Kimberly McLeod

443-***-****

ad3kug@r.postjobfree.com

https://www.linkedin.com/kimberly-mcleod-b465832?utm_campaign=share_via&utm_content=profile&utm_medium=android_app

Professional Skills:

Excellent communication, facilitation, and interpersonal skills.

Strong problem-solving abilities and the capacity to adapt to changing circumstances.

Sound business ethics, including the protection of proprietary and confidential information.

Ability to work with all levels of internal staff, as well as outside clients and vendors.

Excellent verbal, interpersonal and written communication skills.

Strong analytical, problem-solving, and decision-making capabilities.

Team player with the ability to work in a fast-paced environment.

Risk Adjustments:

Quality and Oversight: Ensured the accuracy of Managed care transactions and health plan Contract and compliance. Built quality metrics and member and plan risks to be evaluated. Pinpointed gap analysis of contracts request for implementation. Claims and max oop evaluated for fiscal year performance.

OCM (Office Change Management) (s)

Sprezzatura for CMS Evaluated Risks for Medicare and Medicaid recipients via Prior Authorizations and approval of procedures.

Aided in Data Lake MDM occupancy for risks analysis and building API’S for 3rd party claims risks analysis.

SAP

Demonstrated outstanding level of professionalism in providing client support, including ability to exercise good judgment, discretion, tact, and diplomacy.

Technology:

JIRA, ServiceNow, Salesforce, MDM, Confluence, SharePoint, AWS, MS O365 .net,

SQL Oracle, AS400, IBM, Legacy, Facets, Active Directory Migration/ Legacy, ETL,

MDM, ServiceNow, Python, Azure, Planview, NASCO, Facets.

Certifications:

Certified SCRUM Master: ID 000767626 Scrum Alliance

Certified Agile Professional: ID 123-7488-e1c17346-1dbb-491b-a75b-1063a195194c

Product Owner Certification in progress

Johns Hopkins University

Odyssey Certificate on Aging Program

Growing on in An Aging Society

SUMMARY

As a Sr. BA, Scrum Master, and Project Manager, my goal is to provide professional solutions in a result-

oriented environment, using proven tools and techniques. Specializing in Change Management, Risk

Management and Regulatory Affairs throughout my career history. Whether performing best practices

for Government, Agencies in example: Healthcare Financing Administration to Managed

Care Organizations, I have been accountable for Federal, State, and Local accounts,

managing projects through the five process groups. I have developed skills essential for

Product Development and bringing change to the Healthcare Industry. You will find that

I have a great attention to detail and have demonstrated the job functions needed to

carry out the position requirements in my prior role as Implementation Manager.

Knowledge of MITA. Incorporated in that is the skill set needed to meet scope requests

and built business relationships. I exhibited the following characteristics:

• Ability to strategically plan and perform the proper gap analysis

• Supervised and Managed others

Salesforce Development via Jira Gap Analysis

• Facilitated meetings

• Incorporated Kanban, Lean, Safe, Waterfall, Agile as applicable, throughout the SDLC

process

Used JIRA to manage configuration of Mandates

• Generate results and report to Senior Management

• Deliver and facilitate work group results by way of clear and concise communications.

• Utilize best practices, documenting work-flow and managing daily tasks

• Using SCRUM to keep abreast of tasks, tools and techniques ensures prompt results

and accountability while providing a road-map of how to better utilize resources.

• Used Lean to establish a solid foundation in the principles and tools used to improve

operations focused on saving money, Worked with Lean organizations on sustaining

high levels of quality, safety, satisfaction and morale.

Data modeling and mapping

Incorporating API’s for Azure and .NET

Used JIRA spec out tasks and dependencies

Provided and assisted in creating Data Lake in order to modernize data usage and save in cost

Build DevOps to improve processes while advance MDM procedures

Utilized Microsoft Deployment Toolkit and SCM as primary tools for creating and delivering complex desktop images that support a wide variety of desktop and laptop models in a large enterprise for government customer all in keeping with modernization requirements and 508 mandate compliances.

