SANDRA F. ENDICOTT, PMP

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

Columbia, MD 21046

Cell: 301-***-**** acoymi@r.postjobfree.com

SUMMARY OF QUALIFICATIONS

Project Management: 20 years experience leading and managing projects in

both Healthcare Industry, and Non-Profit Association Business environments

Healthcare Industry: 14 years' experience including Private Exchanges,

HIPAA, Medicare, Provider Networks, Web-based Enrollment and Billing

Systems, Claims Systems

Methodologies: PMLC,SDLC, CMMI Level 3, Waterfall and Iterative, JAD, GAP

Analysis, SIPOCMS, Swim Lanes, Building Effective Work Teams, Workgroup

Facilitation

Technical Knowledge: Clarity, MS- Project, MS-SharePoint Content

Management, Teamtrack, Benefitfocus Online Enrollment Suite of Tools,

MetaVance Membership Application, HP ALM QA Tools, ClearQuest, MS Office

Suite, Access databases, NASCO, and ITS

EDUCATION

B.S. Business Management: Human Resources & Labor Relations, University

College, University of Maryland

PMP Certification, PMI Member

PROFESSIONAL EXPERIENCE

NTT Data, Inc. September 2004 - Present

Senior Project Manager to CareFirst Inc.

As a Senior Project/Program Manager, the skills below are critical in

deploying the projects I have implemented.

. Project Initiation with both internal and vendor teams following

PMLC/SDLC methodologies

. Facilitate discovery sessions, requirements gathering, JAD sessions,

ensuring proper requirements and design documents are developed and

approved

. Meet regularly with Senior Management to report status, issues, and risks

. Build and manage portfolio budgets from $2M to $10M and schedules for all

SDLC deliverables

. Participate in vendor contract reviews, negotiations, and invoice

reconciliation

. Manage a team up to 25 which includes monitoring internal business and

technical deliverables, and vendor milestones

. Identify and report on project dependencies, issues, risks, and

mitigation strategies

. Develop and execute Account Migration Strategies for moving 200+ Accounts

from one vendor to another

. Develop sales talking points and account letters in collaboration with

Corporate Communications to assist in the transition from one vendor to

another

. Develop and monitor internal and vendor Change Requests in scope, time,

or budget

. Facilitate issue resolution sessions with project team, vendor, and

accounts to enable smooth account implementations

. Develop joint implementation task list with deliverables for internal

project and vendor implementation teams to ensure successful account

implementations

. Monitor development of internal training and standard operating

procedures for all system users

. Conduct Lessons Learned during project closure for each project

. Mentor Jr. Project Managers for the Project Delivery Team

AONHewitt and CareFirst Large Group Private Exchanges (03/14 - present)

The private exchanges are 2 separate projects that are scheduled to be

launched in the first quarter of 2015.

The Large Group Corporate Exchange will offer CareFirst products and target

the medium sized employer groups that are looking for defined contribution

benefit plans to offer to their employees. This involves building a

website that has decision tools to help the potential member select the

best 3 benefit plans to review. In addition, an avatar will be added for

the immersive shopping experience and guide the member through selecting

the benefit plan that is the best suited for the member. The technical

infrastructure will use the current architecture with the Benefitfocus and

NASCO enrollment platforms to support the exchange. There will also be

some integration with vendor file feeds.

The AONHewitt private exchange will target large group employers, 5000+,

market space. This private exchange will offer standard metallic level

benefit plans and include various insurance carriers. The project team

will build a CareFirst micro-site that will be targeted to potential

members and provide a clear description of the value and advantage of

joining a BlueCross BlueShield plan. In addition, a dedicated customer

service unit will be trained and implemented to support this exchange.

Various business areas throughout the company will need to have new

business processes implemented to support the exchange and this line of

business. The technical infrastructure will use the current architecture

to support the exchange with minor changes.

Employer Group Waiver Plan - Part D Pharmacy (03/14-Present)

Large Group employers who offer retiree coverage, particularly

municipalities, are exploring ways to reduce costs associated with retiree

health benefit costs. Many employers have or are considering moving away

from a Retiree Drug Subsidy (RDS) strategy towards an Employer Group Waiver

Plan (EGWP) - a Group Medicare Part D plan - to lower costs associated with

retiree pharmaceutical coverage. EGWPs enable employers to maximize

prescription drug subsidies provided by the federal government and

pharmaceutical manufacturers, resulting in substantial savings compared to

RDS plans. Further, RDS plans lost their tax advantage status in 2013 and

are now costing Large Group employers more money to provide to their

retiree members.

