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HIPAA Program Manager

SUMMARY

• Over 18 years of Healthcare Industry experience. Project Lead and Head of research in 25+ consulting engagements.  Associated with HIPPA & Health Care Regulations since 1997.  Conducted HIPAA Assessment & Gap Analysis on: Transaction Standards (ANSI X12N version 40.10), Standard Code Sets (ICD, CPT, HCPCS, CDT & NDC), Unique Health Identifiers (in-progress-legislations),  Security (PKI, authentication, and non-repudiation) , and Privacy (Patient Centrality, Protected Health Information at Data Element Level, Designated Record Sets and De-identification).  Detailed Knowledge for Business Process ReEngineering & Data Modeling of the following workflows: Eligibility (X12 270/271) & Enrollment (X12 834), Authorization (X12 278), Claims & Encounters (X12 837), Status Inquiry & Response (X12 276/277), and Remittance (X12 835).

PROFESSIONAL EXPERIENCE

GlobalCare Inc., Atlanta, Ga.

Jan 2001 - Current

HIPAA Officer

• Heads up a HIPAA team for this Claims Outsourcing Organization which processes claims for TPA's and Health Plans.
  
  Currently proceeding with remediation after successful HIPAA gap analysis. Project is in testing currently for eligibility, authorization, and claims transaction code sets. In addition to HIPAA Compliance, business benefits were:  Automated and Standardized processes for faster submissions and quicker payment, Reduced Claim Denials & Front Office Cost Reduction, Improved Coding Efficiencies & automated EOB posting.

C-Bridge Consulting, San Francisco, CA

Jun 1999 - Dec 2001

Managing Director, Health Care & Insurance Practice

• Subject Matter Consultant and Practice Leader providing strategic and technical integration services to the healthcare industry on: HIPAA Education and Awareness, Assessment Methodology and Remediation Gap Analysis, Clinical Trials Process Flow, EHealth & Electronic Medical Records.  For a major payer organization, completed a HIPAA assessment and compliance gap analysis for their eligibility, enrollment, and claims authorization processes. Provided a comprehensive report and remediation plan to close gaps with a service based architecture and a program office to systematically monitor remediation, testing, and compliance certification. Identified in detail the content and format gaps, systems affected, and impact on data structures with a detailed cost benefit analysis. 

Barclays Global Investors, San Francisco, CA

Jul 1997 - Jun 1999

Principal, Americas Finance & Administration

• Directly managed 30 employees and a $5.8 million operating budget and a $28 million capital budget. Led the IS organization to support the Finance and HR organization in the Americas with 100 end-users. Was brought on board to stabilize the IS team and implement Oracle Financials and Oracle HR globally in conjunction with KPMG. Key responsibility for security, risk management planning and disaster recovery.  

 

Digital Equipment Corporation, New York, Boston, Tokyo, and Singapore

Feb 1986 - Jun 1997

• Eleven (11) Year tenure with Digital in a wide range of business functions including overseas executive, Sales, Consulting Operations, Strategic Planning, and Product Management.

Digital Equipment Corporation, New York, Boston, Tokyo, and Singapore

Feb 1986 - Jun 1997

Managing Director, Asia Pacific, Singapore (Nov 1992 - Jun 1997)
HealthCare & Service Industry Outsourcing

• Oversaw 11 countries with over 300 employees billing over $80 million in professional fees from outsourcing, systems integration, and strategic services supporting multi -vendor sites running health care, insurance, and telecommunication applications on IBM, DEC, and HP. Increased overall service levels by 70%, while reducing unit costs by 23 %. For the Malaysian Health Department, orchestrated the development and implementation of category management, efficient replenishment, and computer-assisted ordering programs.

Integration Services Director (Feb 1986 - Nov 1992)
New York Region

• Various positions including account support manager, program manager, and consultant to healthcare and insurance industries in New York and New Jersey. Accounts managed include Prudential, Cancer Treatment Centers, and Schering Plough.

American Cyanamid Company (Lederle Labs)

Apr 1984 - Feb 1986

Director, IS International Planning & Administration

• Responsible for the planning, administration, and supervision of the International Division of this major pharmaceutical company for a $24 million system development budget. Supervised planning analysts and financial administrative staff responsible for IS charge out budgets.

Schering-Plough Corporation

May 1978 - Apr 1984

Manager, Clinical Trials and Laboratory Automation

• Managed a clinical trials administrative group consisting of clinicians, administrators, RN's, and librarians to provide administrative support to Phase II trials for a number of respiratory products under various stages of regulatory submission.

EDUCATION

• Cambridge Executive Institute on MIT Campus, Cambridge, MA.
• Strategic Systems and Change Management
• IBM Executive Institute, Rochester, MN.
• MidRange Systems Planning
• MBA: Rutgers Graduate School of Business, Newark, NJ
• BSME: University of Kerala, India