SUMMARY

• 15 years IT / 10 years HIM Experience
• Master of Science Degree in Health Informatics and Information Management
• 9 Health Information Management s: EPIC, Cerner, Nuance, GE Health, Elekta
• 2 years EPIC Project Lead for CRM related enhancements and upgrades
• 6 years Health Insurance Experience Medicaid Management Information Systems (MMIS) and Proprietary Private Payor Applications
• Extensive Knowledge of the MITA Business, Information and Technical Architecture Framework
• Responsible for major implementations, enhancements and upgrades to Medicaid Management Information Systems (MMIS), Ambulatory Health Systems, and Laboratory Information Systems
• Lead role in Public and Private Sector Implementations/Migrations/Go - Lives with multiple stakeholders

PROFESSIONAL EXPERIENCE

Confidential

Senior IT Applications Analyst

Responsibilities:

• Provide recognized knowledge of product features, functionality, and utilization of the following application software:
• Nuance Dragon Medical Transcription/Dictation, Optum Claims Manager, Nextgate Enterprise Index, Idology Expect ID IQ Authentication, OpenText EMR, MedFusion Confidential Portal, Imprivata ConfirmID, and Biscom Fax Communications Server
• Manage stakeholder expectations by analyzing expectations and requirements
• Identify project issues and risks and resolve or escalate as appropriate
• Lead Meetings and Collaborate effectively with colleagues to complete tasks
• Monitor system effectiveness and/or performance to: determine if there are any potential problems report critical findings to peers and/or manager resolve complex problems.
• Create cases for all phases of testing interfaces, data conversion, enhancements, proposed workflow solutions and each new release as assigned
• Develop disaster recovery initiatives with scheduled drills and tests
• Traind users on functionality and system changes
• Provide assigned on-site support during go-lives and system upgrades
• Provide 24/7 support when scheduled Resolve or triage support calls as applicable

Confidential

Solutions Architect

Responsibilities:

• Health Information Management Division
• IT and Application Development and Deployment
• Collaborate with State Government to ensure statutory and regulatory compliance Develop SOPs and Protocols for Client Registration, Process and Activity
• Guide Strategic Direction to Implement Laboratory Management Solutions using SMART methodologies and objective criteria
• Create Final check and of Technical Tasks performed by Lab Technicians
• Implement, Perform all necessary Technical Testing, and Train Staff on Complia Laboratory Management Application
• Streamline Product Analysis Processes and Automate Report Distribution Employed User Centered Design (UCD) Project Management Methodologies

Confidential

Epic Applications Analyst

Responsibilities:

• Lead EPIC Tapestry Analyst and Subject Matter Expert for Cross-Functional Business Units
• Responsible for Automating Claims Adjudication, Prior Authorization and Referrals Customer Relationship Management and Provider Relations Lead
• Develop, Promote, Test, and Support all CRM Related Enhancements and Upgrades
• Configure Vendors and Networks, Create Templates, Routine Imports Create and Maintain Providers and Provider Contracts, Create and Configure Health Plan Contracts
• Configure Tapestry Automation for Eligibility and Enrollment
• Document and Automate Medicare Advantage, Federally Facilitated Market Medicaid, and Children’s Health Insurance Program and Load Schedule Workflows for Streamlined Process Improvement Train Super-User Staff on Custom Epic Toolbar Configurations, Checking in and out of Pools, Coverage Status Definitions, Changes to Termination Processes, etc.
• Lead Member ID Card Distribution and Correspondence Project
• Automate Rules for CRM Tasks, Create Distribution Schemes for Internal Communications Create & Automate Referral Letters for Clinical Staff with SmartForms and SmartTexts
• Epic Bridges tasks and configurations for EDI Division
• Map Translation Tables, Bridges and Conversions Extract and Stage Data, Work HL7 Queues and Troubleshoot Errors Configure Interface, Build Records Orders (EAP) and Result (LRR) Components
• Create test cases for regression, stress, and user acceptance testing in multiple environments
• Reporting Workbench and Data Courier Administrator
• Maintain System Definitions, Master Files, Category Lists Configure New Users and Manage Security Classes
• Collaborate with Multiple Vendors, Providers, and other Business Associates to Interface for EDI Transactions
• Eligibility and Benefit Inquiry and Response
• Claim Status Inquiry and Response
• Authorization and Referral Requests, Prior Auth and Notification Inquiries, Hospital Admission Notifications
• Electronic Remittance Advice
• Create Test Scripts, Delegate Super-Users, Train Department Management
• Generate Reporting Workbench Reports for Performance Measures and Quality Control
• Collaborate with Centers for Medicare & Medicaid Services to Implement Hierarchical Condition Category (HCC) System
• Collect data from multiple sources for Extract, Transfer, Load (ETL) delivery to CMS

Confidential

Senior Clinical Applications Analyst

Responsibilities:

• Electronic Medical Records Division
• Lead Senior Analyst and Subject Matter Expert (SME) for:
• Nuance Dragon Medical Transcription/Dictation Powerscribe 360 Radiology, Mosaiq Radiation Oncology and Quantim HIM Coding Surescripts Clinical & eScripts Messenger, Document Manager
• Successful Migration from Cerner to EPIC Electronic Medical Record Suite
• Support/Sunset Legacy Applications and FaxCom Server
• Implement Integrated Risk Management
• Create RSA Archer Controls for Compliance
• Support Virtual Desktop Interface Migration
• Administrator for Clinical Application Pools
• SME responsible for Configuration and Implementations to:
• Cerner Millennium PowerChart EMR Radnet Teleradiology and Medical Imaging & Remote Report Distribution
• Provide recognized knowledge of features, functionality, and utilization for INTEGRIS Confidential /Provider Portal

Confidential

Project Manager

Responsibilities:

• Lead Planning Specialist and Subject Matter Expert for:
• Elseveir Medical Artificial Intelligence / SAP Predictive Analytics for Population Health Management
• COLD Picture Archiving Communications System and Clinical Document Architecture
• Confidential Enterprises | Atlantes Care Management Suite SME
• Implement Medicaid Management Information System (MMIS) Enhancements
• Lead Analyst and Subject Matter Expert for the Nation’s first CMS Medicaid EHR Provider Incentive Payment Program
• SME for Federal Health Information Exchange/E-Prescribing Initiatives
• Manage Project Workbook for Change Orders and Customer Service Requests
• Disaster Recovery and Risk Management Plans, Recovery Procedures and Validation Processes
• Surveillance and Utilization Review (SUR) and Management and Administrative Reporting (MAR)
• Support Eligibility and Enrollment, Oversee Provider Data Maintenance and Configure Provider Portal
• EDI Administrator for Professional CMS 1500 and Institutional UB04 Claims Processing
• Support successful conversion from, ICD-9 to ICD-10 Standards
• Medicaid Information Technology Architecture (MITA) National Framework Member
• Complete State Self-Assessment and Advanced Planning Strategies for Federally Funded Medicaid Eligibility Determination and Enrollment Activities
• Conduct Sessions for Specialty providers on Meaningful Use Objectives and Clinical Quality Measures