SUMMARY

• 10+ years of experience as a result driven Project Manager professional.
• Proven accomplishments and superior skills in project management (Healthcare, Life, Health and Retirement Insurance, Pharmaceuticals, Data Mining, Payment Integrity, Telecommunications, Federal and State Government and Information Technology) contract negotiations, quality improvement, learning and development, vendor management/ relationship building, resource planning / management, budgeting and financial analysis in Healthcare and Technology Industries.
• Consistently recognized for problem solving abilities, oral and written communications.
• Possess strong analytical skills, attention to detail and the ability to grasp complex issues.
• A strong team player and committed professional who thrives in a fast - paced, collaborative, project-oriented environment.
• Experience with strengths in project, asset, and vendor management in an environment where strong communication and leadership skills can be effectively utilized.
• Experienced in Agile, Waterfall and Critical Path development methodologies.
• MS Project Server, Project Web Access, JIRA, SharePoint, Clear Quest and Plan View - Utilized as a central project center for document sharing.
• Managed development of business process flows to increase productivity for End Users.
• Experience with HEDIS, NCQA, and STAR Rating requirements.
• Knowledge of professional fee billing, reimbursement and third-party payer regulation and medical terminology.
• Coordination with multiple departments and department leads to move user from On-Premise to Microsoft cloud infrastructure.
• Successful Microsoft Office 365 Migration.
• Successful in qualifying, negotiating contracts, on-boarding and managing relationships with 200+ Information Technology and Healthcare suppliers to support my Customer accounts.
• Multiple coordination meetings regarding cloud vendors and On-Premise engineers for pre/post migration strategies.
• Microsoft Project - Create, maintain project plans, schedules, scorecard, and client presentations.
• Managed ICD-10 External vendor testing for Trading Partners, Payers, Providers and Clearinghouses.
• Coordination with On-Premise engineers and managers to structure project and bring to successful Go-Live.
• Familiar with DRG, APR/MS-DRG coding, audits, and reimbursement.
• Experienced in Computer System Validation, User Acceptance Testing and System Integration Testing
• Developed Project Change Control, Issue, Risk and Budget tracking processes.
• Managed multiple projects and personnel across multiple sites and all phases of the deployment life cycle.
• Developed Project Charter, Schedule, and Resource Plans according to PMBOK knowledge areas.
• Created and maintained internal PMO documentation, such as Issue, Status, Change Management and Risk logs.
• Wrote Project Change Request when the scope of the original project was modified.
• Developed Implementation Methodologies and managing software implementation, Medicare Part A, B and D knowledge.
• Implemented Radiology Practices Revenue Cycle/Financial Systems that integrate to RIS and PACS systems
• Familiar with medical terminology, ICD-9, ICD-10 and CPT coding, medical billing, and claims processing Pre-authorizations.
• Prior experience performing gap analysis and assessments involving HIPAA 5010.
• Full SDLC Implementation Experience from Initiation to Execution on Claims and Care Management Applications.
• Consulted with large payer organizations, supplementary insurance, third-party administrators, and providers on strategic planning and process improvements for ACA, HIPAA, Hitech, ICD-10 Compliance.

PROFESSIONAL EXPERIENCE

Confidential

Senior Project Manager

Responsibilities:

• Managed project implementation for Confidential .
• Consulted with Project team regarding all aspects of project planning and scoping development.
• Responsible for forecasting and planning future resource needs.
• Support tracking of project plan and completes status for executive level reporting and project level reporting.
• Utilized project management tools and methodologies modeled by PMI PMBOK.

Confidential, Dayton, OH

Senior Project Manager

Responsibilities:

• Managed Medicare Advantage and Dual Special Needs Plan implementation.
• Managed HEDIS, NCQA and Quality product requirements.
• Developed project plan, weekly status reports, risk, and issue logs in adherence to EPMO standards.
• Ensured project milestone deliverables were complete and approved throughout project lifecycle.
• Served as liaison between business analysts, production team, vendor partners and Stakeholders.
• Collaborated with Stakeholders and IT managers to develop solution planning and strategic project initiatives.
• Monitored Revenue Cycle process, policies, and procedures for DSNP implementation.

Confidential, Atlanta, GA

Senior Project Manager

Responsibilities:

• Developed report tracking system to provide milestones and deliverables status for daily & weekly scrum.
• Managed payer claims for implementation for Medicare/Medicaid.
• Communicate consolidated status updated on milestones and deliverables for weekly stand-ups with internal and external staff, use internal tracking system to monitor progress overall process.
• Created and manage timelines for all projects, ensure workflow progress efficiently and projects/staff are organized as priorities shift.
• Monitored online project status, ensured problem resolution for escalated enterprise-level technical issues and updated communications using project web server throughout project phase and go-lives.
• End to end implementation of immediate down pay claims and reimbursement system.
• Served as project manager for multi-site healthcare IT system implementations; managed project plan and budget, provided industry best practices for decision making.

