JAMES F. MONAHAN

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South Weymouth, Massachusetts 02190

Cell: 978-***-**** and email: adrrn4@r.postjobfree.com

EXPERIENCE

Temporary Work (continuous): CVS-Health, RI, and Amazon, MA Operations Responsibilities (8-2020 -- 3-2021)

Perform vital operations work for large companies during global pandemic, including order fulfillment and customer services areas. Improved skills in fast-paced and high-tech environments. Learned many new business processes and industries.

MassHealth Operations, Executive Offices of Health and Human Services, Quincy; Operations Program Coordinator III (8/2017 – 2-2020)

Carry out essential projects in Claims Operations business-process analyses as well as publications editing and management. Responsibilities in maintenance of claims reporting and statistics, MMIS configuration of systems, interfaces, projects, and claims. Assist with management of long-term care processes with new contractor and internal staff. Work with MassHealth program integrity management as needed for compliance to Federal, State, and agency standards with audits and other directives.

MassHealth Office of Clinical Affairs, Executive Offices of Health and Human Services, Boston; Pharmacy Program Coordinator III (3/2005 – 7/2017)

Extensive work in implementing and ongoing management of the 340B pharmacy program for CHCs and HLHCs. Previous responsibility in development of NewMMIS interfaces with the pharmacy claims-processing system (POPS). This included all aspects of configurations of interfaces, job processing, test cases, and related aspects of claim receipt/payment/QA. Assist with contract management of new POPS systems, staff and pharmacy development team. Ongoing work in claims review and implementation of rebate collection for physician-administered drugs. Significant work with MassHealth Provider Operations and contractors on revalidation of all pharmacy credentials.

MassHealth Operations, Executive Offices of Health and Human Services, Boston; Manager of System Support (4/2002 – 3/2005)

Manager of the System Support unit in Claims Operations entailed extensive claim-processing systems knowledge, along with the managing six union employees of various levels of skill. Extremely fast learning of highly technical knowledge was required. Numerous relationships with all program managers, stakeholders within state government and the community of healthcare providers was challenging and rewarding. Managing Systems Support responsibilities directly effected billions of dollars in the expenditures, resulting very high visibility.

Unisys, Somerville; Senior Health Analyst (8/1998 - 4/2002)

As a team member of the MassHealth contract, responsibilities included working with medical providers, state agencies, and medical associations concerning MassHealth claims and policy. Primary senior staff dedicated to the dental and physician communities. Provided customers with highly complex information, such as analysis of claims. Also presented large-scale and one-on-one trainings to providers. Acted as a team leader and provided guidance to others.

Unisys, Somerville; Associate Editor (9/1992 - 4/1997)

Responsibilities for MassHealth contract included proofreading, editing, and managing all manuals and billing instructions for medical providers. I performed similar work on two newsletters. Another position at Unisys involved intense editorial and management work on large-scale proposals, under tight deadlines.

American Journal of Surgery, Louisville, Ky; Data-Review Editor (11/1991 - 9/1992)

Responsibilities included reviewing and critiquing medical data within accepted manuscripts.

University of Louisville, Department of Surgery, Louisville, Ky; Assistant Medical Editor and Freelance Medical Editor (10/1990 - 9/1992)

Responsibilities included editing medical manuscripts.

EDUCATION: Wheelock College, Boston, Bachelor of Science, May 1987.