Professional Experience

• Excellent motivator, communicator and trainer with success in targeted education using standard Instructional System Design ISD models and a positive and productive work environment.
• Knowledge of all aspects of the healthcare industry including institutional, LTPAC, medical, mental health, pharmacy, third party liability, prior authorization and dental.
• Proven skills in business process reengineering BPR , organizational change management OCM , and all aspects of project management.
• Over 15 years of experience in Health Care IT, including claims and encounter processing, eligibility, surveillance and utilization review, provider processing and HCFS/CMS requirements. As well as over 10 years of experience in Project Management and system implementation.
• Effective leader of large project teams, groups and divisions stressing the improvement in process management and systems implementations.
• Expert in the identification, analysis, and resolution of various systems needs/problems and operational issues, continuously maintaining performance goals and savings initiatives
• Focused and educated in Federal, State and local government regulations and standards including but not limited to ACA, HIPAA, MITA for MMIS, HIE and others.
• Adept at reducing development costs, setting project standards and providing traceability for project tasks.

Relevant Experience

• Providing Project Management Oversight services in support of enhancing the current integrated eligibility legacy system with a Common Access Front End CAF , Integrated Document Imaging System and Enhanced Customer Service Center. The PMO is responsible for the following:
• Business process reengineering, including gap analysis and development of as-is and to-be process models for Child Support, Child Welfare, Provider Licensing, and Economic Stability.
• Change management and stakeholder communication, including readiness planning, establishment of a communications network and development of communication materials.
• Organizational assessment and design, including assessment of skills, job duties, training needs, and development of organizational model and organizational transition plan.
• Project Management operations PMO , including management of scope, cost, schedule, risks, reporting, communications, etc.
• Implementation support, including deliverable reviews, training management and delivery, testing support, and monitoring.
• Assisting the Department in planning and procurement for system vendors, including development of requirements, RFPs, and IAPDs.
• As Project Management Consultant tasks included but not limited to:
• Writing of project standards for information exchange and dissemination both externally and internally to all project participants and stakeholders with a vested interest in project progress.
• Setting the standard for all phases of the Department's business process reengineering efforts.
• Using the ADDIE model to assist the Department and its vendor, in development of effective training and organizational change management models for all staffing levels impacted by the new technology.
• Provide guidance to management staff related to contract interpretation, organizational change management, training, scope management, risk management, performance metrics, communication and product implementation.
• Provide mentorship and project management oversight in the development and establishment of a project help desk and implementation command center.
• Develop and implement the use of tasks management processes to ensure that targeted business objectives were realized in each phase of the new system implementation.

• Performed the Business Transformation/OCM role for Phase I of the MITS project as part of the HP Enterprise Services team. For this project, the Business Transformation task was structured as a component of the System Integrator contract, subjecting it to management by the SI vendor. The role focused on assisting the state in transforming their business from both a business process and organizational perspective. This included the following tasks:
• Development and management of a guiding Business Transformation Plan
• Capture and analysis of existing business and functional processes
• Development and presentation implementation state To Be processes based on MITS functional design
• Development and delivery of MITS specific desk top procedures
• Development and delivery of Ohio specific Organizational Change Management training for selected Ohio Department of Jobs and Family Services ODJFS leadership and staff
• Organizational Assessment and Gap Analysis
• Development and support of an Ohio specific external and internal transformation communications strategy
• As the Senior Business Consultant, worked with the primary contractor and State staff to refine the current business strategy and in some instances develop a new strategy in line with CMS standards and MITA requirements as a business process reengineering lead consultant. She used her skills to identify useful best practices, performance metrics and recommend solutions to performance gaps while providing reassurance to the client during difficult transitions. Her responsibilities included the following:
• Lead team member in the development, implementation, transition and customization of processes in line with State specified guidelines. These activities included:
• o Gathering and management of business requirements,
• o Documentation of existing business processes and development of new processes,
• o Determine process gaps and inefficiencies,
• o Scope and requirements management, and
• o Administration of engagement activities in support of work products and deliverables.
• Prepared Procedures/Training Manuals and other documentation to facilitate smooth transition of functioning processes and ensuring conformance to Service Level Agreements. Often considered the example to use in the development of documentation for client submission.
• Monitored the overall functionality of business processes, identified improvement areas and implemented adequate measures to maximize customer satisfaction level.

