Manager Sales
Resume:
JOHN ROSZKOWIAK
*** ***** *****, *******, ********** 94949, 415-***-****, **************@*****.***
HIGHLIGHTS OF QUALIFICATIONS
Experience with Revenue Cycle Management, Electronic Data transactions and Management, Systems Architecture, Solutions Design, Project Management, Sales, and Customer and Vendor Relations.
High degree of experience in the development and implementation of healthcare systems.
Proven record of innovative and effective leadership and staff development.
Extensive computer, writing, presentation, and counseling skills.
KEY ACHIEVEMENTS
Increased the number of trading partners by 300 percent for the Claim Status and Eligibility and Benefits transactions and volume from 800,000 to 3.0 million over four years.
Implemented an outreach program to increase electronic data volume for membership which resulted in a 24 percent increase over two years.
Successfully led the Blue Shield Implementation of Healthcare Reform/Admin Simplification Phase I, II and III from requirements to implementation.
Responsible for the migration of over 500 employer groups to the new membership system at Blue Shield.
Led the development, implementation and sales of CareMedic Systems revenue cycle application. Named as the vendor of choice by the Iowa Hospital Association.
Developed for Blue Shield, daily reporting to track and meet the goals of 100 percent membership accountability and 48 hour processing.
Recipient of Blue Shields highest annual award, the 2015 Mission and Values in Action Award.
PROFESSIONAL EXPERIENCE
Vice President Healthcare Services – Devcool Inc. Present
Responsible for the development and maintenance of Devcool's Claims Analytics Dashboard solution.
Executive responsible to ensure the Product is performing as designed.
Directly work with the customer base to continue to grow the product.
Responsible for the development of strategic partnerships, development of new business and product sales.
Serve as the head of the business consulting team.
Set the direction of the product to meet the ongoing needs of the customer and remain current with industry trends. Transparency and client relations.
Drive product strategy and development.
Senior Manager, Electronic Data Interchange Business Operations – Blue Shield of California 2009 - 2015
Performed as the Electronic Data business driver for multiple projects:
oThe successful 5010 conversion program for all transactions
oBusiness Driver for the Admin Simplification Phase I, II and III projects from requirements to implementation.
oMigration of enrollment groups to the new Facets Platform
oConversion to the IBM Sterling solution for internal and external communications
oThe stabilization of the Blue Shield enrollment system and moving from nine formats to a single compliant format.
oMembership revenue cycle management and transparency project
Identified as one of the key leaders at Blue Shield in 2015
Process owner for the successful electronic enrollment enhancement project, joint business and IT project to improve transaction transparency and client relations.
Responsible for the full electronic enrollment process, from the Group/Vendor to the membership loading.
Serve as the primary business contact with the Blue Cross Blue Shield Assoc for all new requirements and system changes.
Responsible for all Real-Time Transaction Global Certification Testing (GCT) for Blue Shield of California
Managed the full revenue cycle flow for claims and membership. Developed system transparency and accountability to the claim and member level.
Serve as a key member of the Shield Advance Program (Facets Implementation) providing cross-functional insight and input in order to assure the success of this effort.
Developed an integrated work environment between the Electronic Data business and IT teams, creating a seamless team all Electronic Data solutions, requirements, development, testing, support and maintenance.
Responsible for the full end to end processing of the 834, 820 and 27x transactions.
Lead an Electronic Data Business operations team consisting of 28 team members.
Transformed the Electronic Data operations team from file correction and manual processing to technical analysts supporting a fully electronic process.
Managed the development and deployment of the Full File Compare project for membership transactions (ANSI 834).
IT Applications Manager – Fireman’s Fund Insurance Companies 2007 - 2008
Responsible for the leadership of the IT team providing maintenance and enhancements to the reinsurance and Financial Operations suite of IT applications for Fireman’s Fund.
Lead the application development strategy as well as manage a team of 13 employees.
Ensures systems developed are accurate, technically sound, and flexible to allow Fireman’s Fund to take advantage of business opportunities in a timely and cost effective manner Provide consulting services to the clients
Aligns requirements from Fireman’s Fund business clients to provide technical solutions on IT products.
Manages a staff of Solution Engineers and Business Analysts that consists of coaching, developing, providing feedback, determining compensation, and developing and implementing resource solutions.
Responsible for regulatory insurance filings and reporting to state and national reporting organizations.
Rated as the top manager in application services based on the company’s metrics rating criteria in 2007.
