Rolf Paul Hartwig

Land O’ Lakes, FL ***** 813-***-**** acoycb@r.postjobfree.com

Analyst Skills

Over 10 years of managed care and patient care workflow.

Research and analyze HEDIS, NCQA, JCAHO, HIPAA, Medicare and Medicaid regulations.

Develop rules and policies based on legal guidelines and regulations.

Develop regulatory compliance programs based on regulations and policies.

Work with government agencies regarding the development or impact of regulations.

Create functional requirements document based on research and analysis.

Knowledge of ICD9 and CPT-4 Codes and analysis of experience related to these codes.

Design database tables and attributes for expected input and output for an application.

Design and interpret database reports for outcome studies.

System Development Skills

Understand all phases of the system development life cycle.

Define all system objects, define their attributes and the processes that define how the objects interact.

Understand multiple development standards and procedures for software quality.

Develop relational database design (logical and physical models) for healthcare applications.

Able to create detailed design specifications that takes full advantage of the system architecture.

Able to create detailed design specifications that can be reviewed to ensure design meets.

Develop and confirm functional requirement of the application.

Establish testing and quality assurance for testing.

Project Management Skills

Utilize industry standard development methods in the system development life cycle.

Analyze project scope and limitations and establish time lines for implementation.

Identify all tasks for project implementation.

Evaluate project staffing needs and identify necessary skill sets.

Set milestones and supporting task to achieve milestones.

Manage large project teams within matrix organizations.

Management Skills and Experience

Create team building and motivation for department staff and project members.

Administer all human resource functions including hiring and termination.

Develop employee growth or corrective action plans.

Outlining department goals and objectives.

Develop and maintain multi-million dollar department and project budgets for goals and objectives.

Demonstrate return on investment strategies for goals and objectives.

Manage large project teams with varying skill sets and levels in matrix organizations.

Communicate with senior management.

Review contracts for appropriateness t corporate policies and legal requirements.

Develop and author human resource and corporate policies.

Software / Application Experience

Microsoft Access Rational Project Tools

Crystal Report Writer Visio

Microsoft Office Crystal Report Writer

Microsoft Project W indows 8.1 and below

Microsoft Power Point Software Development Tools

Rolf Paul Hartwig

Land O’ Lakes, FL 34639 813-***-**** acoycb@r.postjobfree.com

Objective: Application of my skills as a registered nurse in an information systems analyst, regulatory

compliance, system development and healthcare delivery, and information technology setting.

Education:

St. Leo’s University, Bachelor’s Healthcare Administration In progress

10/10 – 2/11

Hillsborough Community College, Nursing Refresher Course

Hillsborough Community College, Associate’s Degree in Information System Analysis 1/98 – 05/01

Hillsborough Community College, Associate’s Degree in Nursing 9/95 - 12/97

Humana Health Institute - Tampa Bay, Licensed Practical Nurse Program 8/90 - 8/91

Licenses: Registered Nurse RN3247612

Licensed Healthcare Risk Manager 5503584

Healthcare Electronic Health Record Specialist R7J7C4B7

Experience:

05/14 – present

Beacon Health Solutions BPO / Global TPA, Tampa, FL

Business Analyst / Project Analyst

Determine and compose business requirements for client implementations

Determine functional requirements for data mapping based on business partner input

Document process flow diagrams for data transfers via FTP servers to data warehouse

Provide meeting minutes for distribution

Track report project objectives and milestone between business partners and clients

Obtain approval for requirements and document tracking

Maintain document library in tracking library systems

10/12 – 04/2013

WellCare Health Plans, Inc. (HealthCare Support Staffing, Inc.) Tampa, FL

WellMed Medical Management (The Judge Group)

Agency Utilization Review and Chart Review Nurse (contract)

Utilize AHCA, CMS and Milliman and InterQual Care Guidelines and Criteria.

Communicate concurrent and retrospective case comparison criteria to management

Case review reporting tool and team meetings.

Provided review results to providers and medical directors.

Escalated non-compliant cases to review committee and medical director

Create case report summaries with recommendations.

07/00 – present

Norse Consultants, Inc. Tampa, FL

Owner/Consultant

Medicaid & Medicare utilization review of in-patient authorizations

o Medical procedure review and research against medical guidelines

o Work with providers, insurer and families regarding medical criteria

Responsible for writing regulatory compliant development documents, policies and procedures and

requirements documents.

Researched and ensured compliance with federal and state standards that apply to healthcare and

insurance business.

Managed meetings with subject-matter experts and development teams to identify and establish issue

resolution procedures and testing criteria.

Created and implemented requirements documents from medical, legal, and insurance staff for

approval.

Rolf Paul Hartwig

Land O’ Lakes, FL 34639 813-***-**** acoycb@r.postjobfree.com

09/08 – 04/2009

Aetna Health Insurance Tampa, FL

Systems Business Analyst (contract)

Analyze business process workflows

Document system and database requirements for multi-line healthcare insurance

Manage requirements gathering via on-site and conference calls with stake holders

Analysis was done via phone interviews and onsite

Requirements Word documentation, spreadsheet and Visio

Manage end user and developer approval

Interview end users and application development staff

Create debase elements and tracking to support HEDIS and CMS reporting

Preformed project management duties

Quality assurance testing

02/05 – 07/05

WellCare Health Plans, Inc. Tampa, FL

Regulatory Compliance Analyst

Compliance Analyst for multi-state, multi-line managed care company

Researched and wrote proposals for regulatory compliance projects

Researched regulatory requirements and industry best practices for project deliverables

Developed and correlated cross-departmental surveys to identify deficiencies areas of improvement

Worked with multi-disciplinary teams to identify implementation strategies

Created both detailed proposals defining program improvements and recommendations

09/00 – 1/05

Eckerd Corporation Clearwater, FL

Senior Systems Manager

System & Data Security (Information Security Officer), responsible for the creation and implementation

of HIPAA and Sarbanes Oxley Regulatory Compliance strategy for the enterprise’s information

systems (70,000 users across all platforms, environments and business units)

Established compliance audit processes for corporate policies and procedures

Developed and managed audit programs to ensure compliance with policies, procedure and standards

Participated in Architecture Review Board for new technology review and selection

01/93 – 2/10

Agency Nurse Tampa, FL and Cleveland, OH

RN and LPN

Provided staffing at major hospitals, rehabilitation centers, long term care facilities, and home care

Maintained an in-depth of JCAHO accreditation standards to ensure healthcare quality care

Responsibilities included:

o patient assessment

o Teaching

o Medication administration

o Admitting and discharge planning

o Wound management and documentation

o Dressing changes

o Communication with physicians

o supervising support staff

o Shift and episode charting.

Contact this candidate