|
(770) 891-6776 cell |
|
SUMMARY:
Seeking perm
consulting position to assist managed
care organizations, state Medicaid and other healthcare organizations with the
following needs:
§
Project
Management (including PMO operations, large-size contract’s overall management),
§
Data
migration, system deployment (e.g. Amisys, Click4Care, Oracle)
§
Functional
Design (JAD, RAD, GSD, DSD, user acceptance)
§
Business
Process ReDesign (BPR)
§
Relational
database systems design / implementation
§
HIPAA -
x12 transactions, codesets/identifiers, Privacy/Security requirements
§
Medicaid and entire spectrum of MMIS/managed care functions (e.g. claims,
membership, provider, utilization review, premium payment and more)
Pursuing
roles that involve significant responsibility, hands-on
leadership and
demand for excellence.
Ready
for full-time employment opportunity to make continued contribution to one
leading-edge healthcare consultancy and its many clients.
EXPERIENCE:
L’Information Consulting,
Chief Consultant
Corp-to-Corp
and W2 contracted consulting services –project management, application development, HIPAA
(privacy, security and all x12
transactions), MMIS (all subsystems including
claims, provider, membership, managed care, utilization review and more),
IT, relational database, data warehouse, and internet
web applications. Most recent
clients are mostly State
Government Medical Assistance / Medicaid programs (GA, NE, MN, IA, NC, IL) and payers (BC/BS, SummaCare).
Assisted in legal proceedings of a major state health agency as
healthcare IT expert, protecting the financial and data integrity interest of
the public agency. Leveraging Amisys
3000 system configuration and claims processing expertise and standard reports
to ensure accurate and truthful actions performed by the State agency’s
contracted vendor. Analyzing backend
database, claim adjudication logic, standardized coding, screen elements (both
the legacy Amisys 3000 system and the current Amisys Advanced suite), standard
reports, payment amounts, stakeholder outcomes (e.g. providers, public health
agency, hospital accounting departments, administrators), turnaround timeframe,
contact history, appeals, etc.
Single-handedly leading HIMSS (Health Information Management System
Society, www.himss.org ) effort to start
Assisted a venture to create patient self-care portal, serving multiple
stakeholder types (e.g. payer, providers, nursing team, facility administrator,
government programs, public health agencies, devices / equipment manufactures
and pharmaceuticals). Creating site
based on web architecture, high-speed high-security access from browsers,
standard data format (e.g. x12, ICD, CPT, DICOM, HCPCS) - essentially a WebMD /
Emdeon service for Greater China region.
SummaCare
Health Plan,
Amisys
Advance Migration, Project Manager
For the $18 million migration project, moving existing Amisys 3000
application to new Amisys Advance version 3.1:
§
Project
Management. Resource planning, contract creation /
finalization / execution between ASI and SummaCare. Jointly created project documents with client
project executive – Project Charter, Project Plan in Microsoft Project,
SharePoint portal, Intranet pages, shared directories. Scheduled training between ASI and the client
(Technical Training, Programmer Training, Release Enhancement, CG
Correspondence Generator, General Navigation and Piping). Led intra-team and numerous planning meetings
on weekly and daily basis to itemize all aspects of smooth project execution –
Risks, requests, fact gathering, progress report, calendar view, “major events”,
staff availability schedule…). Using PMP
(project management professional) best practices.
§
Managing
technical staff and Business Analyst. Overview and directions for the
vendor resources such as UNIX Administrator / Oracle DBA, business
re-configuration BA. Interacted with
numerous other matrix-team members such as client’s IT Operations Manager
(servers), IT Services Manager (SQL Server data warehouse from Amisys 3000,
report writing, application development, surround code creation and management,
Amisys configuration), business users (Claims Operation Manager, Customer
Service Manager for providers and members); Amisys new product development
manager, helpdesk, technical service group VP, implementation services VP,
training team, ASI sales team.
