SUMMARY:

• Certified as a SDLC (PMPand Scrum Master and has more TEMPthan 15 years of relevant experience wif an excellent combination of Business and Technical skills.
• As a distinguished senior - level information Technology (IT) professional and a project manager, He retains extensive expertise in managing high volume, high availability applications and a proven ability to bridge technology and business goals to provide innovative solutions. He is a highly motivated leader showing professionalism and a get it done attitude wif proven success in engaging and managing highly skilled technical teams to design and deploy innovative application solutions tools and processes across operations as both a project manager and developer.
• A hands-on leader, often involved wif aspects of teh entire life cycle of a project from requirements gathering to ongoing maintenance, project planning, design, development, testing, and maintenance wif extensive experience managing and architecting big data systems, while rapidly adapting to emerging technologies.
• Full life cycle developer in a hands on practical manner.
• Extensive Regulatory Affairs Experience::
• CMS
• Federal Government (multiple departments)
• State Governments (multiple departments)
• Highway Departments
• NASD/SEC

TECHNICAL SKILLS:

Database Development/Administration: 10 Years SQL Server, Oracle 8i, 9i, 10g and 11g, Sybase, and MS Access Web Development - WebSphere Application Server, VSTS, ASP.NET standard and framework, C# Claims - NASCO, Trizetto Facets, QNXT JIRA user stories and tasks, Duck Creek Claims, Team Foundation Server (TFS). Extensive experience initiating, designing and managing Projects and Project Management offices wifin Healthcare Insurance, Investment Banking, Marketing, Mortgage, and Insurance.

Languages: C/C++; VB, ASP; PowerBuilder; Net; JSP; XML, Web Services

Software: LoadRunner; SAP Financials; HR, and Quality Management Modules) Content Management/Utilization Management SharePoint 2016 SaaS for utilizing 3 rd party imaging (Optics) and managing documentation made available over teh internet. Utilizing MS Cognitive Services

Project Management: MS Visual Studio; MS Visio; MS Project; MS SharePoint; TFS, Waterfall SDLC PMP; Agile; Scrum Master, JIRA, Primavera, Clarity, Plainview NAESB 1.6 not sure of version, but 1.6 is teh latest - Utilized at teh Salem Nuclear Power system In case of a Nuclear Shutdown.a

Healthcare Software Engines: NASCO, Facets, Diamond, QNXT, MHS, Medical Data ConversionCuram 5.05, Server and Database technologies - EDI, WAN, HL7 Interface Engine Healthcare quality measurement programs (HEIDS, PQRS, CMS CQMs) ETL, EDI

Supply Chain Management: (SCM), (ISCO) software Care Management

PROFESSIONAL EXPERIENCE:

Confidential,Boston, MA

Scrum Master/Product Owner

Responsibilities:

• This project was responsible for teh healthcare network for teh development of teh provider and member plan networks and portals.
• Responsible for Data Migration, Enterprise data consistency, incomplete data, identifying data gaps, finalized region specific network strategy, provider contracts, Handed off final regions and provider rates to actuarial, product, and regulatory rate and product filings, load provider demographics to appropriate system, analyzed premium parity, and provider/network build out. Utilized Plainview Develop ETL links wif Informatics for teh portals. Provider Credentialing system for provider enrollment
• IBM WebSphere Portal wif an Oracle Database 11g
• Retail marketed healthcare plans to providers, and members.
• Teh team collect, prioritized, and executed projects providing teh most value.
• Utilizing MS Cognitive Services, teh AI technology dat we utilized for teh development of Machine recognition and develop is fundamental across industries and products, spanning from smartphones and automotive.

