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(770) 891-6776 cell |
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SUMMARY:
Seeking perm
consulting position to assist managed
care organizations, state Medicaid and other healthcare organizations with the
following needs:
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Project
Management (including PMO operations, large-size contract’s overall management),
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Data
migration, system deployment (e.g. Amisys, Click4Care, Oracle)
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Functional
Design (JAD, RAD, GSD, DSD, user acceptance)
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Business
Process ReDesign (BPR)
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Relational
database systems design / implementation
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HIPAA -
x12 transactions, codesets/identifiers, Privacy/Security requirements
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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:
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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.
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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.
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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).
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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
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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).
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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.
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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.
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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,
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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.
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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).
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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.
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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.
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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.
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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).
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Functional
Expertise. Deep familiarity with multiple subsystems and
their performance standards / reports.
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Familiarity
with MMIS applications from ACS and EDS.
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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.
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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.
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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
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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.
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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.
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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:
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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.
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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.
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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.
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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:
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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.)
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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.
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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)
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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.
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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…).
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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)
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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.
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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.
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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;
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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,
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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.
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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.
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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.
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Electronic Documents Management
System Planning (EDMS).
Scanning, document archival and real-time sharing; workflow improvement through centralized
knowledge simulating ERP in a paperless service-industry environment. Compliance to HIPAA’s document retention
requirements in Privacy and Security rules.
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MMIS System overview: Learned about the MMIS claims processing
system here, including the HealthCare Operations team’s architecture, web-based
claims submission system (MN-ITS), adjudication process, X12 acceptance
schedule, submitter testing process, etc.
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Assisted other areas with database
query / maintenance tasks.
SOS (State Operated Services, health service provision facilities owned
by State of
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Led users in Contracts retreat: Created consensus vision regarding electronic
process improvement (departure from paper-only process); led group to accept
new database which interfaces with enterprise data (MAPS) rather than
maintaining duplicate and isolated data; gathered user complaints and wishes
for new system; established timeframe (project management), user interface
preferences and priorities in RAD process; gained executive approval and
sponsorship; led training sessions.
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Teaching users about Technology: Access database, Windows security, ODBC,
searches / filters / queries, basic operations in Windows and Word, saving
documents in varying formats (HTML, RTF, PDF), OLE attachments in databases.
StatE OF
Contractor; Privacy /
Transaction / Security Analyst, HIPAA Project Management Office
(PMO).
Scope: MMIS,
Medicaid, all NE-HHSS applications, entire intranet and internet sites, 6000+
employees, 10 facilities, all affected submitters in state of Nebraska.
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Privacy Rule Compliance: Led NE-HHSS to be HIPAA Privacy compliant by
the 2003/04 deadline, through documentation, assessments, inventory, risk
identification, risk mitigation, sanctions, violation reporting mechanism,
regular meetings, Business Association identification/treatment, training /
certification to entire workforce (video, online training, binders,
certificates), websites, FAQs to all stakeholders, PHI identification
throughout entire agency (systems, work areas, documents, facilities,
departments), and reports/recommendations to the Senior Management team and
HIPAA Steering Committee.
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Security Rule Compliance: Educated the HIPAA PMO, Steering Committee
and others regarding the specific requirements and overall intentions of the
Final Security published on 2/03;
published standard templates for assessing ePHI exposures for all 20
required and 24 addressable specifications.
Created Privacy-Security policies to address the three types of safeguards
(Administrative, Physical and Technical).
Worked with the ITS Security representative to share resources regarding
new security threats (e.g. SANS vulnerability alerts, common exploits, top new
tools for hacking, overview of NMAP tool).
Linked certain Privacy requirements to Security requirements (e.g.
access logging, user role identification, audit trail, password management,
regular security reminders).
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Transactions/Codeset Compliance: Single-handedly led the entire process --
analyzed all 400+ applications in NE-HHSS to inspect TCS impact using
standardized template and interviews; filtered the list of systems down to 100+
TCS-impacted systems; identified top-7
systems to focus all priority and resources on (including MMIS / data warehouse
and on-line eligibility web system);
created project timeframe, bi-weekly status reports and other executive
summaries for the HIPAA Steering Committee;
created and delivered training sessions for multiple internal / external
groups; led joint designs for Office of
Mental Health and Substance Abuse / Addiction and the Magellan software
vendor; created benchmark summary of all
50 states’ Transactions / Codeset projects based on their internet sites.