Follow SDLC Practices

· Claims Engines

· Vendor Feeds

· Networking Management

· Benefit Configuration: Incorporate Salesforce in product selections

· Improve Consumer Experience

Throughout my career I have facilitated workgroups governing:

• Regulatory Affairs

• Mandates and Configuration Management

• Contracting, Reinsurance, Compliance

• Corporate Initiatives

• Risk Management

• Managed Change Control Board

• Non-standard and Customized Accounts

Accomplishments:

· Agile Professional Certification

· Change Management

· Identity Management

· Risk Management

· CRM - Customer Relations and Requirements Management

PROFESSIONAL EXPERIENCE

WINTRIO LLC. For the United States Department of Agriculture (USDA)

Washington, DC. 01/4/2023 – 10/30/2023

PROJECT MANAGER/ SCRUM MASTER

• Develop Milestones

• Use agile and waterfall methodologies values, principles, and practices to plan,

manage, and deliver

• API solutions.

• Work with Senior IT Management to define implementation goals

• Determine and manage tasks, issues, risks, and action items.

• Schedule and facilitate scrum events, meetings, and decision-making processes.

• Monitor progress and performance and help teams to make improvements.

• Lead and facilitate team meetings; e.g., daily stand ups, sprint planning, sprint review,

• Backlog grooming, monthly team meetings, increment planning and retrospectives.

• Plan and organize demos and product/system testing.

• Contribute to projects where needed, including analysis, testing, and documentation.

• Ensure proper use of collaborative processes and remove impediments for the scrum

team.

• Prepare and present status reports to stakeholders.

Incorporate Azure preparation to insure Legacy transition to Azure. Used API’s proof of

concept as preferred tool to save cost in reporting and forming a data lake repository.

USDA Project

Task 1: Cloud operation and development services

Task 2: Application development and maintenance support services

Task 3: Database management, development and maintenance support services

Have served as servant leader in prior roles throughout my career and have the ability

to build positive working relationships throughout the organization and continue to do

so.

Serve as a point of contact for health Reinsurance monitoring of infrastructure tools and

services.

Establish relationship with business owners and stakeholders to identify and

consult on business needs.

Develop monitoring and health dashboards in Microsoft Azure.

Define monitoring requirements with the Engineer teams and customer to build

out capabilities.

Clearly communicate business needs to a development team through user

stories and acceptance criteria.

Work closely with the team to establish Project Backlog, Sprint Backlog

and Release cycles resolve impediments, and provide direction on scope of work

to be accomplished.

Review and evaluate work completed by development team to ensure proper

scope has been met.

SPREZZATURA MANAGEMENT CONSULTING, LLC, Arlington, VA

Agency Name – CMS

Project Manager, Healthcare Delivery

07/25/202-11/2/2022

• Initiate Security Data Lake

• Facilitator of Stakeholders for User Stories

• Plan team building exercises

• Implement security data Lake

• Facilitate Retrospectives

• Gather requirements Reinsurance

Amtrak Cyber Security Washington, DC

Senior Consultant 1/2022 – 7/2022

Amtrak: Sr Project Manager-Cyber Security, WDC

• Develop Milestones for Cyber Security documentation. Monitored and coordinated all

system operations, including security procedures, and liaison with infrastructure,

security, DevOps, Data Platform and Application team

• Met with Engineers and Developers to conduct all ceremonies and Workplan, Action

Items, Risk Analysis, Gap Analysis

DOD-DISA-Ft. Meade: IT Project Manager Scrum Master 6/202012/2021

Compqsoft LLC.

