Over ** 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.

Area of Excellence

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

Management

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

Relationship building

Career Accomplishments

Experience in HealthCare, Aircraft, Local Government, Toll and Textile industries implementing large scale information systems; heavy involvement with both direction and delivery of systems.

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

Professional Development

HIAA Managed Care Part A, Part B

Keane Project Management

Effective Leadership

Birkman

Six Sigma Black Belt (in process)

PMP (In Process; applied to take exam)

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

P R O F E S S I O N A L E X P E R I E N C E

Senior Program Manager (Electronic Transaction Consultants 5/2014 – 5/2015)

Responsible for management of all software development for company's largest account (NTTA)

Management PMO team (3 PMs, 50 matrixed development staff of 50) for $18 million account; role included both managing projects and having responsibility for additional projects being run by direct report project managers (within PMO structure)

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 (National Government Services/Wellpoint Health Enterprises 5/2013 – 5/2014)

Acting in Business Development role on large Hosting/Infrastructural contract opportunities

Management and Technical solution contributions to recent NGS Federal Government agency (CMS) contract win; contract value $200 million plus; project management role in driving solution development to tight target dates

Significant role in staff ramp-up required to service the contract

Contract award 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

Project Management for process involving large Data Center footprint reduction; this involved the movement of significant data center resources to an outsourced vendor, projected savings $ 5 million

Unemployed 12/2012 – 4/2013

CDS suffered a multi-hundred million dollar revenue loss when TrailBlazer Health Enterprises went out of business. This led to a layoff of TrailBlazer account management and technicians. During this time I initiated two certification processes and secured my current position with National Government Services.

Director, Applications/Client Services (Companion Data Services) 10/2006 – 12/2012

Acting in Roles as Program Manager/Project Manager/Account Executive

(Manage two Managers, several Project Managers and technical staff of 20)

•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 by Federal government contractors

•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 (CMS Medicare Advantage/ National Encounter Program); 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 Northrop Grumman and CMS 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 CMS Section 1011 UARS Claims Processing system for Novitas Medicare 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 TrailBlazer Health Enterprises(CMS 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; CMS 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 CMS 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 (Blue Cross Blue Shield TN) 9/1993 – 10/2006

Managed Government Systems (CMS 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)

Successful conversion of Medicare New Jersey Part A workload from Horizon to Riverbend both on time and under 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 (Gulfstream Aerospace) 6/1988 – 9/1993

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 (Computer Task Group) 5/1987 – 6/1988

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

Systems Application Manager (Salem Carpet Mills) 6/1984 - 5/1987

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 (Chattem Drugs and Cosmetics) 8/1981 – 6/1984

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

Programmer Analyst (Hamilton County Government) 5/1976 – 7/1981

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

Adjunct College Instructor (Dalton Community College/Chattanooga State Community College

9/1999 – 10/2006

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

Education

University of Tennessee - Master of Business Administration, June,1995

(General Business)

Georgia Southern University - Bachelor of Business Administration, June, 1991

(General Business)

Cleveland State College - Associate of Science with Data Processing, major, June,1976

Certifications

Six Sigma Black Belt (In Process)

PMP (In Process)

HIAA Part A, Part B, Managed Care

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