§
Technical
Activities. Helped ASI and the client to perform
technical tasks as well – collected inventory of all legacy Amisys Surround
Codes, collaborated on the creation of a NPI (national provider ID) strategy,
inventory of all 3rd party interfaces with Amisys (e.g. McKesson
Claimcheck 8.5, CRMS 5.5 / 6.0, Pricer, Grouper, AboveHealth, Macess imaging
and workflow…), server performance tuning (Java codes, HP UNIX servers, Oracle
database, migrated test records), setting up of multiple Amisys environments
and accounts (clean image, development, testing, data migration / configuration
rounds, training).
§
New
Product Development. Helped ASI to demo new products remotely and
in-person – CSA (Customer Service Application), ACMS (Advanced Care Management
System / Click4Care), ODS (Operational Data Store), and comparison among
different versions of Amisys (3000, version 1.0, version 2.0, version 3.0 /
3.1). Helped to establish dedicated call
center staff through unique phone queue, VPN access into client servers, and
Siebel remote access for problem reporting.
Tracking all bugs and issues in the newest release.
Blue
Cross/Blue Shield of Massachusetts & Enterpulse,
Healthcare
Functional SME and Strategist
For the Member Portal and
§
Marketing,
Proposal and winning the Contract. Assisted the primary vendor, Enterpulse, to
win this large engagement with superior web design skills, pertinent
association between application design and healthcare requirements,
industry-leading theories (personalization in healthcare portal,
patient-centric usage, integration in RHIO / NHIN approaches, HIPAA / x12
standardization, 24 x 7 proactive prevention tools, live connection among all
participants in the healthcare cycle).
§
Strategy
Formulation. Collected critical requirements (as Senior
Business Analyst – Healthcare IT) from all areas – Sales, Marketing,
Innovation, Case Management, Member Support, Call Center, Provider, Broker Relations,
Medical Policies, IT, Architecture, etc.
Collaborated with Web User Group and Steering Committee to ensure
accurate capture of needs and complete coverage of all Enterprise Portal
Strategic Goals.
§
Information
Systems Familiarity. Interacted with multiple systems throughout
the project: NASCO (national claims),
Metavance (EDS replacement system), local/regional claims system, BlueServ
customer service modules, WebMD medical education content, PHA Personal Health
Assessment tools, data warehouse among all BCBSMA information systems, ESI
Express Scripts Pharmacy Benefit Manager, etc.
§
Multiple
Major Functions. Claims, authorization, case management, benefits
(summary and detailed), formulary (covered drugs, non-preferred drugs, 3rd-tier
drugs, recalls), year-end summaries, online message center, performance
reporting, personalized charting, “personal coach” interaction with members,
§
Assisted
in Creation of Multiple Documents. Personalization strategy, current state,
comprehensive inventory of all existing contents (public and authenticated
data), taxonomy, user case (UML modelling language), technical strategy,
project plan, steering committee reports, current asset categorization,
executive interview notes, etc.
§
Goals
accomplished. Helped the market-leader to maintain
competitiveness in the fierce local market; maintaining member satisfaction
which translates to highest possible renewal rate (member retention); achieving
market parity with leading-edge member-centered portal design; allowing patients
to take control of their own wellness.
State of
Contractor & Contract Administrator.
Serving OMMISS, and multiple stakeholder departments – DMA (Medical
Assistance / Medicaid), DFS (Facility Services), DPH (Public Health), and DMH
(Mental Health).
§
Project
Administration. Assuring ontime, on-budget implementation of the
$22 million, 2-year MMIS application overhaul contract (total amount - $122M
for 4 years of Fiscal Agency operation, after Build stage). Closely monitoring incoming vendor (ACS State
Healthcare) overall performance – budget, invoices, deliverable (timely
arrival, quality), customer satisfaction level (relational database &
multi-dimensional reporting), issues/risks, executive communication, status
reports, data migration, transition (from outgoing vendor, EDS), contract
amendments, change requests (CSR), status reports and “compliance roadmap”.
o
Close
focus on all items listed in the RFP and the winning proposal – formal requirements,
timeframes, penalties, payment terms, legal restrictions, milestones, payment
increment schedules, communication plan, and more.
o
Created
relational databases to capture, centralize and report on all of the above
items. Using Microsoft Access for rapid
deployment, minimal cost, and ease of future ownership by the client’s full
time staff.
o
Drastically
improved executive team awareness of problems, significantly reduced lead time
for Project Administration tasks – since joining the team and reengineered the
Contract Administration team.
