PROFESSIONAL EXPERIENCE

Confidential

• Project Management Office PMO Manager: Responsible for managing/coordinating all PMO activities and oversight through defining and maintaining standards for project management within the project through employing experience using PMBOK, Agile, Lean and Six Sigma methodologies. Striving to standardize and introduce economies of repetition in the execution of the project. Being the source of documentation, guidance and metrics on the practice of project management and execution.
• Transition Management: responsible for migrating the function or the process from HP to the client organization. good communicator with extensive interaction with the client strong Project Management skills comfortable in working in a cross-cultural environment, good understanding of the existing processes and technologies in managing the day to day affairs of a migration Produces regular management reports.
• Change Management: Logged all Request for Changes RFCs for a Change Control Board CCB meeting, and worked with all necessary parties to coordinate change development, testing and implementation, in accordance with schedules Reviewed and determined if a reported defect or issues is a candidate for an RFC Managed the change log with all progress that occurs, including any actions to correct problems and/or to take opportunities to improve service quality Reviewed all implemented changes to ensure that they have met their objectives Reviewed all outstanding RFCs Closed RFCs Produced regular management reports Maintained the Requirement Traceability Matrix RTM and ensured outstanding RTM items were delivered within scheduled timelines.
• Business Analysis: Project Management of EDI staff and business processes, responsibility for formal project specifications and project status reporting, personnel work assignments. Assist with system design overview and database requirements. Work with and between trading partners, clients, management, technical and non-technical personnel to define issues and identify solutions. HIPAA EDI resource person segments, elements, loops, etc. , negotiate with Trading Partners, work on legal issues with corp. attorneys, perform vendor selection.
• Incident Manager: Responsible for coordinating incident management activities and for project incident management through to identifying, analyzing, and correcting hazards to prevent a future re-occurrence. Identifying incident events that could lead to loss of, or disruption to, an organization's operations, services or functions. Development processes to limit the potential disruption caused by incidents, followed by a return to business as usual.
• Schedule Manager: Ensured effective schedule management throughout the life of the project through applying a well-planned and structured approach to schedule management. If necessary, suggest changes to keep the project on time through identification of work progressing compared to the master schedule.
• Documentation Manager: Responsible for coordinating the document management activities and for project document control. Coordinated and controlled the flow storage, retrieval, creation, updates, processing, printing, routing, and distribution of electronic and paper documents in a secure and efficient manner, while ensuring the documentation was accessible to authorized personnel when required.
• EDI Validation: responsible for attaining HIPAA EDI validation from Medicare, Medicaid, and other payers or government carriers. Developed HIPAA EDI Transmissions for both government carriers and commercial entities. Work includes complete business cycle management and hands-on production as well. Create EDI Testing process, documentation, and performance matrices.
• HIPAA Resource: Completed several HIPAA Projects, a key resource for HIPAA projects for government plans, large insurance companies, clearinghouses, and healthcare providers. Companion Guides, legacy system integration, HIPAA code set resolution and payment posting projects, including Claims, Eligibility, Claim Status, Remittance, COB, Explanation Of Benefits EOB or EOP and other healthcare IT projects. Work with government carriers and payers to support the provider community, including Institutional, Professional, Dental, and specialty work such as Encounter transmissions, Secondary Payers, and Cross-Over billing. Includes Medicaid MCC / MCO and Medicaid Management Information System MMIS work.
• EDI Department Designs. For this type of work the following skills have been utilized: Project Scope determination corporate interviews to determine the scope of project. Work Flow, WBS Work Breakdown Structure Trading Partner Selection: Hardware, software, and vendor services are determined after appropriate interviews. Development of Job descriptions, documented in detail, including skills needs, desired experience, and a general description of costs. Production phases are documented as well as a test plan for deployment.
• Trading Partner / Vendor Management: Manage the requirements and selection for Trading Partners and Vendors. Schedule conferences, JAD sessions, participate in negotiations, set/create/resolve EDI TP issues and create legal draft points for corporate attorneys.
• Gap analysis: Trading partner assessment was performed as well as corporate readiness for EDI production. Industry knowledge was shared to assist in long-term goals. Gap analysis was performed to identify changes, which was kept within the corp. objectives both financially and objectively.
• Technical Specification Creation for EDI. Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837- I, P, D , 835 Remittances and others. Resource for UB92 and HCFA1500 billing formats transaction sets requirements, EDI development and Design, X12 protocols through Version 5010, conversion needs and understanding of legacy EDI formats, such as UB92 Versions 4, 5, 6 and NSF.
• Use cases, test plan creation and Companion Guide development: Development or oversee others in developing EDI Specifications, Test plans and/or companion guides for the 837 Institutional, 837 Professional, 837 Dental, 835, 270/271, 276/277, others. Test plan design, from stage to production, including both internal and external requirements. Companion guides and crosswalks were developed using Excel. Insurance and clearinghouse entities were consulted to insure proper integration and compliance, research done on segments and elements as needed. Mapping staff were instructed on EDI issues and management was made aware of systems issues, status, and progress.
• Research and Reporting for upper-level management : Interview stakeholders, create and maintain reporting and milestones for upper management. Participate in corporate meetings to resolve issues and present solutions. Identify resources needed for special projects.
• RUP, Rational Unified Process: Inception phase-define scope elaboration phase-analyze needs construction phase-create product/source code transition phase-delivery, installation and user sign offs.
• Reviewing/editing client request for proposals, reviewing proposal responses and statements of work for HIPAA TCI implementation Plans.
• Providing guidance in understanding HIPAA implications, modifications, and change orders for client subcontractors.
• Staying abreast of changes in HIPAA TCI Rules and Regulations and the impacts on client previous implementations in order to ensure current change orders and future/ongoing TCI compliance.