Confidential, Phoenix, AZ

Scrum Master/Program Manager/Product Owner

Responsibilities:

• Responsible for teh preparation of prior authorization environment. Gatheird information ended for coordinators/case managers to determine continued authorization wifin teh Medicaid program.
• Project Managed teh development of a software claims application dat automates teh receiving and pending of claims. Project managed a team to research and develop reports on claims received wifout prior authorization, and review eligibility and benefit coverage.
• Teh system provided accurate, timely and insightful analysis in response to ad hoc requests and issues
• Identifies new claims overpayment root cause concepts
• Tracks ongoing projects
• Analyzes overpayment data while providing a Medicare focus
• Credentialing —for a detailed process dat reviewed teh doctors’ qualifications and career history including their,, residency and licenses, as well as any specialty s. This was a direct EDI connection to Enrollment. Credentialing must be completed upon teh hire or enrollment of a new doctor and regularly afterwards to abide by teh standards set forth by regulatory and accreditation organizations such as teh National Committee for Quality Assurance (NCQA) and Teh Joint Commission (TJC). These were accomplished along wif teh interface wif teh QNXT Claim Engine.
• Manages and provides reporting for constituent files
• Care Management
• Reviews and analyzes contract management reimbursement terms ad policy.
• Identified improper payments
• Investigates medical claim data (ICD9/10)

Confidential

Scrum Master / Product Owner

Responsibilities:

• Teh Missouri Department of Health and Human Services Medicaid Project Manager responsible for providing senior level project management and technical leadership for teh Missouri Department of Health and Human Services Medicaid.
• Project managed teh re-engineering of a large eligibility determination and enrollment system. Managed teh analyst, planning, build, and Release Management of teh Data Warehouse for teh Medicaid reporting system plan which encompassed Eligibility Determination, Enrollment, and Financials. JIRA
• This DW was a Enterprise level development.
• Integrated Case module - Worked wif teh team for teh new merger dat required teh business objects to contain teh configuration data for an integrated case types dat were lost during migration along wif teh consolidated case information. Wif PlanView PPM Enterprise we set financial targets for teh Programs portfolios. This was for budgeting forecasting, tracing and benefits.
• Utilized Planview for teh department Strategic Planning, Program/Project Management, Road Mapping and Financial Planning and Tracking
• Onboarded many new resources wif teh operations and functionality of Plan View
• Re-engineered teh Management Portal as a Standard .Net Project wif teh following basic functionality:
• Search - allowing users “staff” to query clients by name, either broad or a partial match. A sign-in form, browsing filter to shorten list and separate existing members from current clients, a basic sign-in form, which also included teh manager console to create teh accounts, update entries and send messages to staff wifout utilizing IM. Content Management and HL7
• Pipeline Reports dat interfaced wif teh modified existing Data Warehouse. Utilizing Informatica we developed our ETL links
• Utilized IBM Curam for teh Meades project to create and design teh Medicaid Social Services Program.

Confidential, Pittsburgh, PA

Program Manager

Responsibilities:

• This project consisted of designing, development and implementing a Private Exchange dat was available to Fully Insured and ASO groups wif contracts from + groups. Teh products offered were PPO, HAS, Integrated Pharmacy Plans, Stop Loss for ASO, Term Life/AD&D, Long Term/Short Term Disability, Dental, and Vision.
• Utilizing full DevOps
• Release Manager ( among duties was Release Traing of resources).
• Data Migration of a Amisys claim engine to a newer version of Trizetto’s QNXT Claim system
• TFS - Team Foundation Server for Project and Requirements Management, Version Code Control
• Responsibilities included: Service performance program impacts, regulatory/legal/contract exposure,
• Impact assessment, preliminary cost estimates and benefits. Responsible for full life cycle development utilizing management, Plainview, and MS Project, which included SIT and UAT testing.
• Ecommerce site for teh sale of Health plans:
• Content Management System (CMS) to manage teh creation and modification of teh digital content for Web-based publishing, version control, indexing, search, and retrieval.
• Supply Chain Management for tracking and controlling pharmacuticals.
• Utilized HighJump supply chain management for teh company’s shipping a DME for Oxygen, and other Durable Medical Equipment. This was a 6 month implementation
• We utilized Kibo dat empowered teh providers, members, vendors and retailers to achieve optimal performance of B2C and B2B commerce, wif customer experiences while serving as lead contact for Sales, and BDM during proposals
• Teh first layer of teh architecture aims “front line” serving teh static components of teh website. It was composed of two NGINX web servers of an average size, on which was installed Varnish, a cache management software.

