I am assisting Morning Day Café with customer service, food preparation, and social media/marketing.

Liberty Help on the Fly - Local office, customer and tech support.I handle some web development, SEO, and Asymmetric Social Media Engagement (ASME - it's like ACME, but a lot better) for my wife's business. My clients are not necessarily local to where we're located here in Liberty, Missouri - and of course I'm (airmobile).

I helped my friend Chris convert his website into the new WordPress Era.https://www.russiarevealed.info/realakula51-aka-rob-mcneece-akula_51-russiarevealed-meetthestaff/

• Assisted CCHCS with assessing their current TMHP encounter submission and remediation infrastructure and business processes.• Analyzed existing processes and recommended implementation of Data Exchange Repository.• Assisted CCHCS staff with creation of DXR database using my well-tested database design in MS SQL Server.• Using Altova MapForce, helped create inbound 837 maps to load data to the DXR database for analysis.

Assisted Cognosante with the CMS 1095A Error Resolution process.

Assisting Cognosante with the CMS 1095A Error Resolution process.

ANSI X12 EDI and applications within Healthcare (HIPAA/HITECH/WEDI/SNIP/4010/5010/ETC)

Assisted SES with product management and strategies for HIX/HBX EDI Operations.

Managed a team of EDI Operations subject matter experts and analysts; implemented into production three SES software products for HIX/HBX EDI Operations.Assisted the Maryland Health Benefits Exchange (MHBE) and Optum/QSSI Team with management of their existing enrollment transaction transmission, reconciliation and error remediation systems and processes during the run-out of the decommissioned Plan Year 2014 HIX. Assisted the Optum/QSSI Team and Sec'y FitzGerald's "I-Team" with… Show more Managed a team of EDI Operations subject matter experts and analysts; implemented into production three SES software products for HIX/HBX EDI Operations.Assisted the Maryland Health Benefits Exchange (MHBE) and Optum/QSSI Team with management of their existing enrollment transaction transmission, reconciliation and error remediation systems and processes during the run-out of the decommissioned Plan Year 2014 HIX. Assisted the Optum/QSSI Team and Sec'y FitzGerald's "I-Team" with defining requirements and implementing solutions *yesterday* for data integrity, daily operations, and consumer case escalation while the old HIX was decommissioned.Implemented the SES Daily Operations EDI Repository (DOER) for the MHBE so that they can analyze and report on all QHP transactions sent and received by the Exchange, whether they were successfully received and processed by the carriers or not. Implemented a contingency web-based data input solution (CEEM, an SES/Coteva product) to replace significant parts of the HIX system developed by the previous contractor. This solution allowed systemic processing of life event and normal enrollment transactions within the QHP universe throughout the remainder of Plan Year 2014. Show less

I try to stay out of the way of a very talented EDI department at this rapidly growing Medicaid/Medicare Advantage payor in amazing South Florida.We are expanding or have expanded our DXR to include 834, 835, 837 (three flavors), 997/999, 277CA, and 820s. In conjunction with our QNXT host and TZG MDe encounter management solution, we continue to intake and report on healthcare claims and encounters for our members in Florida.Still watching EC Map and EC Gateway perform magic on… Show more I try to stay out of the way of a very talented EDI department at this rapidly growing Medicaid/Medicare Advantage payor in amazing South Florida.We are expanding or have expanded our DXR to include 834, 835, 837 (three flavors), 997/999, 277CA, and 820s. In conjunction with our QNXT host and TZG MDe encounter management solution, we continue to intake and report on healthcare claims and encounters for our members in Florida.Still watching EC Map and EC Gateway perform magic on a daily basis. Grateful to continue to play a part in that success story. Show less