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TAG Leader and Project Manager: Appointed as the leader for three TAG’s
(Technical Advisory Group) which are multi-disciplinary teams of functional
leaders: Distributed Systems TAG (IT,
help desk, HR, public relations, MMIS, healthcare financing, HIPAA executive,
Privacy analysts), Internet / Intranet TAG, and N-FOCUS TAG (online
eligibility, DDE system); Created all
meeting documentation such as agendas, minutes, handouts, to-do worksheets and
pre-meeting reading assignments. Created
project binders for all three TAG’s to track issues, progress, project plans, resolution
methods, attendance, etc. Regularly gave
reports to IT management team and the HIPAA Steering Committee.
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Internet / Intranet: Singled-handedly created the “HIPAA Online”
intranet site to education and inform all 6,000 geographically dispersed HHSS
employees on all HIPAA projects;
single-handedly created the Internet site ( http://www.hhss.state.ne.us/hipaa
) to offer extensive, out-to-date, user-friendly, interactive HIPAA information
& tools to all external parties (consumers, business associates, providers,
clearinghouses, payers, and others);
responding to all feedback regarding these two sites via internet
emails, phone calls, and personal visits;
regularly publishing updates and gaining approvals from the HIPAA
Executives of NE-HHSS.
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MMIS TAG: Representing the HIPAA Project Management
Office at the MMIS remediation meetings.
Led discussions about external access for certain business associates;
participated in testing, project status, transaction and resources coordination
discussions among business, technical and PMO decision-makers.
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External communications:
Single-handedly answers all FAQs, transaction submitter question, privacy
complaints, clarification questions, testing enrolment and other external
requests; wrote the announcement emails
for Internet and Intranet for external parties (news media, users, HHSS
employees); led vendor meeting and
Regional Board discussions regarding TCS, clearinghouse selection, architecture
for TCS-compliant system, and trails of decisions / info flow / funds.
Affiliated Computer Services (ACS)
Inc.,
Senior HIPAA Programmer Analyst
– Security, Web Portal & x12 Testing
State
of Georgia Medicare/Medicaid/state - employees HIPAA project (See “Skills”
section for other details)
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Transaction: Reviewed and revised Crosswalk Analyses for
multiple transactions (834, 837 I/P/D, 835, 820, 276, 277); Wrote up multiple Test scenarios based on the
x12 transaction; turned selected test
scenarios (837 Professional/Institutional/Dental claims, 835, 820) into actual
raw-text files as test scripts, following the rules and formats (e.g. loops,
segments, data elements, repeats, loops, hierarchical structure, required
elements, situationals) using EDIFEC SpecBuilder 4.0, 5.0 and 5.1; Clearinghouse interaction; data warehouse
interaction with Mercator translator;
Jointly reviewed and approved the 7-layers of edits, such as initial
file type check, x12 rules compliance, core system known problems, eligibility,
benefits, history check and adjudication rules check; Familiarity with UB92 and HCFA1500 standard
forms; created the “Required elements”
report for State of Georgia MMIS based on WPC PDF documents; Web-data-elements to web-functions analysis
(ETL data pulls in and out of enterprise-level MMIS data warehouse, presented
in HTML/ASP format); certified multiple
submission methods into data clearinghouse (FTP, email, web HTML, XML, proprietary
interface, tape, fax, phone IVR);
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Privacy: Established standard template for all
policies and procedures; participated in the HIPAA Steering Committee’s Privacy
Workgroup with State decision makers and all vendors/partners; established the policy revision and approval
process; Drafted initial policies;
“Privacy and Security” report (i.e. linking similarities, concurrent
requirements between Privacy Rule and Security NPRM); Technological solution to
Access Log and Edit history (i.e. store query requests rather than entire
datasets; offload to archived data warehouse);
Privacy implications for Customer Support Center, IVR (phone system),
and initial password to log in; Customer
Center’s privacy issue on IT system (e.g. patient-requested blocked fields –
how to show or hide it); Physician’s
assistant’s rights and privileges; Who
owns responsibility to maintain access of users (i.e. physician’s practice
administrator, Processing Center, State’s MMIS Administrators?) Scope of
permission for Physician to see his/her patient’s data; Privacy statement on the MMIS Web
Portal; Transferability of PHI after
sale of business; foster children’s PHI
and legal guardian’s right to see/access/modify them.
