SUMMARY:

Accomplished Information Technology professional with a background in Managed Healthcare, Benefits Administration, Group Health Claims, Home Healthcare, Hospital and Physician Billing Systems, Federal Government, and IT Contingency/Disaster Recovery Planning. Excellent analytical, problem solving, negotiation, communication, and active listening skills. Proficient in classroom training, technical writing, staff and vendor management. Assertive, innovative project manager with a customer focus.

SOFTWARE/TECHNICAL SKILLS:

General: MS Office 2007 & 2010, MS Access, Visio Professional 2007 & 2010, MS Project 2007 & 2010, Microsoft Project Server, Lotus Notes, Clarity, Open Workbench, Rational Rose, RequisitePro, Rational ClearCase, Rational ClearQuest, Oracle Financials 11 (GL, A/R, and Projects), Visual Basic, Crystal Reports, Documentum, Sharepoint, Strohl Systems LDRPS 9.1, Strohl Systems Incident Manager 2.1, TestDirector, Remedy, Platinum EMP, PlanView Enterprise 10.1, Fieldglass. WebEx, Live Meeting, Nortel Periphonics IVR.

Healthcare Specific: Dezine DME Professional ver. VI, Productive Data Management PiMS, MPACS CASI, ERISCO FACETS, R.I.M.S. QicClaim2, McKesson Horizon Homecare, McKesson STAR 8.0, TechRX Managed Care Pharmacy, QS/1 Community Pharmacy, Foresight HIPAA Validator, Edifecs SpecBuilder (HIPAA validation tool), and Edifecs Transaction Manager.

PROFESSIONAL EXPERIENCE:

Confidential

Technical Project Manager Senior

Responsibilities:

• Responsible for managing the migration of government business, Medicare and Medicaid, from legacy WellPoint systems to legacy Amerigroup systems. Also implemented new Medicaid business on Amerigroup systems. Overall, this included business for approximately forty states. Managed both local and off - shore resources. Project budget over 1 million dollars.
• Monitored creation of requirements/technical design documents and participated in requirements gathering sessions.
• Managed development/coding, SIT, and UAT.
• Facilitated weekly meetings with project team to review progress and document/resolve issues.
• Participated in move to production and post-production support activities.
• Responsible for weekly Scorecard reporting and managing resource allocations in PlanView.

Confidential

Technical Project Manager Senior

Responsibilities:

• Successfully managed development/implementation of an interface to the WellPoint PeopleSoft payroll system, for a subsidiary company, which allowed more effective time keeping and eliminated signing in to 2 different systems to track time.
• Successfully managed development/implementation of an interface to allow extraction of Medicaid HEDIS data from the WellPoint legacy system to Amerigroup legacy system to enable Amerigroup to generate and manage HEDIS reporting for WellPoint.
• To support the launch of a new product affecting 1.4 million customers, managed multiple releases to update software, databases and web sites to accommodate the new product features.
• As part of the Payment Innovations Data Foundation team, managed Change Requests for new features/functionality including monitoring creation of requirements, technical design documents, development/coding, SIT, UAT, move to production, and post-production support.
• Responsible for weekly Scorecard reporting and managing resource allocations in PlanView.

Confidential

Project Manager

Responsibilities:

• As PM for the ANSI 5010 837 Claims workgroup, successfully implemented the 837 transactions with all major providers and clearinghouses.
• This consisted of managing software implementations through all phases of the SDLC. As PM of the ICD-10 Provider workgroup, managed a portfolio of nine applications to implement the ICD-10 code sets through all phases of the SDLC.
• Responsibilities included management of budget, resources, schedule, facilitating project meetings, preparing and presenting weekly project status reports, project schedule updates, creating and presenting change requests to the Change Control Board, and adhering to all BCBS IL established guidelines.
• Projects combined budget exceeded 1million dollars.

