Customer Service Management

Director - Information Technology

Extensive experience in health information systems acquisition, conversion,

implementation, operations, integration, business intelligence and

reporting to collect, analyze and improve metrics in:

Quality of Care Regulatory Compliance

Customer Satisfaction Financial Reporting

Marketing and Member Retention Business Process Efficiency

Disease Management Claims Adjudication

Project Implementations Software Development

New York Presbyterian Hospital 2005 -2009

Corporate Director Information Technology - Community Health Plan (2007 -2009)

Member of health plan's executive management team responsible for aligning IT

objectives, policies and operational strategies with corporate quality of care,

customer satisfaction, regulatory compliance, marketing and business process

efficiency goals. Hands-on manager of operational software, information technology

strategies, data management techniques, business intelligence and data awareness

initiatives.

. Designed, built and administered Microsoft (2005/2008 SSMS, SSAS, SSIS,

SSRS, .NET, Office) and SAS (9.1.3) business intelligence platforms for

clinical, operational and financial analysis of health plan data

. Administered production SQL Servers (2005/2008) and applications software

to support health plan operations

. Acquired and incorporated standard data (HL7, ANSI X12, NCPDP, XML),

Eagle extracts and numerous other proprietary data sources into data

warehouse repositories and production databases

. Built and managed daily, weekly, monthly ETL processes to support data

warehouse, production operations, outsourced vendor obligations,

regulatory and internal application interfaces

. Utilized MS Office, SSRS, SAS, Crystal Reports, Business Objects and

Panorama to access structured business intelligence models, generate ad

hoc queries and produce daily, weekly, monthly production reports

. Developed BI strategies and algorithms to identify, stratify, manage and

more effectively reach out to diabetes, asthma, AIDS, depression, ADHD,

maternity/newborn and other high risk disease patient populations

. Developed strategic plan and budget to convert hospital IT and telephony

support to self supported infrastructure to maximize the quality and

efficiency of plan operations and customer service

. Reconciled plan claims payables with hospital receivables (Eagle) and

provided extensive financial, provider, and patient continuity of care

analysis to hospital finance group for sale of health plan

AVP Information Services - Community n Plus (2005 -2007)

Senior IT executive responsible for developing information technology and business

intelligence strategy to cultivate business intelligence, data ownership, and

decision making capabilities that enabled the plan to:

. Introduced Kimball data warehousing techniques and OLAP technologies (SQL

Server 2000/2005, MS Office, .Net, Crystal Reports) to collect, monitor

and analyze clinical, financial and operational plan data

. In-sourced technology infrastructure, administration and operational

support for plan enrollment, customer service, provider network

management, claims adjudication, utilization, disease and health

management operations

. Administered production SQL Servers (2000/2005) and applications software

to support health plan operations

. Built and managed daily, weekly, monthly ETL processes to support data

warehouse, production operations, outsourced vendor obligations,

regulatory and internal application interfaces

. Acquired and incorporated standard (HL7, ANSI X12, NCPDP, XML), and

proprietary data sources into data warehouse repositories and production

databases

. Interfaced plan enrollment rosters with hospital registration systems

(Eagle) to improve accuracy and efficiency of registration, billing and

payment processes.

HealthFirst, Inc. 1994 -2004

Director Software Development

Senior software manager recruited to implement information systems for start-up HMO

and MSO. Managed systems implementation, conversion, integration, business

intelligence, custom software development, systems operations and administration

for multiple MSO clients. Applied a broad range of highly customized, deeply

integrated technologies to all aspects of managed care and MSO operations and

management.

. Developed custom VB/C#/ASP .Net client/server and web base applications

software targeting MS SQL Server/IIS and AS400/DB2 platforms including

patient billing and explanation of benefits, patient and provider CRM and

appeals and grievances.

. Created SAS data warehouse structures to accommodate New York State

financial, operational and quality of care regulatory reports and data

feeds. including: QARR/HEDIS, MMCOR, MEDS, HPN, KIDS transactions, etc.

. Developed real-time HIPAA compliant IVR, web and client/server

eligibility verification, claims status and authorization/referral

transaction capabilities that significantly reduced incoming customer

call volumes

. Developed provider extranet (IIS, SQL Server, ASP/VB .Net, Crystal

Reports) for forms, report and policy/procedure distribution, including

monthly patient rosters, explanation of payments and utilization

management reports that significantly reduced postage cost, delivery

times and provider call volume

. Automated correspondence for enrollment, member services, provider

relations, medical management, subscriber premium billing, explanation of

benefits, appeals and grievances and member ID cards

HealthLink Inc. 1992 - 1994

A large PPO and open access network based in Missouri, servicing a variety health

benefit insurers, third party administrators, union trust funds and employers

throughout the county.

Senior Systems Analyst

. Hired to work with executive and health management teams to design,

prototype, develop and implement information systems for startup worker's

compensation line of business, including integration with existing

PPO/HMO software. Covered over 500,000 PPO/HMO and Workers Compensation

lives

. Introduced and developed macro based claims pricing and adjudication

systems to replace existing systems allowing for incorporation of new

lines of business, more aggressive contracting with servicing providers

and additional benefit options for premium customers

. Created physician profiling systems modeled after early NCQA HEDIS

quality metrics to assess physician status in utilization review, quality

assurance ratings, legal and regulatory profile, contractual compliance,

billing practices, site review status and customer satisfaction

MedCare HMO and MedHealth Clinics 1987 -1992

Founded in 1987, became the largest HMO in Illinois State, offering Medicaid,

Medicare, small and large group health coverage. MedHealth Clinics, founded in

1990, operated 9 clinics throughout the greater Chicago metropolitan area.

Director of Information Services

. Rapidly promoted through the ranks from programmer, to director

. Developed and supported multiple software products including clinic

scheduling, registration, billing and A/R systems and HMO sales,

enrollment, customer service, provider, claims, billing and A/R

processing systems

. Highlights include: integrated HMO/Clinic data bases, user interfaces and

reporting; integrated claims and utilization management systems; 24-hour

triage hot-line support systems integrated with concurrent review and

utilization management systems; automated data exchange between

government and commercial clients

BA, Computer Science, University of Iowa, Iowa City . 1987

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