Mohammed Islam

MOHAMMED S. ISLAM, MScBI, MCP

**** ** ** *****

Sunrise, FL- 33322

Phone: 954-***-****

Email: acd9x7@r.postjobfree.com

Overview:

• Healthcare is a PASSION, not a job.

• Health Information Technology (HIT) specialist (HIPAA certified) with experience managing functions in a

fastpaced, everchanging business environment.

• Experienced system manager, remaining current in technology, and personally self-confident.

• Excellent analytical and organizational skills.

Education: Ph. D. (Candidate), Information Systems

Nova Southeastern University, Davie, FL

A Certificate Program, Leadership Strategies for Information Technology in Health Care

Harvard School of Public Health, Boston, MA

Master of Science (Chancellor Award), Biomedical Informatics

Nova Southeastern University, Davie, FL

Bachelor of Science, Management Information System

Barry University, Miami

Certificate: MCTS (Microsoft Certified Technology Specialist – BizTalk 2006)

Training: NextGen EHR models - how to set up, configure system attributes, customize workflow

template, and using the Electronic Health Records (EHR), Enterprise Practice

Management (EPM), and Electronic Dental Record (EDR) applications.

Conducting Effective ICD-10 impact assessment – Evaluate how ICD-10 will affect

People, Process and Technology across the entire organization.

• Training conducted by Deloitte Consulting LLP

Experience Highlights:

05/05- Present AAJ Technologies, Fort Lauderdale, FL

Current Responsibilities:

Principal Consultant /Project Manager

• Leads organization’s heath information technology (HIT) initiatives and s erves as the

main point of contact and subject-matter expert for strategic customers and prospects.

• Oversees all aspects of solution development, architecture and management processes

from concept development to implementation and maintenance.

• Translates customer requirements into operational strategies associated with each

solution to ensure client needs are met in a cost-effective and timely manner.

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• Verifies and validates gathered requirements, utilizing analytic skills and subject matter

expertise, document business requirements, technical specifications, use cases and

process workflows.

• Consults with technical team members on relevant areas of subject matter expertise such

as healthcare clinical and/or business topics, understanding of healthcare data, and

interpretation of business requirements.

Project Management

• Manage requirements, effectively track the status and changes. Provide traceability

through the project lifecycle.

• Build and maintain productive working relationships with colleagues and key stakeholders

such as clients, senior management, project leaders and subject matter experts.

• Manage onshore and offshore project teams.

• Methodologies: SCRUMS, PMBOK, EDS’s SDLS and PM3

Architecture and Framework Experience:

Microsoft Connected Health Framework (CHF) is a Service Oriented Reference Architecture that enables

healthcare organizations to accelerate new business opportunities and meet complex and changing business

demands. Application: Used to build the CTS system.

Project Experience:

Independent Living Systems (ILS), Miami, FL

• Responsibilities – Solution Architect and Project manager

Lead, managed, design and architected a Care Transition Assessment and Management system (CTS).

CTS guides and manages the patients through their movements from one care-setting to the next, “ patient’s

care transition journey”, aiding the caregivers to prevent a vast majority of these hospital readmissions. The

four key care transition elements which are addressed through the CTS are:

• Medication management

• Physician follow-up

• Home & community based services

• Disease education and self-management

Solution Design Principles: Patent must be always visible during the care transition journey. Case managers

(coaches) should be held responsible for there patients and also for their action.

With the care transition system is in place, healthcare providers follow a very specific set of guidelines with their

patients in order to properly educate them on their upcoming transition process. Once this education is

complete, a series of appointments or tasks is entered into the system to ensure the entire follow-up process is

executed and no information is lost between caregivers.

Besides the healthplan funded care transition programs, CTS also supports the Community-Based Care

Transitions Program (CCTP). CCTP provides federal funding to test models for improving care transitions from

hospitals to the community for Medicare beneficiaries at risk of being readmitted to an acute care facility within

30 days of discharge from a hospital.

Simply Healthcare Plans, Inc, Miami, FL

• Responsibilities – Sr. Analyst

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Responsible for capturing the requirements necessary to design, develop and implement the Simply Healthcare

Plans (SHP) daily and monthly Agency for Health Care Administration (AHCA) EDI 834 Benefit Enrollment and

Maintenance files load process to the QNXT system. Deliverables:

• Proposed integration and .Net based solution to automate the load process

• Define workflows and business rules to assign PCP to the members from Choice

Counseling (CC) file

• Define workflows and conceptual solution to assign PCP to the members based on

GEO coding (Latitude and Longitude) and ranking techniques.

