GEORGE QUITERIO

P.O. Box ****

Ormond Beach, FL *2175

Cellular: 727-***-**** Email: ac1nr5@r.postjobfree.com

SUMMARY

An analytical & managerial professional, who is adept at quickly grasping the fundamentals of any business enterprise, identifying improvements to its existing business processing paradigms, and effectively communicating recommendations to senior management. Possesses the capacity to work in a variety of roles, independently, or, within a team environment, onsite & remotely, requiring little or no supervision, while performing multiple tasks of varying complexity.

Skills:

ICD-9/10-CM & CPT/HCPCS

Healthcare Compliance, CMS/ACA

Vendor/Account/Project Management

HIPAA-X12 7030 & 5010/HITECH

Patient Relationship Management

Electronic Records Management

Data & Process Modeling

Business Rule & Report Design

Test Case Design & Q/A

WORK EXPERIENCE

Cognizant/Trizetto, Englewood, CO 2016 to 2017

Global Business & Technology Consulting Services Company

Senior Associate

As a Senior Associate, worked on a remote basis from Florida, directly with Cognizant’s Regulatory Services Team. Hired on as Subject Matter Expert in Affordable Care Act, (ACA), business operations, specifically, in support of Enrollment, Payment, Risk Adjustment functions performed on the Health Exchange & EDGE Server platforms. Conducted monthly webinar sessions to Trizetto Product Services management highlighting Federal & State rule making. Work products generated include 2018 Notice of Benefit & Payment Parameters, ACA Market Stabilization requirements, a 2018 Letter to Issuers Summary Brief, and Gap Analysis for proposed changes between the ANSI X/12 7030 & 5010 data standards on the following transactions; 834 Enrollment, 820 Premium Payment, 837 Institutional Claim.

Method 3 Consulting, Camp Hill, PA 2015 to 2016

Regional Business & Technology Consulting Services Company

Healthcare Management Consultant

As a Management Consultant, worked on a remote basis from Florida, directly with a client, Ritter Insurance Marketing, headquartered in Harrisburg, PA. Hired on as Subject Matter Expert in Affordable Care Act, (ACA), business operations, specifically, in support of Enrollment applications generated on a Web-Broker software platform. Work products generated include 2016 ACA Web-Broker functional requirements, a Marketing Competitive Analysis Summary, and Gap Analysis for 2016 changes to the Federal Facilitated Exchange electronic Premium Payment transaction, which uses the HIPAA 820 data standard, and the Enrollment transaction, which uses the HIPAA 834 data standard.

EngagePoint Inc., Calverton, MD 2014 to 2015

National Healthcare Enrollment & Billing Software Services Company

Healthcare Management Consultant

As a Management Consultant, worked directly with an EngagePoint client, State of Missouri Department of Family Services, to devise/adopt a data conversion strategy to convert Medicaid & CHIP participants so that these health programs could be administered, using EngagePoint's Enrollment & Finance product application platforms. In addition, proposed an audit methodology to ensure that converted data could be tracked/monitored/reconciled at the Account, Household, Policy Owner, Dependent/Beneficiary levels.

Enumation Systems LLC, Rockville, MD 2012 to 2014

Regional Business & Technology Consulting Services Company

Healthcare Management Consultant

As a participant on Florida Health Care Plan's HIPAA 834 5010 Enrollment Automation & ACA corporate initiatives, via a series of group interview sessions with FHCP internal clients, (Enrollment, Marketing, Member Services), and FHCP's Sponsors/Third Party Vendors, authored User Stories that documented "new" data & business rule processing requirements to enhance FHCP's EDI Manager online & batch enrollment applications.

GEORGE QUITERIO Cellular: 727-***-**** Email: ac1nr5@r.postjobfree.com Page Two

As part of a team of Business Analysts, worked on an evaluation & gap analysis of Trizetto's QicLink product to determine whether or not it could be used to replace Florida Health Care Plan's legacy core administration system. This effort involved capturing, via data & work flow diagrams, "as-is" functionality being performed by FHCP's Member Services, Case Management, and Central Referrals Teams.