Confidential, Louisville, KY

Project Manager

Responsibilities:

• Managed and identified all impacted business areas on project plans to maintain schedule.
• Managed MS Office 365 migration and system updates throughout enterprise.
• Used BPM to integrate and merge new acquired businesses under one department.
• Worked with payer systems for nurse auditing where CDI claims are managed.
• Establishes timelines for project / product development and monitored each critical point to ensure timely completion.
• System migration from a CMS platform to an eQuip.
• Facilitate software system upgrades and instillations for data mining and auditing.
• Managed Nurse Auditor implementation for current version of 3M.
• Developed an implementation strategy for Hyland/AnyDoc to prevent production delay and revenue loss.
• Served as liaison between business operation, IT team, vendor partners and C-Suite.

Confidential, Atlanta, GA

Learning Program Manager

Responsibilities:

• Partner with Learning Consultants and Design Leads to select of appropriate technology enabled solutions and designing system configurations.
• Partnered with IT and Business to develop process flows for system upgrade and implementation.
• Seamless transition from Waterfall to Agile Methodologies.
• Developed timelines, scopes, budgets, risks, assumptions success criteria, communication protocols, resource requirements and additional tools necessary for a successful implementation.
• Managed payer claims for implantation for Medicare Advantage.
• Train, coach and support key project leads to leverage Learning and Development technologies (My Learning, Knowledge Library and Adobe Connect)
• Developed expertise in claim processing modules with accelerated expertise in claims, enrollment, system support functions, benefit plans capitation and letter generation.
• Utilized UI/API’s during a system migration for Medicaid platforms.
• Manage and partner with internal vendor managers and procurement to mitigate logistical issues.
• Partner with Learning Consultant to develop training environment strategy and work with project IT teams during implementation.
• Participate and manage project budget development.
• Develop and execute a clear communication strategy that support the Learning and Development brand along with project deliverables.
• Conduct ICD-10 audience analysis and quality improvement for Medicare/Medicaid associates.
• Create Learning and Development ICD-10 training strategies for GBD and commercial business.

Confidential

Senior IT Project Manager

Responsibilities:

• Outreach to approximately 6,000 providers in network for education and electronic support to code to the granularity requirement of ICD-10.
• Ensure a seamless implementation in all Operational areas through education, metrics, and documentation.
• Claims Review Systems - Determine new audit, fraud and rules and enhanced application.
• Provider customer service components to be assessed and remediate first to support initial set of providers migrating to ICD-10.
• Validate that vendor outreach and impacts have been covered, e.g., finance, actuarial, underwriting, pricing, claims, business operations, etc.
• Manage UAT and SIT testing for all claim’s implementation software life cycle.
• Maintain system validation and testing schedule for an on-time nationwide Go-Live.
• Track deployment of vendor specific ICD-10 changes to environments, such as test and production.
• Coordinate E2E and IPT testing with vendors.
• Build customer client reports to migrate between care management systems with increased integration of data and telephony enhancements.
• Integrate Care Gaps into Care Management workflows and optimize gap identification across multiple systems to ensure proper prioritization of interventions.
• Maintain reports required for financial information to be accessed by EPMO via online reporting portal tools.
• Developed updates and manages business plans, schedule, process changes and incremental costs / benefits to the business.
• Coordinates 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 and dependencies.
• Assisted with the development and delivery to ensure a more seamless transition process during go-live.
• Coordinates with appropriate Business Leads and SME's to develop business requirements, workflows, marketing materials, training documents, and other business-related deliverables.
• Followed Confidential ’s LEAN Methodology policies and procedures.
• Perform detail reports in the office 365 portal for mail statistics, SharePoint, OneDrive, and usage summaries.

Confidential, Alpharetta, GA

Senior Implementation Consultant/ Revenue Cycle

Responsibilities:

• Developed effective working relationships with the clients, through on-site visits and conference calls.
• Utilized Salesforce for project reporting and documentation.
• Prepare documents to perform validation during software implementation and system upgrades.
• Managed coordination with data-base engineers to migrate data from On-Premise into the cloud.
• Coordination of 50 in-house application to the cloud
• Managed Confidential 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 Confidential Horizon clinical systems applications.
• IT Security utilized with EHR implementations.
• Coordinate team members for site-specific & regional system configuration design.
• Managed all internal and external project interfaces across teams and organizational levels, including Confidential and client executive levels.
• Migrated systems for EMR.
• 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 Confidential Horizon Surgical Manager, Meds Manager, and CPOE applications
• Served on committees aimed at integration of several other products with the claims system.
• Assured compliance and adherence with customer guidelines and Confidential 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.
• Led Go Live Ready Assessment (GLRA) and Optimization initiatives.
• Identified application problems and developed constructive and creative solutions.
• Provided onsite and offsite training for end users on product releases.
• Negotiates with vendors for maximum buying leverage.
• Develops vendor RFP templates and vendor approval requirements.
• Worked with Support and Development teams on defects and new client requirements.

Confidential

Account Manager

Responsibilities:

• 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.
• Managed solution development efforts to best address client needs and requirements, while coordinating the involvement of all company personnel.
• Managed Implementation of CRM, Salesforce for call center.
• Provides weekly status updates from to sales team and C-Level Executives.
• Responsible for achieving company sales quota for designated strategic accounts.
• Maintain high client satisfaction that met company standards on strategic accounts for customer retention.