SUMMARY

• Skilled Senior Project Analyst/Consultant with over 20 years of experience in healthcare and teh military health system. Worked directly with CEOs, COOs and CIOs on multiple projects. Extensive experience including consulting, sales, programming, training, leadership and implementation. 10+ years of direct patient care, over 10 years of instructor experience.
• Senior Chief Hospital Corpsman (SCPO / E8), Submarine Independent Duty and Instructor. US Navy, honorable discharge.
• Managed all phases of several multi - year clinical healthcare projects, including planning, business requirements, user acceptance, resource management, and quality measurements. Engaged and coordinated care providers in EHR, Quality and Risk Adjustment implementations and projects. Managed design, structure, development and planning issues within scope
• Developed and implemented project plans for new practices participating in an Accountable Care program for teh largest health insurance company in teh United States. Led population health management to meet shared goals of partnerships. Led HEDIS reporting and CMS Stars programs.

TECHNICAL SKILLS

• Hl7 programming/interfaces, laboratory, pharmacy and formulary installations/updates, ICD10 mapping and setup, billing, coding, best use of clinical data, clinical templates, SQL queries, HEDIS, Stars, CCD (ASTM Continuity of Care Document), clinical documentation, quality assurance and metric tracking, XML, SAS, CPT, CPT2, ICD10, ICD9, CMS reporting.
• Advanced proficiency with MS Project, Access, Word, Excel, PowerPoint, SharePoint, and Visio

PROFESSIONAL EXPERIENCE

Confidential

Consultant / Owner / Project Manager

Responsibilities:

• Led process design and project implementation teams in process improvement activities. Diagnosed opportunities and developed solutions using principals of excellence and related tools.
• Created business requirements, workflows, reporting, analysis and audits for plans and programs to support continuous quality improvement.
• Communicated project and initiative updates to executives and key stakeholders.
• Worked in/with Fee-for-Service, Medicare Advantage, Medicaid and Marketplace claims data
• Delivered and presented presentations. Used Six Sigma DMAIC (define, measure, analyze, improve, control) to improve teh processes, tools, and customer contact methods (cold calling, RFPs, networking, etc.) to achieve sales targets.
• Supported and drove projects related directly to sales, growth-oriented strategic initiatives, business innovation development, and partnerships.

Confidential

Senior Project Manager/Consultant/Analyst

Responsibilities:

• Created, controlled and improved end-to-end HEDIS and population health business processes in a pilot project.
• Defined and developed analytical methodologies and procedures for QI (quality improvement) initiatives and implementation and delivery of automated solutions by querying, collecting, analyzing, and summarizing information and trends. Designed test and use cases.
• Coordinated HEDIS and QI related projects for NCQA submission. Led project coordination, trouble-shooting, and adherence to strict deadlines, maintained project schedule, business requirements, program progress, and status. Analyzed NCQA technical specifications in detail, determined business requirements, matched them with teh project plan and designed methods to accomplish objectives (to improves HEDIS scores and align with NCQA requirements).
• Provided quantitative analysis on quality measures by planning, collecting and analyzing population health and claims data, using SAS and SQL programming / coding to extract and analyze appropriate data sets. Designed enterprise-wide data governance and master data management activities.
• Led process improvement practices across teh seven largest community health centers (CHCs) in Hawaii with shared risk accountability for improved outcomes.
• Developed and implemented project plans for all practices participating in teh program. Met shared strategic goals of partnerships. Used claims data to effect change and drive process improvement.
• Collaborating with clinical leaders, analyzed population health clinical trends, measured outcomes to ensure care improvement is timely, measurable and effective. Used advanced statistical analyses, techniques and tools to reveal trends and opportunities. Implemented HEDIS and Stars measures with all Hawaii clinical partners, working with teh UHC Medical Director.
• Provided recommendations for analyzing data and trends, developing work flows to optimize care delivery, and aligning best practices with process improvements.
• Heavy use of statistics/metrics and advanced analytical tools, including MS Excel, databases, SQL, MS Access, to data mining of insurance claims, appointment data and electronic health records.
• Electronic health records major systems used included Epic, NextGen, GE Centricity, Allscripts, and McKesson PracticePlus and InteGreat.

Confidential

Consultant / Owner / Project Manager

Responsibilities:

• Electronic Health Record Consultant and Project Manger
• Requested and received agreement from CEOs, CIOs, COOs, and Lab Managers in Hawaii for 100% participation (all non-federal acute care hospitals and teh two largest laboratories in teh state) in an AHRQ Pilot Project for comparative effectiveness research. Designed HL7 interfaces - using 2.5.1, LOINC. Led vendor selection and proof of concept processes. Teh end goals for dis multi-million dollar project were to improve efficiency and effectiveness (Six Sigma Goals) by advising physicians on which lab tests to order on ER admission. Along with teh Database Manager and Programmer, used Process Mapping in order to select (vendor/product selection/RFP) teh best HL7 interface engine for dis project.
• Led and managed all phases of a 2-year clinical health IT project including programming, planning, cost and resource management, and quality measurements. Engaged and coordinated teh care providers in EHR implementation. Worked to control change, teh budget, and scope. Installed modules and trained end users in specialty clinics including Adult Medicine, Family Practice, OB/GYN, and Pediatrics.
• Relied on Lean Six Sigma principals to accomplish all goals (customer first, flexibility, focus, velocity, complexity). Using Lean methods, worked closely with teh CEO, CFO and Steering Committee to ensure that teh project was accomplished as quickly as possible with minimal variances in teh project plan.
• Generated over $500,000 in sales within 6 months in a new market at a startup company with a product still in development (Catalis EHR / Catalis GHR) by contacting over 1,000 physicians with cold calling, faxing and other direct marketing method. Designed and implemented agreement with HMSA (Blue Cross) Hawaii for Catalis Hawaii approval and participation in teh HI-IQ EMR Program.