• Performed all SCRUM Ceremonies and Reports

• Weekly PowerPoint reports of Burn-down and Burn-up Reports

DOD- Washington DC Navy Yard: Project Manager/ Certified Scrum Master

• Trouble Shooting and update systems, categorize patches and workflow tickets

• Assign tasks according to requirements and digital transformation

• Document business processes and workflows. Met with client weekly

DOD DISA Ft Meade: Sr. Systems Analyst, Team Lead

• Applied Agile practices performing SCRUM Principles and assign tasks according to

requirements and digital transformation

• Maintenance, Migrations and Integrations and document business processes and

workflows

• Responsible for Tracking usage of SailPoint, Azure, for timely patches via Sun

Technologies. Updated resources for Identity Management with Access Management

for Providers needing to have access to various systems

• Report failure frequencies to Management as well as closures and all Scrum

Ceremonies

• SailPoint usage: Managed employee permissions, digital identities, information

security, data access, compliance on a unified portal.

Defense DTMO Transportation Modernization:

Project Manager / Scrum Master Arlington, VA 1/2019 - 3/2020

• Conducted Daily Stand ups

• Focused on Client Facing, Relationships

• Initiated, Planning, Execute, Monitor and Controlled

• Gather Alternatives or Retrospectives for client to choose from

• Provided Artifacts supporting Vision and Scope for project and digital Transformation

• Provided Test Records, User Stories for UAT

• Ensure all data records are Cyber Secure and in compliance of PII and HIPPA.

Member of Change Control Board

• RUN Tests according to SPECS and Requirements Qualifiers for all Scenarios.

Stipulate Blackout dates and correlation with systems start and end dates for Transition

and Migration Implementations.

• Crosswalk interaction for data when following ETL provisioning. Program phase 1 of

initial load of 6,000 members of military and 1,000 civilians. Present projected load of

Army Travel Modernization 3 million.

Change Management

• Performed SCRUM Ceremonies

• Met with Product Owners, facilitated meetings, update artifacts, negotiate changes

• Met with Sales Teams and trained and advised Marketing and Production

TIFF, Baltimore, Baltimore MD Baltimore County- Change Management:

Project Manager Baltimore, MD Jan 2017- Mar 2019

• Responsible for gathering requirements and performing gap analysis, and have

illustrated current, Reinsurance existing workflows, developed organizational network management

plan.

• Provided user stories for developers so that Scrum ceremonies could be done during

daily SPRINT exercises

• Incorporated the use of Cloud, Reinsurance Pega 7 to distribute data in the Disaster Recovery

workflow and used Agile tools and exercises.

• Coordinate the successful release of high-quality, stable software teams

• Coordinate proper collaboration across all the scrum teams

• Act as a leader to foster collaboration and communication between team members on

technical issues, on process improvements, and in addressing and escalating project

risks and issues; Break down cross-team barriers

• Facilitate Program Increment (PI) planning. Oversee the schedule and manage PI

deliverables

• Track, analyze, and report standard agile metrics. Work with stakeholders to develop

and maintain the roadmap. Trained staff on Agile. Waterfall, and Kanban features.

• Identify, communicate, and resolve program-level roadblocks for geographically

distributed scrums. Act as a unifier helping individual goals become program goals

• Integrated Cyber security, Microsoft Office Project SharePoint Server.

• Utilized tools for sprint planning increments to determine what the team should

complete in the coming sprint from the backlog or list as work to be done

• Tracked managed sprints, led daily stand. Identity Management Software

• Performed requirements gathering from the business users of the system while

adhering to SDLC (Software Development Life Cycle) industry best practices

• Performed Data Modeling and features for Kanban, SAfe, Waterfall, Agile

methodologies

As Implementation Project Manager assigned to State, Local, and Federal accounts

including VA (Veterans Administration) and SAMBA (Special Agents Military Benefits

Association) accounts

Responsible for group Structure set-up of veterans group structures and benefit

loads.

Approved benefits via Contract and Compliance and Congressional orders

accordingly.

