Manager Data Entry

diane twehous

*** **** *****, ********* ****, MO 573-***-****, *****.*******@*****.***

PROFESSIONAL SUMMARY

With more than 25 years of experience working with Medicaid Management Information Systems, I offer expertise

managing Medicaid fiscal agent contracts, operations, and business development efforts. My career includes significant

financial contributions in contract and project governance, system implementation and maintenance, claims processing,

and improving operations processes. As the primary liaison to Medicaid State government entities for more than 10

years, my team was able to demonstrate clear understanding of expectations and fulfill goals and business requirements

successfully. Dedicated to continuous improvement, I engage employees to value an unyielding commitment to

customer service using honest and frequent communication.

C HRONOLOGY

Vice President General Manager Missouri Medicaid Operations

Wipro Infocrossing – Jefferson City, MO

07/2006 – 12/2013

• Developed winning strategies and led Infocrossing to win a $400M Missouri MMIS contract in 2007.

• Successfully led the account through contract start up and planning during Wipro acquisition of Infocrossing while

maintaining all contract service levels.

• Executive program manager overseeing multiple complex system enhancements including VSAM to DB2

conversion, Rules Engine and complete rewrite and technical upgrade of Medicaid web application.

• Consistently met or exceeded contract service levels during the life of the contract.

• Received no liquidated damages or contract penalties.

• Maintained high margins throughout contract period through cost reduction and added efficiencies.

• Increased revenues through new business wins and contract amendments.

• Negotiated $5M ICD-10 project and successfully avoided contract dispute.

• Negotiated contracts with vendors and subcontractors.

• Responsible for Missouri Medicaid budget and financial results.

• Directly responsible to corporate Wipro for Missouri account P & L.

• Responsible for the successful operation of the fiscal agent contract including claims processing, multiple provider

and recipient call centers, MMIS enhancement, maintenance and daily processing, staffing, facilities management,

business continuity, privacy and security.

• Served as HIPAA privacy officer.

• Responsible for account growth and new business development for Missouri Medicaid Operation and other

Missouri State government initiatives.

• Responsible for the Wipro Infocrossing relationship with the Missouri Office of Administration, Social Services

and Information Technology Service Division.

• Responsible for Wipro Infocrossing representation to the State of Missouri’s legislative executive entities.

• Worked with local lobbyist firm to acquire State legislative support and new business opportunities.

• Worked with Wipro Infocrossing partners to present process improvement and cost saving opportunities to the

State of Missouri.

• Served as Ombudsman for Wipro Corporate North America.

Account Manager Missouri Medicaid

Infocrossing Healthcare Services – Jefferson City, MO

11/2003 – 06/2006

• Led team through acquisition of contract by Infocrossing from Verizon with no issues from client and no

interruption in contract services.

• Developed strategies and prepared the Missouri account for the Fiscal Agent MMIS re-procurement effort.

• Effectively negotiated multiple contract amendments including the HIPAA Transaction Sets, HIPAA Security, a

contract price reduction representing a $2.9 million savings to State, and a contract renewal with additional option

1

years requested by the State.

• Guided operational and systems staff in the successful implementation of a Paperless Claims Initiative that

resulted in an electronic submission rate of 98% and reduced operational costs to State.

• Responsible for the administrative oversight of the entire Infocrossing Missouri Medicaid operation.

• Directed the successful operation of the fiscal agent agreement between State of Missouri and Infocrossing for

claims processing, call centers, MMIS enhancement and maintenance, contract amendments ensuring all

contractual requirements were met.

• Responsible for Missouri Medicaid fiscal agent operations budget and financial results.

• Initiated staffing solutions to improve the Recipient Services Call Center resulting in a reduction of the backlog.

• Responsible for corporate growth and new business development for Missouri Medicaid Operation and other

Missouri State government initiatives.

• Key in developing strategies with State executive staff to solve new business issues, provide enhanced services,

and improve performance.

Claims Manager Missouri Medicaid

Verizon Information Technologies – Jefferson City, MO

04/1991 – 10/2003

1. Directed 51 employees in the Document Control, Data Entry, Resolution, and Medical Policy units,

processing more than 4.5 million Medicaid paper claims annually meeting all contractual requirements and

metrics; managed and guided a team of four supervisors to ensure that Verizon recommended solutions to the

State that expedited and enhanced claims processing.

2. Ensured the timely and accurate processing of all claim receipts according to State and CMS guidelines.

3. Monitored performance of MMIS to ensure processing issues were identified and resolved efficiently.

4. Directed the conversion of microfilming processes to an imaging application for paper claims providing

easier, quicker, and wider access of documents resulting in faster claims resolution.