Strategic Staffing Solutions Inc., New Orleans, LA 2011 to 2012

National Business & Technology Consulting Services Company

Healthcare Management Consultant

As a participant in a corporate initiative to upgrade its web portals, authored a comprehensive business functional requirements document that addressed the “re-write” of Blue Cross/Blue Shield of Louisiana’s Global Communications System, (GCS), which was comprised of 16 functional applications. This assignment entailed capturing "as-is" functionality, via the "reverse engineering" of the current program code base, along with capturing "new" business functionality from internal/external clients & business partners, via various requirements gathering techniques, (i.e. interviews, surveys, focus groups, etc.).

Comprehensive Health Management Inc. / WellCare, Tampa, FL 2008 to 2011

A U.S. health plan administration firm committed to providing premium customer service to its provider partners and the membership it services

Senior Business Analyst

As a participant in a corporate-wide initiative to standardize CMS compliant, Medicare provider demographic categorizations, facilitated weekly meetings that inventoried all Medicare demographics used throughout the corporation, and designed a Standard Operating Procedure template used to house business rules that addressed identification & data capture, credentialing, contract configuration & loading, directory, federal & state regulatory reporting of Medicare provider demographic information.

Authored a presentation given to Senior Health Services Management that addressed a functional gap within the Peradigm claims system to adequately assign & store CMS Service categorizations in a compliant manner.

Authored a presentation given to Health Services Management that addressed the need for uniform address data edits & standardization algorithms, the risks that inconsistent, {provider, member, vendor}, address information poses to the corporation, and immediate, intermediate, and long-term strategies to mitigate those risks.

As a participant in the Third Party Vendor {TPV} project, identified areas to ensure quality data edits, error & process cycle reporting, were being performed. This included providing “mock-ups” of Email notification of TPV Process Cycle statistics, Detail & Summary Error reports, which were reviewed & adopted by the I/T and Corporate Ancillary teams.

As a participant in the process improvement initiative of HSD table construction, designed a data model for CMS regulatory data elements not currently stored in any corporate legacy systems. Specifications included a relational data model, “source-to-target” data maps, and business rules designed to parse provider demographic data into their appropriate HSD tables for the purposes of network adequacy reporting.

Allstate Insurance, St. Petersburg, FL 2006 to 2007

A U.S. insurance and financial services firm committed to providing premium customer service

Exclusive Agent

As a participant in Allstate's R3000 Employee/Agent sales management program, gained experience with Allstate's health, property casualty, and financial services products, along with their Lead Management, Premium, Claims processing software applications, and HIPAA & S.E.C. Regulatory/Compliance office procedures.

HSBC / Household Finance, Tampa, FL 2003 to 2005

A global banking and financial services firm committed to become the world’s local bank

Senior Analyst - Business Systems

Project Manager & Lead Analyst led a composite team of U.S. and “off-shore” personnel in the delivery of a Privacy repository. Information stored in this repository was a corporate asset used to ensure that Customer Relationship Management and Marketing areas were compliant with federal and state Privacy legislation.

Project Manager led a composite team of U.S. and “off-shore” personnel in the delivery of a Consumer Lending transaction history repository. Revolving and Closed-End consumer loan transactional information stored in this repository was used to satisfy queries from federal and state regulatory agencies. The components of this application were extract programs and a DB2 relational database with its logical and physical models developed and maintained with the use of ERWIN 4.0.

GEORGE QUITERIO Cellular: 727-***-**** Email: ac1nr5@r.postjobfree.com Page Three

EDWARD JONES, St. Louis, MO 2002 to 2002

A global brokerage and investment firm committed to the satisfaction of individual investor financial needs

Investment Representative

Provided investment products, services, and information that individuals needed to achieve their financial goals. Financial products sold were Stocks, Bonds, Mutual Funds, Annuities under a Series 7 licensure.

IBM, Tampa, FL 2000 to 2002

Mid & Small Financial Markets Business Intelligence Consulting Services Practice

Consultant

As a member of the Enterprise Performance Suite, (EPS), leadership team, developed a business plan that help secure $830,000 in internal IBM development funds for 2001. Financial institutions use EPS to help target profitable customers for both marketing campaign analysis and customer relationship management systems. The components of this solution were an ERWIN 4.0 logical data model, a DB2 UDB 7.3 data warehouse, which was populated using DB2 Warehouse Manager and a meta data model with its associated reports developed using Business Objects 5.0 Designer and Report Manager modules.

