SUMMARY:

• Over 20 years of management experience in large, HealthCare IT environments (focused largely on Medicare and Medicaid, but commercial as well) managing process design/redesign and development of technology solutions to align with organization vision and strategy. Led the development and deployment of numerous programs, projects and products in both Managed Care and Fee - For-Service environments.
• Developed and led systems request prioritization mechanisms, process design, architecture definition, and system implementations with robust quality and delivered within time and budget constraints. Managed deployment of systems at client-sites, made client presentations, and led successfully the development of new business development and operational management of that business after acquired (process design, software development and infrastructural). In addition, my experience within the Managed Care environment (11 + years) has included extensive process work with systems prioritization mechanisms, innovative work with PBM process/relationship management, Vendor Management, and numerous systems implementation in a very tough, Tennessee Medicaid Managed care environment.
• Managed Care
• HealthCare Insurance
• Systems Request Prioritization Processes
• PBM Process Management (Medicaid Managed Care environment)
• PIP (Performance Improvement Processes)
• CMMI Methodology
• Matrixed Resource Management
• Collaboration
• ISO 9000 Quality
• Security Management
• Program Management
• Business Case Development
• Project Manager Management
• Program Success Measurements
• SDLC
• Service-Oriented Architectures
• Workflow Automation
• Strategic Initiatives
• Vendor Relationships
• CISCO
• Change management
• Network Support
• Resource Management multiple locations
• Superior Communication skills
• Financial Accounting; Knowledge and Management
• Web Application Development
• Systems/Application-Integration (Middleware)
• Agile
• Revenue Cycle Management
• EHR Implementations
• Cerner Interface Development and Deployment
• Application Development and Deployment
• Risk Management
• Project Management
• Deep COTS Implementation experience
• Vendor Management
• Change Control Management
• Program Compliance
• Technology thought leadership
• Project Risk Management
• Business Case Development
• HIPAA
• Testing Guideline Development and Implementation
• ICD-10 Strategy and Deployment
• Service Level Agreement
• 17 years Medicare and Medicaid Business/Systems Experience; 3 Years Commercial
• Ecommerce
• External Trading Partners
• Process Improvement
• Enterprise Governance
• Compliance; tightly controlled and managed
• Large Scale Systems Conversions
• Multi-tasking/Problem Solving
• Database Analysis
• Data Cleansing and Conversion
• Team Leadership
• C-Level relationship management
• Client
• Streamlined processes with technology solutions to deliver cost effective systems, and delivered critical projects within budget and time constraints.
• Successfully developed large scale new business/Program Portfolios; managed and continued to grow that business along with successful client relationships.
• Infrastructural management (within matrix capacity) in large, national data center
• Budgeting for multiple programs in the multiple millions, and performing at and below those constraints

TECHNICAL SKILLS:

Languages: Cobol, RPG, Easytrieve, Ads/O, XML, SQL, .net

Databases: Oracle, MS SQL Server, DB2, IDMS/R, MS Access

Application Servers: WebSphere, Oracle Application server

Operating Systems: Windows 2000, UNIX (Solaris, AIX), Z06, Linux

Methodologies: CMMI, Waterfall, ISO, Crosby, Agile

Other Software: Microsoft Office (Excel, Word, Access, Outlook, Visio, PowerPoint, Project), Sharepoint

Methodologies: Portfolio Management (extensive past 8 years); SDLC, Waterfall, Agile, Risk Analysis

PROFESSIONAL EXPERIENCE:

Senior Program Manager

Confidential

Responsibilities:

• Management PMO team (3 PMs, 50 matrixed development staff of 50) for $18 million account
• Multiple successful implementations of several software projects with hours exceeding 20,000 and cost savings exceeding $300K; expanding of interoperability with other Toll companies generating additional revenue of $200K per year
• Implementation of various quality improvements to process, leading to 75% reduction in defects in release implementation

Program Manager

Confidential

Responsibilities:

• Management and Technical solution contributions to recent Confidential contract win; contract value $200 million plus
• Significant role in staff ramp-up required to service the contract
• Contract involved the implementation of a hardware/software monitoring tool across multiple implementations within coastal US, as well as the management of a infrastructure tool suite, also used extensively at several sites
• Program Management for process involving large Data Center footprint reduction; this involved the movement of significant data center resources to an outsourced vendor, resulting in a net savings of $5 million plus

Director, Applications/Client Services

Confidential

Responsibilities:

