SUMMARY

• Over 30 years designing, implementing, improving, managing commercial and government program Healthcare systems and services
• 10 years with national payer organizations, 8 years with regional BCBS organizations, 10 years of Medicaid product experience, and 5 years on provider practice management and medical record systems
• Administered departmental budgets of 50M, ITO Delivery and P L responsibilities for contracts with a TCV of 300M, managed 200 person IT organizations and extensive experience with on/off shore blended staff
• Successfully performed duties as Enterprise Architect, Project/Program Manager, IT Director/VP, Product Manager, Services Delivery Director, Account Executive and CTO
• Extensive system selection, implementation, conversion and configuration management experience with several membership, claims and care management products, having successful completed 14 business system transformations
• Design and administration of EDI Gateways, Business Rule Engines, Workflow Systems, Member/Provider/Group/Broker Portals, Content Delivery Management Systems, Document Imaging/OCR and Repository Management, Test Automation, Interactive Voice Response and Care Management Applications
• Responsible for definition and delivery of Enterprise IT Strategies with focuses Healthcare Reform Implementation Exchange Integration, Data Quality Management / Warehousing / Integration Strategies, IT Performance Metrics, Business Process Improvement Initiatives, and Enterprise Release / Configuration Management and Planning
• Deep business expertise in HIPAA 4010/5010 transactions, ICD-9/10 transformation, PPACA/HIX, disease management, claim pricing, benefit adjudication, PHR/EHR systems, departmental business analytics, and provider network management
• Extensive experience with Buy vs. Build research determination, RFI / RFP creation response, M A Due Diligence, IT Cost Containment, Multi-Platform / Multi-Vendor System Integration, EPMO and Release Management
• Participant in numerous interoperability workgroups focused on seamless healthcare information integration across continuum of care, linking claim data with patient personal health records and provider based clinical data

Personal Attributes

• Cited as an adaptable out-of-the-box thinker, with a 'gifted' approach at managing change and building relationships through negotiation and the development of a trust climate between IT and business constituent groups
• Formally trained public speaker with outstanding communication skills, confident manner and professional demeanor
• Highly organized, disciplined and proponent of structured methodologies, repeatable processes and defined best practices
• Boot-Strap organic career advancement beginning as developer, then advancing to systems analyst, team manager, departmental director, and chief technology officer

Chronology and Achievements

Confidential

Program Manager

Responsibilities: Develop a program framework for MA Hospital Network, administering an 8M grant from the state focused on reduction in 30-day readmissions for chronic ill patients congestive heart failure and diabetes , Emergency Department utilization by behavioral patients, overall length of stay and health care costs.

Confidential

Functional Requirements and Design Lead- 9 mo. Contract

Responsibilities: Team Lead staff of 16 for requirements and design efforts associated with conversion to new Membership / Benefits Administration system Curam for the District of Columbia DHCF MAGI and Non-MAGI populations. Responsibilities included framework definition business operations, reporting and interfaces , resource management, session facilitation, MITA 2.0 maturity assessment, and MMIS liaison.

Confidential

Project Manager- 6 mo. Contract

Responsibilities: Project Manager on Claim Processing and EDI Gateway System Selection HealthEdge engagement for Elderplan, a Brooklyn, NY based Hospital Health Plan with several Medicare SNP and Medicaid products. Organized requirements gathering, management and prioritization, RFP creation and scoring, presentation agenda and scenario development, advised on MITA 2.0 compliance, and performed demonstration facilitation.

Confidential

UAT Test Lead 9 mo. Contract

Responsibilities: Created a UAT Center of Excellence using the implementation of all Health Insurance Exchange business onto the NASCO membership platform for Horizon BCBS of NJ as a basis.

Confidential

Senior Director

Responsibilities: Manage all aspects of IT delivery for blended on/off shore staff augmentation account team at Blue Cross Blue Shield of Vermont. Keane staff represent 90 of the organization's IT department PMO, development analytics, configuration, testing, infrastructure and help desk .

Achievements: Administered staff responsible for creating EPMO, ICD-10 assessment, successfully completed Edifecs implementation, reorganized and enhanced account team delivery SDLC, grew account team staff footprint by 20 . SME on HIX participation, defined IT Strategy, lead virtualization initiative, and implemented test automation. Oversaw early stage Agile rollout, and point on Cloud Computing initiative.