The EGWP project will be implemented for Large Group employers on the NASCO

platform for the 1/1/15 open enrollment period. The current architectural

structure that supports the Pharmacy Benefit Management program will be

reused for the EGWP project with a few changes to the CET claims file,

billing and finance process, and a field change to add the HICN number.

Automated Benefits Administration Program (12//12-02/13)

The Automated Benefits Administration program is comprised of 3 projects:

automation of the manual benefits coding required to adjudicate claims on

the NASCO platform, automation of the benefit coding that occurs in NASCO,

and a Web-based interface that captures account products and benefits using

a single point of entry for the sales team.

The current process of implementing and maintaining group benefits on the

NASCO platform is complex, time consuming and largely manual; this results

in inconsistent benefit data reported across various platforms. NASCO has a

centralized benefit library tool that will be used to deliver benefit data

to all delivery channels. The "Builder" component of NASCO's solution

provides greater standardization and reusability of benefit data components

for packaging product offerings. The "Automator" component

of the solution is used to generate a format of the benefits data that can

be directly consumed by the adjudication engine.

When completed, this project will reduce the time to install an account

from an average of 60 days to 15 days. First-form is a NASCO tool that

will provide a frontend, web-based interface (GUI) to capture account

benefit descriptions, scrub the descriptions for accuracy and, once

approved by the account, automatically load the benefits into an Enterprise

Benefit Data Store in real-time to populate web-portals, the online

benefit narrative.

Automated Electronic Enrollment Program (06/11-02/13)

The Automated Electronic Enrollment Program is a portfolio of 2 projects

that CareFirst is deploying to build online enrollment portal and direct

submission of automated enrollment files for their National Accounts.

Partnering with the vendor, BenefitFocus, CareFirst is utilizing the

vendor's online enrollment application to simplify enrollment data

collection, and management for CareFirst Large Accounts book of business.

A web based portal is provided for CareFirst accounts and group members to

enroll, view and manage enrollment related data. Accounts can also

choose to submit their automated electronic files in any format directly to

CareFirst who sends to BenefitFocus for processing outbound enrollment

files to the NASCO and FACETS platforms. Over 200 Large Group accounts

were migrated to the Benefitfocus enrollment platform.

Regional Provider Network Project (04/10 - 06/11)

The Regional Provider Network Project established a single set of regional

medical networks that would support all CareFirst medical products by

January 2011. Project implementation eliminated multiple Provider

Networks and consolidated the remaining provider networks which resulted in

simplifying payment to the providers and reducing costs internally to

CareFirst. Over 200+ National Accounts were migrated to the RPN network.

Blue 2 and ITS 10.2 Project (1/09 - 04/11)

These projects are mandated by the BlueCross BlueShield Association and

involve implementation of software releases 2 times per year for

enhancements and changes to the current National ITS Systems platform.

In addition, a web-based portal is adding functionality for responding to

Inter-plan inquiries on claims status, medical records, and operations day

to day business.

Medicare Advantage Project (04/07 - 12/08)

Implementation of CareFirst's product portfolio expansion which offers

Medicare Advantage Private Fee-For-Service (MA PFFS) plans to Medicare

eligible members. Defined and implemented program requirements per CMS

regulations. Set up the Provider, Customer Service and Pharmacy business

areas to support the new Medicare Advantage Program. Set up 4 different

call centers to service Medicare Advantage members.

NASCO's MembersEdge Project (09/04 - 03/07)

As a NASCO Consultant worked with launching a pilot of National Accounts

to a new Real-time Membership module. This involved building a team of

business analysts to develop requirements for the CareFirst plan and then

testing the module releases. Once the product was stable, an account

migration plan was developed and executed to move Large Group Accounts from

the NPS system to Members Edge. Product releases and account migrations

required a heavy effort of analysis and testing for successful

implementations.

WebMD (03/04 - 09/04)

BPO Quality Assurance Manager

. Developed and implemented a QA Program for the Business Processing

Outsource (BPO) department.

. Managed the quality of 8 Telework Centers that operated in the US, Costa

Rica, and Europe. As a new unit for the BPO, QA processes,

procedures, and goals for the Telework Centers and QA Staff were

established.

. Developed weekly/monthly/quarterly QA reports for clients, telework

centers, and executive management team, detailing the quality status of

50,000 daily processed claims.

. Managed a 5-member local QA team with responsibility for hiring and

terminations, establishing quarterly goals, annual performance reviews,

and building a quality team.