Confidential

• Act as intermediary in price negotiations between buyers and sellers of Residential, Commercial, and Investment, Industrial, Agricultural/Land Properties.
• Arrange for title searches and for meetings between buyers and sellers wherein details of the transactions are agreed upon and the new owners take possession of the property.
• Help to arrange favorable financing from a lender for the prospective buyer, Home Inspections, Structural Inspections, Geological Surveys, and Property Surveys often, theses make the difference between success and failure in closing a sale.
• Obtain listings/agreements by owners to place properties for sale. Researching and generating Comparative Market Analysis CMA of Seller's Home.
• Understanding of environmental regulations, zoning, home, termite, and radon inspections, and property repair needs, and by ensuring all special terms of the contract are met prior to the closing date.

Confidential

• Directed, established, maintained, and planed the overall policies and goals for business development. Identified potential business partners and negotiated agreements. Coordinated and negotiated with the product development, marketing and with sales group. Managed a group of business development professionals, software developers, and business and technical analyst. Relied on experience and judgment to plan and accomplish goals.
• Consultant to business constituents with an emphasis on scoping, project definition, requirements formulation, policy and procedures, solution design, and implementation execution and deployment though all stages of system development life cycle, from requirements gathering, development, test, User Interface Test, security audit, beta pilot, marketing, and launch.
• Development of Internet solutions technology, specializing in B2B, n-tier, eCommerce sites for several clients. Manage business and technical employees through empowering and improving their technical skill sets on Web based solution projects, implementing cutting edge technology through product development planning, allocate resources, interviewing candidates for diverse projects, and Windows based applications.
• Strategic Web site planning and user interface design for end users and internal support engineers. Devise solutions to high demand support needs for Internet software for the client to interact with Web page as the information delivery mechanism.
• Oversaw research for technical solutions and written documentation for engineers supporting internet software, Beta test networked client-server software, document results, report findings to Tech Support, QA Test , Development, and Program Managers.
• Clients were Commercial, Healthcare, Insurance, and Governmental

