Product Manager Project
Resume:
JUDITH A WILSON
South Windsor, CT ***** 860-***-****
adz6qj@r.postjobfree.com
PRODUCT OWNER / PRODUCT MANAGER
Agile Experience Project Management Offshore Team Relations
Senior Business Consultant with 20+ years of experience in Healthcare Insurance. My objective is to obtain a position that will offer career opportunities to utilize my expertise, experience, and leadership, as well as problem-solving skills. An advocate for process improvement while leveraging collaboration, communication, innovation, and problem-solving skills to implement successful business solutions, enhance operations, and mitigate regulatory risks.
KEY STRENGTHS
Attention To Detail Project Management Extreme Thoroughness Ability To Multitask Assist With Road Map Creation Revenue Generation Strategic Vision Data Interpretation Process and Procedure Refinement Staff Training Business Planning Stadardize Methodologies Agile Methodology Waterfall Methodology ExtensiveNCQA/ URAC knowledge Credentialing - Re-Credentialing knowledge Healthcare Audit experience
AREA OF EXPERTISE
Experienced Business Professional with demonstrated track record in business consulting. Exceptional program, team and project manager. Skilled in mentoring staff, integrating ideas and customizing approaches to support specific goals. Planning Scrum team goals
WORK EXPERIENCE
Aetna, A CVS Health Company, Hartford, CT December 2019 - Present
Senior Manager - Business Consultant
Managed two offshore teams for Admin and Operations within PRMS. (Provider Relationship Management System) Act as SME Keep track of sprint activities. i.e.: percentage done with in the current sprint and escalating any concerns to the Delivery Lead or Scrum Master.
·Determined root cause for fallout within PRMS (Provider Relationship Management System, a Salesforce application)
·Skilled in requirements gathering with business stakeholders.
·Tracked PRMS (Provider Relationship Management System, Salesforce application) automation numbers, adhering to a yearly goal of 90% fallout errors within Salesforce application.
·Performed PO check out after monthly releases.
·Coordinated closely across teams - to deploy Provider Onboarding Center capabilities to finish Contracting Journey while ensuring the Credentialing Project is still on track.
·Aetna Mindfulness Advocate;
·Triaged Production Defects win in Jira application for resolution.
·Planned and led UAT sessions.
·Finished out and successfully deployed Credentialing/Re credentialing project, following NCQA/URAC regulations - on target and on budget – 05/2023.
· Lead PO for Lumen project (outsourcing Credentialing and recredentialing to a vendor) with Pilot commencing on 5/1/2023.
·Business rules lead with ODM (Operation Decision Center) application. Build business rules for credentialing and onboarding projects.
·Tracked budget and reported out status of projects, adhering to strategy and funding.
United HealthCare, Telecommute, CT July 2012 - December 2019
Provider Data Consultant
Managed Demographic and Credentialing information migration from NDB, Pulse to MDM.
·Facilitated Reference Data build and Business Rules for migrating the data over to MDM (Master Data Management).
·Created and tracked Features/User Stories in CA Agile (Rally) accepting the User Story when completed.
· CA Agile SME. Keeping track of sprint activities i.e.: percentage done with in the current sprint and escalating any concerns to the Delivery Lead or Scrum Master.
· Aligned roadmap activities to capabilities in CA Agile (Rally) to the Features via Value Stream Intake tool.
·Aligned Feature T-Shirt size with roadmap budget amount.
·“Loaned” to MDM (Master Data Management) UAT area for 90 days to help test user stories and act as SME to understand the intent of the User Story.
·Reviewed and determined root cause for fallout that occurs. Present Business Rules to IT partners for review as needed and evaluated root cause for any fallout errors.
Judith A Wilson 860-***-**** Page 2
Telecommute in CT July 2012 - July 2013
Provider Installation Specialist
Reviewed contracts for elements needed for loading in Emptoris and NDB, follow state guidelines for credentialing and any product specific elements.
·Worked extra projects as needed, for instance Tricare (Government program) project to ensure all providers are loaded to pay correctly and to ensure the regulatory requirements were completed for criminal review before loading into the system.
·Acted as a mentor for new hires and worked in the following systems: Rally, Emptoris, NDB, Pulse, Facets.
Aetna, Hartford, CT December 2000 - July 2012
Network Coordinator May 11, 2010 - July 2012
Reviewed implant cases received in for payment, adhere to contract language on specific cases. Review and analyze and process invoices that come in for savings.
·Recorded savings in Quick base database and report monthly. Savings for 2011 were 900K. Goal was 450K.
·Facilitated post payment vendor calls monthly.
·Acted as liaison for vendors with Network for problem facilities.
Quality Manager-AWCA (Aetna Workers’ Compensation), Hartford, CT January 2009 - May 2010
Quality Manager-AWCA Review analyzes contracts in Strategic Contract Manager for accuracy, handle credentialing day to day activities for the unit, manage two people effectively.
·Tracked and prepared monthly reports for Quality-of-Care meetings.
·Managed monthly credentialing reports and supported internal and external audits for our vendors.
·Worked on gathering regulatory requirements for a pending Tricare deal.
Quality Consultant - AWCA (Aetna Workers’ Compensation), Hartford, CT July 2006 - January 2009
Reviewed and analyzed negotiated contracts for accuracy in SCM.
·Performed rate review to follow PADU guidelines.
Audit Analyst, SME, Credentialing Application Management, Middletown, CT May 2001 - July 2006
Reviewed, analyzed and evaluated practitioner profile against National Committee for Quality Assurance (NCQA) guidelines; maintain information in credentialing databases
·Supported extensive research and analysis of sensitive Provider issues; ensured all practitioner information is verified and accurate.
·Worked on FI files (Further Investigative) for providers that had board actions or malpractice actions on the credentialing file.
Claim Analyst, Hartford, CT December 2000 - May 2001
Processed short-term disability claims.
EDUCATION
·Windham High School - 1graduate
·Retail Banking Certificate -Finance
·Leading SAFe 6.0 (Scaled Agile Framework)
·SAFe for Teams 6.0 (Scaled Agile Framework)
·SAFe POPM 6.0 (Scaled Agile Framework - Product Owner/Product manager)
·SAFe LPM 6.0 (Scaled Agile Framework - Lean Portfolio Management)
·Six Sigma – Yellow Belt – Through United Healthcare/Optum Learn center course)
·Medical Terminology - Aetna Learn Center course
·Brown University – MBSR (Mindfulness Based Stress Reduction) CVS partnered with Brown to have an instructor teach.
PROFESSIONAL REFERENCES
Scott Moule
Strategic Product and Program Leadership in Healthcare (Avility)
Purvi Bhatt
Lead Director, Business Consulting (Aetna, a CVS health Company)
Amy Buycks
Manager, Business Consulting (Personal Friend/Co-worker (Aetna, a CVS Health Company).
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