• Provided leadership, oversight and management for the integration of the Special Education Records and Information Management System SERIMS with the newly developed Achievement in Montana AIM data system, E-Grants system, and student information system to meet federal accountability requirements. The primary developer of staff procedures and training curriculum used to ensure the design and implementation of the special education data collection and reporting processes fully meet the needs of the client.
• Montana Office of Civil Rights OCR representative for special education. Responsible for evaluation and monitoring of Federal and State civil rights regulations for all public education facilities across the state of Montana.

• Initially hired to design and develop a State Medicaid provider training program, expanded responsibility within the first two months, to include supervision of all customer call center personnel in both Nevada and Virginia, medical billing department manager, and EDI manager. Developed a marketing campaign to increase EDI provider participation in Nevada Medicaid by 20 within the first year and a key member of the design and testing team for business rule development/updates for the Nevada MMIS. The following are highlights of her efforts on the project:
• Considered the Subject Matter Expert SME for HIPAA and all aspects of Nevada Medicaid. State staff and provider requested management instructor/consultant.
• Developer and designer of collegiate style provider training program to assist healthcare billing staff in appropriate coding and billing practices within the insurance industry.
• EDI Manager responsible for a team of analysis and the implementation of all HIPAA transaction interfaces for Nevada Medicaid. Responsibilities included HIPAA awareness, EDI business analyst, and Health Care Systems SME. Tasks included gathering detailed design requirements for HIPAA compliant transactions, EDI provider training and NPI conversion for Provider systems.
• In less than one year as EDI manager Ms. Smith consistently exceeded the 80 State required EDI provider participation rate by more than 5 .
• Medical billing and administration management consultant for both large community hospitals and assisted living facilities.

• Assisted in directing the duties and responsibilities for both in-house and remote staff as a requested lead project member of two project teams for Oregon and Montana during the design, testing, and implementation of two multi-million dollar State-owned Decision Support Systems DSS . Developed and implemented State approved training materials for the corporation's ad-hoc query software tool and DSS, wrote system mapping documentation and business rules and considered the customer's resident expert. In addition to the following responsibilities, performed comprehensive research, analysis, and reporting for Montana Medicaid's Surveillance and Utilization Review unit and became primary system support for both States.
• Comprehensive Medicaid experience in areas including provider relations, targeted case management, fraud and abuse analysis, and policy development using her outstanding operations and resource management abilities, time management, organization, and analytical skills.
• Written project standards for internal and external communications for all project participants and stakeholders with a vested interest in project progress.
• Established standard for all phases of business process reengineering.
• Lead member of UAT team during Oregon and Montana DSS development and requested operations support staff lead following project completion.
• Using the ADDIE model to develop effective training and organizational change management models for all staffing levels impacted by the new technology.
• Develop and implement the use of tasks management processes to ensure that targeted business objectives were realized in each phase of the new system implementation.
• Conducted SURS studies research and analysis of medical and mental health claims and recommended solutions for State Medicaid policy and procedural issues.

• Hired as a Certified Nursing Assistant and promoted rapidly into her role as a facility consultant while attending college in pursuit of her degree. In her new role, she acted as an instructor, consulted on office management practices, policies and procedures, and conducted marketing research. While working for Masonic Home, Ms. Smith also gained valuable experience in facilities policies and procedure modification, marketing research, negotiation skills, and teamwork. Her responsibilities included:
• Development of a personal client base through her ability to provide therapeutic recovery and long-term patient care for both Medicaid and Medicare patients.
• Performing market research on current and potential clients for the creation of a new facility fee-for-service payment system.
• Consulting on the facility's reorganization by performing time studies and quality control processes for existing office practices and recommending solutions to improve quality of care, budgeting, and procedural practices.
• Administrative management consultant on medical coding and insurance billing procedures.