Confidential

• Using experience and knowledge for the development HIPAA training programs for clients and Covansys Personnel development of methodology documents and tools for HIPAA assessments for the Transactions, Code Sets, Identifier Team TCI and Privacy Security Team.
• Researches, analyzes and proposes new architecture designs and evaluates and recommends enhancements to existing architecture. Designs, researches and develops components of architecture. Coordinates and/or provides technical direction on integration of new complex technologies with overall architecture. Troubleshoots and resolves or recommends highly creative solutions for complex problems that impact HIPAA regulations and/or organization architecture. Participates in presenting technical plans and proposals to various technical and non-technical groups and provides recommendation.
• Managing TCI assessments of substantial Health, Life, and Annuity Insurance companies and state government facilities, while assisting other TCI teams in their client assessment activities. Assessment activities include, extensive travel, review of client documents, client interviews, gap analysis, report writing, implementation plans, training programs, fielding client and Covansys personal questions, and follow-up activities for remediation work.
• Reviewing request for proposals RFP , developing client statement of work SOW , management reports, and management presentations.

Confidential

• Utilized Electronic Data Interchange in Local Proprietary Formats, National Standard Formats, and ASC X12N Standards
• Actively participated in UNCH cross-functional teams for projects: Y2000, HIPAA, and ASC X12N Standards.
• Managed EDI software installation, client server, EDI, EDI training projects.
• Participated in contract development, review, and negotiations.
• Data Management Initiatives.

Confidential

• Utilized Electronic Data Interchange in Local Proprietary Formats, National Standard Formats, and ASC X12N Standards.
• Developed and maintained five MS Access databases for tracking testing and production status of all persons/entities that participated with BCBSNC in the transfer of electronic data.
• Trained EDI division personnel in Windows95, Microsoft 97 Access, Excel, PowerPoint, Word , TSO, RLINK, HyperTerminal, JCL, LRSP, EDI Essentials, GENTRAN: Basic and Plus systems, interpreting Cobol programs, Protocols, ASC X12N Standards, NSF, and BCBSNC Standards.
• Actively participated in BCNSNC cross-functional teams for projects: Y2000, HIPAA, ASC X12N Standards, Windows95 Rollout, Microsoft 97 Professional Suite Rollout, and Blue e.
• Project Manager for EDI projects stemming from HCFA CMS Mandates, HIPAA, and Corporate Goals, while maintaining BCBSNC Customer Satisfaction.
• Traveled to sites in the medical community and billing services to assist/train/inform the community of BCBSNC systems and opportunities with EDI transactions both interactively and in a batch environment.
• Maintained personal computing environments for the EDI division. Assisted the internal TAG division in troubleshooting and repairing PC's, LAN connections, software installation, tree building, and security.
• Blue Cross and Blue Shield
• Utilized LRSP and system knowledge extensively in order to successfully research and resolve telephone, walk0in, and written inquiries concerning membership, claims processing, and benefit issues.
• Trained the State Health plan Customer Services Representatives in Dell personal computing systems using IRMA mainframe display, Windows95, and Microsoft97 Professional Software.
• Developed a better understanding of benefit provisions and limitations by researching North Carolina General Statutes and NC State Health Plan administrative and medical policies, and applied knowledge to successfully complete inquiries with twenty-four hours. Notified management of system, procedural, and benefit issues as well as provided assistance in resolving issues.

Confidential

• Developed extensive knowledge of North Carolina General Statutes and Federal General Statutes through research, and successfully applied statutory provisions during investigations.
• Responsible for all aspects of casework including investigations, apprehension, and arrest of person accused of narcotic violations within the State of North Carolina.
• Assisted in investigating Narcotic, Alcohol, Prostitution, Homicide, and Fire Arms violations with the Federal Bureau of Investigation, Alcohol Law Enforcement, Drug Enforcement Association, United States Customs, Georgia Bureau of Investigation, Internal Revenue Services, and Federal and North Carolina Attorney General Offices.