Enrolled membership and provided training on benefit offerings for the client

during open season and yea round. Provided assistance for extenuating

circumstances to advocate for membership

Responsible for Financial det up so that funds associated with war/ mission

traumas were applied and funded appropriately

Sought appropriate prior authorizations for claims

Delegated dedicated assignments to cases were deemed appropriate

Federal Insights, Baltimore, MD: Sr. Project Manager

Nov 2015-2017

• As the SME for Change Management Consultant provided change management

Principles for Facets

• Provided SWOT, Gap Analysis (performed requirements analysis to provide user

stories for the Product Owner)

• Capitalized on illustrating future state business requirements and process

management workflows to perspective contractors for CMS for the ACA website.

• Train and Managed resources on Identity Management and Cyber Security principles

• Consulted with client about SDLC artifacts and setting up repeatable processes for the

project management staff.

DST Health solutions- Medicare Advantage: Project Manager/Scrum Master Aug 2016 –

Dec 2016

• Implemented configuration management practices of mandates to be developed,

coded, loaded, Reinsurance tested for claims and Cyber Security

• Agile tools for scrum tools for sprint planning.

• Performed gap analysis for coded, tested claims processing on current

future platforms then applied this data to guide the transformation of the systems using

Agile methodologies.

• Processed claims in compliance with policies procedures as defined by the Centers

for Medicare Medicaid’s (CMS) Regulatory Affairs as applied for Facet.

• Used SCRUM Responsibilities Agile Methodologies as needed perform checks balances as needed to perform according to priority set by the product owner.

• Active Directory Migration/ Legacy

• Updated changes for IT development product enhancements

• Conducted configuration analysis to gather impact to data in the Data warehouse so

that adjustments could be made for universal and isolated challenges. Bachelor of Arts

in Communications

Baltimore County: Project Manager/ Scrum Master Feb 2015 – May 2018

TIFF Consulting LLC.

• Worked as part time for cross-functional Change Control Board to evaluate using

either Agile or Waterfall methodologies. Ensure that all sprints were shippable and UAT

were DONE.

• Identified any challenges developers are faced with that may encumber their progress

• Provided up-to-date Backlogs so that progress is shown, and dependencies are

carried out with priority. Managed risk by identifying issues Reinsurance then allocating appropriate

resources

• Reported to management and stakeholders via the 5 process groups and workflows

Initiate, Plan, Execute, Monitor and Control, Reinsurance Social Responsibility

• System Migration for GMIR, FLXX facets, AS400 moved applications from one

Facets

premise to another. (example enterprise server to cloud or cloud to cloud)

• Assisted in training users pointing out the outdated legacy system and the need to

undergo digital transformation

QuTech - Center for Medicare Medicaid/ Quality Technology Federal Project:

Business Analyst Sep 2013 – Feb 2015

• Worked with QSSI, CGI, CMS to field open enrollment QA, using CALT, FEPS,

CISCO, Remedy, CMS WEBMAIL, Navigator, HIOS, SHOP, Edge Server, QHP, EIDM,

Reinsurance HUB.

• Used Remedy ticketing Software to ticket and track research workflows for efficiency

• Ensure that all artifacts are complied with corporate SDLC policies and guidelines.

• SailPoint and Azure were used for Identity Management with Access Management for

Providers needing to have access to various systems

• SailPoint usage: Managed employee permissions, digital identities, information

security, data access, compliance on a unified portal.

• Key identifiers were used to set up end users according to department. This was for

DHHS for CMS. Provided end-to-end security, and activation. These capabilities enable

seamless and safe customer experiences while providing business with actionable

customer insights

• Active Directory Migration/ Legacy

• Maintained a website with WordPress to communicate the latest SOP changes

required by CMS.

• Provided Tier3 support for edge server used to help with ACA’s Reinsurance Risk

Adjustment.