Successfully integrated into the team three full time offshore resources, managed onsite training and transitioned the work offshore while maintaining a high level of productivity.
Manager Implementations and Training (Contractor) – TeraHealth Inc. 2007
Manager all new client implementations for TeraHealth’s MedeConnect eligibility application.
Responsible for overall customer satisfaction with the MedeConect product.
Provide consulting services to the clients
Perform analysis on the clients’ business processes and recommend changes to enhance the value of the MedeConnect product.
Review the client’s systems and recommend changes to improve the eligibility processing
Identify the clients custom requirements prior to implementation, to include reports, and dashboard screens
Perform Return on Investment (ROI) analysis.
Ensure the client is effective trained on the application.
Maintain a strong working relationship with the client management team, from the C-level to manager.
Coordinate the project teams from the client and TeraHealth to ensure all project goals and requirements are achieved
Director - Healthcare, Ness Innovative Business Services 2006
Responsible for the overall development of the healthcare business for Ness IBS.
Established three new strategic healthcare business partnerships in my first six months with Ness IBS, Perot Systems, Science Management Corporation and InterSystems Inc.
Oversaw the Healthcare team of over one hundred employees.
Manage the existing strategic relationships with InterSystems Inc. and Perot Systems.
Responsible for the management and development of the Revenue Cycle Management application
Provide business process and activity management with the goal of increasing hospital revenue and staff efficiencies
Develop monitoring and dashboards for the management team.
Provide system integration of multiple backend systems
Manage the project teams, oversee the development of requirements and work with our vendor partners in the delivery of the application.
Oversee the development of the Ness Claims Processing application for hospital and clinical claims submission to payers.
Responsible for the development and delivery of the application to include, requirements development, system architecture, application functionality, deployment and sales.
Oversee both onshore and off shore project requirement and development teams.
Solutions Design Consultant, Kaiser Permanente 2005
Responsible for the Health Plan Operations team overseeing the solution design for Individual and Group Sales, Benefits and Contracting, Underwriting and publications for all Kaiser Regions so they are in compliance with the Medicare Modernization Act.
Managed the development of the overall MMA architecture for all Kaiser Regions and identify system interfaces and impacts.
Supervised the solution design for two critical national initiatives as part of the MMA project.
Explanation of Benefits, which is a statement of activity, sent monthly to members enrolled in Medicare Part D, this is the largest mailing done by Kaiser in its history.
Retirement Drug Subsidy, in which Kaiser Permanente submits to CMS for the purchasers the activity of its Medicare Part D eligible members for reimbursement.
Monitor the development team as they develop and deploy the solutions to ensure it is in compliance with the approved architecture.
Managed a team of eight Solution Design Consultants responsible for the Health Plan Operations aspect of the MMA project.
Oversaw the development team to ensure that the solution architecture was delivered according to the business requirements
Work closely with business teams to identify and document business and system requirements related to the Medicare Modernization Act.
Director, Systems Architecture and Design, DeltaNet Inc. 2002 to 2004
Managed the overall distributed systems architecture and design for the Delta Dental Enterprise.
Developed architecture solutions for several enterprise initiatives which included;
Web based eligibility, claims and enrollments systems.
Interactive Voice Response (IVR) system.
Electronic Invoice presentment.
External Web authentication system.
Enterprise Application Integration (EAI) solutions.
Supervised a staff of twenty-two which included business and systems analysts, architects and technical writer resources in a matrix environment.
Managed the outsourced development and support team in an outsourced environment.
Supervised six project managers working on multiple projects to include the Biztalk implementation, Onyx (CRM) upgrade, EIPP implementation and Oracle Financials project.
Ensured that the delivered applications were in accordance with enterprise standards through code and design reviews.
Spearheaded the Enterprise’s Technology Standards Committee, establishing and monitoring the overall process from proposal to implementation.
Presided over enterprise technology evaluations and product selections.
Responsible for the System Architecture and Design budget and financial planning.
Project Director for several strategic initiatives; which included the implementation of the HIPAA translation and Enterprise Application Integration (EAI) tool, development of the enterprise web based claims processing and enrollment systems.
Responsible Director for the analysis and design phase for the enterprise claims adjudication system to replace the existing mainframe system.
Oversaw strategic vendor relationships for Systems Development, the vendors included Oracle, Microsoft and Onyx.
Led the development and documentation of the Enterprise Technology Plan.
