Project Manager Team Member

ROMAN RHYNE

P O Box **** Berkeley, CA ***** *************@*****.*** 510-***-****

Position Objective: Healthcare Project Manager [Remote]

Experience in overseeing the design, development & implementation of software solutions, e.g., EPIC [all modules], CPT, ICD-10, HCPCS, Rev Codes, Six Sigma, Scrum, SDLC [Agile, Waterfall], SAS, SQL, Tableau, JIRA, Python, McKesson Paragon applications [clinical, EHR, hospital], Next Gen Ambulatory EHR & physician practices, Microsoft Office Suite [Word, Excel, Power Point, Visio, Outlook]

Healthcare domain such as eligibility, claims processing, provider relations

Candidate has more than 7 years of experience in process change, system implementation and team building

Oversee medical records [EHR] & prepares audit reports for HIPAA, MediCal/Medicaid, Medicare Advantage, SOX, HEDIS, CAPHS, CMS for contractual & regulatory requirements

Complies with Software Development Life Cycle and company’s Computer System Validation

Track record of excellent task management skills such as planning, prioritization, meeting and delivering projects on budget and on time

High level of customer service and leadership ability

Comprehensive knowledge of state and federal regulations and health care industry best practices and procedures

Strong organizational, analytical, multi-tasking, documentation, presentation and outstanding technical writing skills

Ability to communicate effectively in both oral and written form to a widely diverse audience ranging from unskilled personnel to highly trained and experienced professionals

Interacts with staff at all levels in a fast-paced environment, remaining flexible, resourceful, and efficient, with a high level of professionalism and confidentiality

Ability to understand the business needs and translate that into a solution that can be leveraged by multiple customers

Education:

M.S., Health Services Administration [in progress], Saint Mary’s College, Moraga, CA

Certificate in Project Management, Boston University, Boston, MA

BA, Political Science [magna cum laude], Lyceum of the Philippines, Manila

Detailed Work Experience:

Heald College, 350 Mission Street, San Francisco, CA 94105

Adjunct Evening Instructor, Health Information Technology [Part-time]

April 2009 - present

Exemplify carriers’ reimbursement methodologies of HMOs, PPOs, IPAs, Medicare, Medi-Cal [Medicaid], Workers’ Comp & other commercial insurances

Practice management, including revenue cycle

Since 2012, have been preparing students on the transition from ICD-9 to ICD-10 including migration to Version 5010, explaining the difference between ICD-9 and ICD-10, emphasizing the need to upgrade to ICD-10 and compliance

Introduction to software applications [e.g. EPIC, all applications]

Quality assurance and reimbursement methodology

Enhance the students’ level of understanding of risk assessment and management

Develop and implement solutions to patient’s complaints

Analyze ANSI [American National Standards Institute] X12 transactions

Teach hospital & physician coding structures [including ICD-9, CPT-4, HCPCS, Level I, II, III, DRG, EOB, modifiers, revenue/accommodation codes, & both HCFA 1500 & UB-92 form fields

Environment: Access, Excel, Word, SQL

The Amazing Group, Inc [TAG], Eastmont Station, P O Box 5536, Oakland, CA 94605

Business Analyst/Project Manager [Full-time]

May 2003 – Dec 2008

Strong aptitude for handling complaint evaluations and investigation

Participate in registration and scheduling services to clinics and medical offices using EPIC’s Cadence application

Provide hospital and clinic clients with strategic, comprehensive project management, implementation support and integration expertise

Oversee medical records [EHR] & prepares audit reports for HIPAA, MediCal/Medicaid & Medicare for contractual & regulatory requirements

Provide detailed & documented requirements necessary to implement changes & meet clients’ business requirements

Perform strategic assessment [gap analysis] & planning to determine the need for improvements

Act as liaison & communicate performance results to key stakeholders

Direct the billing, collections & training activities in the assigned facility

Update all ICD-9, CPT-4 & HCPCS codes, E/M level coding, applicable DRG/APC grouping schemes to ensure the highest reimbursement available for services performed

Responsible for continuously improving the knowledge base of coders & billers with respect to reimbursement regulations relating to Medicare & MediCal/Medicaid

Environment: SAS, SQL, Crystal Reports, Access, Excel, Word, Visio

Alternative Technology, 629 J Street, Sacramento, CA 95814

Business Analyst/Project Manager [Full time]

Jan 2001 – April 2003

[Worked from home as an independent contractor]

Develop specific methodology/work plans for determining areas/department to be reviewed

Perform tests on clients’ software to include but not limited to system development life cycle [SDLC] and disaster recovery plans {DRP]