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Security: Participated in architecture design for
overall system (database server, de-militarized zone, firewalls, legacy system,
mainframe, NT-based servers, VPN, web server, client-side security, encryption
during public IP transmission);
redundancy, disaster prevention and business continuity planning (e.g.
back up method and frequency; site
selection; monitoring tool, staff qualification, alert process, penetration
attempts reporting, physical protection for server room, environment
requirements for server room);
participated in preliminary discussions on vulnerability assessment
(i.e. port scanning, packet sniffing);
desk-top printed media access control and badge-based facility control;
created one-page summary for the entire set of Security issues / 5-parts
taxonomy; created Powerpoint presentation to train developers and state employees
on what is HIPAA Security; conducted the
training and Q&A sessions;
interfaced with Web Design team (IBM), data owners (State MMIS owners),
system owners (Georgia Technology Authority), users (State employees) and
application designers (ACS application development); Reviewed and revised the N-tiered design for
data clearinghouse; discussed
implications (i.e. speed, accuracy, ease of deployment, technological
compatibility, cost, timeframe required) for multiple media input methods (DDE,
proprietary software, x12, paper-based, internal users via core system).
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Consulting: Designed, wrote up and conducted HIPAA
training sessions for clients and my own company; conducted project planning,
roles assignment, process design and ongoing maintenance for HIPAA team’s RAD /
DSD documents (Rapid Application Design, Design Specification Document)
approval process; participated in
4-layered testing methodology – unit testing, system testing, integration
testing and user acceptance testing;
screen layout design for portal;
project management focusing on testing steps’ work load and deadline
compliance.
As
part of the Corporate HIPAA Team:
§
Lead HIPAA intranet website
development within ACS State Healthcare. Lead Web Portal Workgroup, an
inter-departmental group. Conducted miscellaneous research for team –
*
The TriZetto Group,
Manager, Transformation Services (Strategic healthcare
IT Consulting)
§
Project
Manager for e-commerce project. Lead the web programming staff in a
consulting engagement for one of the world’s largest medical devices
manufacturers, by designing a new e-business product for its chronic pain
patients and provider community.
Designed all functions, all technologies and entire Beta site’s
layout. Responsible for project planning
and day-to-day management of staff and activities. Created project timelines, led daily and
weekly meetings, gave executive summary report to consulting division director,
recorded issues and risks, solved the biggest problems (e.g. synchronization of
efforts among San Francisco team and India team, managing client’s expectation
for functions) through team collaboration.
§
Created a HIPAA Assessment Tool
for the company and its clients.
Administered the Niku system (SQL-server based data warehouse receive
data feeds from multiple sources), managed SQL Server databases, Allaire JRun
services, IIS Internet Information Server, WebLogic full text search tool and
JDK (Java developer kit). Created
high-complexity Crystal Reports that aided clients and consultants in mining
data regarding HIPAA compliance and created tools that automated the entire HIPAA-compliance
assessment process in Visual Basic, working with java, SQL Server, and Excel.
§
Created a database for TriZetto’s
consulting arm to track of all vendors, competitors, partners and other types
of companies. Designed entire relational
data structure, entities, relationships and infrastructure. Created Beta
version and shared information over company’s network.
*
AnswerThink Consulting Group.,
Manager, Technical Strategy
§
Led a technical team
(DB experts, security experts, ASP/CGI coders) with website re-launching for a
mid-western investment bank. Helped build a website that offers end users
the following: strong authentication model, stock and mutual funds
trading capability, improved & highly consistent look and feel, ability to
see market charts, research and analysis articles.
§
Project management for large
project. Maintained
the team’s project plan for a large consulting engagement (30 people, $8M
project, 8 months), reported regular progress to the client’s executive team,
updated all teams’ progress (HTML artists, data access team, ASP/Java
programmers, site architects, business analysts) through Microsoft Project
tracking. Met all major deadlines – demo
versions, component milestones, testing, delivery, user acceptance, documentation,
etc.