Revitalized and educated the support and infrastructure teams on the Enterprise’s Development Methodology based on the Rational Unified Process.
Director All Payer Product, CareMedic System’s Inc. 2000 to 2002
Presided over the development and implementation of Care Medic’s All Payer Solution (CAPS) for editing and submitting of UB92 and HCFA-1500 claims electronically.
Responsible for all aspects of the product including; sales, planning, resources, product functionality, electronic output formats, edit research and development, quality assurance, sales, marketing and staffing.
Supervised the Development team which delivered the applications, ensured the delivered code met the requirements developed in the requirements phase.
Managed the CAPS Quality Assurance team, ensured system and payer testing was completed according to established standards.
Developed and oversaw the change management and overall performance management processes for the project and ongoing development and support.
Conceptualized and developed with the programming team an integrated Claim Status module.
Achieved company goals by completing product development, payer certifications and Beta testing within six months.
Successfully completed Beta testing in two locations, which resulted in product acceptance within thirty days of implementation.
Identified, hired and developed staff for product support, payer testing and certification, quality assurance, implementation, training and claim processing.
Established and implemented standards, procedures and policies for support, development/edit requests, payer testing and certifications.
Negotiated contracts and established working relationships with several clearinghouse operations to include EC Solutions, WebMD, THIN and Per-Se Technologies.
Oversaw payer certifications with four national clearinghouses and thirty state specific payers over an eighteen-month period.
Successfully conducted Sales presentations and product demonstrations resulting in fifteen new contracts.
EDI Project/Operations Manager, UCSF Stanford Health Care 1998 to 2000
Standardized the claim and remittance application and processes for UCSF Stanford Healthcare.
Responsible for submitter enrollment, collection of payer communication and edit specifications for UCSF Medical Center, Stanford and Lucile Packard Children’s Hospitals.
Originated a standard edit request system for UCSF Stanford using a Web based request system.
Increased the volume of electronic claims submissions resulting in an increase in revenue within the first sixty days for commercial payers.
Increased electronic remittance posting, six additional payers implemented in the last year. First to successfully post inpatient remittances for Health Plan of San Mateo.
Supervised a ten person staff that is responsible for the electronic claims submission and remittance posting for UCSF Stanford Health Care.
Key member of the GE conversion team at UCSF, responsible for implementation, testing and maintenance of the system edits.
Business process owner overseeing the UCSF Hospital conversion from McKesson system to the Siemens (SMS).
Account Manager, QuadraMed Corporation 1994 to 1998
Account Manager responsible for the Columbia/Health Care America Ambulatory Surgery Division strategic partnership.
Performed assessments for new clients’ business office processes and provided recommendations to maximize the advantages of QuadraMed’s EDI product.
Successfully sold additional QuadraMed products and services to existing clients to include:
claim processing business services
Outsourcing of unprocessed claim backlog
QuadraMed’s Electronic Remittance Product
Certified and implemented five different insurance payers in fifteen states.
Extensive knowledge and experience in electronic claims processing in thirty-eight states.
Responsible for testing payer specific edits, developing training and installation procedures for QuadraMed’s EDI division.
Installed and maintained QuadraMed’s EDI product in over 70 facilities across the United States.
Successfully developed and trained division personnel on a standard method for building, installing systems and customer training.
Prepared and presented product demonstrations to Executives of Columbia/Health Care America, Surgicenter Information Systems and Catholic Healthcare West which resulted in over four hundred new customers.
Successfully trained the billing staffs of over seventy hospitals and surgery centers on the use of computers and associated software.
Officer, United States Army 1983 to 1993
Commanded two Field Artillery Batteries forwardly deployed in the Republic of Korea.
Exercised total supervisory responsibility for over 220 personnel, 53 vehicles, and over 20 million dollars of equipment for 24 months.
Supervised a 20-person team that planned and executed an exercise involving 5,000 personnel over a six-day period.
Developed and implemented five long-range (one year) training plans.
Completed nine-week course on effective communication.
Other Significant Experience
Certified and implemented five different insurance payers in fifteen states.
Exercised total supervisory responsibility for over 220 personnel, 53 vehicles, and over 20 million dollars of equipment for 24 months.
Supervised a 20-person team that planned and executed an exercise involving 5,000 personnel over a six-day period.
Developed and implemented five long-range (one year) training plans.
EDUCATION
Baccalaureate of Arts in History, Glassboro State College, Glassboro, NJ
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