Sr. Business- Technical Implementation ICD 10 Compliance /Meaningful Use Program Manager/ HIM/Revenue Cycle Manager

Confidential

• Established timelines for program/product development and monitored each critical point to ensure timely completion, Worked with solution leadership and customers in the development of requirements for new solutions and product enhancements for ICD 10 Remediation Program. Responsible for the overall planning, execution, and delivery of all components of multiple clients ICD-10 programs moderate-complexity readiness project, with minimal supervision and direction
• Responsible for managing the Stage 1 and 2 Meaningful Use Project
• Managed the risk analysis and planning of the ICD-10 conversion effort as it pertained to specific business areas within hospital systems, particularly Revenue Cycle/Patient Financial Services
• Managed upgrade of 3M Encoder Pro
• Reviewed ICD-10 policy development - supported and coordinated the identification of current ICD-9 policy issues - matched requirements to existing technology capabilities
• Provided strategic leadership for ICD-10 Revenue Cycle initiatives within non-profit, 2 Billion health system with1200 operating beds across of 5 acute care hospitals and 2 behavioral health facilities, 700 physicians, over 50 non-acute entities
• Managed Epic ICD-10 program clinical and financial technology upgrades, management of training across clinical and revenue cycle departments and payer alliance testing
• Led Revenue Cyle PB,HB,HC and PC Claims,ADT/Prelude/Cadence/HIM project teams through Build, Test, and Training task deploying Epic Resolute and Community Connect for several physician practices and 900 hospital beds to ensure successful go-live
• Responsible for managing and /supporting the other sections within the HIM Dept which would include: HIM Team Lead, Discharge Analyst Technician, Clinical Documentation Improvement Coders, the Inpatient, Outpatient, and Ancillary Coding Team, Physician Incomplete Specialist, Release of Information Technician and the Health Information Technicians.
• Provided oversight to HIM team responsible for campaigns, Coder Productivity Mitigation, Dual-processing ICD-9 and ICD-10 parallel environments , Mapping Translation, Change Management, etc.
• Prepared and/or assisted in preparing functional and detailed specifications for applications development take a strong lead in the direction of work groups to achieve such. Worked with senior level stakeholders and IT managers to develop solution planning and strategic project initiatives.Led GLRA and Optimization Cutover Initiatives
• Responsibilities included, but not limited to: managing functional systems design, mapping, requirements gathering, acceptance testing, operations maintenance, end-user training and configuration of software for a systems remediation for 45 ICD10 million compliance project
• Planned, directed and coordinated the staff and activities of ICD-10 projects, ensuring project milestones and budgetary constraints are maintained.Collaborated with Senior Project Managers to define time-frames, funding, procedures, deliverables and staffing levels.
• Worked with IS, vendors and customers to develop project proposal outlining deliverables, requirements, risks, assumptions, key stakeholders, roles and responsibilities, and budget.
• Worked with senior management build and managed the program management function to support projects. Assisted in defining and developing departmental wide program management practices, governance standards, processes and metrics. Reviewed high level deliverables across projects, and reports to senior management on projects' status.
• Implemented engagement review and quality assurance procedures in accordance with established methodology to ensure successful project execution. Developed testing standards and post implementation support models.Managed scope and mitigates risk across all projects.
• Identified and resolved critical issues. Assisted in the evaluation and re-design of project plans and objectives as necessary.Selected, developed, managed and evaluated direct reports oversees the selection, development, management and evaluation of indirect report

Epic Revenue Cycle Senior Project/Program Implementation Manager

Confidential

• Responsible for tracking and managing timelines and deliverables of implementation related to Revenue Cycle department project PB,HB,ADT,HCs defined, documented and consolidated the requirements from multiple work groups, delivering high quality analysis deliverables, such as work flow diagrams, policies and procedures, project timeline documents and status reports
• Led GLRA and Optimization Cutover Planning Initiatives
• Responsible for managing projects from original concept through final implementation. Interfaced with all project-affected areas including customers, client services and various departments for Express Scripts PBM Implementation. Managed revenue cycle workflow sessions
• Defined project scope and objectives. Oversee/coordinate all project aspects and serve as project manager between clients, line management and internal and external resources. Planned and directed project budgets and schedules. Monitored the product/program/project from initiation through delivery, interfacing with customer on all matters. Assessed project issues and developed resolutions to meet productivity, quality and client-satisfaction goals. Developed detailed work plans, schedules, project estimates, resource plans, budgets and status reports.
• Conducted project meetings. Managed the integration of vendor tasks and tracked and reviewed vendor deliverables.
• Led project teams through Build, Test, and Training task deploying Epic Resolute and Community Connect for several physician practices to ensure full end-user buy-in.
• Prepared and/or assisted in preparing functional and detailed specifications for applications development take a strong lead in the direction of work groups to achieve such. Worked with senior level stakeholders and IT managers to develop solution planning and strategic project initiatives .Led GLRA and Optimization Initiatives
• Provided support to team members for day to day problem solving responsible for deep understanding of all program processes to aid in the support and troubleshooting of the implementation and ongoing operations of the project .Maintained and updated data, site and project status in multiple databases for tracking and reporting
• Published a weekly reporting packet, managed the Change Request process to ensure faster, more consistent cycle times, managed the impact of change into project planning and reporting ,managed the reporting of status against corrective action plans, managed the process to re-baseline project plans, managed quality management plans to ensure that proper sign-offs are being obtained, ensured proper collection and storing of Program documents, conducted ad-hoc Program/Project analysis ,prepared materials for executive presentations.Facilitaed Go Live Readiness assesments and provided Go-Live Support