• Managed Client Services Systems (all development and support for four national accounts), consisting of 2 managers, 4 Project managers, 14 Systems/ Programmer Analysts with development/maintenance duties on 150+ systems (EDI interfacing, claims processing, claims payments, financial reporting, multiple customer portals) and several platforms (Multiple SQL Servers, Web-based architecture, IBM Z06 mainframe) ; all programs run using standard SDLC processes and developed to internally based and controlled standards, with associated project planning, featuring measurements, risk management and often SLAs; adhering to high compliance standards (HIPPA..Etc.) auditable
• Led process improvement effort and developed software that dramatically reduced the mail cost by $1M per year with a key document; led business case developments, requirements development, testing, implementation (including custom developed interfaces) for each project phase, supervised feature delivery and modifications in final phase; PIP (Process Improvement Processes) projects were part of the modifications and continued to increase savings opportunities
• Key role in acquiring and managing $60 million dollar Infrastructure Design/Implementation/Software Development Process Account ( Confidential Medicare Advantage/ Confidential ); negotiation and conflict management skills successfully used and vitally important to acquiring and managing this account; highly collaborative environment consisting of vendors, clients, IT applications professionals, and Matrix managed infrastructure team in the CDS national datacenter; CDS roles included Infrastructure, Business Analysis and Requirements Definition, Testing/Quality Assurance, and Data Retrieval and Reporting
• All milestones associated with this Program (COTS CNSI ECAMS Implementation) have been met and the full production implementation remains on schedule; both Confidential and Confidential have recognized this Program as a great success; 100% compliance with all Service Level Agreement measurements (included service desk incident and request measurements)
• Responsible for contract initiation and ongoing account management associated with the implementation of Confidential Section 1011 UARS Claims Processing system for Confidential Services; key role in developing the contract and leading the implementation; value $6 million dollars; support recognized each year by client as outstanding
• Tenure as Account Executive/Program Manager for Confidential ( Confidential Medicare Contractor) has included implementation of numerous process improvement projects for TrailBlazer Part A, and Part B Non-Base systems, resulting in tightly controlled, high accuracy processing environment; ISO Quality Standards met consistently with high accuracy and major improvements to support capabilities implemented
• Business development activities contributing to Medicaid market development and entry
• Successful implementation of TrailBlazer MAC Jurisdiction 4 for Part A and Part B claims processing/payment and reporting processes; included extensive interface development, both data cleansing and conversion; all projects within this program delivered both on schedule and within budget; Confidential recognized as one of the best MAC Program implementations in the nation
• Recent successful implementation of WPS claims/payment workload migration, moving from Mutual of Omaha to TrailBlazer
• Process improvements implemented for Part A, Part B, and Section 1011 UARS support, ultimately improving quality and reducing costs of Non-Base services for TrailBlazer
• Responsible for Confidential CWF Eligibility contract management servicing six Hosts for three years; yearly proposal submission and budget management, in addition to all production support including daily processing, problem resolution, and release implementations
• Numerous process improvement projects for CWF contract, resulting in tightly controlled, high accuracy processing environment

Systems Application Manager

Confidential, TN

Responsibilities:

• Managed Government Systems ( Confidential Medicare and State Medicaid), consisting of 5 Project managers, 22 Systems/ Programmer Analysts with development/support duties on 100+ systems, several platforms (Multiple SQL Servers, UNIX/HP, IBM ES9000 mainframe)
• Direct Reports included 5 Project Managers running multiple projects, operating structurally as PMO
• Established and coordinated corporate steering committees and master project planning concepts which improved productivity
• Reduction in large mainframe IMS claims system downtime by 98% through resolution of root cause maintenance problems and implementation of technologies allowing joint batch/online access
• Managed large, successful HIPAA Programs for both Medicare and Medicaid (all on time and within budget)
• Large scaled conversion from HP 3000 to server-based COTS ORACLE AMISYS claims processing system
• Multiple Internet project implementations involving eligibility, claims, EHR (Electronic Medical Record) applications interfaced to Cerner Software, and authorizations information access to providers

Project Manager

Confidential

Responsibilities:

• Managed 2 to 7 programmer analysts/systems analysts
• Successful implementation of Accounts Payable/Purchasing package, resulting in $350K per year in additional vendor discounts; deep supply chain process redesign
• General maintenance and development on aircraft maintenance systems

Advisory Systems Engineer

Confidential

Responsibilities:

• Designed and coded various Accounting, Marketing, and Manufacturing sub-systems

Systems Application Manager

Confidential

Responsibilities:

• Performed administrative duties and project management for 4 - 7 systems analysts/programmers
• Project Management, systems analysis/design and installation, and support for various order entry, shipping/receiving, and marketing systems

Systems Analyst

Confidential

Responsibilities:

• Completed analysis, design, coding and maintenance of systems in Accounting, Distribution, and Sales/Marketing business areas

Programmer Analyst

Confidential

Responsibilities:

• Completed analysis, design, coding and maintenance of various Accounting/Finance Systems

Adjunct College Instructor

Confidential

Responsibilities:

• Taught IT courses including systems analysis, Database Design, Various General Management courses; excellent ratings consistently from both faculty and students.