Project Manager Resume Profile

Project Manager

Professional Profile

Experienced Manager with over 25 years managing hospitals and projects in clinical, financial and marketing services. PMP, MBA, credentials. Led project initiatives with budgets over 860K with multi-disciplinary and cross functional teams of over 100 employees, and managed operations over 35 million in revenues.
Effective and innovative leader with proven success in building motivated teams with strong communication processes to identify strategic issues, resolve problems, improve efficiency, and initiate changes to optimize productivity and create profitability in highly complex organizations. Has valuable experience maintaining effective customer relationships and bridging the gap between physicians, clinical staff, technical support, and operations.

Areas of Expertise

Project Management PMP
Financial Accounting Systems
Revenue Cycle Management
Pharmacy Benefits Management
Electronic Health Records
HIPAA and HITECH Regulations
Medicaid and Medicare
Business Intelligence
EDI X12N transactions
Healthcare Administrative Management
Marketing and Sales Management
Business Process Improvement

Experience:

Project Manager - Learning Consultant

Confidential

Developed a corporate wide training program to provide services for dual eligible Medicare and Medicaid recipients. Components of the program include clinical, LTSS, behavioral health, pharmacy, customer call center, claims, appeals and grievances, and quality management.

Project Manager - Consultant

Confidential

Developed and implemented the Corporate HIPAA Compliance Program for the medical banking services of 140 healthcare customers. Consultant for HIPAA HITECH privacy and security issues across the enterprise. Developed new HIPAA HITECH Privacy and Security Policies and plans to comply to the new HIPAA Omnibus Rules and CORE EFT and ERA Operating Rules of the Affordable Care Act.

Business Project Manager

Confidential

Business Process Management:
Electronic Health Record - Led four projects to develop and implement an EHR accessed through a web portal containing patient and provider profiles, e-prescribing, drug pricing, claims submission, and electronic RAs.
Disease and Case Management Services company's first for the Confidential Program. A preventative health program was implemented through the development of a Confidential and an EHR with data from medical claims, patient interviews, and clinical follow-up. Budget: 886K
Clinical and Electronic Health Records Systems:
Business Intelligence, EDI, and Data Services:
Financial Management Systems:
Confidential's Financial Claims Payment Operations of the state's 971 million budget. Managed accounting reports, budgeting, banking services, and TPL recovery.
New Hampshire Medicaid's Pharmacy Management System. Managed the upgrade to claims processing, call center, reporting, rebates, TPL recovery and developed the company's first of e-prescribing system. Budget: 885K
Virginia Medicaid Pharmacy Administrative Management Program which included a Drug Utilization Analysis Program, Reporting, Formulary Management, and call center for PAs.
Pennsylvania PACE Pharmacy Program- Implementation of an updated Pharmacy Call Center operation and reporting system. Budget: 272K
Business Intelligence Program Led the design and implementation of a business intelligence system using Informatica and Cognos to replace 1500 legacy reports for the Pennsylvania PACE Pharmacy Program.
EDI - Led implementation of Virginia Medicaid's EDI Services for the first HIPAA compliant MMIS program in the country. Provided technical analysis for the production of the 835, 820 and 834 HIPAA X12N transactions.
E-prescribing - Developed and implemented new program integrating physician's prescribing with prior authorization, trial adjudication and prescription routing to pharmacies. Budget: 413
Automated PAs Developed and implement new prior authorization application with clinical rules engine to automate the process and eliminate physician calls to the pharmacy call center.
Business Process Models developed using ERwin Process Modeler for Medicaid MMIS claims and payment services to implement new SOA architecture, develop state of the art products, and enhance existing functionalities.
Managed and prepared responses for Medicaid RFPs. Wrote the sections on the project management processes and methodologies used in managing pharmacy systems implementations.

Project Manager - HIPAA Consultant

Healthcare Provider Services

Confidential

Administrator and Financial Manager of several healthcare organizations managing over 100 employees and 12 direct reporting managers. Managed finance and accounting, billing and claims, marketing, physician relations, personnel, clinical services and general facilities support.
Revenue Cycle Management - Developed procedure manuals and trained staff in over 30 hospitals.

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