evidence-based best practices along with highly efficient, standardized, and reliable workflows. Patient care data across all PHS Delivery System was immediately available to clinicians both for viewing and clinical decision support and to Revenue Cycle departments for integrated charge capture and reporting. The system supported real time metrics along with best practice operations enabling highly effective business processes.
• Conducted analysis and design collaborative meetings with application analysts of each site to complete impact analysis related to workflows, interfaces, external systems/vendors, documentation improvement, reimbursement, productivity, forms, reports, contracts, and training.
• Prepared Interface scope document that defined Epic and Non-Epic interfaces that needed to be evaluated and/or created as part of the Epic Enterprise project. In many cases, Epic interfaces exist as a result of the Ambulatory project but needed to be edited to include Inpatient and Revenue Cycle transactions for the Enterprise project. Perform system assessments on affected applications and interfaces to include: ADT/Prelude, Cadence, Claims, EpicCare Ambulatory, HIM, EpicCare Inpatient Orders and Clinical Documentation, Resolute Hospital and Professional Billing. Interfaces included: Incoming/ Outgoing Ancillary Orders and Results, Incoming/Outgoing Clinical Lab Results, Incoming/Outgoing Financial Transactions, Incoming/Outgoing Imaging Orders and Results, Incoming/Outgoing Registration and ADT, Incoming Clinical Lab Orders, Incoming/Outgoing Pharmacy Orders to/from EpicCare, and Outgoing Dietary Orders.
• Prepare scope document to outline the facilitation and support of the remediation efforts of Presbyterian Delivery System’s (PDS) IT systems and technology including performance of all daily work, activities and tasks necessary in order to achieve the ICD-10 Adoption Program’s objectives and the successful adoption of ICD-10 standards and requirements for the Presbyterian Delivery System - IT Technology and Tools Work Stream. Provide direction and coordination for the remediation of PDS IT applications, interfaces, electronic data exchanges containing ICD-9 and DRG codes to achieve ICD-10 compliance, as well as any necessary associated work to servers, networks, databases, systems engineering, IT security and/or desktop services. Support integrated testing between PHS and external business partners, vendors and clearinghouses.
• Developed and implement project plans for Epic Enterprise deployment and successful adoption of ICD-10 standards and requirements with minimized financial impact for the Presbyterian Delivery System - HIM / Clinical documentation Work Stream which includes the following groups: HIM/ / EWC / Coding workgroup, Clinical Documentation workgroups, PMG (including Home Healthcare Physicians), Hospitals / SubAcute / Rehabilitation, Emergency Medicine, Regional Hospitals, Ambulance.
• Oversee Steering Committee approved ICD-10 IT budget for capitalized cost totaling $6 million covering hardware, software, CAC tool and services, Epic Ambulatory, contract labor, maintenance, training and certifications, and IT infrastructure items (networks, servers, databases, security, systems engineering, and desktop services).
• Drafted team charter that provides overall governance, oversight and direction necessary to support the remediation of Presbyterian Delivery System’s (PDS) IT systems and technology including performance of all daily work, activities and tasks necessary in order to achieve the ICD-10 Adoption Program’s objectives and the successful adoption of ICD-10 standards and requirements for PDS.
• Engage software vendors and application services providers in Epic Enterprise and ICD-10 readiness discussions to identify when ICD-10 compliant applications will be available and establish a mitigation/contingency plan in the event vendors are unable to deliver on time.
• Developed ROI and assess feasibility for tools that may facilitate the ICD-10 migration (e.g. Computer Assisted Coding, Code Mapping/Translation tools, Coding tool for Home Health, adopting 3M Code Finder across the organization).
• Produced Epic Enterprise and ICD-10 program implementation roadmap involving analysis and design phase to draft design specifications and test cases, build phase to modify all interfaces, testing phase to perform internal testing of critical, medium, and low-impacted applications, and integrated/external testing phase to test outbound interfaces to state and federal government agencies.
• Utilize Enterprise Project Management System (EPMS) to view, track, and report resource allocation metrics data to include percentage of time resources are dedicated to a project, resource availability from other application support teams, and productivity related to percentage of time resources spend on each task per week.
• Conduct weekly Epic Enterprise and ICD-10 IT Work Stream meetings with IT applications Team Leads, IT Application Managers, and IT Director to review presentation outlining project summary, project dashboard, project scope, project milestones/deliverables, and action items.
• Ensure weekly and monthly reporting to CIO, VP of IT and Revenue Cycle, Physicians Advisory Council, CMIO’s, ICD-10 and Epic Enterprise Directors, IT and HIM Directors, and Epic Enterprise and ICD-10 Executive Steering Committees.
• Followed PHS Finance Policies that outlined capitalizing IT project costs that are incurred during the Application Development stage to include: Coding, Developing, Writing/building (interfaces, code, system architecture, etc.), Testing, Installing (ex. New hardware needed exclusively for the given project), Training (only training to teach qualified staffs to become “Application Developers” for the given project, and only if we have chosen to not hire otherwise qualified third-party Developers), Implementing (get system to operate according to original design specs), Development of ASSET documentation for original design/build only, and “Leading” Project Management. All other stages such as Preliminary and Post Implementation stages were allocated to the operating expense budget.
• Organize integrated project team and determine role/responsibilities, project staffing and resources, and project scope.
• Utilize Agile/Scrum methodology to performed sub-group management of development tasks, iteration schedules, and test cycles related to implementation of code sets, updating core records, updating and modifying clinical builds, claims acceptance, updating health plan operations build, and modification work for all Epic Ambulatory interfaces.