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Manager Reporting And Analytics Resume Profile

NC

SENIOR PROJECT MANAGER PMP 1212433 / ARCHITECT / MANAGER / DIRECTOR / CIO

High-performance Information Technology Professional with excellent analytical, communication, project management and interpersonal skills. Diverse technical, application and development experience derived from rapid learning and effective application of cutting-edge technologies. Team leader with fine-tuned multi-tasking capabilities, used to motivate, train and mentor people at all levels of technical expertise. Creative, very hands-on problem-solver who accurately assesses technical situational challenges and successfully transforms ideas into appropriate workable and make-sense solutions.

PROFESSIONAL EXPERIENCE

Confidential

Manager Reporting and Analytics

Hi-Level, temporary position to fill in for outgoing Manager.Responsible for a staff of ten persons acting as analysts and technical participants in Business Intelligence gathering, analysis and presentation.Worked closely with management at director and VP levels on determinants for strategic and tactical planning/modeling and actioning implementation models and activities. Management areas were from all healthcare spaces i.e. provider, authorizations, claims, member, eligibility, etc. Also directed reporting of KPI and SLA measurements for vital customers top 2 of BCBSLA, including quality checks over data reported. Established project plan, schedule, risk and communication management plans for CMS Section 111 automation effort. My superior, senior VP acts wholeheartedly as a reference and has provided me a reference letter which can be supplied as required.

Confidential

Task Manager

Serve as Project Activities Manager for Conversion of all data, documents, images, archives, etc. for State of Louisiana PRISM Implementation MMIS . Conversion was from Molina legacy systems to CNSI Target system eCAMS .

  • Author and promulgate paradigm for data conversion efforts i.e. strategies of raw vis--vis derived.
  • Establish and manage relationships with State and Legacy Vendor staff and Management members participating in effort.
  • Determine source s of legacy data and ascertain formats, content, structures, attributes and availability of data
  • Direct efforts to accurately Map Source to Target data Field/Column elements Files/Tables.
  • Author Data Conversion Plan Paid deliverable to State 1.5 mill that documented policies, procedures documents and Project artifacts.
  • Establish architecture for HIPAA compliance over all PHI related information being consumed by the data conversion process.
  • Using MS Project, established multiple Project/Program plans to identify milestones and associated actions to accomplish them within budget and time frame allocated.
  • Manage Data Conversion scope to Provider, Member, Authorizations, Claims and Reference areas MITA compliant .
  • Evolve strategy for archive, older documents and images to a digital format for access to user community.
  • Evolve strategy for paper document storage and retrieval.
  • Manage Interfacing Inbound and Outbound to CNSI Partners Magellan, Noridian, etc. through design sessions utilizing existing vendor interfaces and those planned and specified in RFP.
  • Specify ETL to populate Data Warehouse s with OLTP data.
  • Evolve interfaces with CMS required reporting and data requirements inbound and outbound.
  • Coordinate data conversion efforts to development efforts to assure data sets are populated for System Testing, UAT Testing and Go-Live.

Confidential

Project Management/Consultant

Serve as Project Manager Consultant to Providers and Insurers affected by 4010/5010 and ICD-9/ICD-10 Compliance.

  • Consulted with clients on remediation strategies for both 5010 ICD-10 initiatives moving them forward from their legacy positions and systems while satisfying HIPAA policy and standards
  • Enabled the business communities in both Provider and Insurer sides of the claims process areas, to achieve more tangible success in claims processing and effective coding of their claims for maximum payment or qualification s
  • Enabled clients to experience impact of GEMS and how it serves them in their practices and business acumen
  • Consulted with clients on effective policy/procedure writing and implementations of same for their enterprise.
  • Consulted with clients on Architecture concerns surrounding Database and Infrastructure elements in their compliance initiatives and actions.
  • Using MS Project, established multiple Project/Program plans for clients to identify milestones and associated actions to accomplish them within budget and time frame allocated.

Confidential

Project/Conversion Manager Contract Position

Serve as Project Manager Conversion Lead for activities associated with the conversion of Claims, Member, Provider, Eligibility and Accumulator history data housed in BCBSNJ QBlue systems Trizetto and others over to the NASCO platform. Supervision of Vendor IBM and NASCO Contractor personnel. Purpose of role was to stabilize conversion between waves of implementation. Each wave was defined by Groups or Plans participating in conversion at the time of the Wave cycle. 5010 compliance and ICD-10 implementation was being performed separately but with our knowledge and participation. Project involved HIPAA X12-837, 835, 834, 270/271, 276/277 and 278 transactions , NCPDP and ICD-10 methodology.