§
Analyzed clients' current
position, internal strengths and weaknesses, technological infrastructure,
requirements, unsatisfied needs, optimal architecture and more. Analysis
lead to the development of a work plan, staffing forecasts, implementation and
purchasing/partnering activities.
§
Provided E-commerce-focused
architectural recommendations for one of the world's largest conglomerate that
serves both heavy industrial clients and light consumer
products. Single-handedly created strategic data integration plan
for its largest global sales organizations, combining all major data entities
into one data warehouse to feeds Siemens’ international web site for ordering
and pricing / availability / specifications.
§
Presented to the company's chief
communications officer and all divisions' business managers regarding the
necessary architecture for the relational database behind their international
corporate website. Helped client to develop a static and plain web site
into direct-to-customer (B2C) and direct-to-vendor, direct-to-supplier (B2B)
standardized portal.
§
Performed multiple roles such as:
Primary interface with client's executive team, internal team-mates and
client's IT department regarding all technical issues. Co-developed the project plan for a 5-month,
multi-million dollar project. Facilitated the life-cycle activities for the
development of a website (assessment, strategy, architecture, technology,
functions, style/voice, site map, wire frame, HTML/DB/graphic/codes
development, integration, migration, testing, approval, transfer, and training).
First
Consulting Group
Senior Consultant, Internet/Intranet/E-health
§
Worked on projects regarding all
aspects of internet technology:
operating system, network topography, architecture, content model, rapid
application development (RAD), strategic planning and feasible technology
alignment, database administration (DBA), helpdesk operations, search engine,
log file operation, server room logistics, etc. (For complete list of
projects, roles and outcomes, refer to "functional version of Resume"
available upon request.)
§
Webmaster for the
Internet/Intranet/E-commerce group's website on company intranet. Shared
latest news among a small group of web experts, maintained internet links for
latest industry trends and vendors, and leveraged the individual knowledge and
experience among all internet consultants in FCG.
*
Enterprises Computing Services, Inc.,
Project Manager
§
Lead teams of international
programmers and decision-makers in many projects, for
State of
*
QualMed, Inc.
Director, Continuous Improvement
(BPR)
§
Lead inter-departmental
improvement (BPR, business process
re-engineering) effort among Sales, Underwriting, Configuration,
Enrollment/Billing, ITS and Customer Service.
Implemented 4 major proposals toward overall lead-time reduction:
[1]. workload monitoring through networked information, [2]. tracking of enrollment variations, [3].
monthly renewal process automation, and
[4]. proactive error prevention through sales/broker/customer relation’s
management.
§
Helped the Customer Service
department to develop monthly control charts for 20 health plans in 18 states,
handled customer grievances and appeals with Microsoft Access databases, and
worker utilization monitor. Took inputs through a wide variety of approaches,
including email, file transfer, and faxed documents.
§
Monitored
the claims department’s process – claim adjudication through Amisys, accuracy
and efficiency of the data entry process through scanned paper claim forms,
adjudication timeframe monitoring, data sharing with Customer Service
department.
§
Helped Denver SBU (Small Business
Unit) to automate
monthly renewal process & daily quoting process. Improved broker relations literatures,
worker motivation,
and external communication with other departments.
§
Plus
many other projects … details available upon request.
*
Pro Brand International, Inc,
ISO-9002 Certification Project Manager,
Internet/Intranet Specialist, MIS Back-up: Executive Assistant:
(more information available upon request)
*
ComNet (Community Medical Networks) Society,
Director, Membership Services
§
Created & continually
maintained the ComNet Society’s 25,000-record multiple-purpose database with
Microsoft Access 2.0. Assisted in the
creation of 1996 ComNet’s HIN-100 Directory.
Conducted membership sales to healthcare executives through Internet and
broadcast fax and maintained member relations.
*
Reuters Health Information Services
Inc.,
Technical Coordinator
§
Acted as primary technical
contact for 3rd party vendors. Designed
and fully implemented the Reuters Health Terminal (multimedia Ethernet
workstation). Designed multiple internal
and external business processes (vendor relations process flow, software
revision, warranty and maintenance program) tracked by databases that I created. Attended and presented in several national
medical-related conferences (HealthInfo, ACP, COMDEX, Networld+InterOp).
