Project Manager Information Systems

Tina Y Green MBA, HCM, PMP, ITIL

*** *. ****** ****** ***********@*****.***

Glenwood, Illinois https://www.linkedin.com/in/tinaygreen

708-***-**** skype id: live:tygreen1217

Implementation /Delivery Specialist, Healthcare IT Specialist, Program/Project Management

Summary of Expertise

Experienced IT Healthcare Information Technology specialist with extensive expertise in Project and Program management, Business Analysis and Processes, and Application Development leadership, particularly in healthcare information systems. A business-focused Health Information Systems professional with a specialization in Delivery/Implementation excellence, Operational and Service Management Leadership and Outstanding Organizational skills.

APEX SYSTEMS - ELEVANCE HEALTHCARE

Senior Project Manager Consultant June 2023 - Sept 2023

Facilitated pre-implementation testing, post-delivery monitoring/reporting with Provider Network teams. Finalized operational standards for implementation of new Provider Network

Executed project planning using SDLC Methodologies (Agile), contributing to execution and development, and using extensive JIRA/CONFLUENCE to guide project delivery.

Coordinated IT teams for seamless project delivery through meticulous planning, and successful implementation of new Provider Network System

INNOVATIVE SYSTEMS GROUP

BLUECROSS BLUESHIELD OF ILLINOIS (HCSC)

Portfolio Delivery/Implementation Lead Consultant – Claims Portfolio May/2021 – June/2023

Responsible for the delivery of major projects in a dynamic environment:

10/2022 – 06/2023 Oklahoma Medicaid Delivery/Implementation Lead

Championed Claims/Encounters Workstream, Finance/Revenue Management Workstream

Guided pre-implementation RFP activities to facilitate Oklahoma Medicaid SoonerSelect, FACETS

coordination of grooming/design with Cognizant/Trizetto and System Transformation Project

Change Management and Change control as applicable to project Infrastructure additions, changes, coordination, and installation as required

Project planning, execution, development using SDLC Methodologies, (Waterfall and Modernized Agile)

05/2021 - 10/2022 - Claims Portfolio Delivery/Implementation Lead

•Spearheaded Group Claims Portfolio

•Establishing milestones and critical paths highlighting risks and mitigation plans

•Facilitating the resolution of risks and dependencies for the project teams

•Coordination with downstream IT product teams to ensure overall project delivery

•Advanced Explanation of Benefits project, requiring effort to alert members of possible costs associated with scheduled procedures, including all claim types, especially Group and Medicare,

•Championing Change Management and Change control as applicable to project

•Providing resolution of critical post-production issues in collaboration with support team

•Project planning, execution, development using SDLC Methodologies, (Waterfall and Agile)

MAKE Corporation (BLUECROSS BLUESHIELD OF ILLINOIS (HCSC)) Jan/2019-March/2020

Senior Program/Project Manager

Established Governance for programs PANDA and PEAQ

Working in conjunction with and to support the EPMO Delivery Excellence expectations to support the Provider Network/Care Delivery Portfolio.

Spearheaded the strategic direction of the Provider And Network Decision Analytics initiative through transformation activities.

• Waterfall and Agile methodologies of the project charter throughout product delivery for a year-long project of $3M dollars.

•Program delivery of new business Application to assess provider performance, known as PEAQ.

• Engaged in proposal strategic activities and start up activities. Implemented project management processes into new $75 million new product development program, PEAQ (Provider Efficiency Appropriateness Quality).

•Leadership reporting project health, costs, risks, and Roadmap milestones

Lumens Corporation

SBPASC(FEPOC)A Subsidiary of CareFirst - BLUECROSS BLUESHIELD Nov/2017-Dec/2018

Senior Technical Project Manager

Core project management member in a matrixed environment, managing the strategic direction of environment creation, testing, and product delivery for a two year $22M project.

Directed workstreams on the delivery of a new healthcare product and healthcare benefits specific to Federal Employees.

•Directed environment readiness, and management of special efforts to sync environments in preparation for product delivery and provided governance recommendations

•Developed and strategically identified suitable testing strategies and objectives across established timelines, utilizing Agile roadmap methodology, role-feature, usability, exploratory, unit, and acceptance testing scheduling and sign-off

•Formal and informal reporting to Senior Leadership Program Executives at CareFirst BCBS and BlueCross Blue Shield Association, Washington, DC

BLUECROSSBLUESHIELD OF ILLINOIS(HCSC) 2001-2017

Application Development Center Manager Jan/2016 – June/2017

Directed 80 offshore resources in delivery of multiple projects, resulting in growth and transformation of business initiatives.

Led, coordinated, managed, and matured annual and multi-year planning processes for 60 resources, moving from reactive to proactive planning, within Claims Processing Product

•Championed SDLC methodologies for Waterfall and Agile principles

•Managed relationships and weekly prioritization of 'A-List-approved' projects ($250,000 and above) across claims portfolio owned by business and information technology leaders.

ICD-10 Integrated Delivery Project -Testing Program Manager Oct/2015-Dec2015

Spearheaded successful post-implementation process of ICD-10 across enterprise, which involved problem resolution. Managed teams, systems, delivery, and high-value budget to ensure compliance with federal mandates as well as efficient problem identification and solution implementation. Led selection, procurement, and implementation of problem resolution for delivery of ICD-10.

•Workstream Leader for testing project, directing staff of 100 employees, 15 systems, and budget of $22,000,000.

