TECHNICAL SKILLS

• Certified Scrum Master
• Certified PMP
• Certified Business Analyst - CBAP
• ITILv3 certified
• Agile Certified
• Medical Writer/Editor
• MS Dynamic CRM certified
• CMS Medicare/Medicaid SME
• ICD 9 - ICD 10 Conversion, SNOWMED, LOINC interface/integration.
• Revenue Cycle Project Manage and Analytics SME x 12 years
• Data analysis and Data analytics SME x12 years
• Data integration and interface SME x12 years
• HL7/EDI SME x8 years
• Population Health and Public Health SME
• Oracle App Expert - EPM, HCMC, PeopleSoft, Hyperion
• Healthcare Insurance Payer Systems (Power MHC System) x10 years
• SME with EMR/EHR full life cycle implementations, upgrades, and conversions, to include paper-to-electronic.
• SME with Enterprise level system implementations (10+ years) exceeding $30 million dollar projects.
• Meaningful Use SME, HEDIS/ACO/PQRS measure writing/data validation
• Serve as the Subject Matter Expert for all aspects of the HITECH Act.
• Claims Analysis & Management
• SME with Electronic Data Interchange (EDI) x8 years and Data warehouse/BUS
• SME in Clinical workflow, design, execution, and training
• CMS Managed Care Contract SME
• Over 12 years of data collection and transmission with tools such as CRM, EHR, EMR, HIE, HL7, etc.
• Expert EMR Build Analyst for ambulatory and acute care facilities.
• EMR SME - Project Manager, Implementation Manager, Revenue Cycle, Analyst, and trainer for multiple EMR’s to include Cerner, EPIC, Allscripts, eCW, NextGen, Greenway, McKesson/GE-Centricity, Athena, Meditech

PROFESSIONAL EXPERIENCE

EHR/Health Plan Implementation Project Manager

Confidential

Responsibilities:

• Conversion of multiple ambulatory clinics under one EHR instance.
• Coordinated the establishment of the Mt. West Region PMO. Hired/Lead/Trained 14 project managers.
• Lead all clinical project activities to include EDW, servers, interfaces, hardware and software needs, networks, infrastructure, Data conversion, chart abstraction, HIE, registries, RCM, training, clinical content, MIPPS, HEDIS, STARSNCQA, population health, testing, mock go-live activities, and post go-live optimization with transition to support.
• Managed stakeholder communication, vendor management, timelines, project plans, weekly status reports.
• Configure/build/train on eCW and NextGen platforms for multiple ambulatory facilities - clinical staff and providers
• Multiple ambulatory EHR programs - eCW, Allscripts PM, Athena, Touchworks, GE Centricity, NextGen, Greenway
• Clinical breast trial project manager - managing patient population, communication, data pulls, reporting, outcomes

Data Developer/Project Manager

Confidential

Responsibilities:

• Lead efforts to establish the Pop Health Data Analytics Department.
• Perform steps required to facilitate extract of data from partner EMR and 3rd party data vendors.
• Expedite the development and approval of agreements/contracts to perform the data extraction work.
• Establish and maintain a process to acquire and load clinical data into the population health platform.
• Working with health care providers and Cerner, support the validation of clinical/EMR data.
• Work with software vendor (Cerner) to complete steps required to load data to the population health platform.
• As needed, use Cerner data upload utility (HIDUU) to upload data to the HealtheIntent platform.

Confidential

Program Manager

Responsibilities:

• Responsible for establishing and standing up the CAMC ACO and Population Health Departments.
• Analyze and process improvement work to identify opportunities to enhance satisfaction and value to user.
• Identify and implement ways to improve workflows, processes, and systems
• Meet with users to document high value use cases, identify and understand challenges, and identify adoption approaches.
• Provide feedback and user insight to improve the system for patients and clinicians.
• Run and compile operational reports.
• Train doctors, nurses and clinic staff on using systems and tools.
• Support doctors and nurses in their ongoing use of systems and tools, adapting approaches to specific clinic needs.
• Development of program performance measures and content for program dashboard and content for performance summaries.
• Assist with activity data extracts and analyses for regular updates to program reports and performance summaries as needed.
• Maintain contact list of key administrators and physicians for routine distributions.
• Conduct chart review as needed for problem solving and quality reviews
• Enhance patient experience through courteous telephone and patient portal interactions.
• Maintain confidentiality and privacy, consistent with HIPAA guidelines.