IBM
Corporation,
Co-Op Employee (more
information available upon request)
Ta Tung Chinese Printing Company,
§
Chinese typesetting,
translation, Chinese type-setting computer system, cross cultural
printing/publishing
Note: * denotes that I left the company
involuntarily, such as layoff or company closure.
education:
Executive MBA: “Global e-Commerce Management”,
Georgia State Univ. ................... September
2001 – November 2002
Primary focus: Finance, e-commerce (healthcare EDI), ERP,
international collaboration
Master of Science, Health Systems,
Georgia Institute of Technology .................................................... June
1995 - June 1996
(A specialty degree within the
Research focus: CHIN
(Community Health Information Networks), Internet/WWW, international computing.
Recent projects: WWW home
page for
Bachelor of Science, Industrial
and Systems Engineering, Georgia Inst. of Technology ........ June
1989 - December 1993
Research focus: International information systems, quality control,
man-machine interface design.
Senior
Design project: Grady Memorial Hospital Diabetic Center, staffing and resources
allocation project.
(six months, on-site)
Certified ISO-9000 Lead Auditor (granted by The Center
for International Standards and Quality – Georgia Tech)
PMP (Project
Management Professional) certification – PMI (Project Management Institute) .................. expected Spring 2006
skills:
Healthcare
Specific Skills
Care Management (case
management, disease management and utilization management); HIPAA: Transactions (ASCI x12: 837 claims, 835, 820,
834, 270/271, 276/277, 278; format concepts such as loops, segments, repeats,
data elements, and required fields; real-time vs. batch process; DDE direct
data entry system, actual x12 text file creation); Privacy (policies,
procedures, final regulation); Security (e.g. authentication, email encryption
disaster recovery/emergency mode operation, audit trail, access log, physical
security, access privileges; specially internet-based, database / data
warehouse and LAN/WAN based information systems); code sets (basic awareness);
managed care financing; payer-side
operational issues (e.g. claims, call center, EDI, clearinghouse operation,
facilities, compliance, audits, documentation, training).
Healthcare Consulting Clients List
Amisys Synertech Inc (AMI); State of North Carolina OMMISS; State of Illinois, State of Iowa – Medicaid
Enterprises, State of Minnesota Dept of Human Services HIPAA office, State of
Nebraska HHSS (Medicaid, HIPAA PMO), State of GA (Medicare/Medicaid/State Employees plan); BCBS Massachusetts, BCBS
Florida, BCBS Oregon, BCBS Association;
PacifiCare, MedTronic, SummaCare / APEX
insurance, Lifeguard HMO, HealthNet Plans;
Meharry Medical College & Hospital, McClaren Hospitals, Medical
College of Ohio, Grady Memorial Hospital, Regional Medical Center of Memphis; ChannelPoint, Siemens, Tools for Health, QualMed Plans for
Health, Fox Systems, IBM Global Services Greater
China Group, Government healthcare agency of GuangXi province, China; and more.
Technology Planning
Data entity identification, design and implementation
for large enterprise data warehouses, RUP (Rational Unified Process), UML
(Unified Modeling Language), 3-tier web architecture (data, business logic,
presentation), security (CISSP-level security topics -- encryption, SSL, token,
certificate, biometrics), strategy-to-technology alignment, software
development process, technical project planning, vendor selection methodology,
script platform selection (ASP, Java, CGI), server planning (reliability,
disaster recovery, redundancy, scalability, interoperability, environmental
factors, usage forecasting), knowledge management
Software & Hardware
Amisys (Amisys 3000,
Amisys Advanced 1.0, 2.0, 3.0 and 3.1), Erisco/Trizetto Facets, MetaVance
(EDS), Click4Care case management suite, OmniCaid (ACS), WebMD PHA,
ExpressScripts Pharmacy Benefits Manager, EDIFEC
SpecBuilder HIPAA x12 Test file creator; EarlyView HIPAA Compliance program,
Privacy and Security modules; Mercator; Microsoft Windows (Windows XP, 2000, 98, NT 4.0 Workstation, NT
4.0 Server, 3.1, 3.11, Workgroups, 95, Chinese), SQL Server 6.5 / 7.0, Internet
Information Server (IIS), SourceSafe, InterDev, Office Professional (Access,
Excel, Word, Powerpoint, Mail, Publisher, Outlook, Project), Frontpage, Works;
Oracle; Sybase; IBM DB2; Informix; SAP
ERP; Crystal Reports 8; Allaire JRun (Java server), JDK (Java Developer Kit),
WebLogic full-text search, Act! for Windows; Netware 3.x client; MiniTab,
Statistica, GPSS/H; Photoshop, Corel Draw;
Server room operations, PC performance optimization, upgrade and
diagnosis. Network development (Ethernet, client-server, wireless LAN, cable
modem, DSL), CD-ROM production, video editing systems, digital photography,
graphics scanner, video conferencing, PCI devices, satellite transmission,
telecommunications, telemedicine, medical imaging, EDI, OCR.
