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Work Background
Molina HealthcareProduct Owner - Digital Channels Manager
Sep. 2016Long BeachProduct Owner - Digital Channel
Providing professional program & product management (PO) for Molina OMNI Web Channel and healthcare Membership and Providers portals. Product Owner, liaison and governance between IT and business Web Portals. - 18 states, 4 million + members (Medicaid, Medicare, & Market Place), and 1 million medical providers. Highlights: Providing professional consultative leadership and product management for a multi-year Provider Portal migration and integration engagement to the Availity multi-payer portal. Ownership and SME support for Architectural design, UX/UI, enterprise scope, and roadmap for new implementation of real-time and batch EDI x.12 834, 270/271, 276/277, 278, 275 and 835 along with Web portal functions for Claims management, member Eligibility and Benefits, Remittance, Prior Authorization, and Appeals/Grievances.
• Identifies areas of risk, and risk mitigation strategies, and calculated earned value and report recommendations to executive stakeholders. • Made recommendations for cost savings and mitigate non- compliance risks as business SME for web portals; developed enhancements of UX (user experience) to mitigate high call volumes for the Call Center, business, federal/state regulatory solutions. Lines of business (LOB) includes multi-state (14) Medicare, Medicaid and Marketplace product portfolio. Creation/maintaining/enhancing Molina business processes; regulatory Federal, State compliance for channel products; project portfolios, and status reporting to sponsors/stakeholders. Determining earned value and ROI calculations, budgets – creation & management; portfolio prioritization and roadmap strategies with timelines, contract compliance and delivery strategies.
Health NetSenior Project Manager
Apr. 2014 - Jun. 2016Woodland Hills, CaliforniaManaged portfolio and delivery of Enterprise-wide solutions. $7+ million budget with multiple projects, phases, and work streams. Healthcare Payer lines of business (LOBs): HMO, POS, Indemnity, Medicare, and Medicaid. Highlight: Delivered Enterprise-wide application - Tracking, management and reporting Out of Pocket & Deductibles (OOP/Deductible Accumulators) for multiple work streams including membership (10 million members), and 2000 providers. Managed: Stakeholders, vendors, project technical teams – 12 persons leads/100 persons extended teams: Managed full life cycle: Initiation, planning, budget and financial reporting, PEGA DCO, Elaboration/Design, Build, SIT, UAT testing and implementation. PM methodologies: Waterfall & Agile. Technical: New application (Healthcare IT) built on PEGA 7 BPM development/server platform. Includes Data migration, Business rules extraction, and integration to internal & external systems via multiple methods including: SOA architecture; software & middleware enhancements; and configuration changes. Integrated with Legacy applications and data: CLAIMS including Auto Adjudication; Data Warehouse, Call Center, Appeals & Grievances, EHR, Member and Provider portals, EDI (270/271, 834), Reporting, and external Vendor/PPG via inbound & outbound data feeds. Delivered configurable business rule-based application (PEGA 7). Member Letter. Application processes, tracks and sends notifications to members (10 million) and medical providers (1000’s) via mail and web portal on business rules engine. Integrated with enterprise application: Accumulator Engine, Claims, Eligibility (membership), provider repositories, and enterprise mailing and printing system.
L.A. Boose Consulting, IncSr. Project Manager/Solution Consultant
Apr. 2013 - Feb. 2014Greater Los Angeles AreaConsulting services to the following clients:
- LA CARE Los Angeles CA: Healthcare Payor – Medicare/Medicaid, HBEX
Performed as Project Director – Work with Project Managers for multiple wok streams in developing requirements, RFPs and vendor selection for Health Benefits Exchange (HBEX) systems and interfaces. Wellspring – Client: Schindler Technology, Integration Consultant – Integrated Schindler SaaS Human Resource application with external clients web portals - LIMITED BRANDS (VICTORIA SECRET), EXPRESS SCRIPTS (PBM). via Single Sign On (SSO)- IDP Initiated design.
