EXPERIENCE:

Confidential

• Present Contract Officer Contract Management Unit and Special Projects
• Responsible for procurement of services for the program office which includes services that are needed to support policy and federal requirements as well as evaluating and identifying the need for new and existing contracted supports.
• Responsible for organizing, planning, developing, and implementing multiple contract types as well as tracking expenditures, assessing compliance with contract terms, monitoring and evaluating performance measures that relate to contracted service deliverables. Creates statement of works that align with policy and cost models for service level agreements.
• Develops Statements of Work SOWs , payment provisions, performance measurements and other language for RFIs, RFQs, RFPs, IFBs, IGAs, sole source contracts, Memorandums of Understanding MOUs and other department contract types.
• Works closely with stakeholders including Department of General Services, Financial Operations, legal, policy, operations to develop program office specific contracts that affect business partners including case managers.
• Develops work/project plans for each new contract and contract renewals to coordinate project activities which includes timelines and details regarding contract preparation, solicitation, evaluation, negotiations, execution and monitoring activities.
• Monitors progress of contractor's obligations against the contract deliverables, identifies and case manages project issues, reviews project risks and initiates risk minimization actions, conducts cost projections escalates any major risks and issues as needed.
• Monitors and tracks contract expenditures and cost projections and their impact on the program office's fiscal year encumbrance.
• Continue to perform communication's role from past position. See position below for details

Confidential

Training/Communications Manager Training and Communication's Division

• Created and distributed approximately 100 communications annually for the Office. Content ranged from policy clarification and enforcement, rate loads, announcements, system changes and issues, initiatives, documentation requirements, job aids, manuals, new forms and surveys. Simplified complex topics using terminology appropriate for diverse audiences. Position demanded a high degree of initiative and independent judgment.
• Identified training gaps and program office training needs. Planned, designed, implemented and/or delivered/presented training, and managed curriculum for internal and external stakeholders. Responsible for supervising staff to support planning, development, implementation, monitoring and the evaluation of program office functional areas as they pertain to communications and training. Created and delivered training material including handbooks, banner alerts, operational guides, webcasts, teleconferences, video conferences, onsite training to providers and associations and provided technical assistance to internal and regional staff and provider stakeholders. Compiled, analyzed and presented financial accountability data monthly and quarterly to support federal assurances. Produced reports that contained time series charts, tables, narratives, source data explanation and verbal presentation to executive staff. High level of collaboration with subject matter experts from ever functional area in the program office, the Department and technical team leads in order to facilitate planning, development, and execution of communications and trainings and to support operational efforts and to enforce policy.
• Developed documentation requirements, criteria, exception and appeal processes for the prior authorization of services and fiscal year limitations while ensuring the processes were aligned with policy and federal regulations.
• Responsible for managing project plan for a new billing and payment system. Presented status reports regularly and identified deviations from project plan parameters. Produced management reports, analysis and remediation strategies for executive staff. Position required concurrent attention and engagement in multiple tasks/projects with competing priorities, strong/effective oral and written communication skills. Program office lead for several federal initiatives.
• Directed, analyzed, and evaluated the performance of unit staff.

Confidential

Contract Manager, Contract Management Unit

• Managed and oversaw independent audits of statewide Medical Assistance Management Information processing system, compiled technical documentation and reports detailing related activities and decisions for executive staff.
• Audited and prepared monthly reports for senior staff on the contractor's compliance with the requirements detailed contract.
• Tested contract business requirements using statistically valid sampling techniques monitored system availability, frequency of system connectivity, and validated tier parameters as it pertained to business partner's contractual compliance.
• Provided analysis, instruction, and administrative oversight of contractor obligations and responsible for review and subsequent approval of contractor invoices.
• Monitored contract operations and served as the technical resource on the contract and bureau responsibilities as it pertained to the contract.
• Directed the review of policy changes and corresponding implementation of system enhancements and represented the Bureau in internal and external meetings.
• Actively participated in testing system changes including test case development.
• Directed the preparation of memoranda and correspondence.
• Directed, analyzed, and evaluated the performance of unit staff.

Confidential

Project Manager, Planning and Implementation Unit

• Analyzed, documented, identified and gathered business requirements for system changes associated with the Office of Medical Assistance OMAP initiatives.
• Project management role responsible for coordinating project activities, reviewing/interpreting Pennsylvania medical assistance policies, departmental objectives, regulations and program changes in the Medicaid Management Information System.
• Developed, implemented, recommended changes to policies, regulations, procedures and systems governing the Medicaid programs by analyzing existing system logic to determine program effectiveness, recommended solutions to problems, developed corrective action plans, and prepared various reports and correspondence.
• Identified complex claims processing system issues, communicated issues to program and system staff, worked with system staff on resolution strategy and conducted production validation analysis to confirm system updated as requested.
• Communicated with all staff levels, business partners, medical providers, federal government representatives, complex concepts associated with the medical assistance program.
• Chaired and actively participated in workgroups that directed the activity of major office wide implementations. Responsible for the planning and implementation components of federal initiatives ensuring compliance and securing funding. This included establishing and updating project plans with actual and forecasted data as well as managing deviations from project plan parameters
• Responsible for meeting facilitation including creating agenda, leading discussions, documenting action items, compiling file notes minutes for distribution to attendees.
• Created presentations for executive staff to present at high profile organization meetings.
• Prepared responses to the federal contacts regarding progress on federal initiatives.

Confidential

Program Specialist, Claims Operations Unit

• Monitored and maintained the Department's Medical Assistance Management Information System to assure that providers are paid in accordance with federal, state regulations and policies.
• Participated with contractor staff and departmental agencies in project planning when changes impacted the Medical Assistance Management Information system.
• Identified, gathered submitted business requirements BRDs for system changes or enhancements associated with state Medicaid initiatives.
• Conducted business meetings, which included devising agendas, leading discussions, documenting action items, compiling file notes minutes and action item follow-up.
• Provided input and recommendations to constituents in regard to changes in operational processes due to new federal and state legislation, system, and operational changes.
• Performed test case review, testing, production validation activities and post-implementation review to validate changes requested were designed as intended.
• Monitored and updated, as needed, the Accounts receivables AR file, led the AR group, managed gross adjustments GA and prudent pay exemption requests.

Confidential

Contract Process Manager

• Team position that required ongoing collaboration with various stakeholders including team members, National Account Managers, finance, legal, MIS personnel to develop national contracts monitor contract compliance and measure contract performance.
• Conducted business reviews, identified business opportunities, and formulated new agreements for over 20 top strategic managed care and traditional insurance organizations.
• Participated in pricing and program negotiations to create mutually beneficial contracts.
• Responded to operational requirements and inquiries with an emphasis on database maintenance and reporting.
• Created and maintained membership details to facilitate the management of customer mergers and acquisitions.
• Communicated regularly provided technical assistance with clients, management, team members.

Confidential

Medicaid Data Analyst

• Received recognition award after designing/implementing new Medicaid database which streamlined workflows, increased operational efficiencies and processing time, produced validity checks and engaged in dispute methodology.
• Credited with having negotiated and resolved Medicaid disputes with multiple state governments saving the company over 1.3 million dollars during one calendar year.
• Generated weekly, monthly, and quarterly management reports that updated quarterly price comparisons, tracked state payments and identified unit disparities.
• Performed forecasting, budget analysis, and cost/benefit analysis scenarios used for senior level management decision making. Responsibilities also included process modeling, risk management, meeting facilitation, variance analysis, and reporting.