Experienced project manager offering 14 years of success leading all phases of diverse managing multiple projects simultaneously within the healthcare field, Working with cross-functional teams and vendors, both domestic, off-shore, virtual/remote Function as liaison between IT and the business and point of contact. Developing detailed project plans, schedules, project estimates, resource plans, and status reports. Conducted several project kick off meetings. . . Significant customer/end-user facing experience and a track record of developing project plans that support IT and business initiatives for process improvement. Industries include healthcare, insurance, retail, publishing, financial services, manufacturing, utility, state and federal government. Entire lifecycle project experience SDLC, waterfall, Agile, and non-traditional techniques from concept, planning, requirements, schedule development WBS schedule , design, build/construction, test/validation, to deployment/operations. 14 years of client facing internally and externally. 8 years of EDI experience analyst to EDI manger

PROFESSIONAL EXPERIENCE

Confidential

Consultant EDI Systems Analyst

• Project: Obamacare Affordable Care Act ACA Enrollment Resolution and Reconciliation 834
• Baseline enrollment process to ensure consistent enrollee information across FFM Federally Facilitated Marketplace for CMS Centers for Medicare Medicaid Services

Confidential

Consultant ICONMA Sr. IT Project Manager EPMO/Business Intelligence/Delivery Manager/Release Team

• Project: HCA EDWard Enterprise Data Warehouse and Research Depot , DX Data Exchange APCD all payer claims database Mandates coordinating / monitoring / onboarding 7 states Project: HCA Health Care Analytics EDWARD: AIM ASO Expansion
• Project: NEE Products
• Coordinated activities communicating with teams of application developers, web developers, designers, and business users for the onboarding program for 7 states. Created, updated, and managed software project timelines and schedules with a results first focus.
• Managing day to day aspects of the project, including directing all business, IT professionals and third party consultants to meet the goals of the project
• Hands-on collaboration with on/off-shore project teams to ensure timely quality delivery of all project deliverables within a regulatory environment.
• Following-up with stakeholders and other project managers
• Working closely with developers, for modifications to coding an meeting deadlines
• All appropriate Artifacts signed and posted to SharePoint
• Working with SME S for improvement operations processes.
• Identifying scope changes needed to be presented to the Change Control Board CCB
• Working closely with the intake team when providing the 50 90 LOE's level of effort
• Focused teams on business objectives and tracked progress to ensure project milestones were completed on time, on budget and with the desired results
• addressing issues and the software/hardware vendors
• Managing all aspects of the project including initiation, planning, executing, closing and controlling the transition to assigned team.
• Identifying and tracking critical path/activities, risks, contingencies and alternatives
• Performing ongoing review of program status as well as determining and implementing risk mitigation solutions, if appropriate
• Identifying and resolving project-related issues that have the potential to impact project deliverables

Confidential

• Managed 4 projects simultaneously involving 34 team members full-time and offshore with budgets of 617,000
• Using SharePoint as repository for all material provided or artifacts created, technical specs, business requirements, meeting minutes, approvals, change release documentation, charters, and gap analysis.
• Utilize the problem ticketing system to prioritize and resolve system related issues.
• provide customer support for all incoming associates
• identifying and managing project risk and developing risk mitigation strategies, escalating as necessary
• Tracking, escalating and resolving issues
• Communications and Change Management
• Testing and training
• Post project evaluation value realization
• Status reporting, including regular team and Steering Committee meetings
• Assessing risk and cross-functional impact and developing mitigation plans
• Working with business to make necessary modifications to the SOP's Standard Operating Procedures for adding the correct formula's and the correct processes
• Managing all aspects of product testing including test planning, documentation, execution, defect management and reporting
• Hands-on collaboration with on/off-shore project teams to ensure timely quality delivery of all project deliverables within a regulatory environment.