• Served as architect for the Simply Healthcare Plans (SHP) Risk Adjustment Processing System (RAPS) solution. As a start-up Medicare Advantage payor, SHP did not start submitting RAPS clusters until 2012. Interpreted the CMS requirements and defined rules for coders to implement to produce monthly RAPS files, both before and after the ICD-10 compliance date.• Architected and implemented a Data Exchange Repository (DXR) for SHP using the same physical and logical design as was… Show more • Served as architect for the Simply Healthcare Plans (SHP) Risk Adjustment Processing System (RAPS) solution. As a start-up Medicare Advantage payor, SHP did not start submitting RAPS clusters until 2012. Interpreted the CMS requirements and defined rules for coders to implement to produce monthly RAPS files, both before and after the ICD-10 compliance date.• Architected and implemented a Data Exchange Repository (DXR) for SHP using the same physical and logical design as was successfully implemented for UHC-NV (below). The primary purpose of this DXR is to completely manage all of SHP’s Medicare and Florida Medicaid EDI Encounter reporting and response reconciliation requirements.• Designed a comprehensive relational database that stored 837P, 837I, 835, 997, 999, and 277 transactions.• Authored maps for populating inbound transactions into the DXR. Accommodated all known ICD-10 requirements.• Designed interfaces between the DXR and QNXT, the SHP adjudication platform. These interfaces included population of claim numbers after QNXT auto-assign, plus a feed for paid claim data to be assembled into Loops 2320 and 2430 in resultant encounters.• Evaluated over a dozen EDI translator vendors. Defined requirements for translator selection, recommended vendor to SHP, and served as a liaison between SHP and Sybase, the selected vendor.• Functioned as an enterprise-level EDI subject matter expert with regard to HIPAA administrative simplification (4010 and 5010), as well as RAPS/EDPS reporting and the entirety of the claims processing life cycle within a payor organization, including upcoming CMS All Payor Claim Database (APCD) and ICD-10 requirements. Show less

Architect for the Lifeprint eligibility interface development; designed EDI portions of the eligibility interface, and logical/physical data models for the staging database where the eligibility transactions would be processed.• Architected, implemented and delivered an interface that took paid claim data and sent it downstream via 5010 EDI transactions in December of 2010 – over one year ahead of the 5010 compliance deadline.• Architected and implemented the automated response document… Show more Architect for the Lifeprint eligibility interface development; designed EDI portions of the eligibility interface, and logical/physical data models for the staging database where the eligibility transactions would be processed.• Architected, implemented and delivered an interface that took paid claim data and sent it downstream via 5010 EDI transactions in December of 2010 – over one year ahead of the 5010 compliance deadline.• Architected and implemented the automated response document reconciliation module, completely processing 999 and 277 transactions that detailed rejected encounters and the reasons for their rejection.• Analyzed the implementation guides for the 837 transactions and designed a relational database that was capable of storing every single character of any professional or institutional claim that any UHC-NV provider could ever send in accordance with the new 5010 HIPAA requirements. Responsible for both the logical and physical data models (well over 100 tables now call the DXR “home”), as well as helping defining the rules by which the DXR would be built.• Re-architected the Lifeprint encounter interface to work with the DXR. Lifeprint thus became the proof of concept for the EDPS implementation. Due to the revolutionary DXR design, personally built the inbound 837 maps that populated the DXR in a matter of days, rather than weeks or months.• Enabled UHC-NV to be one of the the first UHG entities capable of sending complete, full and conforming 5010 encounters in both 837I and 837P formats downstream to OptumInsight in support of the CMS EDPS project by virtue of the DXR Implementation.• Assisted with development of the new UHC-NV paper claims processing system and methodology by defining the relational data models to store everything a provider can submit on either the CMS-1450 (UB 04) or CMS-1500 forms, and implementing the maps that read this data and convert it to HIPAA 5010-compliant claims. Show less

• Provided project management support and risk mitigation analysis in support of AT&T’s CalNet 2 contract, a critical-visibility new business initiative for AT&T involving modification to existing systems and new systems interface functionality. This multi-billion dollar project will put in place the management, billing and accounting system for all of the State of California’s telecommunications functionality in the coming years. This effort has been expanded to include the County of… Show more • Provided project management support and risk mitigation analysis in support of AT&T’s CalNet 2 contract, a critical-visibility new business initiative for AT&T involving modification to existing systems and new systems interface functionality. This multi-billion dollar project will put in place the management, billing and accounting system for all of the State of California’s telecommunications functionality in the coming years. This effort has been expanded to include the County of Los Angeles and State of Alabama also, with development for the State of Tennessee actively underway.• Developed ANSI ASC X12 811 telecommunications invoice transaction maps supporting AT&T Client Invoice System (CIS) via ODBC database connectivity, as well as several other AT&T internal systems and entities via reports and flat files. • Managed a team of three full-time offshore EDI development and project management resources based in Pune, India. • Continued in my role as senior EDI expert. Show less

