System Manager

Jian Li

* ******** **., ******* *****, NJ *****

Phone 908-***-**** Email: *********@*****.***

SUMMARY

Over ten years of experience in healthcare IT management. Extensive

experience in managed care data and database management, application and

database system implementation and support, data conversion and reporting.

Outstanding skills in providing business intelligent solutions to improve

business process.

PROFESSIONAL EXPERIENCE

Metropolitan Jewish Health Systems

IS Manager, Managed Care

December 2007 to November 2013

Application Architect

November 2013 to Present

Lead the MJHS managed care IT team to develop database system and

architecture and provide solution to support plan's strategic planning and

daily operation. Collaborate with all business units to satisfy regulatory

data submission requirements. Ensure accurate and secure data exchange

with external vendors. Support the daily operation for

Elderplan/Homefirst's software and application and systems.

. Lead the managed care IT team to provide analytical data to support

the plan's strategic planning. Represent IT in plan's strategic

initiatives, collaborate with business in defining business

specifications for data requirements and database systems

implementation. Enforce SDLC in providing business intelligence

solutions.

. Oversee all member, provider, claim and authorization systems for

Elderplan and Homefirst. Manage system configuration, updates and

upgrades to ensure compliance. Maintain change control for all managed

care systems.

. Lead the managed care IT team in designing all system interfaces, data

load, business reports, extracts as well as data submission to fulfill

regulatory requirements.

. Coordinate with business operation to ensure timely and qualified

submission of encounters to meet regulatory requirements. Implement

encounter tracking systems to improve submission accuracy and

acceptance rate.

. Coordinate network group and DBA group to ensure database performance

and high database availability. Design and implement database disaster

recovery strategy for both database and application.

Accomplishments:

. As technical lead, participated in Elderplan's claim system conversion

and Elderplan/Homefirst claim system merge. Major tasks included the

server and database provision, all conversion load files preparation,

all reports, interfaces, extracts conversion as well as the re-design

of all regulatory submission. Managed the system deployment during the

implementation.

. Designed and implemented all data extracts, interfaces for Elderplan's

MAP and MA products. Served as technical lead in Elderplan's business

expansion projects and in the FIDA system implementation committee.

Led the ICD-10 implementation in reporting and served in the ICD-10

claim implementation team.

. Implemented tracking system to monitor all stages of claim processing:

summarize 227 denials to assist vendors reduce compliance rejection;

create reconciliation reports to ensure no claim fallout during

various stage of claim processing; analyze claim pended reasons to

ensure high auto adjudication rate. Elderplan maintains over 90% of

auto adjudication rate and achieve over 98% accuracy in claim

processing in recent audit. Implement system to reconcile between DOH

member rosters with member system as well as claim system to ensure

proper claim payment and reduce the premium billing rejection from

over 450 to less than 50.

. Improved Homefirst MEDSII submission acceptance rate from 38% to 98%

and increased the submitted encounters over five times.

Royal Health Care New York, NY

Assistant Director for MIS

November 2006 - September 2007

Supervised MIS department daily operation. Collaborated with all other

departments in company's overall initiatives. Assisted CIO in formulating

IT development strategy.

. Improved MIS policies, procedures and processes to enhance data

quality. Assured data infrastructure integrity for all data collection

and dissemination. Enforced proper programming standard and change

controls.

. Represented MIS in company's new client implementation projects.

Coordinated efforts from all functional areas in claim system

conversion, allocated and scheduled MIS resources to meet deliverable

requirements.

. Implemented new database technology and business intelligence solution

to improve the accuracy and efficiency of data delivery. Designed MS

SQL Server 2005-based data warehouse and data ETL infrastructure.

. Supported company applications and secured data interchange internally

and externally for clients, company users, government agencies and

vendors at multiple facilities.

. Motivated the work of programmers and administrators; enhanced their

professional development; evaluated their performance and assured

their accountability.

CancerCare Inc., New York, NY

Director of Information Technology

April, 2003 - November 2006

. Directed the development and implementation of company's data

warehouse structure, decision support system and enterprise reporting

system

. Led the network integration projects to centralize and automate

network and application management, and enhance system monitoring and

auditing.

. Managed IT budget, and maintained vendor relationship.

. Ensured consistent service level.

IT Manager October, 2000 - April, 2003

. Designed Windows 2000 active directory with multiple sites structure

and implemented group policies based on business requirements

. Led the conversion of OpenVMS clinical system into a SQL 2000 server-

based clinical system. Implemented other SQL-based financial system

and fundraising system.

. Designed and enhanced system backup and recovery and database

redundancy.

. Provided reports and data extracts to support various needs.

. Supervised IT helpdesk operation to support all company's applications

and systems.

System/Database Administrator October 1997 - October,

2000

. Administered network and database operation and security.

. Managed OpenVMS clinical system.

. Expanded the local area network into a multiple location wide area

network.

EDUCATION

MS in Management with specialization in Management Information System, New

Jersey Institute of Technology

One year of study toward MBA in International Business, Virginia

Commonwealth University

BA, English Language and Literature, Xiamen University, P.R. China

CERTIFICATION

Microsoft Certified Database Administrator (MCDBA)

Microsoft Certified System Engineer (MCSE)

Microsoft Certified Systems Administrator (MCSA)

Oracle 8: Database Administration; Performance Monitor; Disaster recovery

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