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HIPAA Senior Strategist

SUMMARY

• 15 Years Healthcare IT experience including: Strategic Planning, Sales, Marketing, Business Process Analysis and Design, Project Management,  Software Development and Implementation.  Worked on HIPAA assessments and implementation projects since 1997.  Currently is a member of several HIPAA regulatory committees. Extensive IT consulting experience with providers, payers, and clearinghouses.  Contributed to some of the major healthcare software vendors' products (including earlier IDX interfaces and EDI modules).  Experience includes both business and technical aspects of all provider clinical operations and all payer operations.

PROFESSIONAL EXPERIENCE

Regulatory Memberships

• Executive Board – HIPAA Compliance and Certification
• Faculty Member – National HIPAA Summit
• Professional DISA
• Chairman, SNIP Code Set Resolution Team
• Member of ASC X12N HIPAA EDI Transaction Subcommittee

J-Anderson, Inc.–Consulting and Software Development company

Feb '03 - Present

Consulting Assignment

• Consulting on a web-based application including design, development, maintenance and support.

Concio–Healthcare Consulting and Software Development Company

Jan '02 - Feb '03

Consulting Assignment

• Responsible for managing budget of $3M, in addition to large staff.  Focused on HIPAA electronic transactions for healthcare. Acted as liaison to business community, as well as trained and mentored software engineers in designing and developing effective HIPAA EDI transaction tools for the healthcare industry.   Managed EDI Solutions operations from concept, design and development to sales and marketing.  Created and delivered business and technical presentations to executives in the business and user community.  Guided and facilitated sales division in strategic targeting, technical training, objection strategies, proposal preparation, and "C" level presentations.

Guided and managed Software engineers in developing HIPAA Tools the following software tools: Compliance Privacy, Security, and TCI Gap Analysis, Transaction Data Mapping Software, and Trading Partner Community Management tools.

Example projects included:

• Developed RFI and RFP for a HIPAA Compliant Billing System with primary focus on Medicaid Billing requirements. Included evaluation of submitting vendors, and development of contingency plans.
   
• Developed winning 1 million dollar proposal for LA Care (a MEDICAID Health Plan) HIPAA Compliance CSC MHC Vendor Assessment. This included scope, statement of work, contingency planning, budget preparation, interview and team selection, project planning, engagement change management, contract negotiation, and "C" level sales presentation.
   
• Project Manager for CommerceDesk Trading Partner enablement implementation for Wellpoint – BCBS GA, Unicare, and Blue Cross California. Project Manager for the EdiFecs CommerceDesk ASP model using SpecBuilder for Payor Specfic Companion Guide. Included validation of HIPAA transactions and front end testing. This model provided a solid testing approach for trading partner implementations. CommerceDesk included transaction testing issue management and resolution tracking. Acted as vendor liaison
   

Millennium Healthcare, Chicago, Illinois

Aug '95 - Jan '02

IDX Approved Consultant and Vendor Liaison

• Responsible for assessing business trends, key customer communications, consulting operations and delivery. Conducted HIPAA EDI implementation readiness assessments and implementation project management. Developed HIPAA consulting tools.  Acted as liaison to users, as well as managed team of 15 consultants, business owners, and technical developers using project budgets from 200,000 to 1 million dollars.

Clients:

Blue Cross, New Jersey
Project Director

• Project Director for EDI X12 HIPAA 835 payment remittance corporate wide implementation. Facilitated team meetings for teams from 5 to 100 staff members. Responsible for software design and development. Developed functional business requirements, technical specifications, operational plans, budgets.  Led six core system implementation teams for corporate wide electronic payment remittance. Project included multiple payer corporations, NASCO, FEP, national accounts, all internal systems, and external vendors. X12N Data mapping for Gentran EDI Gateway.

Blue Cross, Florida 

The Trizetto Group, owner of RIMS, Ericso FACETS, and Internet ePlan
Consulting Team Project Manager

• Consulting Team Project Manager for EDI X12 HIPAA Transactions and Code Sets. Developed transaction set maps for Healthcare 837 claims, and 835 Payment Remittance/Capitation. Facilitated code set cross maps.  Assisted in overall development of executive summary for HIPAA readiness assessment. Facilitated IT/Business meetings - 30 team members.