• Architected and implemented unattended, operational system for exchanging vendor/trading partner files to/from Tibco application architecture. • Assisted senior management in dealing with state Medicaid organizations and health care providers. • Prepared educational materials and facilitated knowledge transfer from Centene resources to Arizona health care providers. • Defined data model for claim and enrollment transactions that will capture all health care data exchanged with… Show more • Architected and implemented unattended, operational system for exchanging vendor/trading partner files to/from Tibco application architecture. • Assisted senior management in dealing with state Medicaid organizations and health care providers. • Prepared educational materials and facilitated knowledge transfer from Centene resources to Arizona health care providers. • Defined data model for claim and enrollment transactions that will capture all health care data exchanged with all parties in accordance with Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) and store it in a transaction-centric SQL database repository. • Served as senior HIPAA expert, reviewing implementation guides and vendor transactions; advised CIO and Director of State Reporting with best practices and methods for improving trading partner transaction processing. Show less

• Designed and implemented HIPAA template maps for all enrollment formats as part of Sierra BRE system implementation.• Implemented HIPAA ANSI ASC X12 837 COB maps as part of bringing Medicare Supplemental line of business in-house.• Defined architecture and modular process functionality to replace all existing EC Gateway processes for Sierra.• Assisted senior management with enterprise architecture for all EC/EDI messaging activity.• Served as senior HIPAA expert.

• Architected unattended operational system for processing all enrollment files that was to be transitioned to all Centene. • Transferred lessons learned and institutional knowledge regarding the unattended operations of Sybase EC Gateway. • Developed HIPAA ANSI ASC X12 834 benefit enrollment and maintenance transactions and ANSI ASC X12 837 health care claim transactions in support of Centene’s FirstGuard acquisition and Arizona line of business. • Maintained contact with… Show more • Architected unattended operational system for processing all enrollment files that was to be transitioned to all Centene. • Transferred lessons learned and institutional knowledge regarding the unattended operations of Sybase EC Gateway. • Developed HIPAA ANSI ASC X12 834 benefit enrollment and maintenance transactions and ANSI ASC X12 837 health care claim transactions in support of Centene’s FirstGuard acquisition and Arizona line of business. • Maintained contact with external vendors and internal business entities to coordinate testing and go-live activities. • Documented installed configuration and provided transfer of knowledge for ongoing operations and maintenance. Show less

• Developed ANSI ASC X12 811 telecommunications invoice transaction and CABS telecommunications industry billing format maps supporting AT&T Client Invoice System (CIS). • Transferred institutional knowledge regarding telecommunications billing process to AT&T staff unfamiliar with EDI. • Assisted AT&T in bringing EDI in-house to their CIS – work traditionally outsourced to off-shore entities – generated significant ROI in a very short timeframe. • Implemented an application… Show more • Developed ANSI ASC X12 811 telecommunications invoice transaction and CABS telecommunications industry billing format maps supporting AT&T Client Invoice System (CIS). • Transferred institutional knowledge regarding telecommunications billing process to AT&T staff unfamiliar with EDI. • Assisted AT&T in bringing EDI in-house to their CIS – work traditionally outsourced to off-shore entities – generated significant ROI in a very short timeframe. • Implemented an application framework that will allow interfaces to the AT&T CIS to be modified in the future to rapidly support new business and/or new methods of operation. Show less

• Architected and designed a Sybase EC Gateway system for managing all HIPAA-compliant healthcare transactions• Acted as senior architect for all implementation discussions with business and technical customers. • Developed and implemented transaction maps using EC Map to take HIPAA-compliant remittance advice, institutional claim, eligibility inquiry, and referral request transactions and respond with the appropriate EDI transaction. • Managed architecture through… Show more • Architected and designed a Sybase EC Gateway system for managing all HIPAA-compliant healthcare transactions• Acted as senior architect for all implementation discussions with business and technical customers. • Developed and implemented transaction maps using EC Map to take HIPAA-compliant remittance advice, institutional claim, eligibility inquiry, and referral request transactions and respond with the appropriate EDI transaction. • Managed architecture through design/documentation reviews and meetings with senior Amerigroup decision makers.• Mapped ANSI ASC X12 837-I, 835, 270, 271, 276, 277, and 278 transactions. Show less

• Maintained liaison between Trigon/EDI Partners on-site resources and Sybase (New Era/PaperFree) hotline personnel during “go-live” for HIPAA-compliant ANSI ASC X12 837 Health Care Claim processing.

