Ashley Wilborn Email & Phone Number

Mission Viejo, California, Us

IIS Support for the New York City Department of Health and Mental Hygiene - Citywide Immunization Registry (CIR) (and related systems)New York’s CIR keeps immunization records for all children and adults who live in the City. CIR consolidates immunization information and shares it with health care providers, families and agencies concerned with public health, to help ensure that NYC residents receive all recommended immunizations. HLN supports these and other IIS features to help all users involved register facilities, order and track vaccination materials, report on their uses, and make informed decisions for the City’s population, with the goals of improving vaccination rates and reducing vaccine-preventable disease. This includes all COVID-19 related vaccination work.● Ashley supports requirements elicitation, gap analysis, testing, implementation and post-launch maintenance needs for the various systems HLN maintains for CIR’s vaccination program. Ashley maintains a strong understanding of existing and evolving requirements and business rules, various databases, an HL7 web service, and several user interfaces that City staff, providers and facilities access for vaccination ordering, tracking and decision support processes. Systems monitored, reviewed, tested and updated include:● Online Registry: Allows providers to report, view and update patient immunizations, maintain and order vaccine inventory, run reports on all data, and more● CAT: CIR Administration Tool – a tool for the CIR staff to review, update or create facilities and immunizations at the provider, facility and patient levels● FACMAN: Facility Management System – over six months, supported the development of user stories, requirements and testing until the system implementation● MVR: My Vaccine Record – over a year’s time, updated existing requirements, elicited and tested new requirements while the system converted to a REACT environment

Boston, Ma, Us

Public Safety Consulting Services (PSCS), Mult. roles● City of Austin, Dispatch Equity & Optimization Efficiency Study, Research Analyst ● Ashland Fire & Rescue Ambulance Services, Cost and Service Analysis, PM ● Cache County Fire & Emergency Medical Services Analysis and Study, PM Covered California, Enrollment and Renewal Operations and Improvements, PM Support ● Supported directors on issues identified during enrollment and renewalCalifornia Department of Health Care Services, Coordinated Care Initiative/Cal MediConnect Project, Consultant● Liaison to DHCS and CMS to develop and review program policies and deliverables● Managed evaluation, monitoring and oversight of health plans’ quality performance measured by quality metrics based in CMS, HEDIS, AHRQ and others● Clarified federal and state policy implementation● Initiated program map to change from pilot to programmatic work stream across divisions● Modified existing quality and performance metrics. evaluated and monitored plan performance updates● Guided quality reviews by Quality Improvement Organization (QIO), External Quality Review Organization (EQRO), National Opinion Research Center (NORC), Research Triangle Institute (RTI) and other entities● Advised DHCS on quality evaluation surveys conducted by entities like CMS and Senior Care Action Network (SCAN) Foundation

Malvern, Pa, Us

Multiple ProjectsNetwork Health Plan, Appleton, WIMedicare Implementation• Developed business requirements and future state processes for the Finance department, including:• Overall process improvement• Premium billing, collection and reconciliation• CMS reconciliation• Member premium reconciliation• Managerial and operational reporting• **Built all requirements by reviewing with the project Medicare expertSanta Clara Family Health Plan, Santa Clara County, CAGrievances and Appeals Policies, Processes and Workflows Improvement• Performed gap analysis of the plan’s grievances and appeals adherence to state, federal and national guidelines (NCQA) and requirements for their CalMediConnect and Medi-Cal lines of business. Analysis also included reviews of previous state and federal audit findings.• Recommended programmatic improvements for new grievances and appeals policies, procedures, work flows and outreach documentation.

Oakland, California, Us

Minimum Essential Coverage Collection and Reporting Project• Interpreted ACA and IRS mandates for BSCA impact• Acted as an internal primary point of contact between management and development teams• Elicited business requirements and developing the corresponding business requirement documents• Coordinated technical requirements documentation• Prepared the Master Test Plan strategy and deliverablesAspect Encompass Module Addition• Collaborated with business teams to document new requirements and processes. • Managed the testing effort for the business and technical teams, including the Master Test Plan documentation and end-user testing coordination.