•

JET Health Solutions, AAJ Technologies, Fort Lauderdale, FL

• Responsibilities – Solution Architect/Project Coordinator

Overseen the development of the Impact Assessments, ICD-10 Lookup and Crosswalk tools.

• Prepared companies offering for migrating from ICD9 to ICD10. The solution is designed to provide guidance,

education and recommendations on how health plans and providers can effectively prepare for and implement

ICD10 changes. The Solutions include:

o Conducting Effective Impact Assessments Tools – an automated assessment tool set that

gathers information via a set of operational and technical questions for each business process to

determine the magnitude of the impact for ICD-10. Tools allow the organization to identify staff who

work with ICD-9 codes and how their job relates to those codes. Additionally identify possible

workflow changes needed to implement ICD-10 codes (e.g., data collection forms, encounter

forms, superbills, etc.).

o ICD-10 Lookup and CrossWalk Generator Tool - Identify the diagnoses most frequently used

and allow users to look up those diagnoses and review the potential new codes for the best match.

•

Fogel Capital Management, Inc., Stuart, FL

• Responsibilities – Solution Architect and Project manager

Lead, managed, and designed a Microsoft Azure, a cloud computing platform and infrastructure, based

Reporting Portal.

The system allow users to reconcile trade data between Fogel and Schwab’s XIP systems in real time.

Additionally, reporting portal’s user interfaces are used for printing and storing of financial reports. Account

opening, budgeting/expenses definition, request approval, data validation, files attachments for reports,

reconciliation of Fogel and Schwab statements are provided via the admin portal.

Tools and Technologies Used:

• Cloud services - Microsoft's Platform as a Service (PaaS) environment that is used

to develop the multi-tier applications and services.

• Data Management – Azure SQL Database used to create, scale and extend

applications into the cloud using Microsoft SQL Server technology.

• Azure BLOB – Used to hold unstructure data (reports, attachemnts, excle files, etc.).

• SSIS – Used SSIS packages to extart the daily transactions from the inpremises

system to the cloud.

• Azure SSRS – Azure SQL SSRS reporting technology was used to genearte and

printing the reports.

• Excel Utilites – A coustome utilty to generate ondemand bulk reports, convert to PDF

and Excle and push to the cloud and make avalable to the user via Azure Queue.

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Comprehensive Casualty Inc., Fort Lauderdale, FL

• Responsibilities – Solution Architect and Project manager

Lead, managed, and designed an Automobile Personal Injury Encounter Management and Claim

Processing System.

Automobile insurers that process and pay medical claims are at risk to high administrative costs and making

high payouts due to fraud. The solution transforms the PIP medical claiming environment to electronic claiming

by a network of providers using a guided workflow process that provide early (from-end) fraud detection and

prevention.

The solution requires a change in operations at the provider’s office to create a patient encounter record,

manage the patient encounter and submitting a claim. The system guides the provider in creating the encounter

record from first contact with the patient through claim submission. This guided workflow process reduces the

administrative cost of PIP medical claiming while encouraging provider participation in PIP claims, by having

the system correctly applying PIP billing protocol and pre-populating required forms.

Amerigroup Inc., Virginia Beach, VA

• Responsibilities – Solution Architect and Project Manager

Lead and managed an offshore team to automat and integrated manual business process for a Medicare

and Medicate health plans. Automated over 50 manual processes which helped the organization to streamline

the process and allocate freed up resources for other critical tasks. Automation allows AMERIGROUP to

monitor its many disparate processes and provide notification regarding the status of each task within a given

process. Monitoring was fundamentally based on the concept of events and exceptions. The benefits

achieved are:

• The Business Users, Process Owners/Operators will be able to monitor the

progress of their processes real-time, whereby lessening the load for the IT staff.

• Automated notifications communicate task completion the interested parties

whereby improving efficiency.

• Automated alerting communicates possible issues to appropriate IT staff along

with descriptions of issues in order to facilitate troubleshooting.

• The system may provide IT staff recommendations based on the process and type

of issue in order to reduce resolution timeframes.

• Allow for a clear audit trail for all process and task executed

• Allow for the creation of process-related metrics to determine task efficiency or

problematic process segments.

• Improve overall communication.