CareFirst Inc. (11/01 - 03/04)

HIPAA Senior Project Manager

Managed 8-member team of Business Analysts for the 837 and 835 Remittance

Transaction Implementations:

. Developed functional specifications, managed team deliverables against

project timelines and deliverables, and led team in developing New and

Changed Business Processes throughout CareFirst business areas as a

result of the 837 and 835 implementations

. Conducted business, technical reviews and walkthroughs of the functional

specs, supported both the technical and testing teams for the 837 and 835

transactions

. Involved in all SDLC phases of the project for the 837 and 835

Transactions

. Developed new business standard operational procedures for the main

business departments impacted by the 837 and 835 transactions throughout

CareFirst. Worked with the Corporate Training department and department

managers to train the employees on the new standard operating procedures

for the 837 Claims and 835 Remittance Transactions. In addition, the team

developed user manuals and training materials to be used by the

operational support business areas for the 837 and 835 transactions.

Implemented Privacy Requirements released by CMS:

. Defined 161 Privacy Requirements that were released by CMS and

implemented those requirements throughout CareFirst to meet the Privacy

Compliance date of April, 2003.

. Implemented privacy regulations and ensured compliance to regulations for

the Corporate Audit, Services and Technology, and Database Warehouse

departments of CareFirst.

. Conducted a thorough gap analysis of each department and defined how

Protected Health Information (PHI) flowed in and out of the departments.

Worked with Department managers to determine which business processes

needed to change and establish any new processes and procedures.

. Developed global policies and standard operating procedures for CareFirst

and tailored specifically to each department's specific needs. Utilized

train-the-trainer program with each of the department managers to train

employees on the new policies and procedures that had been implemented as

a result of the HIPAA Privacy Regulations.

. Developed and implemented the Issues Resolution Team Process for HIPAA

project. Facilitated formal and informal Issue Resolution Meetings with

appropriate HIPAA and CareFirst Teams to identify solutions to the Gap

Analysis with transactions and codes, Privacy and Security to meet CMS

HIPAA Compliance. The Issue Resolution Team facilitated meetings with the

HIPAA Design Teams, Subject Matter Experts, Business Analysts, Technical

Analysts, HIPAA Compliance, and Stakeholders.

. Performed Gap Assessment for the Privacy Department. Facilitated

numerous sessions at various locations for selected CareFirst

participants, answered questions about HIPAA requirements as applied to

CareFirst Departments. As a facilitator and analyst, worked with the

Privacy Team on Phase I Gap Assessment using Expedite Gap Assessment

Tool.

METAMOR ENTERPRISE SOLUTIONS/PSINET (08/00 - 06/01)

Business Development

. Developed Associations Vertical Market through networking, cold calls,

and trade shows, referrals, marketing mail campaigns, and working through

reseller chains.

. Demonstrated the iMIS Association software package to potential clients

and closed sales using "Solutions Selling" Methodology.

. Up-sold Consulting Services to Association, Non-profits, and Membership

Organizations in E-Business Strategies, Custom Applications, Strategic

Technology Planning, Hosting, ISP, and ASP Solutions.

. Responded to RFPs, RFQs, and RFIs for US House of Representatives, and

built VCMS business unit through selling software and services to US

House of Reps.

DAVISON ASSOCIATES, INC. (12/94 -08/ 00)

Vice-President of Operations

. Managed company's largest account over $2 million revenue with a 28%

gross profit margin. Directed the activities of 40+ consultants. Doubled

employee base in one year.

. Budget responsibilities for department, expenses, account profit and

loss, employee reviews & salary actions.

. Implemented team-based infrastructure per CEO's vision.

. Responsible for annual contract negotiations and renewal for assigned

accounts.

. Conducted sales presentations and developed proposals for new clients.

Sales activity resulted in establishing long-term business partnerships

with over 25 new managers in existing accounts.

. Developed new line of productized services targeted to small and medium

businesses and restructured the corporate infrastructure with managers to

support new business line. New business line resulted in over 30 new

clients in first year of operations.

. Developed new marketing strategy with sales team to include corporate

capabilities, direct mail campaigns, and telemarketing.

. Handled any Manager/Employee conflicts, Employee Relations Counseling,

Management Counseling and Coaching for effective win/win strategies with

employees and clients, career counseling, hiring and terminations,

performance probations, etc.

. Participated in the review and selection of employee benefits plan.

Oversight of benefits implementation.

. Developed and revised corporate policies and procedures: Paid time off,

developing Employee Handbook, developing a performance based review

system, corporate orientation, reviewed corporate compliance issues for

operating with Federal Contracts

KCM COMPUTER CONSULTING, INC. (02/90 -12/94)

Employment Manager

. Recruited and placed technical consultants with major businesses

throughout the Washington DC and Baltimore Metropolitan areas.

. Grew business from 30 to over 120 consultants over a 4 year period.

. Participated in client presentations.

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