§
Project
Management. Oversight of the 12 Detailed Work Plans
(DWPs), totalling at 14000+ tasks.
o
Familiar
with 5 basic process groups and 9 knowledge areas: Initiating, Planning, Executing, Controlling and
Closing; Integration Management, Scope
Management, Time Management, Cost Management, Quality Management, Human
Resource Management, Communications Management, Risk Management, and Procurement
Management.
o
Familiar
with ACS’s issue management systems – SilkCentral / Segue.
o
Leveraging
the online, web-based nature of these tools to optimize real-time data sharing
and collaboration – such as ODBC linkage to State’s own contract management
databases.
o
Using
skills and past deployment experiences to empower technology in Project Management
process. Integration of data (relational
data modelling among performance, financial, issues and staffing data),
real-time collaboration (FTP’ed Microsoft Project plans, ODBC’ed into Access /
SQL Server databases).
§
Functional
Expertise. Deep familiarity with multiple subsystems and
their performance standards / reports.
o
Familiarity
with MMIS applications from ACS and EDS.
o
Improvement
and Approval of RAD chapters – e.g., communication plans, Facility Services,
issues management system. Collaborating
with business units (state staff), fiscal agents, and consultants/vendors.
§
Database
Tools Creation. Independently
Created multiple databases – Amendment, Expenditure, 600+ deliverables, CSR
Change Service Request, Contract RFP requirements, staff, surveys, performance
of all subsystems, and more. Integrated
all data entities through intelligent indexing.
o
Creating
applications using best-practices: data modelling,
RAD (rapid application development), user requirement sessions, functions inventory
list, graphic GUI optimization, automation macros, security.
o
Using
relational database to promote new business processes – digitizing workload,
deadline calculation, exception processing alerts, segmenting work based on
criteria intervals, zero-lead-time workflows.
§
Consulting
skills. Requiring minimal supervision; constantly
exceeding expectation of time, quality; thought leadership; customer-first
mentality; amicable working relationship with other consultants & full time
staff; constantly improving Contract
Management Team’s efficiency.
State of
Contractor & Business
Analyst, Core MMIS System Contractor.
Assisting the State of
§
Joint Acceptance Testing. Leading all vendors and business units in
joint test plan design, communication process, problem identification / rework
/ retest strategy, consistent test cases/scenarios/scripts, test scope, weekly
team meetings, etc. Using IEEE Standard
829, “Standard for Software Test Documentation”, as industry-standard approach
to proper documentation outline.
§
Test Case Quality Assurance (Q A). Approving and enhancing all proposed tests
from the QA test writer. Applying my
hands-on experience with other MMIS systems (GA, MN, NE) to improve the scope
and accuracy of MMIS programming test cases.
Covering all aspects of MMIS include:
Recipient subsystem, providers, claims, reference, MARS, SURS, Medically
Needy, TPL, managed care and EPSDT.
Gained detailed familiarity with the ACS MMIS system through mapping out
all screens and subsystems.
§
Data Load strategy. Created multiple documents to lead management
and programmers in reaching consensus regarding how, what and when to move
mainframe-based data sets among the different regions/environments –
development system, unit test system, base-line reference system,
system-testing system, acceptance testing system, and production system. Incorporated considerations for – scope, data
ownership, technical requirements, backup/restore utilization, inter-agency
cooperation requirements, etc.
Contractor & Project
Manager; HIPAA Security Rapid Assessment/Remediation, Office of
Info Technology.
Single-handedly leading the entire HIPAA Security
compliance project. Created Microsoft
Project plan to cover all 3 Safeguards areas, 18 requirements and 42
specifications of HIPAA Security.