Senior Implementation Project Manager

Confidential

Project Scope: Identify all requirements to establish a Vendor/Procurement/Medical Management department for a start-up healthcare company.

• Responsible for working with the internal team strategy, creative, implementation, new business and finance to ensure that work is delivered on strategy, on time and on budget for a 50 million project
• Provided overall oversight for Medical Management Program
• Implemented and managed small projects or elements of larger projects such as Trizetto Care Advance 4.41,MedAI,Mckesson Interqual ,Milliman Products
• Worked with Senior PM's to author and manage scope of work , meeting reports and distribute to team project timeline
• Project Managed the Implementation of TriZetto's CAE product for Healthcare systems. Hands-on SME for all medical management applications in CareAdvance 4.41 for hands -on configuration, developing clinical edits, Types of Service, Service ID's, clinical data conversion, served as Team Lead for medical management team.
• Project Managed the Pharmacy Implementation of Mckesson RxPak, Trial Script, and Trial Script XT.
• Establish timelines for program/product development and monitored each critical point to ensure timely completion, Working with solution leadership and customers in the development of requirements for new solutions and product enhancements for all Medical Management System Implementations
• Provided executive management with periodic status reports of program development and costs, and g maintained a close relationship with contract clients.
• Provided oversight on the development of design concepts and test criteria. In conjunction with Purchasing, review/approve all vendors of critical materials for costs and delivery performance.
• Directed the administration of contracts and closely interfaced with contracted clients
• Manage and direct all phases of each approved program from inception to completion

Senior Implementation Revenue Cycle Project Manager

Project Scope: Worked with healthcare clients United Healthcare, BCBS and Kaiser on initiavies such as HIPAA 4010, 5010 and ICD 10 and,Epic projects.

• Led internal small to midsize projects to ensure that they met all scope, time, budget and quality expectations, through planning, controlling and managing.
• Coordinated with other business areas including but not limited to: communications, clinical, membership, product development and set up, operations, legal and quality improvement to determine impacts, constraints, costs, resource needs, scheduling conflicts, dependencies, etc.
• Managed the integration of vendor tasks and tracks and reviewed vendor deliverables. Managed corporate and third party vendor efforts to plan, build and implement solutions to internal problems and issues.
• Provided strategic planning and oversight for EpicCare Resolute, ASAP, Stork, Inpatient Clinicals product implementations across health system impacting their operations and workflow analysis
• Led over 20 analyst in the application configuration and Design process to achieve the desired outcomes
• Performed day-to-day management, mentoring, and coaching of 20-person implementation team
• Led design team for the EpicCare Enterprise Architect initiative in creating design standards, developing/enforcing quality assurance policies, and overseeing enhancement and optimization projects
• Oversaw all integrated testing and problem issue resolution activities for escalated enterprise-level technical issues and design questions that crossed application teams
• Assisted with the development and delivery of the end-user training program to ensure a more seamless transition process during go-live

Senior Implementation Project Manager

Confidential

Project Scope: SDLC project Migration/Upgrade project for numerous Medical Management Applications

• Implementation Project Manager for implementation of Facets Medicare and Customer Service Module. Responsible for team configuring Facets software application installation rel 4.3.1. Plus served as the SME for all medical management applications both for business requirements and configuration 2005 2007
• Responsible for Beta testing of Care Management software and Business Lead for Medical Management configuration and design of Facets 4.X and Trizetto CareAdvance
• Responsibilities included, but not limited to: Functional systems design, mapping, requirements gathering, acceptance testing, operations maintenance, end-user training and configuration of software
• Establish timelines for program/product development and monitored each critical point to ensure timely completion, Working with solution leadership and customers in the development of requirements for new solutions and product enhancements for all Medical Management System Implementations
• Provided executive management with periodic status reports of program development and costs, and g maintained a close relationship with contract clients.
• Assisted with the development of HIPAA 5010 Impact Assessment methodology and Conceptual Design for insurance claims processing and eligibility systems remediation for compliance project.
• Managed the full life cycle of each project, including understanding the HIPAA mandates and communicating impacts, developing and managing a budget, as well as managing all deliverables along the projects continuum.
• Worked with clients to create a roadmap to ICD-10 and 5010 in a three 3 phased approach. Phase 1, the Readiness Workshop, educated and developed an awareness of ICD-10 and 5010.. Phase 2, the Roadmap to Assessment. Performed discovery sessions of the current processes and technology. Phase 3, Implementation, was based on the results of the Assessment and provided the support to perform the transition of all the affected components to ICD-10 and HIPAA X-12 5010.
• Working with solution leadership and customers in the development of requirements for new solutions and product enhancements for Facets
• Manage and direct all phases of each approved program from inception to completion.
• Performed detailed customer needs analysis on products participated in and coordinated the preparation of each program proposal
• Worked directly with vendor management solutions to determine readiness for 5010 and ICD-10 transition.