Confidential

• Managing day to day aspects of the project, including directing all business, IT professionals and third party consultants Corelink to meet the goals of the project
• Working with architect and business user's to determine the area's impacted and creating flow for visual, facilitating all meetings gather the appropriate information needed
• Working closely with vendor / meeting to discuss the impacts to the adjudication system and necessary modifications to system programs, input/output screens and reviewing reporting components for modifications
• Reviewing data warehouse expanding for appropriate information to be stored
• Managing remediation of all systems which may or may not be impacted for this initiative
• Responsible for Mapping Team, created project plan, tasks necessary for modifications and all validation tasks for backward mapping for the GEM's
• Responsible to Finance Neutrality, purchasing a neutrality tool for DRG shifting and working with the business area for understanding, testing of the tool, configuration and test scenarios for high-volume claims

Confidential

• Managed 3 projects simultaneously involving 28 team members full-time and offshore
• using SharePoint as the repository for all material provided or creation of artifacts created, technical spec's, business requirements, meeting minutes
• Approvals, change release documentation, charters, and gap analyses for future reference.
• Facilitated session gatherings to capture and document requirements for Data Informatics work stream functions and EDI Consolidated Gateway work stream, to include EDI X12 Claims transactions.
• Facilitated all session gatherings for capturing and documenting requirements necessary for the Data Informatics work stream functions, and EDI Consolidated Gateway work stream, to include EDI X12 Claims transactions in support of the integration
• Coordinate work for Business Analysts. Assign Business Analysts to Unit Testing tasks. Work with Trading Partners for connectivity issues liaison between customers and corporate staff or between IT and Business Units perform system matrix testing.
• Managed business analysts, EDI analyst, test analysts and development teams that are responsible for delivering all necessary large highly visible initiatives for this project from inception to completion
• Report status of projects to executive management via regular meetings, one on one conversations and executive steering committee meetings
• Following the PMO Project Management process guidelines and supporting the PMO governance model
• Managing all aspects of product testing including test planning, documentation, execution, defect management and reporting
• Managing quality assurance testing, including manual, automation and performance testing
• Assisted in the presentation to the Funding Request Committee for the projects under my assignment as necessary
• Negotiate for resources for the projects from within a matrix organization.
• Assisting in developing comprehensive system and user acceptance test plans
• Managed areas of interest business analysts, test analysts and project coordinators on:
• The CareFirst software development life cycle process
• Peer Review / Approval process
• Requirements process
• Quality Center QC process
• Overcoming specific issues on projects
• Facilitated all JAR and JAD sessions for the ICD initiative
• Involved in the peek review of Test Plans, Test Cases with the QA team to verify implementation of new features and enhancements
• Control the project schedule, budget, risks, issues and report any deviation to project key stakeholders/sponsors
• Clarity tool used for issue, risks and changed management as well as resources
• Worked closely with testing team to determine what scenarios had been needed and monitored all tasks and facilitated all defect meetings concerning the testing for ICD-10
• Prepare weekly status reports for project sponsors and business owners
• Conduct stage gate review meetings to obtain stakeholder agreement to move forward with the project
• Managed all levels of testing for initiatives, oversight for test plans and scenario's
• Clarity used for Centralized projects, resources, staffing and budgets inform impact of change
• working with NASCO on modifications to the application going through the NASCO process for changes,
• Supporting and managing FACETS multi-modifier initiative focusing on assessment of formula's which have been calculating claims incorrectly and causing very high penalties, which involved adjudication systems NASCO and FACETS
• Coordinates and monitors training efforts to ensure that necessary education tools are provided to employees
• Identifies and communicates training needs and schedules with training department projects staffing requirements for the business unit guides supervisors in coaching and counseling employees coordinates employee development and incentive initiatives

Confidential

• Managed the activities surrounding modifications to the CAS payment system and data exchanges accumulators , provider, member and benefit connect. The team includes Business Analysts, Developers and Project Manager
• Project Manager Responsibilities for delivering all business requirements, functional specifications, project plan, and test plan, UAT and signoff's.
• Managed Ecommerce WEBSITE online store project.

