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Technology leader, application development, SaaS, data management

Alpharetta, Georgia, United States
August 15, 2018

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Greater Atlanta, GA Phone: 806-***-**** Email: Linkedin: SUMMARY

Tenacious, transformational IT leader seeking an opportunity to drive the success of a dynamic technology team through my solid educational foundation, ownership mentality, 15 years global hands-on experience ranging from midcap to Fortune 500 businesses with a proven track record of execution and thought leadership developing roadmaps, architecting solutions, implementing mission-critical initiatives, directing cross functional delivery teams, and establishing the infrastructure that has repeatedly resulted in accelerated performance with a motivated will to solve, succeed and win. Proficient in financial management having a proven performance managing operational budgets of up to $5M, and capital expense budgets of up to $30M. Expert in establishing governance controls, systems, and processes necessary for SOC2, SOX, HIPAA, and PCI compliance. ACCOMPLISHMENTS & EXPERIENCE

ZELIS HEALTHCARE, HEADQUARTERED BEDMINSTER, NJ 4/2017 – 2/2018 A $500M healthcare cost management and payments solutions provider including network analytics and design, network access and cost management, claims cost management and electronic payments to providers.

Chief Information Officer, Network Solutions, ATLANTA, GA IT leader of $130M Network Solutions division architecture, software development, business intelligence, data management, project management, and EDI teams managing the firm’s primary and supplemental PPO and referenced-based pricing solutions. 10% YOY Revenue Growth Goal, $3M OPEX, $6M CAPEX, and 39 employees.

• Lead the implementation of Santech Provider Data Management platform migrating multiple redundant legacy provider solutions into a single source of truth. Included massive provider, network, and contract data cleanup effort. Established uniform import and export layer that consolidated hundreds of import and export formats into a standard canonical import and export layout. Partnered with Operations to create SOPs and analytics to ensure data remained clean.

• Customer and Network implementations lacked prioritization, reporting, and process resulting in no visibility, inconsistent results, errors, and prolonged implementations lasting 90+ days. Created an Implementation Manager role with ownership over the end-to-end process. Managed the development of cross functional roles and responsibilities, a repeatable process, and standard reporting. Resulted in increased revenue and transparency by decreasing the average implementation turnaround time to 30 days with the highest value implementations appropriately prioritized.

• Led the development of referenced-based pricing microservices, decoupling the logic from the repricing engine and optimizing allowing for a 10x volume increase by exposing services across the enterprise and externally to allow pricing at point of prior authorization. Built entirely in Azure establishing a cloud presence and developed a roadmap for future cloud migration. Delivered scalability, monitoring, and decreased on premise infrastructure footprint.

• Established PMO processes, reporting, and documentation and instituted Portfolio Management strategy. Delivered transparency and alignment on project approval, prioritization, and scope and enabled the ability to track results against estimates.

• Division eliminated in early 2018.

CHANGE HEALTHCARE (FORMERLY ALTEGRA HEALTH), HEADQUARTERED NASHVILLE, TN 2014 – 2017 A $3.5B Healthcare technology organization with 10,000 employees. Offers solutions to lower healthcare costs and improve patient access and outcomes. Vice President, Information Technology, ATLANTA, GA Chart Retrieval and Clinical Review $80M division IT leader of global software development, data management, product design, and testing teams overseeing successful product development and delivery of suite of custom applications and analytics to support 24x7 global HEDIS and Risk Adjustment operations and Clinical Care Visits LOB. 27% Revenue Growth goal for Risk Adjustment, 2% Revenue Growth goal for HEDIS, $2M OPEX, $6M CAPEX, reporting directly to CIO with 42 employees and 4 direct.

• Partnered with business leaders and led IT through transformation project to improve margin, enhance customer value, and achieve differentiation and market leadership. Led to $6M annual ROI. o Created a work distribution process that instantly prioritized incoming medical charts and eliminated the need for a work assignment team by moving to a “pull” methodology where coders always had access to work the next highest priority chart. o Delivered technology-assisted coding platform using natural language processing and OCR to flag diagnoses codes in charts resulting in a 50% increase in charts per hour.

o Re-engineered chart QA methodology and application to move away from a blind QA to an industry standard agree/disagree QA process. Resulted in doubling of QA capacity.

o Modernized call center by implementing Cisco Finesse, Calabrio Analytics, and Cisco dialer. ROBERT SPURLOCK • PAGE 2


• Applying best practices, stricter governance, and increased collaboration, decreased annual percentage of defect resolution time across software development and data management from 10% to 3% in first year. Realized shift of 7000+ hours from OpEx to CapEx.

• Data Management import and export code was running over periods of up to days resulting in delays starting projects, impacting system performance, and missing customer SLAs. Managed the rewrite of data management functions using modern code and replication resulting in process that ran in minutes. Eliminated contention, increased revenue by adding days to new projects, and met all export SLAs.

• Sync times, frequent crashes, and application bugs plagued a field practitioner Windows Surface mobile application used for home assessments, resulting in difficulty retaining practitioners and missed SLAs. Performed complete architectural review and selected and implemented the iPad Air 2 with embedded LTE. This decreased cost per unit 45%, reduced build complexity from 50 pages to 1 and nearly eliminated defective units

(from 30% to 1%). Managed line by line code review resulting in the elimination of all reported defects.

• Migrated on premise data center and telephony to Dimension Data Managed Cloud and SQL Server from 2008 R2 to 2016. Added redundant architecture, eliminated SQL replication using Always-On, and stabilized self-service reporting and data intense operations by taking advantage of Always-On. Reduced SQL Server CPU usage from 70% average to 4% and eliminated system latency, reducing database downtime from 5% to zero.