Blue Cross, Georgia

• Price Waterhouse Coopers, BCBSGA IT Healthcare EDI Legislation Readiness Assessment for HIPAA (Healthcare Information Portability and Accountability Act of 1996) at Blue Cross, Georgia.  Consulting Team Project Manager for HIPAA EDI X12N Transaction set mapping assessment. Developed transaction set maps for Healthcare 837 claims, 278 request for authorization & referral and claim status, 835 remittances, 271 Eligibility, 834 Enrollment, and 835 Capitation. Developed Budget estimates for project savings and cost estimates.  Facilitated, trained and supported technical team of 5 members.

Ameritrade
IT Software Consultant

• Routine program enhancements for internal and external customer reports using automatic email for distribution. Software: Mumps, Cache, Java, SQL, MS Excel.

University of Alabama, Birmingham
IT Developer

• Member of the NEW IDX installation team. Responsible for Mumps design, development, implementation, technical and user training for IDX Healthcare applications BAR, SCHED, MCA, IDXtend. Team Leader for IDX Upgrades. (2000-2001)

HealthAmerica
IT Developer

• Member of the NEW IDX installation team. DBMS Trainer, M Programer using IDX MAPs. Customized IDX Customer Service Module.  IDX Project Lead. Custom report development using Cache Object script (mumps). Routinely created reports sent via email to user departments. Responsible for Cache object mapping, global mapping, Weblink development, and EDI programming for IPO department.

University of Illinois, Internal Medicine Associates, Chicago, IL
Project Manger

• Responsible for Visual Basic design and development for HL7 Claim Interface Development into AS 400 system. Processed data into and out of MS Access / SQL Database using customized Visual Basic Objects.
   

Northwestern Medical Faculty Foundation, Chicago

July '94 - Aug '95

The Largest Out Patient Medical Office in Midwest.
Project Manager

• Provided executive level presentations on System Proposals, Software Products. Supervised five programmers using MS Work Group Network for IDX SCHED, IDX BAR and Dunn and Bradstreet systems. Trained programmers in use of IDX DBMS and database globals. Developed coding standards for MUMPS. Project Manager for 13 teams simultaneously: IDX Upgrade team manager, IDX Managed Care, Customized Chart Management, IDX Patient Registration, IDX Enrollment EDI Interface, IDX Invoice EDI Interfaces, IDX Scheduling Real Time Interfaces, System Security, all Financial Applications and their interfaces (GL, AP, AR, Payroll). Special projects: Patient Arrival/Departures and Patient Marketing Newsletter. Payroll Administrator for WINDOWS NT Dunn & Bradstreet applications. Team member for DEC VAX system performance and tuning team. Assisted and trained VMS systems programmer. MUMPS coding for a variety of projects, as needed. 
   

University of Miami Medical School, Bascom Palmer

Dec '91 - June '94

In Patient & Out Patient Hospital, and Out Patient Clinic
Senior Analyst Software Conversion Team Leader

• Responsible for software conversion from custom Honeywell COBOL to DEC VAX Intersystems MUMPS for NEW IDX installation. Custom Applications converted and integrated with IDX BAR and SCHED were: Surgery Log to track patient, staff, and materials for all surgical cases. Surgery Scheduling used to block OR Rooms for the Faculty Providers. Patient Services systems used to schedules Pre-Admission Services. Acquired an in-depth knowledge of IDX Data Structure, and methods of processing Hospital Invoices and clinical appointments. Designed and developed Real Time Interfaces for IDX Medical Applications to In-house systems for patient registration, admissions (ADT ), invoices (BAR), appointments (SCHED), and personnel.
   

State of Florida, Health and Rehabilitation Services

Jan ' 87 - Dec '91

Out Patient Family Medical Office/In Patient Psychiatric Hospital
Consultant

• Responsible for overall system management, network communications, programming, training, and daily operations for a large clinic. During this period, the data processing department grew from a single on-line terminal to a county wide network of systems. Supervised support 10 staff responsible for data control, user support, and user training. Developed curriculum to train directors, managers, supervisors, and all others staff on the in-house applications and current computer technologies. Managed software development contracts. Implemented use of Optical Mark forms. Developed custom MUMPS reports are required.

EDUCATION

• Six Sigma Black Belt Certification in Progress
• University of Miami, postgraduate studies in Quality Management.
• Metropolitan State College, Denver, Colorado, undergraduate Computer Science Management