Program Manager at Medicaid Services State of Alabama

Developed EDS(W) RFP and was responsible for creation, review, and approval of all PMBOK and Agile artifacts. Conducted MITA strategy review and planning to align Medicaid system initiatives.

Program Manager at Medicaid Services State of Alabama

Developed EDS(W) RFP, created and approved PMBOK and Agile artifacts, and reviewed MITA strategy and planning for Medicaid implementation.

Program Manager - NASCO at Ernst and Young, BCBS Transition Project

Led proprietary system to Facets conversion projects. Monitored projects and project managers ensuring goals are met. Coordinated with stakeholders, monitored KPIs and SLAs.

Program Manager - NASCO at Ernst and Young, BCBS Transition Project

Led proprietary system to Facets conversion including core and additional components. Oversaw project managers and monitored projects to ensure goals and KPIs were met. Managed stakeholder communications and SLA adherence.

Program Manager at Sentara HealthPlan

Responsible for creation, review, and approval of all PMBOK and Agile artifacts. Implemented CredentialStream and Axual which incorporate case review and performance metrics. Oversight of key projects such as QNXT Upgrade, managing member enrollment, claims, provider and benefit plans, utilization management, workflow, and NetworX.

Program Manager at Sentara HealthPlan

Responsible for creation, review and approval of all PMBOK and Agile artifacts. Spearheaded QNXT Upgrade involving core systems like Member Enrollment, Claims, Provider, Benefit Plan, Utilization Management, Workflow, and NetworX. Implemented CredentialStream and Axual systems with built-in case reviews and performance metrics.

Sr. Project Manager (TPA) at Public Consulting Group, Boston, MA

Implemented new MAPD (Medicare Advantage) product and integrated Trizetto QicLink claims platform and portals. Managed project deliverables, supporting hybrid Agile and PMBOK methodologies using Jira and Confluence. Responsible for portfolio management and cloud-based database management.

Sr. Project Manager (TPA) at Public Consulting Group, Boston, MA

Implemented new MAPD product and integrated new Trizetto QicLink claims platform and portals. Managed cloud-based database management and ensured project deliverables and support activities were met.

Project Manager - HITRUST at UHG Vision – March Vision, Los Angeles, CA

Led client through HITRUST remediation process for HITRUST certification. Evaluated findings and assigned remediation work.

Project Manager - HITRUST at UHG Vision – March Vision, Los Angeles, CA

Led HITRUST remediation process and certification assessment. Assigned remediation work to workstreams and managed findings evaluation.

Proxy Product Owner (Claims) / Medicare / Medicaid Program Manager at Advantasure (TPA Services), Richmond, VA

Served as claims advisor and consultant for Medicare Advantage, Medicaid, and Duals claims projects. Contributed to design documents using SDLC and Agile methodologies. Managed Medicare and Medicaid initiatives, integrating acquisitions and portals. Facilitated sprint delivery and backlog management.

Proxy Product Owner (Claims) / Medicare / Medicaid Program Manager at Advantasure(TPA Services), Richmond, VA

Provided claims advisory and consultancy for Medicare Advantage, Medicaid, and Duals projects. Contributed to multiple design documents using SDLC and Agile methodologies and managed sprint delivery with scrum master.

Sr. Program Manager at Anthem Health Plans, Atlanta, GA

Managed Medicare/Medicaid product launches and initiatives including policy and product implementations. Led integration of Employer Group Retiree Medicare Advantage product. Managed PEGA CRM implementation. Responsible for full program budget and portfolio management. Supported telehealth and value-based payment projects. Utilized Tableau for health data analytics and supported PMO process improvements.

Sr. Program Manager at Anthem Health Plans, Atlanta, GA

Managed Medicare and Medicaid product launches including TriZetto Facets implementations. Oversaw integration of Employer Group Retiree Medicare Advantage products and PEGA CRM implementations. Responsible for program budgeting and data analytics.

Sr. Program Manager at Hewlett-Packard, Columbus, OH

Managed Medicaid projects implementing state policy changes including health data analytics and MITA assessments. Led Opioid Crisis IT program and managed CRM interface development and EHR data extracts.

Sr. Program Manager at Hewlett-Packard, Columbus, OH

Managed Medicaid IT projects implementing policy changes for Ohio. Led health data analytics efforts and MITA assessments and managed IT initiatives for the opioid crisis program.

Sr. Project / Program Manager at Harmony Technology Services, Miami, FL

Worked with HHS and ORR contractors to cost and schedule case management and medical procedure tracking systems. Assisted customer with Kronos implementation and integration of cloud-based ESB software with EHR connectors. Supported CMS Merit-Based Incentive Payment System (MIPS) data submissions. Integrated Salesforce CRM and Kronos.