Provide direction, develop & implement training programs for claims processing & enhance reimbursement

Import data [INGENIX] into SAS tables

Develop and/or implement appropriate procedures & protocols

Generate reports that reflect the medical providers’ weighted average of collections for each ICD-9, CPT-4, HCPCS Level II codes, DRG, APC or revenue codes as appropriate

Analyze ANSI [American National Standards Institute] X12 transactions

Edit data entry for errors including non-valid codes, missing units & typographical errors

Use current AWP [average wholesale price] of drug tables to analyze HCPCS Level II codes

Use locally specific current RBRVS & MDR tables to perform analysis

Environment: SAS, SQL, Crystal Reports, INGENIX, ANSI X12, Access, Excel,

Word, Visio

Chinese Community Hospital, 445 Grant Ave, Ste 700, San Francisco, CA 94108

Internal Auditor [Full-time]

Jan 2001 – Dec 2001

Identify implementation requirements & billing alternatives to 125-group members of the Hospital’s IPA [Independent Practitioners Association]

Help implement EPIC modules on patient admission/registration & patient accounting

Supervise & provide leadership support to training & mentoring staff, performance evaluations, analyze & develop work flows to track productivity & other aspects of operations

Coordinate with UM, claims department in the preparation & documentation for corrective action plans necessary for health plan audits

Brief senior management of new regulations, health plan requirements & industry collaborative efforts

Analyze contracts to be able to identify errors in reimbursement & flaws in contract details

Participate in data processing cycles & implementation to ensure regulatory compliance with Medicare, clinical revenue coding & managed care applications, 837/837, 270/271 transactions,

Create summary statistics on bed occupancy, treatment days & discharges

Analyze ANSI [American National Standards Institute] X12 transactions

Supervise encounter data submission to HCFA [Medicare] for risk adjustment

Provide accountability to the state’s [California] Department of Managed Care

Environment: SAS, SQL, Crystal Reports, Access, Excel, Word, Visio

MEDNET Systems, Inc, 4457 Willow Road, Ste 203, Pleasanton, CA 94588

Program/Implementation Manager[Full-time]

Jan 1998 – Oct 2000

Manage product development process to achieve a unified model by working with programmers & other technical system vendors

Input ANSI X12 adjustment reason codes on system’s database

Analyze ANSI [American National Standards Institute] X12 transactions

Plan, manage and monitor activities related to the implementation of HIPAA privacy & security standards

Recommend solutions to provide new/enhanced data elements to trading partners [HCFA 1500 & UB-92]

Develop claim processing procedures for both payers and providers

Identify & create non-technical user requirements & data formats for Workers’ Compensation software

Code & test programs, assist in planning implementation schedules for software applications, e.g., EPIC, Invision, 4, Meditech, IDX, McKesson HBOC

Prepare documentation [functional, technical specifications & training manuals]

Environment: SAS, SQL, Crystal Reports, GUI, ORACLE, Access, Excel, Word,

Visio

Western Career College, 1400 65th Street, Emeryville, CA 94608

Evening Instructor, Medical Insurance Billing & Coding [Part-time]

Sept 1997 – July 1998/Sept 2002 – Nov 2002

Taught hospital & physician coding structures [including ICD-9, CPT-4, HCPCS, DRG, modifiers, revenue/accommodation codes, & both HCFA 1500 & UB-92 form fields

Exemplified carriers’ reimbursement methodologies of HMOs, PPOs, IPAs & other commercial insurances

Environment: Access, Excel, Word

Camino Medical Group, 244 Carroll Street, Sunnyvale, CA 94086

Reimbursement Analyst [Full-time]

July 1995 – Dec 1997

Perform simple regression analysis on billed charges, allowed amount & actual payment

Create tabular reports for amount owed [[descending order], number of days over due & maintain claim register per insurance company

Maintain the billing & accounts receivable system of the medical group

Disseminate revenue information to management

Perform on line application processing [OLAP]

Responsible for all aspects of re-billing

Environment: SAS, Crystal Reports, Access, Excel, Word

Meris Laboratories, Inc, 2390 Zanker Road, San Jose, CA 95134

Patient Accounts Representative II [Full-time]

Jan 1994 – June 1995

Strong background in all aspects of accounts receivable

Initiated research activities on unpaid & underpaid accounts

Up to date knowledge of insurance billing for Medicare & all other insurance carriers

Maintained 3rd party relationship s with HMOs, PPOs, & IPAs including Medicare & Medicaid [Medi-Cal in California], ICD-9, CPT-4, HCPCS

Environment: Access, Excel, Word

Contact this candidate