Confidential

Ambulatory EMR Program Manager

Responsibilities:

• Managing project plan, tasks and deliverables for internal staff, as well as vendor management.
• Managing internal budget and vendor/consultant budget.
• Provider engagement with requirements gathering.
• Executive and stakeholder communications for summary of current state status reports.
• Presenting to steering committee’s for decision-making purposes
• Managed Care Contract Management/CMS, Quality and Reporting
• Identify, mitigate and manage risks and issues impacting implementation.
• Responsible for designing, configuring, testing, implementing and supporting the clinical and ancillary healthcare information systems used for the delivery of patient care and other supporting functions of the organization
• Evaluate customer requests for system changes, data retrieval requests, system performance problems and optimization pportunities, and will participate in the timely resolution of these activities
• Testing the system, including any configurations, customizations and new releases, prior to production implementation
• Assisting with the development of ongoing maintenance support procedures
• EMR implementation for Athena, GE-Centricity, Cerner and Allscripts Sunrise projects.

Confidential - Austin, Tx

Senior Program/Project Manager

Responsibilities:

• Managed timelines for ongoing projects - Cerner/Allscripts/Athena implementations and conversions
• Revenue Cycle Program Manager
• Cerner Managed Care Contract Management/CMS - Build and Load
• Created communication plans to all stakeholders and business owners
• Created executive summaries around project status
• Managed project plan and deliverables
• Managed and assigned all tasks and owners around the deliverables.
• Created and implemented workflow and training for all ambulatory staff.

Confidential - Dallas, Tx

Manager of Applied Clinical Informatics for Acute Care

Responsibilities:

• Vendor Management
• EHR Implementation interfaces, training of Athena, Cerner, and Allscripts for 18 full life cycle go-lives.
• Incident Management
• Clinical Strategist
• Internal Project Management
• Population Health/Public Health
• Quality metrics and initiative analytics (Local & State)
• Revenue Cycle analytics
• Cerner Managed Care Contract Management/CMS - Build and Load
• Meaningful Use Implementation
• Data mining and analytics - EDW
• Interface/Integration analyst

Confidential - Coppell, Tx

Senior Clinical Healthcare Solutions Architect

Responsibilities:

• Provides clinical direction and guidance for clinical solution development in ambulatory and acute care settings.
• Responsible for gathering requirements as it pertains health informatics, build and implementation of Athena.
• Build and Implementation of CBO metrics and Meaningful Use according to client participation
• Can code quality metric definitions based on a variety of EHR presenting system data models for Cerner and Centricity.
• Uses clinical knowledge and expertise to define disease states for data tag functionality.
• Designs powerful dashboard visualizations and ancillary reporting for clinical analytics solutions.
• Expert in PrecisionBI build application features and functionality
• Create and merge Revenue Cycle program for new facility acquisitions
• Cerner Managed Care Contract Management/CMS - Build and Load
• Provided guidance over the ERP and EDI systems and transitioned them into the CBO.
• SME with TR3 implementation guidelines, HL7, file types, and real time transactions.
• Participates in software implementation and/or upgrade projects associated with clinical presenting systems.
• Provides leadership throughout the clinical solution design and integration process.
• Provides guidance with regard to design best practices, procedures and techniques associated with clinical data.
• Provides clinical systems expertise and training to non-clinical Healthcare Solutions Architects as needed.
• Writes and edits documentation such as customer requirements, technical specifications, training and reference content.
• Keeps current with emerging trends in healthcare analytics and provides recommendations for new solution offerings.
• Provides customer feedback to the PrecisionBI organizations to continuously improve our solutions.
• Provides on-site and web-based customer training on the features and functionality in conjunction with clinical solutions.
• Supports the sales demonstration environment and product demonstration needs of the Sales organization.
• Supports Services organization as needed to help resolve customer issues.