Programming Languages
Can independently program in SQL (structured query
language), Visual Basic, Crystal Reports, HTML, BAT files, INI files, and
Fortran/Pascal. Can work with codes in
ASP, Java, CGI / PERL, JSP, UNIX, XML
and many more.
Business Skills
Technical Sales / RFP /
bidding process, strategic planning, financial reporting (accounting),
resources theory, Business Process Re-engineering
(BPR) (change management, impact control, empowerment, process study,
improvement through measurable metrics, executive buy-in), FOCUS-PDCA,
certified ISO-9000 lead auditor (granted by Center for International Standards
and Quality, CISQ), meeting facilitation, executive interviewing,
brainstorming, active listening, public speaking skill, industrial &
systems engineering tools (sampling, statistics, forecasting, inventory,
flowchart analysis, process improvement, simulation, layout design, queueing
theory, regressional analysis, etc.), empowerment, diversity utilization,
motivation; CRM, supply chain, financing, ROI, asset valuation, M & A,
business law, intellectual property protection.
Project Management
PMP-level skills/experience: Leading large client teams (e.g. Nebraska
HIPAA PMO project management office, TAG technical advisory group; Minnesota
DHS contracts / attorneys teams) or consultant teams, ontime and under budget;
Issues and Risks management;
documentation and reports creation/distribution; Risk mitigation strategy; Large-scale project’s overall management (30
staff, $8M, web portal development for stocks trading site); Technical Project
Manager (4 staff; ASP / Java / database-to-website connectivity / technical
architecture); chronic-pain management site development team project management
(5 staff, RAD, medical diagnosis and treatment plan tool); state-wide
information system project manager (5 staff, DBAs and programmers, regular
reports to clients/executives)
“People Skills”
Patient, explaining complex topics with simple words,
win-win personality, ability to listen “between the lines” to hear customer
true needs, showing empathy, able to leverage trust as critical success factor
in project implementation, proactively teaching users technical concepts and
strategic visions, very likable person, effective communicator (written,
verbal, one-on-one conversation), excellent command of English language.
ACTIVITIES:
§
HIMSS
(Healthcare Information & Mgt. Systems Society) Greater China Region SIG
founder member and chairman (2005 - 2006), session speaker (2006); Roving
Reporter (1995-1996).
§
Project
Management Institute (PMI); Healthcare SIG (special Interest group): LIG formation committee core member (2005 – current); International Development SIG member (2005 – current).
§
Monte
Jade Computer Technology Association, National Association of Asian American
Professionals (NAAAP) Chapter Manager, CABAM (Chinese-American Business
Association of Minnesota) board member.
§
Delta
Chi Fraternity, Founding Father (1990), Secretary (1991), National
Outstanding Secretary (1991)
§
Georgia
Tech Chinese Student Association, Two-term President (1992 -
1993, 1995 - 1996)
§
Georgia
Tech Crew Team, Vice President (1992), Inst. of Indust. Engineers,
Alpha Pi Mu Business Fraternity
§
Georgia
Tech Graduate Student Senate, ISyE Senator (1996), Human
Resources Committee (fall 1995)
§
Georgia
Tech Wellness Center, Student Advisory Board Founding
member (1991 - 1992)
Version: 2006-05-08-B