• Integration with TriZetto’s Facets system

Coventry Health Plans, Chicago, IL

• Responsibilities – Solution Architect and Project Manager

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Managed, designed, lead development effort, and implemented a healthplan enrollment and integration

solution for an over $8b annual revenue health plan organization.

The goals of this project included:

• Implement a single pre-enrollment, underwriting, and rating system solution that supports Coventry

Individual Product business, enterprise wide.

• Consolidate pre-enrollment, underwriting, and rating systems across Vista and Coventry Individual

Product business

• Migrate Vista’s individual product business to the single system solution in conjunction with the

Vista Phase 2 conversion to IDX (AS400/DB2 enrollment and claim processing system) systems.

Vista Health Plans Inc., Sunrise, FL

• Responsibilities – Solution Architect

• Responsible for B2B solutions to establish bi-directional exchange of data (insurance application and status)

between eHealthInsurance Inc. and Vista Health Plans’ underwriting system (1-Up) utilizing BizTalk 2006 as

the message broker to route the transactions to the PowerMHS (AS400/DB2 enrollment and claim

processing system) backend systems using Screen Scraping and message routing solutions. User

workflows was managed via MACESS interfaces.

• Architected, designed, and developed Web based (.NET, C#, ASP.NET, SQL) health insurance enrollment and

automated approval (auto adjudicating) underwriting process (HIPAA compliant) solution for the Vista Health

Plans Inc. Implemented the EAI and B2B integration (BizTalk 2006) solutions to establish bi-directional

exchange of data between all of the key systems within Vista that facilitates the services and products being

offered to the customer.

• Defined and set architecture and framework guidelines for Service-oriented Architecture (SOA) framework,

layered object-oriented service based Application framework. Author formal requirements, analysis and

technical design documentation. This document presents the baseline integration architecture and guidelines

necessary to build enterprise applications via BizTalk 2004/2006 Server framework using Patterns, UML2 and

Business Process Modeling Notation (BPMN) to capture and describe the proposed Provider Services

interfaces.

9/10 – Present Adjunct Instructor – Nova Southeastern University

• Teach special topics: Health Interoperability, EHR Functional Models, Health Workflow Process Analysis,

Design Patient-centric Health Care systems, ICD-10 Impact Assessments.

Membership:

• AMIA, 2009-2010

• HIMSS, 2010-2011

Publication:

• Automated Underwriting Program Evaluation for Health Information Technology

• Poster: Presented at AMIA 2009 Annual Symposium

White Paper:

• How rule based automated health insurance underwriting process work

• Human Computer Interaction: Usability Study of WebMD, from concept through execution, 2008

• Components of an Automated Alert and Event Monitoring Systems

• Information Privacy and Security in Healthcare – Protecting Electronic Health Records (EHR), 2009

• Automobile Personal Injury Encounter Management and Claim Processing System – a guided workflow, 2010

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Recent Public Speaking:

• Care Transition - The Future of Healthcare Forum, Sponsored By Microsoft Ft. Lauderdale Office, on Date:

September 5th, 2012

SPECIFIC KNOWLEDGE AND EXPERIENCE

Databases:

DB2, MS SQL Server & SSIS, Access, IMS/DL1, Oracle, Ingres

Programming Languages:

Microsoft .Net framework, C#, VB.NET, WPF, WCF, SQL, PL/SQL, HTML, XML, XSD, XSLT, XPath, ASP, ASP.NET,

VBScript, JavaScript, JDBC, Cascading Style Sheets

Integration/Interoperability:

AS400/DB2: PowerMHS, Facets, Macess, QNXT, MDM, Vantive, Siebel, IDX

Portal: eHealth, Salesforce

Tools: BizTalk, Mirth (open source HL7 utility), Biztalk HL7 adapter, Biztalk EDI Adapter.

Heathcare: EDI 834, 837, HL7 V.2, ICD 9, ICD 10

Tools & Technologies:

MS-Office (Word, Excel, Project, Visio, Power Point), VS, Team server, Crystal Report, Visual SourceSafe,

Macromedia Dreamweaver, BizTalk Server 2004/2006, Web Services, SOAP, WSDL, BPEL, and BPMN, UML, EDS

SLC3, IEF, INCASE, PM2, SCRUM

Cloud Computing:

Microsoft Azure - a cloud computing platform and infrastructure.

Cloud services - Microsoft's Platform as a Service (PaaS) environment that is used to develop the multi-tier

applications and services.

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