Confidential - Irving, Tx

Senior Program Manager

Responsibilities:

• Responsible for day-to-day operational management of all activities and functions in the designated program area within the Information Management Strategy and Application Division, including building, developing, implementing, and evaluating program policies, procedures, and standards. Also, determining and monitoring program budgets, providing technical advice and/or oversight to staff or other departments in ambulatory and hospital settings.
• Program management design of MU matrix to include implementation and training for case management, acute care
• Ambulatory, in patient, oncology, LIS Cerner, Epic, Athena, eClinicalWorks, Centricity, and Allscripts EMR models.
• Budget and financial administration – developed and managed detailed budgets, tracking all capital and operational expenditures and regularly reporting the status of all assigned projects.
• Facilitate enterprise standardization and rationalization, managing and updating the Clinical Strategy line portfolio.
• Manage all aspects of application end-user rolls, responsibilities, and assignments.
• Evaluate and design all clinical workflows for all involved providers and entities.
• Oversee the implementation of all projects – EMR implementations, government and corporate initiatives, vendor relations
• Conduct research into all legal issues and contracts regarding the project.
• Communicate with all stakeholders, vendors, staff and internal teams to facilitate understanding, ownership, and accomplishment of project goals and objectives.
• Cerner Managed Care Contract Management/CMS – Build and Load
• Interpretation and definition of the MU regulatory requirements, implementation guidelines and train physicians on MU.
• Liaise between the project teams, technical and clinical, to communicate the project goals in terms both teams understand.
• Organize and collaborative team structures to include Health Plans, IT, Analysts, BI, Finances, Revenue Cycle,
• Ability to articulate issues caused by EDI specific market changes and expert understanding of how they affect operations
• In-depth knowledge of state interchange transaction protocols related to EDI transactions and claims formatting.
• In-depth knowledge of Texas Set rules and guidelines, as well as other states
• Life Cycle Management – Manage the product life cycle for a set of related software programs.
• Manage portfolio of applications for relevant system, and fit them within enterprise architecture.
• Conduct release planning for all go-lives, upgrades, or implementation projects, as well as contract management for such.
• Design and develop application integration and enterprise architecture.
• Conduct pre-implementation gap analysis, scope definition, requirements, mapping, metrics, KPI’s and ROI.
• Manage and construct project scope, project plan, overviews, dashboards, and reporting.
• Document all project events and milestones
• Managing conflict between individual project groups
• Identifying and evaluating all resources needed for the project

Confidential – Richardson, TX

Senior Business Analyst and Senior Project Manager

Responsibilities:

• Liaise with business partners to understand business functionality and their business needs.
• Responsible for supervising direct reports both FTEs and contracts, providing guidance and mentoring to ensure successful completion of goals and objects.
• BA Lead activities including managing multiple development projects, development groups, and/or application support functions for major business segments for Case Management and PBM Cerner Models, as well as Athena and eCW. Managed Care Contract Management/CMS – Build and Load
• Responsible for maintaining functional and non-functional specifications in a portfolio of systems/applications designed to meet business requirements throughout project and program lifecycle
• Formulates and defines system scope and objectives through research and fact-finding combined with an understanding of applicable business systems and industry requirements
• Solicits and documents the functional specifications to assist the Solution Architect in the design of technical structures based on the existing standards and processes to meet business requirements
• Provides strategic support in order to document and appropriately capture functional specifications according to rganization process in alignment with overall Change Framework and IT Operating model
• Collaborate with the Solution Architects, Application Security, Application Developers and Testers to ensure they understand the functional, technical and business requirements
• Configures system/application, security settings and options to ensure business requirements are fulfilled
• Manages project tasks assigned within scope, quality and timeframe allocated with PM supervision
• Responsible for all operations within Revenue Cycle and Claims department
• Developed and implemented standard operational procedures for medical claims department.
• Provided education and training of providers regarding appropriate billing procedures.
• Responsible for a claims volume of over 10,000 claims per week.
• Established quality and production standards for claims department and monitored department performance to ensure a claims turn-around time of 7 to 14 days.
• Analyzed claims data for accuracy of billing, as well as the investigation of potential fraud and abuse.
• Responsible for maintenance of system support files including vital ICD-9 and CPT databases.
• Managed and supervised 10 claims examiners including hiring, performance evaluations, payroll, and scheduling.
• Participation in organization-wide quality improvement program to ensure compliance with all HCFA requirements and HEDIS reporting measures.
• Expert with sending and receiving information using EDI.
• Expert with EDI setup for software vendors, clearing houses, pharmacies, and service bureaus.
• Worked with Care Coordination team and member benefits management team on various projects.