Divided the project into 5 distinctive steps: Preparatory tasks, Initial meeting (kickoff),
Inventory, Assessment (risk identification), Remediation (deliverables
production), and sample audit to conclude the Initial Compliance stage. Held meetings with key areas and
individuals: Clinical, dental, admissions,
HIPAA Privacy Official, server room staff, Oracle administrator, McKesson administrator,
employee orientation team, policy/procedures team, etc. Work directly with the CIO, leading
rapid-delivery team of OIT managers. Key
areas of focus include:
§
Policy/Procedures –
leveraging existing ones (HIPAA Privacy, new employee orientation, OIT),
bringing those up to the level that HIPAA Security requires. Modified existing IT and departmental
policies to address pertinent HIPAA Security requirements, and created new ones
to fulfil missing areas not yet addressed by existing policies. Helping HR department to deliver these
policies’ training to all existing and new future employees through “Weekly
reminder emails”, orientation program re-design, and integration into the
annual re-certification process.
§
Technical aspects
– Running vulnerability scan with Nessus / NeWT (inspecting open port, default
accounts/passwords, availability of security patches and updates, …), charted
entire network (routers, primary servers, VPN, firewall, web servers, database
servers, modem dial-up ports), creating a new Disaster Recovery Plan from
scratch, freeing up network bandwidth with new firewall/proxy policies,
managing server and workstation images, new processes for incident awareness
(active monitoring, alerts) and handling (reporting, responsibilities,
protocol), password management (e.g. change frequency), application-level and
OS-level automatic lock-up, patching all open ports with configuration
modification and patches/fixes, audit trail / access log, etc.
§
Administrative aspects
– Identified all ePHI-impacted areas and information systems, formed new
“Security agreement contract” with all existing and new employees, producing
new set of comprehensive and ePHI-exposure-level-customized training programs,
creating new security reminders, instituting ongoing/regular internal audits,
centralize all user access’s management (e.g. rights determination, termination
of staff account removal), appointment of HIPAA Security Officer, new contracts
with Business Associates / trading partners, etc.
§
Physical aspects
– create individual accountability for server room entry, improve server room’s
physical protection, enhanced physical asset awareness and logging, etc.
Produced sustainable, rapid, comprehensive, balanced,
affordable, empowering HIPAA Compliance plan for all affected
stakeholders. Ensured that full-time
staff are the owners of the compliance process and can continue to operate the
plan without consultants’ help. Produced
paper-based binders and on-line file directory to maintain all pertinent documents
– gap analysis, compliance plan, weekly/monthly/annual IT assessment reports,
all policies, network charts, e-PHI locations spreadsheet, training program,
related HR and Privacy documents, vulnerability assessment reports, training
records, and more.
Contractor; HIPAA Privacy
Implementation, Information Technology and Strategy (ITS), DHS Privacy
Official & Appeals / Regulations (contracts) group.
Scope: All DHS
Business Associates, all DHS contracts from recent years (16000+ contracts,
$600+ million dollars last year / $18.8 Billion over last 15 years, 730,000+
vendors), all 87 Minnesota counties and their information privacy agreements
with DHS, all 8 types of contracts (professional/technical, grants, master
contracts, blanket, inter-agency, annual plans, income contracts, other
non-encumbered contracts). Major
accomplishments include:
§
Maintained HIPAA Privacy rule
compliance for State of Minnesota Dept of Human Services. Roles include: Business Associate management, PHI disclosure
management, support for the Privacy Official, tracking individual requests for
information and privacy complaints, creating tools (easy-to-use databases) for
tracking compliance, etc. (see details
throughout later sections.)
§
Initiating HIPAA Security
compliance activities with ITS team. Integrating HIPAA Security into policies and
procedures, linking Security efforts to existing Privacy practices (e.g.
contracts with business partners, PHI disclosure, training material, access
control for workforce, ePHI handling at work areas, facilitating meetings
between Privacy Official and Security Official), reviewing system exposures to
HIPAA required & addressable specifications, sharing Inventory Templates
for initial audits and follow-up compliance reviews, summarizing the 20
Required elements and 22 Addressable Elements to education workforce, etc.