5. Coordinated the conversion of more than 1 million State provider enrollment documents into images and

subsequent sorting into electronic folders; automated the document process and provided easier and broader

access to documents which eliminated paperwork for State.

6. Coordinated provider manual documentation and a major Internet enhancement to distribute provider

manuals on-line through the Internet.

7. Implemented a quality assurance process improvement to key verify through the REI verify system resulting

in identification and correction of keying errors eliminating adverse impacts to the provider community.

8. Integral in initiating system changes to enhance the manual and automated processes of the MMIS that affect

the Claims department creating value-added services for State.

9. Planned and executed the conversion of nursing home Turn-Around-Documents into electronic format.

Research Administrator Missouri Medicaid

GTE Data Services – Jefferson City, MO

06/1989 – 03/1991

1. Assisted the Claims Manager in the day-to-day operation of the Claims department and served as Interim

Claims Manager in the absence of the Claims Manager.

2. Liaison to State personnel in coordinating processing and handling procedures.

3. Contributed as a team member to the development, testing, and implementation of the new Claims Processing

Subsystem during this major system enhancement.

4. Coordinated the online placement of the Resolutions Manual during the implementation of the new claims

processing system.

Claims Manager

GTE Data Services – Tampa, FL

08/1988 – 05/1989

1. Assigned to the Health Services Group working on GTE’s healthcare business development.

2. Participated in proposal development for Medicaid and other healthcare procurement efforts.

3. Reviewed documentation, analyzed requirements, determined RFP goals and objectives, and developed

solutions for submission in responses.

4. Worked with MMIS systems staff during installation and testing of the certified online MMIS, including

developing test data and serving as application liaison to system personnel during exam entry and cycle

completion.

Implementation Claims Manager Missouri Medicaid

GTE Data Services – Jefferson City, MO

2

02/1988 – 07/1988

1. Significant contributor to the successful transfer and implementation of the Missouri MMIS including:

procuring qualified staff; developing and implemented workflow and claims handling procedures for the

Document Control, Data Entry, Resolutions, and Medical Policy units; designing all claim forms and

supporting documents; managing initial takeover of mail receipts from local post office, including

coordinating and supervising the sorting, screening, microfilming, and control procedures for incoming mail

in preparation for data entry; and directed the testing of data entry edits applied to 19 data entry screens,

including eight specific claim screens.

2. Effectively teamed with State personnel in developing approved resolution procedures for the proper

adjudication of suspended claims.

3. Served as liaison for State during testing and implementation phases of the Missouri MMIS.

4. Assisted with implementation of structured data test by formulating expected outcome, performing follow-up

review and analysis, and resolving discrepancies between expected and actual results.

5. Directed management team to develop and document internal quality standards and follow-up procedures.

6. Served on a team to convert IV Phase Data Entry Language to the REI Tartan Data Entry Language,

including updating existing data entry manuals with new functions and capabilities and training 28 data entry

operators.

7. Managed manual functions associated with a transparent takeover of monthly automated nursing home cycles

and worked with State MMIS personnel to ensure the timely receipt and processing of Turn Around

Documents from more than 370 nursing homes.

8. Created control mechanisms to monitor claims inventory, data entry, and suspended claims file.

9. Developed formal procedures that enabled State personnel to adjudicate suspended claims requiring special

handling outside normal processing procedures.

Claims Manager

GTE Data Services – Tampa, FL

08/1987 – 01/1988

5. Assigned to the Health Services Group working on business development in the healthcare arena.

6. Integral part of the Missouri MMIS proposal team; reviewed documentation; analyzed State requirements;

and determined RFP goals and objectives.

7. Developed and refined manual functions for the support of applicable subsystems.

8. Developed and refined the existing Wyoming MMIS manual functions to support new automation of the

MMIS for all subsystems in the proposed MMIS solution.

3

T RAINING/CERTIFICATIONS

1. 7 Habits of Highly Successful People 4. Data Processing: Certificate in Introduction to

2. Corporate Executive Leadership and Training IBM PC

Courses 5. Pharmacy Technician Certificate

3. Graduate Leadership Jefferson City

COMMUNITY INVOLVEMENT

6.

7. Member Jefferson City Rotary Club 9. Current member Jefferson City United Way Board

8. Past member Board of Directors Jefferson City of Governors

Rotary Club 10. Past member St. Martins Parish Council

4

Contact this candidate