Confidential

Consultant Technical Project Manager / Delivery Manager/Helpdesk Manger

• Project: Authorization Feeds Modifications Staff Augmentation
• Managed the Supporting Authorization Feeds initiative and focused on review and modification of incoming and outgoing feeds. Coordinated 400 authorization file changes for testing.
• Managing all aspects of product testing including test planning, documentation, execution, defect management and reporting
• Help re-organize an set standards for the reorganization of the helpdesk area,

Confidential

Consultant enterprise Technical Project Manager / Enterprise Batch Manager / Enterprise Test Manager

• Project: Implementation WEB / Meta Vance Application
• Managed and coordinated the entire implementation from conception to completion.
• Managed several project managers and followed PMO Project Management process guidelines to support the PMO governance model.
• Participated with the Medicaid SME's in creating and monitoring files eligibility, claims and demographics which are submitted to the State through CMS through the MSIS
• identifying and managing project risk and developing risk mitigation strategies, escalating as necessary
• Managing all aspects of product testing including test planning, documentation, execution, defect management and reporting
• ConfidentiaL Consultant: Enterprise Technical Project Manager / Delivery Batch Manager Project: TPA self-funded program / integration e-mail system application / EDI
• Managed projects for a subsidiary of United Healthcare called JD Reynolds, Kaiser Permanente and United Healthcare
• Integration email System. The teams included Business Analyst, Developers, and other support staff.
• Migrated 5 sites consisting of 1,300 internal users. Analyzed and resolved inbound and outbound EDI issues 837/835/834 . Created and maintained maps for various EDI healthcare transactions.
• Oversee operational support for EDI platform and applications, including issue resolution
• coordinates and monitors training efforts to ensure that necessary education tools are provided to employees
• o identifies and communicates training needs and schedules with training department projects staffing requirements for the business unit guides supervisors in coaching and counseling employees
• o coordinates employee development and incentive initiatives
• ConfidentiaL Consultant EDS Project Manager / EDI Manager / Helpdesk tier 1 tier2 / Test Manager Project: Implementation of the EDI Middleware SYBASE
• Developed and maintained the project plan, milestones and documented reporting strategy for the execution of tasks.
• Assisted the business units to maintain 837/835/834 mapping standards. Assisted the account management in the evaluation of RFP service level agreements.
• maintain good working relationships with Trading Partners and ensure SLA Service Level Agreement are being met at all times
• Participates in resolving EDI clearinghouse/provider EDI issues
• Implemented HIPAA/EDI support team Help Desk Tier1, Tier2 and Tier3 reporting and escalating of issues.
• Troubleshoots new and existing EDI map issues
• Ensure accurate entry of EDI claims into Facets adjudication by transferring corrected claims from facets batch to AMISYS adjudication
• Remove claims from Batch that cannot be reconciled with current member demographic data and prepare for return to provider
• Report to management incorrect member data for correction in issuers files.
• Work on 837s, 835, 270/271, 276/277, 834, 820 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets. Create export and XML processes for Lotus Notes. Create EDI Export and Import processes and work with EDI Trading Partners, Payers or Vendors. Perform a range of telecommunications processes, including FTP, Dial-up, TCP/IP, Web transfers.

.

Confidential

Project Manager

Managed and coordinated planning, execution phases, and worked closely with AEP resources and the electric trading partners. Support intranet application for QA/QC, Accounting, Production and Distribution. Assisted in analysis, design and implementation of architecture, batch, and configuration and application server set-up.