• Partnered with CIO and IT counterparts across divisions to institute Data Governance Committee to ensure continuous delivery of data and information security, quality and value to the enterprise and client base. Collaborated to define polices, processes, and procedures, define data definitions, standardize data cleansing, and build the infrastructure and security necessary to provide data when and where it is needed. LOVELACE HEALTH PLAN, ALBUQUERQUE, NM 2009 – 2014

A health system consisting of 6 hospitals, physician group, pharmacies, and a health plan serving New Mexico. LHP insured members serving New Mexico’s commercial, Medicaid, and Medicare markets. Products included medical, dental, vision, and wellness products for commercial, retail, and government markets. Lovelace Health Plan was an integrated entity within the Lovelace Health System in New Mexico and served Medicare populations in Oklahoma. Lovelace Health System was part of Ardent Health Services family of health systems in New Mexico, Oklahoma, and Texas. LHP was acquired by BCBS and sunset in 2014. Enterprise Architect (2013-2014)

Reported to CIO, responsible for software development team and all technology and touchpoints used by the health plan and the seamless integration of IT infrastructure, business processes, and vendor functionality.

Sr. Application Architect (2010-2013)

Primary solutions and technical architect responsible for providing technical expertise, leadership, and project management related to the support, cost control, implementation, custom development, vendor management, and maintenance of the core software applications utilized by the health plan. Application Architect (2009-2010)

Responsible for technical expertise and project management. Owner of application and interface inventory, and DRBC including accountability for ensuring accurate documentation and diagrams of the firm’s systems, databases, hardware, and vendor systems.

• Worked with CIO to insource custom development. Hired six developers, defined coding standards, created development infrastructure, and led team. Resulted in lower costs and improved speed to market. Proved critical to launch healthcare exchange product.

• Upon learning the Trizetto Enrollment Gateway product would not be completed in time for PPACA Exchange open enrollment architected and led development of inhouse custom product. Partnered with multiple departments to develop workflows and SOPs. Engineered 834 engine, Azure based payment portal, premium reconciliation, and appropriate reporting. Managed development, product testing, compliance, and launch over 6 months completing the product as planned.

• Identified as the key IT resource to be retained through last day of business following acquisition of Lovelace Health Plan by BCBS. Created and managed complete transition, sunset, and data archival plan including all major systems, equipment, and contracts.

• Reported Medicaid encounters did not reconcile to financials, revealing $50M discrepancy. Rejections were 5X contract requirements and the state issued intent to sanction 5%, risking ~$3.5M in quarterly capitation payments. Challenged by the CIO to restore order, remediate issues, and eradicate financial discrepancies. Identified root cause, created and led an action plan referencing data from multiple systems, reconciling 100% of issues within 90 days. This nearly eliminated errors, reduced liability from $50M to <$1M, and avoided sanctions.

• Partnered with Trizetto and trading partners to architect and develop a complete end-to-end claims reconciliation process that ensured that all electronic and paper claims were accounted for throughout the claims lifecycle from trading partner to 835. This allowed the organization to proactively identify and correct claims fallout and stay compliant with prompt payment SLAs.

• IT lead on massive modernization and consolidation of operational systems. Partnered with Trizetto and Accenture to upgrade multiple disparate legacy systems, claims, enrollment, customer service, contracting, and Medicaid Encounters to single Facets 4.71 platform. Managed Data Conversion, Data Warehouse, Infrastructure, Interfaces, IVR, Reports, Letter Server, Batch, and Controls. Managed a $30M budget and delivered a single modern compliant platform capable of fulfilling future initiatives (5010, ICD10). This became the foundation for upgrading ancillary products and vendors.

• Technical lead on multiple projects including:

o Implementation of Facets Constituent Web Services to launce Group, Member, Provider and Broker portals. o Market expansion into Oklahoma Medicare arena with new Medicare Advantage plans. o Admin Simplification

o ZeOmega’s Jiva case management implementation.



• Facets environment owner accountable for coordinating with Trizetto hosting and internal stakeholders to manage batch schedule, daily operations, monthly metrics reviews, change pack management, and monitor SLAs and performance.

• Perform architectural reviews of all enterprise changes, capital expenditures and demand management requests.

• Review and approve all vendor contracts and RFPs.

• Developed and maintained technology artifacts including architecture diagrams, application inventory, DRBC, data definitions, vendors, and all technology touchpoints.

ACS COMPIQ (ACQUIRED BY XEROX/CONDUENT), DALLAS, TX 2004 – 2009 Workers Compensation medical bill review technology division as part of a $6B IT services company with 74,000 employees. Also provides business process outsourcing solutions to businesses, government agencies, and non-profit organizations. Software Engineer

Full stack .Net engineer responsible for developing innovative, robust data-driven software solutions, and leading offshore development efforts to ensure a successful and agile development environment.

• Following acquisition by ACS, shifted to offshore model. Led offshore development team of five developers.

• Developed an 837 format claims routing platform to connect with external PPOs to provide network discounts. Produced 837 file generation, translation, routing, and repricing engine, and led testing to launch within 6 months. This allowed ACS CompIQ to add leased external PPO networks to product offering. Solution became the framework for state encounter reporting.

• Expanded on 837 engine to develop a Workers Compensation State Encounter reporting system. Included platform to correct rejections and track history and produced necessary reporting.

• Developed a claims examiner portal and image workflow used by claims adjusters to determine compensability.

• Worked on custom document management workflow system that imported bill images and allowed manual or automated assignment to workers compensation claims before being routed for compensability and data entry.

• Developed a Medicare fee schedule calculator using CMS available data.

• Developed a Provider Inquiry portal to track provider service contacts and produce correspondence.

• Worked on proprietary Nurse Path case management module.

• Developed numerous custom data and image loads.



MBA in MIS with emphasis in healthcare data management (2014) Bachelor of Science in Computer Science (2007)

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