  • Supervision of 5 direct, 12 indirect vendor reports IBM offshore and onshore and several NASCO participants. BCBSNJ SMEs added another 10 indirect reports to project
  • Conducted due diligence over JAD sessions, Impact Analysis and Gap Analysis and resolutions and direction of/to them and approval responsibility for BRD and TRD documents
  • Direction/authority over design documents including cross-walk, transformation, business rule and mapping strategies and documents
  • Daily review and assessment of CSR documents Scope creep items from published requirements documents and coordination of them through wave implementation process or Change Management disciplines
  • Guide and direct code base migrations/promotions though Unit Test and into SIT/UAT/Production environments
  • Standard architectures used with some NASCO nuance to enable multiple platform/vendor conversions
  • Authored Project Plans and Portfolios associated with each wave Planview

Confidential

Senior Project Manager Contract

Executive-Level Project Manager of over 5 million dollar Encounters Project Phases 4 5. Activities managed were related to encounters Claims Paid/Denied and submitted via EDI using HIPAA Transaction, UB92, UB04 and HCFA 1500 formats and Member, Eligibility, Provider and accumulator history. Implementing PMO and Project Management disciplines within Organization. Performed Executive and Director management, coordination, assignment and oversight of budgets, contracts and tasks associated with Encounters conversion to bring transactions into 5010 compliance and ICD-10 implementation. Project heavily involved with 5010 Initiative X12-837, 835, 834, 270/271, 276/277 and 278 transactions , NCPDP and ICD-10 conversion.

  • Supervision of 11 vendor Accenture offshore and onshore and 15 Wellcare direct personnel. SMEs added another 30 indirect reports to project
  • Conducted due diligence over JAD sessions, Impact Analysis and Gap Analysis and resolutions and direction of/to them
  • Approval responsibility for BRD and TRD documents
  • Participated with Architecture groups on hardware, database models, Informatica configuration, Cognos and network structures and topologies
  • Authored and managed Project Plan MS Project consisting of over 5000 tasks
  • Approval authority of design documents including cross-walk, transformation, business rule and mapping strategies and documents
  • Prepared Executive and Director level management documents on status and progress of project Red/Yellow/green Assessment/Rating . Performed necessary communication of this information to these management groups weekly.
  • Conducted Stage Gate reviews and preparation of materials associated with completion of each step in the SDLC 10 step
  • Assisted in reviews of Excelys, EDI and EDS softwares and implementations/conversions.
  • Assisted PMO on Policy/Procedure documents and associates improvements
  • Assisted in evaluations of Scrubber, XML, EDI and HIPAA transaction tool solicitation and approval for purchase

Confidential

  • Establish PMO principles and begin implementation of Policy/Procedures for all Projects underway and to be undertaken
  • Complete AS-IS to TO-BE Requirements gathering, etc. including Gap Analysis
  • Complete Project Management Planning including all essential Project plans Communications, HR, QA, Procurement, Risk Mgmt, etc.
  • Complete Authorship of State of Florida, MED3000 and IT Project Management Plans using Project 2007
  • Evaluation of software products to be used for various phases of software and establishment of procurement budgets
  • Coordination of all Project Plans with Vendors and State of Florida
  • Establish and Direct Steering and Senior Project Committees
  • Coordinate project activities with State and employer Senior Management to satisfy requirements and expectations
  • Coordinate IT infrastructure elements with Third-Parties Trizetto/Facets/COTS and internals

Confidential

  • Oversight of Conversion of major datasets Provider, Member, Eligibility, Claims and Prior Authorizations for SIT, UAT and Production environments. This included schema update guidance, GAP analysis, ETL development guidance, Test Case creation and execution, and defect resolution
  • Oversight of Interface development for external partners and agencies. This included establishing transformation rules, ETL developer guides, Test Case creation and execution, and defect resolution
  • Staffing and work assignments within On-shore and Off-Shore Development teams
  • Led SCRUM sessions in morning for Progress Teams and late afternoon for Progress Team Leaders
  • Weekly Issues/Actions reporting and updating for management reporting
  • Detailed guidance to DBA and ETL developers on planning and priority of assignments
  • Coordination with infrastructure teams on environment availability and expectations
  • Coordination of Project Plan updates on a weekly basis for PMO status reporting
  • Coordination with Configuration teams on reference tables, structure and population
  • Personal contact with State, Partner Third-Party and Agency SMEs and management supplying data or expecting data from MMIS as well as conducting weekly status meetings with Project Managers or Leaders of these groups
  • Coordination of Conversions and Interfaces with Implementation team and promotion of programming into SIT, UAT and Production environments
  • Initiated JADs and Requirements Gathering sessions as required