Confidential

Project Manager / Coordinator Manager / EDI Coordinator / Delivery Manager / Test Manager

• Managed and coordinated planning, execution phases, and working closely with Sterling Commerce.
• Assisted in the retirement of the adjudication system Genelco and migrated members to FACETS adjudication system.
• Implemented HIPAA /EDI transactions 837, 835, 270/271, 276/277, 820, 834 and 997 acknowledgement .
• Worked closely with the Medicaid unit and managed tasks while modification to Trizetto FACETS adjudication for Medicaid enrollment Oversee operational support for EDI platform and applications, including issue resolution
• Managed day to day tasks for program changes to the CDJFS county department of job and family services welfare system modifications needed to current processes and align new requirements, worked closely with the business units
• Managing all aspects of product testing including test planning, documentation, execution, defect management and reporting
• Medicaid reviewing data in the cerrs application and transaction manager for the 834
• Managing quality assurance testing, including manual, automation and performance testing
• Work on 837s, 835, 270/271, 276/277, 834, 820 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets. Create export and XML processes for Lotus Notes. Create EDI Export and Import processes and work with EDI Trading Partners, Payers or Vendors. Perform a range of telecommunications processes, including FTP, Dial-up, TCP/IP, Web transfers.
• Assisted the account manager in evaluating RFP and service level agreements
• Assisted in Implementing HIPAA/ EDI support team helpdesk Tier1, Tier2 and Tier3 reporting and escalating of issues
• Opening remedy tickets for unresolvable issues from Tier1,2 processes
• Assisted client to support any outstanding issues with clearinghouses for inbound and outbound transaction

Confidential

Consultant: Project Manager / EDI Coordinator / Delivery Manager / Test Manager

Project: Implementation of EDI Middleware GENTRAN

Managed and coordinated planning, execution phases, and worked closely with Anthem. Assisted in the retirement of the adjudication system Genelco and migrating members to FACETS adjudication system. Managed installation of the server base application Gentran.

Project: IMPLEMENTATION OF MIDDLEWARE GENTRAN

• Managing and coordinating planning, execution phases, and working closely with Anthem to coordinated implementation and worked closely with Sterling Commerce.
• Managing on-site technical team for the implementation of the translator GENTRAN for HIPAA / EDI initiative
• Assisted in the retirement of the adjudication system Genelco and migrating member s to FACETS adjudication system
• Managed installation of the server base application Gentran
• Created all documentation for the import / export processes, modifications to existing maps
• Implemented HIPAA / EDI transactions 837, 835, 270/271, 276/277, 820, 834 and 997 acknowledgement
• Coordinates and monitors training efforts to ensure that necessary education tools are provided to employees
• identifies and communicates training needs and schedules with training department projects staffing requirements for the business unit guides supervisors in coaching and counseling employees
• coordinates employee development and incentive initiatives

Confidential

Senior Project Manager / Program Analyst / Project Coordinator /EDI analyst Adjudication System

• Manage on-site technical team to provide support for existing adjudication system while implementing new adjudication system META VANCE MAINFRAME ,
• Worked very closely with vendor EDS to implement the translator SeeBeyond
• Implemented 837, 835, 270/271, 276/277, 820, 834 and 997 acknowledgement transaction
• Coordinated and supported the EDI / HIPAA middleware product SeeBeyond, import / export process, implemented and enhanced existing schemas, provided support for e Xchange trading partners, e Gate Monitoring, control brokers, bobs, logs and journals
• MQSeries modification necessary for communicating back and forth to different platforms operating systems, middleware , changes needed to programs for sending data through messages as well as work flows
• Working closely with NASCO for EDI transmissions problems with claims adjudicating correctly with EDI transactions especially with 837I
• Coordinates and monitors training efforts to ensure that necessary education tools are provided to employees
• identifies and communicates training needs and schedules with training department projects staffing requirements for the business unit guides supervisors in coaching and counseling employees
• coordinates employee development and incentive initiatives

Confidential

Position: QCARE senior Program Analyst / Implementation of the Adjudication system

Positions: QSTATE /senior Program Analyst / Project Lead, Implementation of the Adjudication system

Confidential

Positions: Programmer Analyst/ System Analyst Industry: Healthcare

Confidential

Positions: Jr Programmer Analyst / Senior Computer Operator / Production Control Industry: Publishing

Confidential

Positions: Supervisor of Computer Operations / Help Desk Manager Industry: Financial Services Credit Card processing Confidential position: full time / Senior Computer Operator / Production Control Analyst Industry: Media