As an active participant in the enhancement and implementation of EPS software solutions, requirements were gathered, and enhancements were made to the EPS logical data model. Processing steps that were necessary to populate the EPS data warehouse were either added or modified. Enhancements to both the EPS meta data model and reports were then made. Through my efforts as a key implementer on a Florida based EPS client engagement, IBM was able to obtain both a client marketing reference and a subsequent EPS support agreement of $85,000.

Senior IBM management acknowledged these efforts, via a Quality Service Award presentation, in the form of IBM Stock Options.

BOOZ - ALLEN & HAMILTON, McLean, VA 1996 to 2000

Global Transportation Business Management Consulting Services Firm

Associate

Primarily responsible for the data modeling and development of a decision support system, the Freight & Trade Processing System, (FTPS), which was used to perform carrier, vehicle, driver credential and safety assessments for the Federal Highway Authority, (FHWA), at both US border and state inspection site facilities. The data model for this application was developed using the casetool, ERWIN 3.5. The database used to support this system was developed using ORACLE 8.i, operating in a UNIX 11.0 environment. The web application, to access this system, was developed using ColdFusion 4.5.1. Message handling for this application was developed, using MQSeries and JAVA.

As part of an analysis team involved in an organization study at New Jersey's Division of Motor Vehicle Services, (NJDMV), primarily responsible for the evaluation of current information system document imaging and archiving technologies and their use by state personnel. This effort involved conducting on-site interviews of NJDVM personnel, which included NJDMV management.

Acted as a team leader in guiding seven people during the programming of both on-line and batch accounting processes for Alabama Department of Transportation’s Comprehensive Project Management System, (C.P.M.S.). The financial and accounting processes constituted 80% of the CPMS system. Software utilized on this project were PowerBuilder 5.0 and Cornerstone 5.02 for GUI development, DB2 5.0 for the mainframe data warehouse, Oracle 7.3 for the client server database, and COBOL II for mainframe batch processing. This solution significantly reduced cost distribution errors and resulted in the elimination of printing partially completed purchase orders, saving Alabama D.O.T. approximately $100,000 per year. Also, during the development phase of this project, participated in the creation of a project needs analysis document, which addressed the lack of resources and time allotted to test this system. As a result of these recommendations, Booz-Allen & Hamilton expanded its presence on this project and generated an additional $250,000 in billing revenue.

Previously, responsible for designing screen prototypes, used in the maintenance of accounting validation tables. Produced functional specifications for Federal Billing, Cash Forecasts, along with the data entry and posting of financial transactions related to Cash Receipts. These specifications were produced, using Microsoft Word 6.0 and Access 2.0. In addition, there had been training on EasyCASE, which was the CASE tool used on the CPMS project.

GEORGE QUITERIO Cellular: 727-***-**** Email: ac1nr5@r.postjobfree.com Page Four

AMERIDATA, Columbia, MD 1995 to 1996

National Business & Technology Consulting Services Company

Software Engineer

Principally responsible for formatting U. S. F. & G.’s “claims extract” for the Fort Howard Paper Company, via COBOL II batch processing. This extract contained Workmen’s Compensation Claim information, which resided on a DB2 Relational Warehouse.

COMPUTER PROFESSIONAL RESOURCES, Prairie Village, KS 1995 to 1995

Regional Business & Technology Consulting Services Company

Software Engineer

Key participant in U.S. Sprint’s Database Marketing Prototype Project, which consolidated various “ad-hoc” batch processes into a single, table-driven batch process, using COBOL II and Teradata SQL. Principally responsible for the coding and testing of any Teradata SQL queries used on the project, along with analyzing, coding, and testing of the Customer Account Update function of this project.

COMPUTER TASK GROUP, Overland Park, KS 1994 to 1995

Global Technology Staffing Company

Software Engineer

An active participant in U.S. Sprint’s Pinnacle Project, which was a conversion of a “flat-file” batch billing reporting system into a “relational” marketing information warehouse using COBOL II and Teradata SQL. Principally responsible for the analysis, coding, testing and documenting of software, which identified a Sprint “client” and constructed both its legal and business hierarchical structures.