Baltimore County: Certified SRUM Master Jan 2011 – Dec 2012

• Facilitated daily stand ups, retrospectives, planning, status meetings to provide

updates on system conversions and integrations projects incorporating ICD10

compliance with CMS Mandates as well as EDI requirements for providers Reinsurance carriers.

• Employed Pega Systems Software to run test claims processes during

• ICD10 training, incorporating Ruby tools to validate that the correct, updated ICD

codes were used.

• Coached and trained staff according to CMS Guidelines on the ICD10 Implementation

Phases.

• Worked in a cross-functional team to scope the project, assess risk, assign

• resources in a work breakdown structure.

• Conducted, on behalf of payer organizations, gap analysis, requirements analysis,

risk analysis – saving millions of dollars in streamlined oversight procedures.

UnitedHealth Group/ OptumHealth, Columbia, MD 2007 – 2009

Sr. Retail Provider Relations Supervisor

• Run test claims to ensure reimbursement payment using EDI were accurate.

• Troubleshoot to determine if there is an isolated incident or universal issue

• Prepared SOP’s for Brand Name Changes

• Salesforce Support implementing Full Life Cycle including 3-6 months after GO LIVE

• Coordinated the signing processing of a wide range of previously unaccounted for

legal contracts from numerous CEO’s of large corporations regarding rate

reimbursement adjustments required for the brand name change from Spectera to

• Identified retail chains needing performance reporting systems then

acted as a liaison between Providers, Operations for UAT, Reinsurance Model Office Evaluations.

• Managed projects, using MS Project to communicate to the cross-functional work

group management.

• Analyzed data for rate variances based on region, creating reports illustrating

utilization from both providers members.

• Implemented the use of EDI to process retail claims for Provider reimbursements.

CareFirst BlueCross BlueShield, Owings Mills, MD 1999 – 2007

Implementation Project Manager/ Program Management -Change Control Board

• Implementation Cross-functional Workgroups consisted of:

• Performed configuration management, change management, and disaster recovery

• Salesforce support from Proposal through Full Life Cycle including 3-6 months after

GO LIVE

• Responsible for new Reinsurance renewing accounts who have elected Benefits. If the client

chose a non-standard or completely customized option, Waterfall Methodology would

be the style of Implementation.

• Served as Leadership as point-of-contact for National, Local, and State Accounts

• Serviced accounts that were Nationwide, with membership in every state

• Involved in Microsoft Office Project SharePoint Server

• Performed control, monitor user acceptance testing

• Evaluated risk adjustment as it relates to the Affordable Care Act BCBS Boston,

Massachusetts.

• Adjusted or denied retroactivity claims according to account request or as mandated

via Regulatory Affairs.

• Performed analysis for Participating Plans (nationwide) compliant with HIPAA.

Provided leadership to teams exhibited strong relationship skills

• Delivered and participated in Migrations, Conversions, and Integrations for all

platforms

• Performed as SME for issues pertaining to software configuration to the change

control board

Diversified Pharmaceutical Services, A Glaxco Company/ now ExpressScripts

1996-1999

• Team Lead/ Product Owner

• Track Claims for Membership for Insurance via Pharmacies throughout the

United

• Product trainer

• Assist pharmacies in adjudicating claims for membership according to either

brand or generic formula

• Provided Prior Auth when necessary

Technology:

JIRA, ServiceNow, Salesforce, MDM, Confluence, SharePoint, AWS, MS O365 .net,

SQL Oracle, AS400, IBM, Legacy, Facets, Active Directory Migration/ Legacy, ETL,

MDM, ServiceNow

Certifications:

Certified SCRUM Master: ID 000767626 Scrum Alliance

Certified Agile Professional: ID 123-7488-e1c17346-1dbb-491b-a75b-1063a195194c

Product Owner Certification in progress

Johns Hopkins University

Odyssey Certificate on Aging Program

Growing on in An Aging Society

Education:

Bachelor of Arts in Communications from Lincoln University, Lincoln, PA

Clearance: Secret

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