Confidential

Consultant

Responsibilities:

• Worked as an independent consultant to assist the company in implementing a Quality System to meet FDA requirements for a Medical Device Data System (MDDS).
• Worked with senior level staff to develop the company’s Quality Management Plan.
• Documented the key processes, developed process maps, and created Visio process flow diagrams.
• Worked with offshore development and engineering team to document step-by-step details of the data migration processes.
• Developed a generic MS Project plan template detailing all data migration tasks.
• Assisted in developing Standard Operating Procedures (SOPs) to comply with FDA regulations.

Confidential

Project Manager

Responsibilities:

• Assigned to an insurance services administrator as a project manager to manage Health Care Reform initiatives.
• Managed all phases of the projects.
• These projects supported benefits administration.
• Developed and maintained project documentation including meeting notes, Project Plan, Risks/Issues Log, Status Reports, Implementation Plan, and other documents as needed.
• Facilitated all project meetings including kick-off, requirements definition, project status, and implementation planning.
• Interacted with peers, business owners, IT professionals, and department heads.
• Provided training in basic personal computer use and MS Office applications.
• Mentored individuals preparing for their PMP certification exams.
• Participated in online Project Management coursework.

Confidential

Program Manager

Responsibilities:

• Responsible for operations in support of various aspects of commercial programs in the Health Solutions division.
• This included call center set up/operations, print services, and systems development.
• Served as primary customer contact on large and complex product or service delivery initiatives.
• Overall program management, project management responsibility for staff management including developer resources in South America, task management, planning, coordination, and delivery of complex member management services or custom products to external customers.
• Monitored programs, products, and services from initiation through delivery interfacing with the customer.
• Participated in the development of proposals for potential clients.
• Managed custom website development for several large commercial customers.
• Developed, defined, and executed MS Project plans, budgets, and schedules.
• Facilitated and led client meetings for the duration of the project/program.
• Established metrics to evaluate the effectiveness of client’s programs.
• Organized interdepartmental activities to ensure completion of services on schedule and within budget constraints.
• Successfully established/implemented a call center in support of the annual Medicare open enrollment activities for several large commercial insurance clients.

Confidential

Sr. Project Manager/Program Manager

Responsibilities:

• Worked in a matrix capacity for both the Business Owner and Senior Management, managed all projects for the business capability.
• Developed MS Project plans for each project and maintained a Program project plan encompassing all active projects.
• Facilitated project and program management team meetings.
• Prepared materials, organized, and lead the Steering Committee meetings with senior level staff.
• Provided timely updates for the Portfolio management dashboard report including weekly status reporting.
• Managed software development through entire SDLC with overlapping iterations.
• Worked directly with vendor, Edifecs, in customization of their HIPAA validation tool. Reviewed and approved all vendor expenditures.
• Participated in testing of HIPAA EDI transactions for compliance with BCBSA and HIPAA requirements in support of benefits administration.

Confidential

IS Project Manager

Responsibilities:

• Responsible for managing new web site development and enhancements to current sites for Confidential .
• Received project assignment and reviewed technical documentation to determine requirements.
• Requested resources and assembled virtual team consisting of local and off-shore resources.
• Facilitated kickoff meetings with client and virtual team.
• Managed virtual team including DBAs, Web Developers and QA testers.
• Managed client expectations and tracked and managed all project issues.
• Tested completed product based on client specifications.
• Participated in UAT with client using TestDirector to track defects and monitor QA progress.

Confidential

Senior Security Engineer

Responsibilities:

• Developed, maintained, and managed project workplans.
• Lead project team meetings including distribution of updated project plans and meeting minutes.
• Reviewed and interpreted federal publications regarding COOP, IT Contingency, and Disaster Recovery planning.
• Prepared technical documents to support Federal audits.
• Created templates to gather site-specific location information to assist in IT Disaster Recovery operations.
• Created templates to document step-by-step procedures for recovery and restoration of essential IT functions.
• Responsible for DR plan testing, distribution, and maintenance.
• Managed a project to build DR plans in the Strohl Systems Living Disaster Recovery Planning System (LDRPS) database.
• Successfully rolled out the State and County IT Contingency/DR plan templates nationwide. (Completed templates from over 2500 offices had been received at the time I left my position.)

