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Work Background
Los Angeles Network for Enhanced Services (LANES)Technical Program Lead
Jun. 2023Los Angeles Metropolitan Area- Client onboarding implementations of health information exchange (HIE) services
- Assist in process improvement and technical client relations for partners like LA Care and Health Net
- Project management in product development, enhancements, new features
IEHPSpecial Programs Manager III
Jan. 2022 - Jan. 2023Rancho Cucamonga, California, United States- Under the Quality Department, projects involving HEDIS quality measures and strategic goals and programs in this area of the organization became a primary focus to help drive up performance measures and create a better member experience for health outcomes
- Plan and execute projects, process improvements, requirements gathering, multi-department support and team lead for projects
- Produce policies or train on project management methodologies for the Quality department
IEHPProject Manager III
Jan. 2019 - Jan. 2022Rancho Cucamonga, CA- 2nd phase of implementing our core benefit administration / claims payment / CRM system for increased stability, resolution of issues left over from the implementation program, and product / enhancement releases
- Resolution of identified overpayment issues and processes in the financial and claims space for correction in Provider overpayments and policy implementation
Work and process flow projects for creating standard work or ability to track productivity
- Improvements in the use of Workfront (project management software) for the PMO developing department wide standards for project and program management and quality for templates, project artifacts, and the use of A3 problem solving to drive to a better work flow
- Clinical or business projects involving the increase of COVID-19 vaccination rates of Medicaid members San Bernardino and Riverside Counties in California
- Voice biometrics implementation for Members / Customer Service Center
Implementation of strategy planning management software (ClearPoint Strategy)
- Project management support for software upgrade for medical management software MHK (aka, MedHOK)
IEHPProject Manager II
Jan. 2015 - Jan. 2019Rancho Cucamonga, CA- In May 2014, I was assigned as primary business PM of the “Core System Replacement Program” to replace the primary member data / provider data / benefit administration / claims payment system from Diamond 725 and Oracle CRM with Health Solutions Plus (HSP). Involved in the planning an execution of all 3 phases of the program from vendor selection (May 2014 - June 2015), implementation prep (June 2015 - Aug 2015), and implementation involving 17 projects (Sept 2015 - June 2018). I was assigned 9 of 17 projects and was a SME at the program level.
- Within the program, I was primarily responsible for PM duties related to business configuration design and build. This involved benefit plans, claims adjudication rules, code exception transforms, contract and fee schedule config, mappings, client-specific transform code scripts for business rules, completion of data conversion, capitation, payment packages, system enhancements, and membership setup.
- Other duties included development of program level reports, training of project team in project management software and practices (SharePoint, Workfront, and methodologies), development of process flows and other project artifacts in support of the program, and vendor management between consultants and software vendors.
- In March 2015 I obtained my Project Management Professional (PMP) certification
IEHPProject Manager I
Jan. 2013 - Jan. 2015Rancho Cucamonga, CA- New hospital / contract implementation and configuration for Loma Linda Children’s Hospital
- ICD-10 code implementation for claims payment software configuration, downloading and pre of code sets, training, and Provider office coding accuracy with new coding formats and processes
- Facilitated the development and management of the largest Request For Proposal (RFP) that IEHP had done to date starting in May 2014 to select a winning bidder keeping to public company and IEHP rules for the transparent bidding process for a claims payment application
- Medical and pharmacy claims recovery vendor implementation
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