Confidential

  • Guide development of application that extracted data from the SureScripts Data Warehouse, cleansed/scrubbed the data via ETL transformations and populated database used for Analytics and Business Intelligence. This application was being efforted using a CRM solution that was cumbersome and ineffective for the purposes desired
  • Performed analysis of data structures within CRM and methodology of data extraction. Schema design and development
  • Development of programming to perform data transformations and apply business rules and intelligence to raw data from data warehouse and CRM data extractions
  • Development of UI for user community to perform analytics and BI
  • Automate process for pull of data from data sources and populate Database

Confidential

  • Complete project management using MS Project and following PMI/PMP/PMBOK methodologies , development and implementation activities relevant to Data Warehouse, Medical Home, Data Analytics and Predictive Modeling activities. Team consisted of 25 direct members .NET ASP developers, graphics artist, supervisor, SQL/SAS programmers, 2 DBAs and 2 business analysts, over 3500 indirect members user community-state wide . Worked 100 within Microsoft technologies IIS, LDAP, AD, Exchange, MS Interoperability and 3.5 framework with some external tool sets from Infragistics, Sheridan and other MS based APIs
  • Complete project management responsibility for external data interfaces including HL7, DICOM, and HIPAA transactions for MEDICAID and MEDICARE data sources. First activities included Medication histories and Lab information via vendor COTS solution. Used SOA as basis for these interfaces and developed around Internet Explorer 6.0 to current and Firefox 2.0 to current for compatibility purposes
  • Using MS Visio and Word, authored Strategic Planning document for organization to act as guidance to Executive and Managing Committees/Board. Acceptance and implementation begin within a week of publication
  • Active and contributing member to NCCCN, Inc. 646 Initiative via Informatics Center data conversions using ETL processes SSIS/DTS , SQL Stored Procedures/Functions and Crosswalks between datasets. Formats were CSV, Flat, Delimited, XML and parseable
  • Conducted assessments of data, data structures and data elements available in disparate databases to support and implement clinical interventions, measures and best practices events and alerts-for-action. SQL Standards in 2000/2005 were exploited and TOAD was used as our data modeling software. Star, Snowflake Hierarchical schemas were developed and administered. De-normalized and normalized Third Normal Form concepts and philosophies were integral to the modeling activities. Led effort here with 2 DBA staff members performing the actual code work and me mentoring and providing vision
  • Synthesized pertinent information ICD9 diagnosis codes, procedure codes CPT and HCPCS codes for analysis and simulation of treatment patterns and needs. Able to simulate patient encounter in data model. VB, .NET, ASP and OLAP cubes SSAS were essential to this effort as well as strong SQL and SAS skill sets in my development staff and user community
  • Liaison with and interface with key partners and Health information committees external to projects within State Agencies and Government
  • Consultative to Executive Senior Management team on current and future IT needs and expenditures
  • Established written policies and procedures over internals controls and application of business rules with compliance to HIPAA ensured. These included job descriptions of staff and operational policies to assure 24/7/365 availability for Data Warehouse. An Agile environment was established for the development staff with some SCRUM activities included. This was very effective and I was able to motivate and mentor my developers easier in this setting
  • Responsible for vendor selection, adherence to specifications, quality of effort and effectiveness of their performance on assigned contracts. This work included writing RFPs, SOWs and evaluation of Contract language s between parties
  • Conducted ongoing technology assessments of medical information systems such as electronic medical records for interface to our data structures. Included here were the transport protocols Burst, Character/Byte, DSL, T1/T3, etc. , ETL packages, crosswalks of information between entities to comply with differing policies and procedures over security and data
  • Using MS Project performed project management over HIPAA Security review of Informatics Center. Was selected as candidate for HIPAA Security Officer
  • Established strong mentoring and planning for/with development staff members through regular meetings, SCRUM Sprints, Resource allocations and external Web-Based training sessions/seminars
  • Best Practice basis/orientation for development, PERT/CPM for Project Management and Use Cases Business Rules established for requirement analysis and specification to development efforts
  • Established strong security over Web and site s activities with ID/Password and Captcha APIs. Trouble-Ticket and Response mechanisms were implemented for 24/7/265 support within web site s . Was able to establish algorithm for determination of response and fix time estimates for user community
  • Conduct was professional and exposure to matters of strictest confidence was evident and intimacy with them was expected and adhered to

COMPUTING OPERATING SYSTEMS PLATFORMS

  • Operating Systems: MSDOS, Windows 3.1, 95, 98, ME, 2000, XP and 7 desktops , NT3.x, NT4.x, 2000 and 2003 Server, SCO UNIX., AIX, VMware
  • Platforms: IBM PC/AT, Risc 6000, IBM 360/370, AS400, DEC VAX.
  • Processors: Intel 80X86 families, Intel XEON, Intel DUAL QUAD, Cyrix, Motorola, TI, AMD.

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