• Architected and designed system for managing claim status and patient eligibility inquiries. • Productized system to facilitate rapid deployment to new clients for managing fast-batch (near real-time) transactions. • Architected and developed Sybase EC Map (New Era/PaperFree) maps to translate health care claim (professional and institutional) and health care remittance advice transactions to internal format, as well as merge response documents from system to original claims. •… Show more • Architected and designed system for managing claim status and patient eligibility inquiries. • Productized system to facilitate rapid deployment to new clients for managing fast-batch (near real-time) transactions. • Architected and developed Sybase EC Map (New Era/PaperFree) maps to translate health care claim (professional and institutional) and health care remittance advice transactions to internal format, as well as merge response documents from system to original claims. • Performed gap analysis on IntelliClaim internal file formats and identified potential new requirements per HIPAA. • Mapped ANSI ASC X12 837, 270, 271, 276 and 277 transactions. Show less

• Reported directly to the CTO and managed a team of 6-8 project managers, integration architects, integration engineers, and integration analysts. • Performed architecture support and design for small and medium managed care organizations implementing the REDI solution – a HIPAA transaction processing, data repository, and data management application built around the Sybase/NEON/PaperFree EDI Server integration middleware product. • Assisted LCS in developing health care claim and… Show more • Reported directly to the CTO and managed a team of 6-8 project managers, integration architects, integration engineers, and integration analysts. • Performed architecture support and design for small and medium managed care organizations implementing the REDI solution – a HIPAA transaction processing, data repository, and data management application built around the Sybase/NEON/PaperFree EDI Server integration middleware product. • Assisted LCS in developing health care claim and health care remittance advice processing functionality within REDI. Show less

• Supported ERCOT in their use of PaperFree technology within their energy transaction clearinghouse. • Managed day-to-day operation of the translation solution developed and delivered by Accenture. • Assisted in troubleshooting database connectivity and inter-middleware connections between SeeBeyond and EC Gateway. • Worked with ANSI ASC X12 814, 864, 820 and other EDI transactions.

Principal Architect (Airmobile) [1/2001-7/2001] - Director, Integration Architecture [6/2000-12/2000]Product Manager, EC Gateway/Project Manager [7/1999-6/2000] - Senior Sales Engineer/Project Manager [7/1998-6/1999]Senior EC Gateway Specialist/Project Manager [1/1998-6/1998]As Product Manager, EC Gateway:• Responsible for the Electronic Commerce (EC) Gateway line of business within PaperFree Systems, Inc. Oversaw software development life cycle for two ‘lights-out’… Show more Principal Architect (Airmobile) [1/2001-7/2001] - Director, Integration Architecture [6/2000-12/2000]Product Manager, EC Gateway/Project Manager [7/1999-6/2000] - Senior Sales Engineer/Project Manager [7/1998-6/1999]Senior EC Gateway Specialist/Project Manager [1/1998-6/1998]As Product Manager, EC Gateway:• Responsible for the Electronic Commerce (EC) Gateway line of business within PaperFree Systems, Inc. Oversaw software development life cycle for two ‘lights-out’ EC/EDI message management applications, both the batch and interactive versions of EC Gateway.• Fielded the application to 30+ customers, authored the system documentation, authored the training curriculum, delivered product training to customers and staff, attended trade shows as the senior technical resource, and provided pre-sales technical support to the sales team. • EC Gateway contributed $5+M to PaperFree revenue during the period I was Product Manager. Show less