§
Comprehensive Revamp of Contracts
Management Process:
Business Process Re-engineering (BPR) for outdated paper-focus, high-duplication / low efficiency / low
accuracy system. Digitize,
paperless, workflow creation, worklists, scanning, integration with MAPS
mainframe and data warehouse (Oracle ODBC), SQL Server upscale project, drastic
time reduction, 100% accountability, queries (ETL extraction, transformation
and loading from multiple enterprise and departmental databases into one active
data store; ad hoc reports for analyzing specific problems; daily worklists
based on user role type), data entities design, BA reporting, customized
mail-merge list, survey results, RAD, low cost, weekly meeting with primary
users, data inventory, inclusion of all users (attorneys, contract
coordinators, management, remote users, Privacy Official), security (NT directory
authentication)
§
Standards and Policies for both
Security and Privacy Rules Compliance: Working with Privacy Official and DHS
Security team in completing 6 out of 175 standards that intersect between data
privacy and security: PHI in phone, PHI
in work area, PHI in meetings, PHI delivery, PHI handling and PHI in
Faxes. Using pertinent resources and
references such as: Published
Information Policy on DHS Intranet, other pertinent policies / standards,
Wood’s, HIPAA Privacy final rule and HIPAA Security final rule.
§
Project Management for Several
Major Efforts. Lead regular
meetings among executives, hands-on staff and consultants. Created meeting agendas, issues, risks,
mitigation plans, and overall project plans.
Facilitated group’s discussion to promote self-discovery of problems and
solutions. Created project binders for
all projects (HIPAA Business Associates compliance, CRM system for entire
organization, Commissioner’s Office communication tracking, document scanning
and workflow improvement…).
§
Project execution of Contracts
Tracking database development:
On-time, under-budget, all-inclusive, detailed documentation, version
control, partnering with appropriate individuals (e.g. Financial Management,
Department of Finance, Application Development group in ITS, IA Warehouse team,
ITS Helpdesk)
§
Business Associate Survey: Single-handedly created the cover letter
(including explanation and citing of pertinent HIPAA Rules, and list of
Business Associate responsibilities) and the BA PHI Disclosure Tracking and
Restrictions survey; gained Privacy Official and Contracts Attorney manager’s
approval through group revisions; sent out all letters; tracking replies
through email, fax and phone calls & entered into comprehensive database. Will share this BA database with HIPAA
Security team.
§
County Agreements: Took inventory of all collected County Data
Privacy agreement (similar to HIPAA BAA); identified those 31 counties that
require reminders and new Agreements sent; marked all such records in a shared
Access database; created entire mailing (cover letter, survey) and created
dedicated Outlook email account to handle these replies and inquiries;
collected all counties’ replies and contacting the few remaining ones
repeatedly.
§
Application Development best-practice: Involved end-users early and throughout
process; executive buy-in early and throughout process; change control; version
control; backing up / disaster recovery; RAD; weekly meetings; legacy system
integration/preservation (ODBC) and data migration; on-site maintenance;
immediate response; delivered user training / training documentation;
§
Business Associate data
integration: Contact
person (title, signing authority), information validation (phone, fax, email),
survey results, Covered Entity identification history, communication tracking,
BAA (BA Addendum) inventory / digitising,
§
Advanced Communications Tracking
System: Build-buy
decision, pricing, process study, incremental changes to current system in
Commissioner’s office (CRM system - multiple media inclusion), enterprise-wide
architecture, collaboration with current systems; used to comply with both
Privacy and Security rules of HIPAA requirements.
§
HIPAA Transcactions/Codesets: Helped Minnesota Counties in sending x12
Claims to Healthcare Operations / MMIS. Located the proper DHS MMIS contacts;
established timeframe; assisted the counties to become earlier test-submitters;
helped Ramsey County Public Health department to work with claims clearinghouse
ProServices to initiate testing with DHS.
§
Assistance with “360 degrees”
Employee Survey: Customized
email for each recipient, mail-merge to Outlook email recipients, assisted the
responsible ITS staff in rapid deployment, test run and final delivery of all
surveys in MS Word / Outlook.
§ Electronic Documents Management System Planning (EDMS). Scanning, document archival and real-time sharing; workflow improvement through c