Kaiser Permanente ITLead Solution Design Consultant & PM
Mar. 2012 - Jul. 2013Pasadena,CALead Solution Architect/Consultant for Kaiser's National Cost Estimation (NCE) program by the CLAIMS division. Scope was development of new Online based costing service for Kaiser patient/member community. Activities included backend solutions for Claims, Benefits and Eligibility data feeds and interfaces (EDI x.12, SFTP, Flat files, SOA); front-end solutions for multiple user channels (FSSO, WSSO); and application data solutions for SaaS architecture (SOA, web services). Assisted business in data analysis/extraction for claims, benefits and eligibility, health plans, services, and provider fees.
EHRiX (Parent of Hi-Tech MD)Managing Director & Chief Technology Officer – CTO
Jun. 2010 - Jun. 2012Garden Grove, California• Created Business plan, partners, cases, scope, resource plans, road map, schedule, strategies, tactics, for commercial software company startup. Flagship product , EHRIX, a federally certified Electronic Health Record (EHR) SaaS based.
• Highlight: Saved company $3 mill in development costs, delivered DHS certified product in eight (8) months! • Principal Architect/solution designer
• Developed/Managed Off/On Shore teams: Software - Off shore (Chennai, India); infrastructure, HIE Integration Managed development of:
o Electronic Health Record (EHR) application and Practice Management Modules; Interface/integration using XML, HL7 2.5.1, TCP Socket to blood and diagnostic laboratories, clinics and hospital partners; and integrations to Health Information Exchange (HIE). o Designed Built-in Charge Capture technology as part of Clinical/Application flow and billing, o ePrescription integrated SaaS solution via Single-Sign-On (SSO), SAML 2;
o 3rd party billing interface built for major billing applications (Meditech, McKesson) (x.12, EDI, HL7) ;
o Clearinghouse integration, SOA web services for all integration gateways;
AccentureTechnology Consultant
Jan. 2007 - Feb. 2008Prescription Solutions (PBM Div. of United Health Group) Irvine,CA• Analysis and designed created for high volume data application. Workflow based with ETL and integration designs for AS400 IBM server platform.
• Performed gap assessment for Claims, completed analysis and design CLAIMS financial reconciliation and Prescription Drug Event PDE process enhancement projects, simultaneously, saving $80K in additional expenses.
Environment: Architecture: IBM iSeries (AS400), DB2, Data Marts, Microsoft SQL server 2007, RxClaim, and OS400. Tools included WorkQuery, iSeries Navigator, and Visio 2007.
AccentureTechnology Manager & Global Project Manager
Oct. 2006 - Feb. 2009El Segundo, CaManager - Technology Consulting
Provided specialized ecommerce, emerging technologies, and custom applications consultation for Fortune 100 clients:
Clients:
Prescription Solutions *(PBM Div. of United HealthCare Group) Irvine, Ca
Technical Solution Lead • Highlight: Developed solutions for high volume Claims data application. • Performed gap assessment for Claims reconciliations for Finance dept. Designed CLAIMS financial reconciliation application and Prescription Drug Event PDE process enhancements. Reduce error rate 90% from $85mil. WellPoint Woodland Hills, CA
IT Project Manager
• Managed four team leads for nine (9)portal full-lifecycle releases. Accenture (Internal Enterprise-wide project)
GLOBAL PROJECT MANAGER (PMO) / Architect
• Highlight: Dual roles as Global PM and Software Architect. Designed, built, and implemented global initiative for "Software Asset Management" enterprise solution for Accenture. System managed software licenses for over 230k employees. Global PM of program teams in thirteen (13) countries and 20+ regions. Total team size - 20 direct reports & over 500 team members.
• Development cost savings of over $2 mil (USD)! Walt Disney Company * / Walt Disney Parks & Resorts (WDPRO) Project Manager, Advanced Projects Group
Developed 1st of kind architecture - SOW for web 2.0 web sites, online game Toy Story Mania, and online interactive architecture for new Disneyland and Disney World attraction. • Highlight: Successfully managed plans & designs for conversion of online game to Toy Story Mania Amusement park attraction including designs of interface module for server-based game components.
