JOHN R. ALMERINO, PMP

ac189a@r.postjobfree.com 732-***-****

Summary

Resourceful and creative certified project manager with over 10 years’ experience in delivering enrollment growth and revenue generating complex cross divisional projects. High comfort level working within matrixed PMO’s with strict project deadlines. Fluency with project forecasting, estimating, resource planning and utilization. Highly attuned to containing scope creep, resolving issues, and mitigating risks. Articulate at communicating to all levels of stakeholder involvement regarding project status, priorities and impacts and risk mitigation.

Tools

MS-Schedule v10

MS Office Suite

SharePoint

Lotus Notes

Outlook

ALM Requirements Tracking

Help Star

Service Now

Planview

JIRA

Professional Experience

Solution Delivery Lead /Program Mgr., Healthfirst Inc., NYC Aug 2014 – Sept 2016

Successfully lead a team of eight cross divisional developers, one remote consultant, and three quality assurance testers to deliver on multiple state mandated project deadlines.

Project delivery produced and enrollment gain of 16,400 members, with a realized revenue increase of $11M per month and $132M annually.

Successfully developed and facilitated the IT strategy used to achieve delivery on all 400 business requirements, use cases and NY State mandated plan revisions throughout project life cycle

Successfully coded, tested and implemented 36 new health benefits inclusive of ICD10 diagnosis codes and 14 rate code table updates used to administer the product

Successfully developed and configured a new enrollment process specifically for this product

Delivered all updates and changes to the accounts receivable process to meet all required financial impacts

Reviewed and updated over 200 member and 247 provider communication letters within project mandated timeframes

Successfully identified changes and configured both the Provider and Member web portals to include an additional 87 new specialty providers

Successfully configured 16 newly mandated reporting configurations from NY State to fulfill weekly and monthly reporting obligations.

Project Manager - Government Programs, Emblem Healthcare Inc., NYC Jan 2014 –Aug 2014

Successfully identified, configured, tested and implemented 96 newly mandated benefits by the state imposed deadline

Successfully lead team of (3) developers, and (2) quality assurance resources to remain on planned schedule

Orchestrated weekly deliverables from (3) developers to achieve stated objectives and remain on schedule

Successfully maintained an up to date IT delivery schedule despite frequent schedule changes driven by the State of NY

Horizon BCBSNJ 1993 – 2014

Lead Project Manager, Medicare Advantage portfolio 2011 – 2014

Successfully implemented the Medicare Advantage portfolio (4) years concurrently

Managed a $1.4M project budget that yielded realized revenue of $27M per month once revisions were in production

Delivered all required changes for the annual Medicare Advantage portfolio of (8) products

Delivered all annual benefit and premium changes [typically 10-20 benefit coding adjustments with 10-20 corresponding testing outcomes and rate code table updates]

Successfully delivered all ID cards revisions for all (8) products for over 900,000 members

Maintained the ID Card shipment schedule with external vendor to stay within Medicare mandated compliance dates

Delivered on time all Member and Provider directory updates to external vendors to remain within Medicare compliance guidelines

Successfully delivered all revisions for Medicare member communication material, mailings and contract revisions (ANOC & EOC) to remain within Medicare compliance parameters for printed material

Successfully delivered all necessary updates to the Member and Provider portals associated with the 900,000 member Medicare insured population

Delivered on-time weekly and bi-weekly progress status of cross divisional team comprised of 16 resources

Lead Project Manager, Private Health Exchange “pilot” effort - 2013

Implemented a new “Private Health Exchange” pilot project with budget of $750,000” in conjunction with the contracted vendor Prime America

Successfully incorporated these new vendor feeds into the Horizon Sales platform

Lead Project Manager, Horizon Special Needs Plan (SNP) Implementation - 2012

Successfully implemented new Medicare/Medicaid product within an 8 month timeframe utilizing a budget of $550,000

Enhancements included all 25 mandated communication letters, additions to 4,300 provider contracts and 27 hospital contracts

Delivered new ID card into production to enroll new membership associated with this product

MBU Division Healthcare Reform Call Center Initialization - 2011

Completed a seamless exchange for a 65 seat telecom call center in Augusta, GA

Successfully coordinated and lead the effort to set up VoIP, call switch routing, call recording and call disposition reporting on schedule

Horizon ID card Redesign – 2010

Successfully lead a $1.1MM effort to redesign ID cards for 24 lines of business issued to 3.4 million insured members

Completed over do upgrade of vendor software to deliver effort

Lead a cross divisional team of (6) resources and testing efforts with a contracted vendor to deliver effort on schedule

Vendor Implementation –Medical Plan Liaisons 2009

Managed the implementation of new vendor pricing software targeted for National Labor accounts w/budget $1.76M

Effort comprised 21 Labor funds with a combined membership of 134,000 and annual revenue gain of $16M

Effort comprised 21 Labor funds with a combined membership of 134,000

Lead cross divisional initiative and efforts between Sales, IT, and the Actuarial departments.

Implemented new reporting formats to track trends in benefit utilization to data mine for cost savings opportunities

MBU Division Project Manager, -2005 -2008

Taft Hartley Labor Funds program -budget of $356,000 9 month effort with annual cost savings of $12M

Performed dual-role as the business and IT PM to implement a new pricing model product for 17 Labor Funds

Effort completed early within 9 months in conjunction with a contracted vendor

Oversaw 1 BA and successfully lead the testing effort

HERE Local 54 Data transformation – Budget $625,000

Lead the data transfer of 52K records for the largest national account labor fund client

Reduced the risk of BCBS Association audit scorecard exposure by 71%.

Enterprise Data Warehouse Data Integrity – budget $850,000 11 months

Completed implementation and end-to-end testing of revised data feeds into the EDW for (3) lines of business (Indiv. Small Grp, Mid-size) from inception to final design managing (5) developers and (1) testing resource

Streamlined the feeds for Referral & Authorization and compressed the input screens from (3) down to (2)

Reduced provider inquiry calls by 15%.

Horizon Healthcare NY – Marketplace Penetration - 2005

Successfully increased the electronic receipts of NY facility claims on behalf of Horizon Healthcare of NY, Inc. with an increased monthly volume of 22,000 transactions

Established 6 new electronic feeds with 6 different New York City hospital plans

Education and Certifications

PMP® Certification, Project Management Institute

Six Sigma Green Belt /Horizon University

B.A. Behavioral and Social Sciences, University of Maryland

Corporate Experience summary

Healthfirst 8/2014 – 9/2016

Emblem Healthcare (contractor) 1/2014 – 8/2014

Horizon Blue Cross Blue Shield NJ 1993 – 3/2014

Contact this candidate