As Program Mgr:• Managed 2 Defense Logistics Agency (DLA) projects for DSTI. Managed 12 systems engineers and EC/EDI support personnel on the $2.5M Subsistence Prime Vendor Interpreter (SPVI) implementation. • Fielded SPVI, an EC/EDI-enabled food ordering application, to 300 access points at 180 DoD installations throughout the US. Managed all aspects of rollout - interfaced with customer at weekly/ad-hoc meetings, scheduled implementations & planned resource usage, mitigated project… Show more As Program Mgr:• Managed 2 Defense Logistics Agency (DLA) projects for DSTI. Managed 12 systems engineers and EC/EDI support personnel on the $2.5M Subsistence Prime Vendor Interpreter (SPVI) implementation. • Fielded SPVI, an EC/EDI-enabled food ordering application, to 300 access points at 180 DoD installations throughout the US. Managed all aspects of rollout - interfaced with customer at weekly/ad-hoc meetings, scheduled implementations & planned resource usage, mitigated project risks, coordinated training, verified invoices, and developed personnel. • Gained additional work from the customer under through extensions and follow-on delivery orders.As QA Project Manager:• Served as the Quality Assurance and Configuration Management Project Manager for the $1M Subsistence Total Order and Receipt Electronic System (STORES) software development effort, a multi-vendor follow-on to the SPVI EC/EDI system. • Implemented a SCM program based upon MIL-STD 973 and other industry standard practices. • Managed the SCM environment, served as technical lead for STORES local access point development, managing two software developers, two quality assurance engineers, two systems engineers, and other support personnel. As Project Manager:• Authored the Functional Description, System Specification, and Training Plan for the STORES system, as well as provided major input into other contractual deliverables. • Coded the STORES facsimile EDI Document transmission module. Provided design and code assistance as well as assisted in the unit, regression, X12 compliance verification, and systems qualification testing for all aspects of the STORES system, including the DSTI-built X12 translation functionality. • Supervised a team of five SPVI installers on a DLA food management information system project. • Performed training and implementation of the SPVI system at DoD sites located within CONUS Show less

• Supported Program Management Office, Sustaining Base Automation in a variety of analysis/project management tasks. • Assisted in resolving system interface development issues and risks. • Developed template program schedule for Increment II system interface development. • Identified and resolved interface data requirement issues. • Participated in requirements site surveys for Fort Bragg and Fort Stewart.• Assisted in development of SBIS Synchronized Fielding Process… Show more • Supported Program Management Office, Sustaining Base Automation in a variety of analysis/project management tasks. • Assisted in resolving system interface development issues and risks. • Developed template program schedule for Increment II system interface development. • Identified and resolved interface data requirement issues. • Participated in requirements site surveys for Fort Bragg and Fort Stewart.• Assisted in development of SBIS Synchronized Fielding Process, defining work breakdown structure for SBIS fielding. Show less

• Periodically administered the physical examination program for the (entire) United States Secret Service.• Managed and administered projects in medical surveillance, toxicology, litigation support and industrial hygiene. • Managed occupational hearing conservation programs (HCPs) in compliance with OSHA regulations for printing, railroad, and gas pipeline industry clients, using customized FoxPro reporting and query tools. Certified as an Occupational Hearing… Show more • Periodically administered the physical examination program for the (entire) United States Secret Service.• Managed and administered projects in medical surveillance, toxicology, litigation support and industrial hygiene. • Managed occupational hearing conservation programs (HCPs) in compliance with OSHA regulations for printing, railroad, and gas pipeline industry clients, using customized FoxPro reporting and query tools. Certified as an Occupational Hearing Conservationist.• Assisted in the development, systems analysis, operational testing, and documentation of medical surveillance, hearing conservation, examination scheduling, and other WOHA-developed FoxPro-based medical database applications. Show less

• Administered ASAE's local area network by assisting users, resolving problems, setting up accounts, and managing the software and files on the file server. • Developed training courses for Management Information Systems department and general staff. • Managed procurement of over 60 advanced workstations, including vendor/workstation selection, cost negotiation and integration into the existing information systems architecture.

• Developed, authored and delivered two information system elective courses for the graduate-level curriculum at DSMC. Developed and presented training courses in WordPerfect, Lotus, Harvard Graphics, and Officepower for students, staff and faculty at DSMC. Trained the trainers.• Analyzed user automation requests, determined requirements, conducted market surveys, evaluated and recommended software packages and vendors. Looked out for the Logisticians.• Helped design, develop and… Show more • Developed, authored and delivered two information system elective courses for the graduate-level curriculum at DSMC. Developed and presented training courses in WordPerfect, Lotus, Harvard Graphics, and Officepower for students, staff and faculty at DSMC. Trained the trainers.• Analyzed user automation requests, determined requirements, conducted market surveys, evaluated and recommended software packages and vendors. Looked out for the Logisticians.• Helped design, develop and implement Phase I of the DSMC Classroom Network Initiative, a $0.25M Novell NetWare-based Ethernet network to support 23 classrooms over seven buildings at the DSMC main campus. Connected the classrooms. Show less