JAMES G WALSH

**** ***** ****, ****** ****, Tennessee 37174 / 615-***-****

ad4vrg@r.postjobfree.com / https:/ www.linkedin.com/in/jim-walsh-mba

SUMMARY AND PROFILE

Technology Leader – Healthcare Information Technology, Software Development and Implementation, Strategic Engagement Planning, Program and Product Management

A Transformative Healthcare IT Leader with progressive experience communicating a vision and strategy, championing and executing while leading and developing Healthcare Information Technology (IT) teams. Worked with cross functional teams widely for network security, infrastructure, asset management and multiple organizations. Versed in the ever- changing IT world and the consistently evolving healthcare roles that hospitals and health plans are faced with. Seasoned in moving the business forward and known for developing and acquiring new technologies and innovative solutions that improve internal operations as well as external customer experiences. Managing the products to a new realm and possessing a proven track record for creating new and inspiring products that are both internal and external customer facing. Bolstering the revenue cycle with innovative thinking and tools to create an infrastructure with the ability to provide ease for forward looking improvements are strong points. Experienced in joint application development, benchmarking, capacity planning, project resource management and cross-functional team building. Increasing the revenue cycle is a main forte’ of mine. Working with on shore and offshore resources is a common practice in program and software development management. Proficient in the SAFe Agile environment. Currently working on the full Scrum Master Certification and Six Sigma Certification.

Professional Strengths

Strategic Analysis and Planning Electronic Data Interchange

Data and IT Governance Team Building, Coaching, and Mentoring

Agile Methodologies Cost Control and Compliance

Product and Program Management Use of the Software Development Life Cycle

System Analysis Disaster Planning and Recovery

Data Center Management Cross-functional Collaboration

Change Management Vendor Management

Negotiation Skills Patient Experience enhancement

Key Performance Indicators Benchmarking Business Intelligence

IT Product Delivery and Senior Project Management Electronic Commerce Architecture

Budget Strategy and Profitability Improvement Emerging and Advanced Technologies

Claims Processing and Adjudication Revenue Cycle Management

Business Analysis TS Security Clearance – needs to be renewed.

Internet and other Technologies

HTML coding and automation, Microsoft Project, Microsoft Exchange, Internet Information Server, ITIL, AGILE, Explorer, DHCP, WINS, Adobe Acrobat, Microsoft Office all version

Currently working on Six Sigma Green Belt Certification

Currently working on Scrum Master Certification

Database

Oracle, Informix, SQL Server, Paradox, Microsoft Access

Programming/Desktop

Visual Basic, .NET, Paradox, UNIX, Linux, VMWare, MS Windows

PROFESSIONAL EXPERIENCE

James Walsh Consulting LLC. (Owner)

Professional Service and Consultation

February 2023 – Present

Serving as a Solutions Services Consultant to healthcare companies and professionals. During this time, I have worked with several hospitals to aid in their selection of Electronic Health Records. I have consulted with organizations on matters pertaining to CMS rules and regulations as well as assisting in disaster recovery plan assessments and modifications. Strong background working with startup companies and non-profit organizations to assist them in building the right teams that will enhance their offerings.

Quorum Healthcare (QHR Health)

Solutions Services Advisor/ Program Manager

May 2022 – February 2023

Serving as a Solutions Services Advisor to critical access hospitals within the USA. Working with a facility in Lancaster Penn. to building a hospital from the ground up, responsible for all IT functions, overseeing the implementation of all the hospital systems to include the low voltage wiring, buildout of the MDF/IDF room for computer equipment installation, and vendor coordination. When not busy with the above, working on a full technical assessment of an Ohio hospital IT department. Reviewing all the facilities, and IT functions, from the helpdesk, accounting, projects, software, and supplying a strategic plan for the next year to show monetary savings. Also, assisting a hospital facility in Moscow Idaho, in the selection of a new EMR/EHR and Ambulatory Clinical system. I managed the program and process of working with Enterprise applications such as EPIC, CERNER, Allscripts and MEDITECH on obtaining demos for the facility and taking them through the selection process. Worked with a team to redevelop the company SharePoint site. Used Jira to document bugs, manage processes and overall manage the project. Visio and PowerPoint were utilized to provide updates to management. Working with all the cross functional areas of the hospitals for HER selections as well as the CEO and Physician providers.