Washington, Dc, Us

Risk Adjustment Evaluation Project, L.A. Care Health Plan• As part of a team of three, Ms. Wilborn worked closely with L.A. Care executives and teams to develop technical, regulation and organizational best practices for the LAC program across risk adjustment and revenue enhancement functional areas.Provider Dispute Resolution Project, L.A. Care Health Plan• Worked closely with L.A. Care executives and teams to develop requirements, workflows and best practices for the PDR program. She also acted as a liaison with the software vendor to ensure the project development and testing were on track. San Benito County Performance Review• As part of a two-person team, Ms. Wilborn participated in the evaluation of several departments’ policies and procedures, services, budget structures and resources.Plan Design Strategy and Oversight, Oregon Health Republic Insurance Company (Co-op)• Assisted in the plan design strategy workgroups and analysis, as well as developed the SERFF filing vendor search.

Nevada Health Link, Individual and Family Plan, Silver State Health Insurance Exchange (February 2013-November 2013): Internal primary contact between analysts, developers and management. Participated in SIT and UAT of various eligibility and identity verification services for the portal. Produced requirement traceability and the System Design Document. Co-led in-person external UAT in Las VegasCalifornia Healthcare Adverse Event and Reporting Tool (CalHEART), California Department of Public Health (October 2011, April 2012 – February 2013): Produced the requirements traceability matrix, test plan and scripts. Co-wrote and edited all deliverables: training materials, implementation plan, system design documentation updates and more. Performed internal and external UAT. Wood Destroying Organism System, Structural Pest Control Board (January 2013 – February 2013): Performed SIT and UAT testing on old and new servers. Created and conducted training for SPCB staff on new features. Evaluated current business processes within the WDO system and offered recommendations.Market Value Program, California Earthquake Authority (December 2012 – February 2013): Created and executed test cases and scripts, as well as identified bugs and performed regression test enhancements. Developed training for the test team to use in future testing efforts, at the request of the test lead. Trained the test lead on standard testing and training processes. Portable Equipment Registration Program, California Environmental Protection Agency (January 2011 –March 2012): Assisted in oversight and administration of SIT and UAT. Gathered system and UAT results. Assisted in writing and editing: implementation plan, system design documents, UAT master plan, training plan, user guides and more. Performed gap analysis and needs assessment. Coordinated and produced a successful application for a Best of California Center for Digital Government award. Produced requirements. Built process models.

Appeals Process Modeling and Mapping, CalPERS (November 2010 – January 2011): Analyzed processes with the Office of Employer & Member Health Services and the Office of Health Plan Administration. Gathered artifacts from internal divisions, external health plans, reform legislation, and external stakeholders.Health Care Reform Implementation (HCRI) Project, CalPERS (May 2010 – January 2011): • Early Retiree Reinsurance Program: Gathered data on disease management programs, performance guarantees, and pharmacy management programs in the Office of Health Policy Administration and the Health Benefits Branch. Conducted interviews and interpreted application requirements. • Legislative Traceability of PPACA and the Reconciliation Act: Traced law effective dates about Medicare doughnut hole, Expansion of Dependent Coverage, Early Retirees Reinsurance, Elimination of Pre-existing Conditions and Lifetime Benefit Limits.Health Plan Rate Negotiations, CalPERS (March 2010 – January 2011): Analyzed performance metrics to improve costs and CalPERS population health. Developed performance metrics contract language. Captured meeting minutes.Health Care Decision Support System – Innovative Progress (HIP) Project, CalPERS (September 2009 – October 2010): With IV&V lead, ensured project components were in scope and contractually accurate. Verified deliverables traced to agency’s RFP. Gathered requirements for new data sources implementation (biometric, lab and disease management). Managed UAT; maintained testing requirements traceability matrix. Wrote: monthly status and quarterly independent project oversight reports; HIP oversight final report. Submitted HIP Project Implementation Evaluation Report (PIER).Incident Reporting Information System (IRIS) Project, California Department of Developmental Services (June 2010 – October 2010): Assisted in joint requirements planning (JRP) sessions. Developed risk analysis and a future business process workflow.