Lawrence S. Lin, MSHS, MBA

 (770) 891-6776 cell

 

 

2526 Mt. Vernon Rd., Ste. B-411

Dunwoody GA 30338

larry@larrylin.org, www.larrylin.org

 

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, Dunwoody, GA; Client sites throughout USA ...........................................   Sept 2002  - Present

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 China and Asia efforts, both within US healthcare market and abroad in Asian countries (e.g. China, Hong Kong, Australia, Singapore, Taiwan).  Started the HIMSS Greater China Region SIG (http://www.himss.org/ASP/sigs_china.asp ); current appointed as chairperson for the SIG; designed a series of 20 white papers for the SIG members to jointly create;  gave numerous speeches and published PowerPoint presentations on this topic (see www.L-information.net for examples).  Working directly and close with industry leaders (e.g. Steve Lieber President of HIMSS; Dave Garets ex-Board Director of HIMSS; Sheldon Dorenfest creator of the Dorenfest US hospital industry database, Margaret Shulte of HIMSS educational programs, BaoLuo Li president of CHIMA …) on global and US-market health initiatives.

 

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, Akron, OH (and Amisys Synertech Inc, Rockville MD)...........   January 2006April 2006

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.

§        Text Box: Familiarity with these Amisys Subsystems
A	Customer Service
B	Membership Processing
C	Claims Processing
D	Liability Recovery
E	Authorization / Medical Management
F	Provider
G	Benefits / Pricing Management
H	Billing / Accounts Receivable
I	Finance
J	Batch Processing
K	Correspondence Generator
L	Standard Reports
M	Interfaces
N	Reference & Controls
O	Business Processes
P	Management Processes
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, Boston, MA ..........   October 2005December 2005

Healthcare Functional SME and Strategist

For the Member Portal and Enterprise e-commerce strategy project -

§        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 North Carolina, OMMISS, Raleigh, NC ..........................................................................   April 2005October 2005

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         Text Box: 02 Eligibility, 
03 Recipient, 
04 Healthcheck, 
05 EVS/AVRS, 
06 Provider, 
07 Reference / Medical Policy, 
08 Prior Approval, 
09 Managed Care, 
11 EDI, 
12 Claims Entry, 
13 Claims front-end, 
14 Claims Pricing, 
15 Claims back-end, 
16 POS, 	17 Claims payment, 
18 Financial, 
19 TPL, 
22 Web, 
23 Reporting Repository, 
24 MARS, 
27 Drug Rebate, 
31 OmniTrack, 
32 General Security, 
33 Architecture, 
34 Interfaces, 
35 Conversion, 
36 EDMS


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 Iowa, Medicaid Enterprises, Des Moines, IA ......................................................   December 2004 – March 2005

Contractor & Business Analyst, Core MMIS System Contractor.

 

Assisting the State of Iowa and Noridian (Core MMIS system contractor) to migrate an entire mainframe-based MMIS system (source code, hardware, dataset, processes) from existing vendor ACS/Consultec to a state-operated facility.

§        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.

 

mEHARRY mEDICAL cOLLEGE & cLINICS, Nashville, TN ..................................................   November 2004 – December 2004

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.

 

Minnesota Dept of Human Services (DHS), St. Paul, MN  .............................................   October 2003 – November 2004

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