CIGNA Healthcare

Strategic Medicaid IT Director/ Program Manager/ Health Plan CIO

October 2020 – May 2022

IT Director for Cigna Healthcare’s Medicaid Program and working directly with the state of Texas DSNP program in creating and implementing programs from and technology perspective. Working in a combined Agile and Water fall methodology and I was working to move them to a Full AGILE methodology. These programs directly impact the Medicaid population of the State of Texas to manage the care of the less fortunate in each state. Working with EDI transactions such as 834, 271, 835, 820, 837I, 837P, HL7, Azure, cloud applications and many others. Working with many providers to ensure they have the appreciated access to care to treat the member’s needs. Heavy into HIPAA, and HITECH initiatives as well as working with cloud implementations and migrations, testing of software and coding, process development of the data. Work closely with the Centers for Medicare and Medicaid (CMS) on processing claims for members and keeping Cigna updated on CMS changes rules and regulations. Working with progression of claims and ensuring the data moves properly into adjudication then to the appropriate data tables within each system. Created the disaster recovery plan for the Medicaid program working with many of the officials in the area for coordinating efforts.

United Healthcare of Tennessee

IT Director / Program Manager/ HealthPlan CIO

September 2015 – October 2020

IT Director for the United Healthcare State (UHC) of Tennessee Community and State (C&S) program. Working directly with the State of Tennessee in creating programs and implementing them from and technology perspective for the health plan. Working with EDI transactions such as 834, 271, 835, 820, 837I, 837P, HL7, Azure, cloud applications and many others. Heavy into HIPAA, Disaster Recovery, and HITECH as week as working with cloud Implementations, migrations, testing of software, coding, process development and data implementations. Deeply involved with the ICD-9 to ICD-10 migrations of 2015-2016. Working closely with the State of Tennessee on upgrading and testing from an end user perspective on their new eligibility system known as Tennessee Eligibility and Determination System (TEDS). Working closely with the Tennessee MMIS group to create high-level programs for United Healthcare. Worked with the state on programs like Employment and Community First, better known as ECF CHOICES. I work closely with the Centers for Medicare and Medicaid on processing claims for members. Working closely with the teams to create and enhance the Dual Special Needs (DSNP) program. Created all the MIPPA reporting for the DSNP program between each of the different MCO’s and Medicare. Responsible for all clinical systems, and programs, funding, and budgeting. I also work closely with other C&S programs across UHC to implement Electronic Visit Verification (EVV) systems, HEDIS applications in HL7 formats and other programs. Currently working with North Carolina, Pennsylvania, Arizona, and Virginia C&S programs to implement medication adherence. Working with the health plan to maximize the revenue cycle in order to maximize the contracted amounts. Worked with each of the contracting agencies for third party software as needed to complete the contract and implementation. Working with CSP Facets from TriZetto processing claims and ensuring the data moves properly into adjudication then to the appropriate data tables within CSP Facets. Assisted in the transfer from Mainframe Facets to the JAVA client server version of CSP Facets in 2015-16, working closely with development, SMEs, and stakeholders. OPTUM handled all of the programming for this and I was a part of the team that moved this company to AGILE.

Community Health Systems Inc.

Senior Program Manager – Consulting, Franklin, Tn.

February 2014 – September 2015

The Senior Program Manager is responsible for overseeing the successful implementation of the Community Health Systems (CHS) Computerized Provider Order Entry (CPOE) systems through a change management process into CHS tier II hospital facilities. These facilities are working to obtain the Meaningful Use (MU) Stage 2 certifications to receive the MU2 dollars from the Centers for Medicare and Medicaid (CMS). Managed 16 direct report project managers and worked with each of them as well as liaison at the CHS corporate office for the facility.

Project completed approximately 30 days prior to estimate completion.

Working closely with each of the facility CEO’s, and providers daily to complete the operations

Managed Community Health System program for 84 Hospital full SDLC life cycle implementation of Meaningful Use stage 2.

Collaborated to design program project plan, charter, and deployment tools. Daily identified and collaborated to assist physicians, administrators, clinical and technical staff to align clinical processes with Meaningful Use Stage 2 objectives, goals, and long-term compliance.

Daily management of program communications with upper and middle management and worked with other stake holders to define business process issues, analyze operational efficiencies, implement creative solutions, and measure delivery of results.

Effectively applied CHS methodology and enforced project standards utilized throughout the fast-paced project.

Experience with multiple hospital and physician office practice disciplines such as Meditech, Cerner, Medhost (formerly HMS), Cerner, along with many others Proficient in Microsoft suite of products

Researched the revenue cycle opportunities and how to save money within each hospital,

Xerox Corporation

Senior Consultant/Program Manager

April 2013 – February 2014

Senior consultant and program manager to a minimum of 7 – 10 hospital business offices to obtain the best revenue cycle and coding platforms for each facility. Worked with many different types of hospital information systems, such as Epic, Meditech, McKesson and HMS. Worked as the engagement manager/program manager over project managers to implement these revenue cycle software platforms. Updated and conversed daily with upper-level management to provide return on investment strategies and ensured that the platforms performed to standards.