VANTAGE COMPUTER SYSTEMS, Kansas City, MO 1990 to 1994

Global Insurance Industry Third Party Technology & Administrative Services Company

Senior Systems Analyst

Re-engineered a batch checkwriter subsystem for both “full-service” and “remote” customers using COBOL II and accessing VSAM files.

Solely responsible for the analysis, coding, testing and documenting of software, which performed 1993 year-end tax reporting for both “full-service” and “remote” customers.

Responsible for analyzing, coding, testing and documenting software, which administered annuities and universal life policies for the Accumulated Interest Group, (AIG).

Converted the Repetitive Payment System from software release 8.0 to release 11.0 that included a database conversion. This database was comprised of various VSAM and “fixed-length” table files.

HARTFORD INSURANCE GROUP, Hartford, CT 1983 to 1990

National Fortune 500 Property & Casualty Insurance Company

Programmer Analyst 1987 to 1990

Analyzed and coded SQL queries, which were used during the conversion of a Workmen’s Compensation statistical reporting system, from IMS/DL1 to DB2/SQL.

Analyzed and provided program specifications to verify and correct commercial lines claim information, which had been accepted via an “electronic-filing” interface.

Programmer 1983 to 1987

Functioned as the Lead Programmer for the Texas Automated Reporting, (TARS), project. Responsibilities included writing COBOL programs, creating both job/proc JCL streams, and developing a system test plan.

Solely responsible for producing electronic reports, using IMS/DB/DC, which were sent to the regional offices, using On-line Hold Capability, (OHC).

Responsible for analyzing, enhancing, testing and documenting software, which supported premium and claim reporting for 10 commercial insurance lines of business.

GEORGE QUITERIO Cellular: 727-***-**** Email: ac1nr5@r.postjobfree.com Page Five

EDUCATION

Certificate in Health Care Informatics, 2010, St. Petersburg College, St. Petersburg, FL

Certificate in Health Information Technology, 2007, Central Florida College, Largo, FL

Bachelor of Science in Biomedical Engineering, 1980, Boston University, Boston, MA

LICENSES/PROFESSIONAL DESIGNATIONS

CHC - Certification in Health Care Compliance, Health Care Compliance Association, (HCCA), March 2014

Securities & Exchange Commission (S.E.C.), Series 6 License, December, 2006

State of Florida 02-15 License, Resident Life including Variable Annuity & Health Insurance, December, 2006

State of Florida 02-20 License, Property & Casualty General Lines, March, 2003

ORGANIZATIONS

Phi Theta Kappa - Alpha Omega Beta Chapter, 2010

St. Petersburg College Alumni Association, 2010

Health Care Compliance Association, 2009

Boston University Alumni Association, 1980

MEDICAL OFFICE APPLICATIONS

MEDISOFT v11.0 - 1 yr.

MEDICAL MANAGER v10.0 - 1 yr.

VISIONARY - 1 yr.

CACTUS - 1 yr.

FACETS - 1 yr.

PERADIGM/XCELYS - 3 yrs.

DATABASES

ORACLE PL/SQL - 1 yr.

DB2/SQL - 8 yrs.

TERADATA/SQL - 2 yrs.

IMS/PL1 - 2 yrs.

VSAM - 3 yrs.

ACCESS/SQL - 1 yr.

TOOLS

WINDOWS 10/8/7/XP - 14 yrs.

BUSINESS OBJECTS 5.0 - 1 yr.

MS EXCEL - 10 yrs.

ERWIN 3.5/4.0 - 3 yrs.

MS POWERPOINT - 10 yrs.

MS VISIO - 8 yrs.

MS PROJECT - 4 yrs.

QUALITY CENTER - 2 yrs.

MS WORD - 14 yrs.

LOTUS NOTES - 3 yrs.

QMF - 6 yrs.

SYNCSORT - 16 yrs.

COMPUTER LANGUAGES

COBOL - 10 yrs.

COBOL II - 6 yrs.

BASIC - 1 yr.

CICS - 3 yrs.

TSO/ISPF - 16 yrs.

POWERBUILDER 5.0 - 2 yrs.

ASSEMBLER - 2 yrs.

EASYTREV + - 5 yrs.

JCL - 16 yrs.

ITEQ/BTEQ - 2 yrs.

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