AccentureDisney - Technology Manager (Consultant)
Oct. 2006 - Apr. 2007Walt Disney Parks and Recreation - WDPRO (Glendale, CA)Developed 1st of kind architecture - SOW for web 2.0 web sites, online game Toy Story Mania, and online interactive architecture for new Disneyland and Disney World attraction. • Highlight: Successfully managed plans & designs for conversion of online game to Toy Story Mania Amusement park attraction including designs of interface module for server-based game components.
Axium EntertainmentConsultant
Sep. 2005 - Jun. 2006Greater Los Angeles AreaDeveloper for Commercial software for Entertainment Industry, Accounting. Movie Production Accounting software development. OOP, 3-tier development in FoxPro, Citrix, Microsoft OS based platform.
ADP - Tax and Financial ServicesSenior Project Manager
Dec. 2003 - Jun. 2005San Dimas, CaliforniaSenior Project Manager
• Reported to Chief Security Officer (CSO). Managed projects in data and web security and infrastructure projects. • Managed cross-functional teams of over 100 employees.
• Won corporate acclaim for design standards for “Tumbleweed - Secure Email and File Transport” infrastructure application. Standards adopted by corporate as enterprise-wide standards for Fortune 500 company. • Authored/managed development of: Web security standards, Business Continuity, Data Security, and infrastructure development. Managed change control, releases and updates to Remedy.
• Highlight: Designed Disaster Recovery backup system reduced risk of $1.5M in daily fines.
• Developed “Threat Management Console”, web-based application for corporate enterprise operations group.
MatrixCities TechnologiesPresident/Founder
Apr. 1997 - Jul. 2003Encino, CAExecutive for technology consulting services firm with offices:Los Angeles, Detroit, & Rabat, Morocco. Clients included - Government:
• City Of Detroit, Michigan
• Detroit Public School District
• City of San Diego, CA
• City of Encinitas, CA
• City of Warren, Michigan
• City of Inglewood, CA.
• Country of Morocco
• County of Los Angeles, CA
• World Bank (United Nations) Private Industry:
• 3-Day Blinds
• Aerospace Corporation
• AMLI –Realty Division
• Daimler-Chrysler • CitiBank
• Computer Sciences Corp (CSC)
• Corporate Apartments
• Dawg Pound Productions
• Energy Interests, Inc.
• Grosvenor International
• Hughes Corporation
• Insignia – Honolulu
• Insignia/ESG Intl.
• Kmart Corporate
• Management Systems, Inc. (MSI)
• Metro-Goldwyn-Mayer
• Oakwood Corporate Apartments
• Pioneer Technologies
• Precision Optical Engineering
• Quality Trading
• R&B Properties
• Seattle Public School District
• Sumarai Oil Refinery
• Sun Valley Health Services
• Trust Company of the West (TCW)
• Twentieth Century Fox Studios
• WhirlPool Corporate
• San Fernando Valley Auto Dealerships
Trust Company of the WestSenior Consultant
Feb. 1995 - Apr. 1997Greater Los Angeles AreaIndependent Technology Consultant for Small caps, emerging markets, Mid Cap, and mortgage backed securities groups. Solution provider, technical architect and software developer. Created "Secured Portfolio" tracking application, re-designed, rebuilt "TAZ", a mortgage backed security application that managed and tracked over $20 Billion in securities, developed leading-edge data feeds and processing modules for external pricing sources and enterprise applications.
Kinder MorganSenior Technology Consultant
Dec. 1994 - Jun. 1995Developed application and technology solutions for Oil and gas pipelines company.
Coldwell Banker Real EstateTechnology Consultant
Feb. 1991 - Dec. 1994Mission Viejo, CA*Highlight* - Designed and implemented commercial grade network based tool, "SCOUT" Used to manage the enterprise WAN/LAN.
-Network Data Communication Expert
-WAN/LAN Engineer (Novell)
-SNA Network Engineer (IBM)
-Infrastructure Engineer
-Software Development Integrator
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