No budgetary responsibility for this opportunity

Implemented Computer Aided Coding (CAC), and Clinical Documentation Improvement Systems (CDIS)

Collaborated to design program project plan, charter, and deployment tools. Daily identified and collaborated with administrators, clinical and technical staff to align clinical processes.

Daily management of program communications with upper and middle management and worked with other stake holders.

United Health Group/OPTUM

Director of Payer Product Management

June 2011 to April 2013

Director of Payer Products for United Health Group was over three product lines and two clearinghouses. The teams developed revenue cycle products for payers and facilities. Creating solutions for the transformation of industry standards as required by CMS (Centers for Medicare and Medicaid), HIPAA (Healthcare Insurance Portability and Accountability Act of 1996), and for payers/providers. Consistently working electronic claim transaction processing such as the 834,835, 837, 277CA and many other X12 transactions. Interacted with the company’s legal, sales, business offices operations, and development as well as other operations within to accomplish new business requirements and opportunities. I had a team of developers that were FULL AGILE methodology. Negotiated all the required contracts to bring this product to market, and with the sales team to win the confidence of the hospital facility or facilities.

Budgetary responsibility for over $200,000 in payroll, $250,000 in development and $5 Million in Revenue within the first year.

Designed applications that increased revenue by 20% and increased customer satisfaction for customer transaction processing.

Designed new JAVA based platform for transaction processing.

Collaborated to design program project plan, charter, and deployment tools. Daily identified and collaborated with administrators, clinical and technical staff to align clinical processes.

Worked with many Third-Party Associations (TPA) such as Great West Health, CIGNA, UNITED HEALTH CARE, TRIZETTO and many more.

Daily management of program communications with upper and middle management and worked closely with other stake holders.

Provided management reporting weekly to upper-level management.

Health Ways Inc.

Product Manager

Nov 2010 – June 2011

As Platform Design Manager, created, managed and implemented the team that was tasked with providing development guidelines for software design for nursing staff utilizing the call center. The call center would reach out to patients with different diagnosis and council the patient on how to manage their own care.

Created technical requirements for development of call center applications.

Created structure between the design and development staffs.

Created policies and procedures for call center staff.

Worked to in force the SDLC process between the design staff and the development staff.

No budgetary responsibility at this opportunity

MediFax EDI - EMDEON Inc. - Change Healthcare Inc.

Implementation Director, Research & Development Director, Nashville, Tn.

February 2001-April 2010

Formulated, designed and program managed the system scope and objectives for new revenue cycle products. Provided overall technical and managerial leadership to the IT team to develop and deploy the new applications built in .NET. Trained and maintained these integrated revenue cycle products division for hospitals. This product produced over $100 million dollars in revenue for the company. The group that I commanded were the first in the company to migrate from waterfall development to Agile development. We built out the full Scrum method with daily stand-ups, storyboards, and customer contact directly.

Budgetary requirements of over $750,000 in salaries, and benefits. $1. 5 mil in equipment and development costs and generated revenue of over $100 million dollars.

Managed third party vendors and offshore resources to develop revenue cycle products using the Software Development Life Cycle (SDLC).

Visited with customers to obtain user stories and translated those to functional development requirements and technical design.

Created the implementation team, customer service team and went on sales calls to train the sales staff on how to sell the product.

All products developed were HIPAA certified as well as certified by WEDI SNP, HFMA, HIMSS, EHNAC and CORE

Products worked with Hospital Information Systems such as Meditech, McKesson, Siemens, Cerner, Dairyland, Epic and CPSI.

Responsible for hiring all staff on shore and offshore.

The software handled EDI transactions like the 270, 271 eligibility transaction as well as claims and adjudication transactions such at the 276, 277, 834, 835, and 837 EDI transactions

Used pure Agile Methodology and Scrum combined in the development environment.

Hired and trained the customer service and implementation teams.

Accompanied the sales team on customer calls to provide the technical expertise required to make the sale.

Developed all departmental standards and was tasked with ensuring standardization within the software.

Products consisted of both webs based, and desktop applications built on cloud technology and multilayer storage capability as well as designed to allow ease of installation, training, and end user friendliness.

Products included Medical Necessity, Advanced Beneficiary Notices, and patient’s ability to pay.

All Products worked with EHR systems like McKesson’s Horizon Patient Folders, and Siemens Envision systems.

Platforms are currently running in over 900 facilities to date.

Negotiated all required contracts and worked with the sales teams to complete contracts that were in flight and gain the acceptance of the facility or facilities.

EDUCATION

University of Phoenix - 2008

MBA

Computer Science, Lamar University

B.B.A

Formal ITIL Training

United States Army Veteran (1st Lt)

(Needs Updating -TSSBI) Top Secret Security Clearance

Formal Scrum Master Training (working on Cert)

President of the 307th Bombardment Group Association – a Non-Profit World War II organization

Contact this candidate