Confidential

IT Specialist, Principal

Responsibilities:

• Interpreted HIPAA Implementation Guides and functioned as the Subject Matter Expert (SME) for all business units.
• Reviewed and analyzed all systems and processes to verify capture of HIPAA required and situational data elements for the various transactions (837I, 837P, 837D, 270/271, 276/277, 278, 835).
• Prepared gap analysis identifying areas where required data was not collected.
• Prepared Visio process flow diagrams to document current state and future state processes for each system/business unit.
• Developed new data collection processes to ensure data capture compliant with HIPAA guidelines.
• Conducted extensive training of the HIPAA Implementation Guides for all billing departments.
• Participated in local and national HIPAA forums to remain current on any implementation issues.
• Monitored HIPAA readiness of software vendors and all Federal (Medicare), State (Medicaid), and commercial payers.
• Tested HIPAA EDI transactions using the Foresight HIPAA Validator.

Confidential

Project/Program Manager

Responsibilities:

• Participated in vendor contract negotiations including preparation of Request for Proposal (RFP).
• Participated in review/approval of vendor (Periphonics/Nortel) Statement of Work and verified/approved all vendor expenditures during project lifecycle. Also tracked and monitored vendor related tasks for timely completion.
• Interacted with customers in defining and documenting functional and technical requirements.
• Developed and managed MS Project workplans for multiple IVR projects.
• Participated in the Impact Analysis estimating process for all new IVR development projects.
• Managed projects related to updates of the Wireless Intelligent Network web site services.
• Facilitated weekly cross-functional team meetings with project management and technical staff
• Involved in all phases of the software development lifecycle (SDLC).
• Produced Visio business process flow diagrams to support management of all IVR projects.
• Managed financials for all IVR projects department wide including Estimate To Complete (ETC), Estimate At Completion (EAC), and Earned Value (EV) calculations. This encompassed 30 to 40 active projects per month.
• Prepared project financial and resource allocation reports for upper management including anticipated FTE estimates.
• Trained and mentored new team members.
• Participated in the Release Management process monitoring all IVR test and production release schedules.

Confidential

Sr. Business Analyst, Project Manager, IT Account Manager

Responsibilities:

• Functioned as IT Account Manager for Specialty Solutions, a national pharmaceutical company.
• Organized and lead meetings with internal and external business partners.
• Participated in review and selection of new vendor software products to meet changing business needs.
• Produced Requests for Proposals (RFPs) and prepared Return On Investment (ROI) documents to support hardware/ software purchases and gain project approval from executive management.
• Managed purchase and installation of upgrades to 34 software applications in support of Y2K initiatives. (Received a written commendation from the Perot consultant team for my accomplishments.)
• Managed implementation and provided on-going support of Oracle Financials 11 (AR, GL, and Projects modules).
• Managed the DME (durable medical equipment) software/hardware implementation process for two remote locations.
• Prepared technical documentation to support software enhancements.
• Managed software development projects in support of an in-house developed software product used nationally by 10,000 nurses to facilitate patient care.
• Participated in the IT Contingency and Disaster Recovery planning process for several business units.
• Participated as a member of the Change Management team assisting the manager in documenting and tracking all enterprise software releases. This included creation of release logs, change logs, status reports, and weekly schedule updates.

Confidential

Plan Administration Manager, Project Manager

Responsibilities:

• Developed work breakdown structure (WBS) for FACETS implementation.
• Project managed the software implementation process including creation/maintenance of Symantec Timeline workplans.
• Assigned and monitored all project tasks for timely completion.
• Developed Visio workflow diagrams to support reengineered business processes.
• Maintained provider database of contracted fee schedules by payer.
• Administered Helpdesk for all FACETS users and produced end-user documentation.
• Participated in development team responsible for custom applications.
• Tested internally developed applications that interfaced with FACETS.
• Developed custom reports using MS Access.
• Prepared materials for presentation to potential clients.
• Created an MS PowerPoint presentation of the FACETS process that was utilized by the national sales force.
• Conducted demonstrations of software capabilities at seminars, for potential clients, and for investors.