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Work Background
ProCom Consulting, Inc.Solution Architect
Sep. 2021United States
DCSConsultant - Data Architect, Business Analyst
Oct. 2019 - Sep. 2021Salt Lake City, UT, United StatesData Architecture and Business SME for Healthcare Claims - Medicaid Data Warehouse
DCSBusiness Analyst
Sep. 2019 - Oct. 2019RemoteBusiness Analysts on data warehouse for New Mexico MMIS
CNSISr Business Analyst
Apr. 2016 - Sep. 2019Salt Lake City, UtahSenior Business Analyst Claims for MMIS project
Valence HealthEDI Analyst
Jun. 2015 - Apr. 2016ChicagoResponsible for directly supporting the EDI needs of Third Party Administrator (TPA) accounts. Leverage EDI knowledge in claims, enrollment, eligibility, and financial systems in day-to-day operations. Coordinate trading partner implementations. Gather business requirements, perform analyses, and present findings. Act as a business liaison to the IT Department EDI technical team.
∙Leverage EDI knowledge in claims, enrollment, eligibility, and financial systems in day-to-day operations
∙Coordinate trading partner implementations
∙Gather business requirements, perform analyses, and present findings
∙Act as a business liaison to the IT Department EDI technical team
∙HIPAA/EDI X12 v5010 healthcare-related file formats including 820, 834, 835, 837, 270, 271, 276, 277, 278, 999, TA1 and 824
∙Regulatory requirements associated with HIPAA, CAQH CORE, ICD-10, and the Affordable Care Act
∙EDI translation software
∙Industry standard health data code sets such as ICD-9/ICD-10, CPT/HCPCS, and Revenue Codes
∙Test plan development
CGISenior Consultant
Aug. 2011 - Jun. 2015Based in Tampa, Florida.Consulting and BPO services for CGI clients. Assignments in Healthcare Insurance domain, including Medicaid, Health Insurance Exchanges and Member Services Operations. 10/2013-06/2015 - Healthcare Claims/EDI SME
SME for initial setup and implementation of medical claims processing for BPO office for healthcare insurance accounts. EDI (837, 835, 834, 820, 278, 270/271, 276/277) configuration, balancing and trading partner setup
Claims processing analysis, remediation
Accumulator data (encounters, deductibles, MOOP) with carve-out vendors
Repricing vendors 12/2012 - 10/2013 - Service Delivery Manager for BPO account
Supervision and operations of 20 person office providing BPO services to Medicare Part D insurance plan. Enrollment, premium billing and accounting, and customer service/call center. 09/2012-12/2012: Engagement Manager, Blue Cross and Blue Shield of Alabama, CGI.
Team to assist client in preparation for participation as issuer in Health Insurance Exchange. Survey and analyze current state, identify desired future state and risks through consultation with internal CGI specialized expertise, form recommendations to mitigate risks and prepare for optimum participation. 03/2012 – 09/2012: Technical Architect, Virginia Department of Medical Assistance Services, CGI. Develop recommendations for processes to support current systems as well as gap analysis and implementing the Patient Protection and Affordable Care Act (ACA). 08/2011 – 03/2012: Senior Consultant, CGI. Serves as a senior consultant for CGI in an effort to procure Medicaid Management Information System (MMIS), Health Insurance Exchange (HIX) and other related contracts throughout the United States; assists in the writing and development of proposals; proposed system architecture and design; provides healthcare IT knowledge, expertise, and healthcare systems solutions for CGI's healthcare line of business as a whole; serves as a health care systems consultant on assigned projects.
Infowave SystemsBusiness Analyst/Data Analyst/SME
Sep. 2010 - Sep. 2011Data analyst contractor working on a data warehouse project for WellCare in Tampa Florida.
ACS, a Xerox CompanyImplementation Architect
Jan. 2001 - Sep. 2010Engaged as a senior integration and infrastructure architect on multiple Medicaid Management Information System (MMIS) implementation projects including Mississippi
ACS: Affiliated Computer ServicesIT Architect
Jan. 1992 - Sep. 2010Multiple responsibilities growing during tenure. Intitally an application analyst/coder for Medicaid Management Information Systems. During tenure responsibilities and skills expanded to network installation, configuration and management; voice installation, configuration and management; office infrastructure support; application design, testing and implementation on mainframe and across multi-platform n-tier configurations, including porting of applications from pure mainframe environment to client/server and n-tier configurations; infrastructure and application architecture support and design for n-tier z/OS-CICS-Windows-Unix implementation of Medicaid Managment Information Systems for multiple state government contracts.
ACSIT Architect
Jan. 1992 - Sep. 2010Application, infrastructure and implementation architecture for Medicaid Management Information Systems (MMIS).
ACS Healthcare SolutionsInfrastructure Architect
Jan. 1992 - Sep. 2010Infrastructure architecture (hardware, software configuraton, licensing, security, communications, environments) for Medicaid Management Information Systems (MMIS).
ConsultecConsultant
Jan. 1992 - Dec. 1996Business analysis, design, coding, testing, implementation of mainframe based medical claims processing for Medicaid Management Information Systems for state governments.
Northstar GuaranteeSystems Analyst
May. 1991 - Jul. 1992Designed and implemented data processing and desktop user hardware and software for startup organization including workstations, networking, interfaces to outside mainframe service, phone system, and data marts. Specification, bidding and vendor selection and management for all desktop and server hardware and software. Configuration, process design and operations for in house server and network. Design, coding, testing and implementation of server based data marts for financial analysis retrieving data from VSAM, IMS and DB2 data sources on outside service mainframe.
Higher Education Assistance FoundationSystems Analyst
Aug. 1988 - Apr. 1991Application design, coding, testing and implementation for federal student loan guarantor.
Farm Credit ServicesSr Application Development Support Analyst
Oct. 1984 - Aug. 1988Internal consultant to application development group at regional commercial banking organization utilizing multi-platform IBM mainframe DOS-VS, MVS; IBM System 36; and DEC VAX systems.
Combined Companies IncData Processing Manager
Jan. 1982 - Oct. 1984Complete responsibility for operation of direct mail advertising computer service bureau, including hiring, supervision, budgeting, systems programming, lead application programming, vendor and customer relations, equipment installation and configuration, site redesign and reconfiguration
Combined Companies, Inc.Programmer Analyst/Computer Operator
Dec. 1980 - Jan. 1982General design and programming for operation of direct mail advertising computer service bureau. Included application programming for customer orders, inventory, internal accounting (GL/AP/AR/FA), job scheduling and tracking, and system programming for DOS, DOS/VSE, VM/370, VM/SP, OS/VS1 on IBM 360/370/4341 mainframes and ISIS on Data General Nova mini. Responsibilities included being available as backup mainframe and minicomputer operator.
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