Confidential

Project Scope: Managed the installation and training of Milliman Clinical Care Guidelines and interactive delivery CPOE products for specified customers

• Managed the installation and training of Milliman Clinical Care Guidelines and interactive delivery CPOE products for specified customers.
• Coordinated with CareGuideQI IT Support Specialist who installed software and trained technicians
• Trained the customer trainers and end-users, as needed , working with the Milliman educator s .
• Followed Project Management Best Practices while creating required project documents, i.e. scope documents, project plans, communication plans and other required documents.
• Managed customer implementation projects from planning through Go-Live.
• Working with solution leadership and customers in the development of requirements for new solutions and product enhancements for Facets
• Familiar with establishing requirements for CMS Medicare Advantage and Medicare Advantage Prescription Drug Plan Programs
• Reviewed current workflow processes and suggest changes to increase work efficiencies, ensuring CMS compliance
• Created Configuration approach documentation for Medicare Part A,B, and D Implementations
• Worked with clients to identify requirements for national and local determinations
• Developed cost/benefit analyses, benchmarking analyses and risk assessment management plans during Business Requirements Phases
• Coordinated all aspects of project and served as project manager between clients, systems, and other departments while maintaining the highest level of customer service.
• Managed the integration of vendor tasks, and tracks and reviews vendor deliverables.
• Developed detailed work plans, schedules, project estimates, resource plans, and status reports
• Performed financial management, administration and planning tasks that related to customer engagements. Created and tracked budgets and invoices for project implementations.
• Managed and supported the Implementation Process through the execution of new business plans and new products.
• Organized workflow to create improvements and efficiencies in the Implementation process.
• Communicated project status to customer's management and Executive teams.
• Worked closely with the Manager of Strategic Accounts assigned to each customer to assure a smooth hand-off at project completion. Operational ized federal regulations as they applied to Medicare processes, practices and procedures relative to claim, call, enrollment, network and other operational areas within the Healthplus portfolio.

Project Manager

Confidential

Project Scope: Successfully managed multiple large enterprise system enhancement implementation projects from planning to post implementation to fulfill the following requirements: Claims Editing Business Logic, Extended Real Time Claim Processing, Internet Access features, Billing Requirements for Blue Cross Blue Shield Association.

Project Manager

Confidential

Project Scope: Responsible for all aspects of the development/implementation of projects and HIPAA programs involving department or cross-functional teams focused on the delivery of a product or program from the design process through a finished state for internal/external customers.

Project Manager

Confidential

Project Scope: Managed several implementations of claims processing and CPOE software including UM and web solutions in various business models i.e. TPA, CMO, PHO, etc.

• Developed effective working relationships with the clients, through on site visits and conference calls.
• Managed Horizon Clinical Implementation including implementation process, order review, project planning, resource scheduling and coordination, system implementation, system integration and system start-up and turnover.
• Managed multiple concurrent clinical projects. Expert knowledge of McKesson Horizon clinical systems applications
• Coordinate team members for site-specific regional system configuration design
• Managed all internal and external project interfaces across teams and organizational levels, including McKesson and client executive levels.
• Managed multi-facility, multi-product implementations across multiple concurrent client engagements including leading and coordinating separate project teams and other project managers that may be assigned
• Responsible for project management on implementations, conversions, upgrades, or maintenance of McKesson Horizon Surgical Manager, Meds Manager, and CPOE applications.
• Developed expertise in claim processing modules with accelerated expertise in Claims, Enrollment, System Support functions, Benefit Plans, Capitation and Letter Generation
• Developed timelines, scopes, budgets, risks, assumptions, success criteria, communication protocols, resource requirements and other tools necessary for a successful implementation
• Served on committees aimed at integration of several other products with the claims system
• Assured compliance and adherence with customer guidelines and Horizon Clinical policies and procedures.
• Established a strong professional relationship with client executive sponsors and product end-users
• Proposed system solutions to client requests, minimizing customization
• Identified application problems and developed constructive and creative solutions
• Provided onsite and offsite training for end users on product releases
• Worked with Support and Development teams on defects and new client requirements

Implementation Consultant

Confidential

Project Scope: Assisted with the development and implementation of contracting and paying strategies for internal utilization management.Trained and implemented business and office hospital business procedures with HCFA compliance guidelines

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Implementation Consultant

Confidential

Project Scope: Assisted with the development and implementation claims reimbursement methodologies.