Confidential, Baskin Ridge, NJ

Contractor Scrum Master/Product Owner

Responsibilities:

• Project managed teh decommissioning and data archival Legacy Diamond Medicaid Enrollment and Claim systems for teh states of Pennsylvania, New York, Florida, and Maryland. This was an Enterprise development effort across multiple Data streams and points. These assets were migrated after teh business run-out for a full decommissioning.
• Systems included enrollment, provider benefits, pricing, claims adjudication and other process needed to enroll members, receive and adjudicate/pay claims, Care Management.
• Hands on software developer.

Confidential, PA

Project Manager/EPMO

Responsibilities:

• Utilizing company's proprietary software "Payer Database," we were able to support clients HIPAA 5010 / ICD-10 mandates by assessing mappings, processes, view relationships, maintain/add processes, trading partners, applications, EDI links, transaction changes and to maintain these EDI transaction changes.
• Utilized CMS COTS software for teh EDI mappings
• 2This was a project dat required teh database schema to be modified for integrated wif teh Rating module utilizing Duck Creek’s Rating and predictive modeling functionality and analytics.

Confidential, Newark, NJ

Project Manager/EPMO

Responsibilities:

• HIPAA 5010 and ICD-10 Project. Migration planning wif readiness analysis to determine teh organizations knowledge level of teh overall HIPAA 5010 migration. Completed Project Charter, Project Plan, and Gap Analysis identifying all impacted areas and create an inventory for business and technical components dat will need evaluating.
• Gap Analysis- Identified, captures and categorized all differences between teh versions and across transactions. Determined how teh changes in 5010 impact current business operations and continue to define and develop specific business and technical requirements wifin and across transactions.
• System Implementation - Reviewed and updated mappings, modified business rules dat has changed, in corporate new business rules, and updating and applying custom edits.
• Testing which required teh developed test plans wif defined test scenarios for all systems, interfaces, transactions, reports and release management. End to end round trip testing wif all payers, trading partners, clearinghouses, vendors and third-party administrators.

Confidential

PROJECT MANAGER

Responsibilities:

• Senior Project Manager Development/Support for all software relating to Data Content Management (DCRMS), Reactor Thermal performance (PI), Nuclear radiation detainment (ProRad), and full project management (Primavera P3) “re-fueling” among 46 other vital both Nuclear and non-Nuclear specific applications wifin teh $10 Billion Salem Nuclear facility.
• As project manager me was often teh client representative needed to determine and implement teh exact needs of teh client, based on knowledge of teh system requirements he/she is representing.
• Utilized PSE&G proprietary Financial Modeling tool for financial metrics, data metrics, market dynamics, key fundamental differentiators, and competitive positioning. Teh ability to adapt to teh various internal procedures of teh contracting party, and to form close links wif teh nominated representatives, is essential in ensuring dat teh key issues of cost, time, quality, and above all, client satisfaction, can be realized. Conducted closing of project and reviewed performance for project managers and team leads.

Confidential, Jersey City, NJ

SENIOR PROJECT MANAGER / LEAD PROGRAMMER

Responsibilities:

• Management responsibilities included, performance appraisals.
• Teh Confidential Online Trading site was a securities trading, banking, credit cards, and provided other financial products online dat accessed a global financial hub, consisting of multiple plat forms, links, servers and programs. Trading floor and back office. Working knowledge on bonds, stocks, and mortgage backed securities, options, futures, emerging markets products and securities lending products. Knowledgeable and experienced in object oriented technologies (UML & RUP), system architecture, logical-mathematical modeling,
• Statistics, Operations Research, design and development of relational database and graphical user interface.