Confidential - Ft. Worth, TX

Manager – Business Intelligence

Responsibilities:

• Consult and work closely with business leaders to understand and implement both strategic and tactical initiatives.
• Liaison between all areas of the company and the Information Technology (IT) department and played an active role in project life cycles by reviewing issues and providing recommendations and resolutions.
• Responsible for collecting, documenting, and analyzing business requirements of current and proposed process solutions to define project scope and offer appropriate recommendations.
• Gathered requirement and translated them into technical & functional specifications for ICD 9 to ICD 10 project.
• Formed the ICD-9 to ICD-10 conversation and impact team.
• EDI setup, maintenance and functionality for payer and payees, as NTSP owns Care N’ Care (Medicaid insurance)
• Budgetary management and oversight for the implementation and adoption of MU compliant EHRs.
• Training and implementation of MU participating physicians groups.
• Clinical lead for software conversion projects in conjunction with Cerner EL and analysts, Athena, eCW, and EPIC.
• Train nurse reviewers in coding and chart reviews and CBO (central billing office) claims processing, coding and reconciliation.
• Analyzed health management programs including: data collection, validation and outcome measurement, financial, pharmacy, claims, provider, and member data for IRS, CMS, HHSC, HEDIS reporting. Cerner Managed Care Contract build and load.
• Provide advanced analytical support for business operations in all or some of the following areas: claims, provider data, member data, clinical data, HEDIS, pharmacy, external report.
• Ensure compliance with federal and state deliverables reporting requirements by performing data quality audits and analysis.
• Create and build a complete data warehouse to include automated queries and reporting capabilities.
• Data warehouse architecture, application design, systems engineering, SDLC and integration using various tools, MS SQL SERVER, Oracle, and Microsoft Access.
• Building/developing SQL queries, scripts, reporting and ETL processes including, Oracle Developer, Oracle Discoverer, Oracle Reports; Microsoft SSIS, SSRS, SSAS, Tableau, QlikView, Suite, Microsoft Office Suite, Microsoft Application Basic
• Use of various Data Warehouse/Data Marts
• Internal data cleansing and data reconciliation analysis.
• Trend analysis in various functional areas of health care management.
• Create and generate reports through MS-Excel, MS-Access, and SQL using Business Rules and Objects to interface and direct links to core databases (ODS/EDW).
• Produce reports for and interface with senior management and internal and external stakeholders.
• Gather and interpret business requirements and monitor data trends to proactively identify issues.
• Execute data changes and update core systems as needed.
• Handle multiple projects and timelines effectively and communicate risks and issues to manager regularly.
• Interact professionally with a diverse group, including executives, managers and subject matter experts.
• Understand and manage organizational change and provide leadership to a team.
• Elicit high-level requirements for any project type through client interviews, document analysis, requirements workshops.
• Critically evaluate all member benefit efforts, initiatives, and projects.
• Decompose high-level information into details, abstract up from low-level information to a general understanding and distinguish user requests from underlying true needs.
• Present information gathered back to the business clients in the format of business requirement documents, use cases, and/or screen designs.
• Collaborate with developers and subject matter experts to establish the technical vision and analyze tradeoffs between usability and performance needs.
• Develop project level strategy and create and execute test plans.
• Develop and deliver documentation and training, also provide training and mentoring.
• Extract, load, model and reconcile large amounts of data across multiple system platforms and sources.
• Model data using SQL and/or other data warehouse analytical tools.
• Implementation, build, testing, training and maintenance of multiple EMR’s across the company and in partnering with multiple hospital systems, to EPIC – ADT/Cadence/Prelude/Resolute; Allscripts, Centricity, Cerner; Athena and eCW.
• Also work with LIS and PBM conversations and implementations.
• Plan and implement the overall analytics and business intelligence strategy
• Lead the design and development of analytical projects designed to understand key business behaviors that drive customer acquisition, retention, and engagement
• Identify opportunities to develop forecasts, statistical models, segmentation schemes, and data-driven analyses to drive marketing and merchandising efforts around customer acquisition and conversion
• Discover new opportunities to optimize the business through analytics and statistical modeling
• Partner with the Technology teams to deliver a stable and highly available reporting platform
• Work with business owners to identify information needs and develop reporting; primary partners include the management team, finance & accounting, marketing, online retail, merchandising and operations
• Oversee all aspects of analytics and business intelligence projects
• Develop and maintain reporting and analytical tools, including Business Objects
• Develop KPI dashboards
• Created and maintained a Revenue Cycle Department
• Integrate web analytics into transactional and customer analytics
• Hire, train, and supervise Analytics team and ensure that team meets the reporting and analytical needs of the business users