•Executive Communications with strong content creation and presentation skills, to distinctly capture the trending and convey messages to an executive audience, via dashboard reporting or general presentations

•Collaborated communication of strategy to implement ICD-10 project by defining, creating, and publishing 'ICD-10 Playbook' to help communicate procedures as of go-live date.

•Structured and scoped strategic initiatives, including identifying the key problems/issues, providing direction on analyses to provide actionable insights, and creating the project plan, including timeline and resource requirements

•Strategic testing efforts for all interfacing claim types, FEP, Medicare, and National Accounts

IT Lead, Provider Testing ICD-10 Federal Mandate Project Mar/2014-Oct/2015

Spearheaded $20,000,000 pilot testing for ICD-10 mandate that included development of ICD-10 dual testing environments. Led technical issue response team, managing testing by 600 providers and 25,000 test submissions to establish controls for testing entities as well as compliance with guidelines. Managed provider testing execution test plan and testing scenarios, achieving starting test date of 2015.

Developed Governance for ICD-10 Testing Program

•Co-created development of comparison review process for provider testing results.

•Defined and executed governance process for strategy, including development of metrics dashboard and regular updates to business and ITG senior leadership on health of ICD-10 strategy.

•EPIC impact analysis across physician network and necessary changes to support ICD-10 changes

•Executed Pilot Parallel testing across all covered group types, including ICD9-ICD-10 claims for Medicare and FEP groups, where pricing of particular concern and acknowledgement.

IT Manager, Health Exchange Release Management Mar/2013- Feb/2014

Provided technical expertise to lead development of release management software/application that supported and drove growth and goals of organization. Utilized technical knowledge, project management skills, and leadership abilities to integrate business goals and implement technical aspects to achieve organizational strategies. ACA project of $380M. Release project budget of $15.5M.

•Led effort to define and create IT strategic release management tool within existing project tracking tool that incorporated release management tab and project management tracking function.

•Tracked business-driven projects, and service improvements into discrete initiatives of The Exchange’s (Internet purchasing capability for individual health insurance) goals.

•Created Dashboard utilizing (Tableau) processes for program status reporting, RAID reporting, budget reporting, and delivery readiness reporting

•Analyzed impacts to HCSC exchange for subsidiaries (Dearborn National, Prime Therapeutics, and MeDecision)

IT Application (Product) Manager, Contract Benefits and Claim Adjudication Mar/2010-Mar/2013

•Improved coding completion time 66% by converting all contract groups and coding updates with enterprise concept.

•Implemented increased procedure and diagnosis coding, resulting in decreasing claim processing throughput time by 35% and eliminating redundancy in claim processing procedures.

•Converted existing VSAM file structure for Benefit applications to DB2/SQL.

•Converted Medicare Benefits structure as required of ICD-10 changes and new requirements

Application Supervisor, Claims Adjudication Jan/2007-Feb2010

•Led Change Advisory Board (CAB) improvement program, increasing claim service-level agreements to 98%.

•Reduced claims IT issues and system downtime, ensuring claims processed service-level agreements with contracted groups, saving $15,000,000 in penalties and fines.

•Partnered with Change Approval Board to develop standards, best practices, and architectural governance that increased core system availability to 99%.

•Converted existing VSAM file structure for core adjudication to DB2/SQL use and processing access

•Medicare claim processing for Medicare Cost, Supplement, and Advantage plans, in coordination with

•Prepared claim adjudication processing for all EDI transactions

Application Supervisor, Claim Inquiry Systems Jan/2001- Jan/2007

•Spearheaded development and implementation of Blue Exchange EDI (276/277 transactions) to support Blue Access for Members claim inquiry web access using the Enterprise Service Bus (ESB).

•Major data extractions for reporting for NCQA, HEDIS, Department of Insurance reporting

Skills and Expertise

•Complex Project Management

•Strategic Sourcing

•Government/Regulatory/CMS /Compliance

•Microsoft Suite Expertise

•Change Management

•EDI transaction processing

•Data Visualization -Tableau

•JIRA/Confluence

•SharePoint

•JCL/Zos/Security

•FACETS/Trizetto

•Azure, Cloud Computing

•Process Improvement Implementation Specialist

•IT Strategy/Legal Collaboration

•VSAM/ DB2/SQL engineering

•COBOL / CICS programming, concepts, administration

•Claim Adjudication SME

•Agile, Waterfall, SDLC, PMLC methodologies

•Application/Product Management

•20+ yrs. Mainframe skills

•Clarity PPM

•Oracle PPM Cloud

•Vendor Management

•Program Management

•Customer Relationship Management

•Software Engineering

•Problem Management

•Incident Management

•Release Management

•Financial Budgeting

•Delivery Management

•Medicare/Advantage processing

•Medicaid processing

Education

LAKE FOREST GRADUATE SCHOOL OF MANAGEMENT, Lake Forest, Illinois

M.B.A., Healthcare Management

NORTHERN ILLINOIS UNIVERSITY, DeKalb, Illinois

B.S., Biology; Minors in Chemistry and Psychology

UNIVERSITY OF SOUTH FLORIDA, Tampa, Florida

Certificate in Health Informatics; On Hold

EPIC system module exposure and use

Certifications In Progress Certifications

Computer (Programmer Analyst) Data Analytics/Health Informatics

ITIL v3.2 Lean Six Sigma Green Belt Certification

PMP

COVID-19 Contact Tracing

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