Sr. Project / Program Manager at Harmony Technology Services, Miami, FL

Collaborated with HHS and ORR contractors to cost and schedule case management and medical procedure tracking solutions. Implemented and supported Kronos and cloud-based ESB software with EHR connectors.

Sr. Project Manager at Independent Living Systems, Miami, FL

Managed conversion to Trizetto QNXT claims system including interfaces and extracts. Led new client implementations (WellCare) covering membership, provider networks, authorizations, claims, and financials. Managed staff of 13. Assisted in PMO program development using Agile and PMBOK.

Sr. Project Manager at Independent Living Systems, Miami, FL

Managed the conversion of claims system to Trizetto QNXT and integration of internal and external interfaces. Led new client implementation for WellCare and assisted PMO development.

ICD-10 Sr. Project Manager at Blue Cross Blue Shield of Tennessee, Chattanooga, TN

Supported Bureau of TennCare for ICD-10 program activities, Medicaid and Medicare program communications, and implementation using Trizetto Facets. Contributed to MITA assessments and administered PMO and project management methodologies.

ICD-10 Sr. Project Manager at Blue Cross Blue Shield of Tennessee, Chattanooga, TN

Supported the ICD-10 program including program facilitation, ICD-10 training, status communication, and contributed to MITA assessment input. Managed Medicare program communications.

ICD-10 Program Manager at Univita (Home Health), Miami, FL

Led enterprise ICD-10 project preparation and implementation for CMS mandated conversion. Developed and implemented new standards and processes including training and new data models. Communicated status and risks to senior management using Agile Scrum methodology.

ICD-10 Program Manager at Univita (Home Health) Miami, FL

Directed enterprise ICD-10 preparation and implementation including training plans and process changes impacted by ICD-10. Utilized Agile Scrum methodology for project management.

ICD-10 Sr. Project Manager at PHP, Lansing, MI

Led enterprise ICD-10 project preparation and implementation, overseeing capital and operating budgets, payer readiness, work plan development, issue and risk management, financial tracking and reporting—all using SDLC and Agile Scrum with tools like VersionOne and Trizetto Facets.

ICD-10 Sr. Project Manager at PHP, Lansing, MI

Managed ICD-10 preparation and implementation across multiple functional areas, including budgeting, compliance, resource and risk management. Utilized SDLC and Agile Scrum methodologies.

Facets Sr. Project Manager at KEBB Consulting (GEHA, CareMore), Melbourne, FL

Managed Facets 4.8 installation tracks including custom development, interfaces, extracts, conversions, EDI, and go-live plan using SDLC and PMBOK methodologies. Managed vendors and integrated efforts for system and integration testing. Reported status to clients.

Facets Sr. Project Manager at KEBB Consulting (GEHA, CareMore), Melbourne, FL

Managed Facets 4.8 installation tracks including custom development, interfaces, extracts, conversions, and EDI. Led vendor coordination and consolidated integrated program project plans.

Facets Project Manager at United Healthcare, Hartford, CN

Managed Facets 4.71 installation for new product expansion on NC River Valley platform. Oversaw all project aspects and plans management up to installation using SDLC/PMBOK methodologies.

Facets Project Manager at United Healthcare, Hartford, CN

Managed Facets 4.71 installation for new product expansion; responsible for all project planning and execution phases.

Facets Sr. Project Manager at CareMore Health Plan, Los Angeles, CA

Analyzed requirements and directed implementation of Trizetto Facets 4.71 including data conversion, interfaces (membership, billing, Salesforce, trading partner), 5010 standards, and ICD-10 assessment. Utilized SDLC/PMBOK methodologies.

Facets Sr. Project Manager at CareMore Health Plan, Los Angeles, CA

Led implementation of Trizetto Facets 4.71 and related data conversion, interface development, 5010 compliance and ICD-10 assessment using SDLC and PMBOK.

Program Manager at No World Borders, Newport Beach, CA

Reviewed HIPAA migration plans for compliance, risk mitigation and deadlines. Evaluated requirements and developed mitigation plans for third-party software impacts. Reviewed business process models and HIPAA transaction changes to support HIPAA 5010 and ICD-10 implementations.

Program Manager at No World Borders, Newport Beach, CA

Reviewed HIPAA migration plans, developed mitigation strategies, evaluated data integration and configuration for HIPAA 5010 and ICD-10 implementation for multiple BCBS clients.

Trizetto Facets Implementations and EDI Gateway at KEBB Consulting, Raleigh NC

Analyzed user and business requirements for implementation of Trizetto Facets and EDI Gateway. Supported design and development of business unit solutions using SDLC methodologies. Worked closely with application architects and technical leads.

Trizetto Facets Implementations and EDI Gateway Consultant at KEBB Consulting, Raleigh NC

Analyzed user and business requirements for implementation and development support in Facets systems. Worked with architects and technical leads to meet business objectives using SDLC.

Program Manager at Blue Cross & Blue Shield of Rhode Island, Providence, Rhode Island

Led planning, design, and implementation of ITS Association-related products for BCBS/RI. Directed major releases and supporting applications, managed maintenance and integration strategy. Contributed subject matter expertise and oversight of project artifacts using SDLC.

Program Manager at Blue Cross & Blue Shield of Rhode Island, Providence, RI

Led planning, design, and implementation of BCBS/RI ITS products. Managed BCBS Association releases and interface strategy. Maintained project management artifacts and supported system integration.

Sr. Project Manager at HMSA Blue Cross and Blue Shield of Hawaii, Honolulu, Hawaii

Managed QNXT projects, evaluating and re-engineering internal control processes. Managed budget of $3.5 million and a 40-person staff. Facilitated infrastructure support for EDI transactions and HIPAA-compliant migration.

Sr. Project Manager at HMSA Blue Cross and Blue Shield of Hawaii, Honolulu, HI

Managed QNXT projects, improved internal controls, led migration to HIPAA-compliant formats, and managed a $3.5 million budget with a 40-person team.

Medicare Program Manager at WellCare Health Plans, Tampa, Florida

Provided executive leadership for Medicare HMO program, leading strategic IT analysis and implementations. Managed $2.5 million budget and 60-person staff, transforming IT into a strategic business unit. Oversaw technology budgeting, design, and compliance including HIPAA. Improved help desk responsiveness and implemented internet and extranet technologies.

Medicare Program Manager at WellCare Health Plans, Tampa, Florida

Directed strategic IT planning for Medicare HMO program, managed $2.5 million budget, 60-person staff, and drove HIPAA compliance and SOX audit processes.

Sr. Project Consultant at Blue Cross & Blue Shield of North Carolina, Durham, N.C.

Managed HIPAA and NPI project deliveries to ensure compliance with mandates impacting legacy systems using SDLC methodologies. Oversaw a $2 million budget and a 20-person team. Designed and implemented new IT services and knowledge management functions.

Sr. Project Consultant at Blue Cross & Blue Shield of North Carolina, Durham, NC

Managed HIPAA and NPI projects, designed knowledge management functions, established technology standards, and oversaw a $2 million budget.

Solutions Design Consultant at Kaiser Permanente, Dallas, Texas

Directed prioritization and delivery of automated enrollment and group bill reconciliation projects. Managed $4 million budget and 10-person staff. Oversaw EDI project components and facilitated delivery of process improvements.

Solutions Design Consultant at Kaiser Permanente, Dallas, Texas

Directed deliverable prioritization for customer solutions and managed EDI and enrollment process improvements with a $4 million budget and 10-person team.

Director of Business System Development-Consulting at SeeBeyond, Redwood Shores, California

Coordinated multi-disciplinary technical teams to deliver successful on-time applications. Managed a 20-person staff and $4 million budget. Assisted clients including AT&T, IBM, and Oracle with EDI, software contract negotiations, and regulatory compliance (HIPAA). Facilitated project meetings and integration efforts.

Director of Business System Development-Consulting at SeeBeyond, Redwood Shores, California

Led multi-disciplinary technical teams for application implementation, assisted clients with EDI and HIPAA compliance, training, and managed a 20-person staff with a $4 million budget.

Director of Applied Technologies at Blue Cross Blue Shield Association, Chicago, Illinois

Oversaw delivery of BlueExchange and BCBSA billing system migration. Managed an $10 million budget and 80-person staff. Implemented project management controls and quality standards for HIPAA projects. Negotiated contracts with major partners and recruited technical staff.

Director of Applied Technologies at Blue Cross Blue Shield Association, Chicago, Illinois

Managed BlueExchange and mainframe migration projects with $10 million budget and 80-person staff. Implemented PM processes and negotiated contracts with major partners.

Senior Systems Management Consultant at Blue Cross & Blue Shield of Florida/Georgia/Nebraska

Directed senior and mid-level staff in healthcare business systems development and implementation. Managed multiple large project budgets and performed cost benefit analyses. Facilitated status meetings and conducted staff performance reviews.