Business Analyst working with the Washington State Health Care Authority with Ernst & Young, who acquired Cambria Solutions. Contracted through The Computer Merchant

Business Analyst working for Cambria Solutions with the State of Washington Health Care Authority (HCA) on their Virtual Health and Wellbeing Portal Implementation Project.

Lead Business Solutions Analyst conducting a comprehensive as-is analysis and documentation of fourteen data systems integrated into DHCS with the merger of the California Department of Mental Health and the California Department of Alcohol and Drug Programs.Coordinating and leading a team of analysts in the documentation of the as-is business process workflow, user stories, narrative descriptions, and capture of functional requirements based on interviews with State business and information technology Subject Matter Experts.Lead researcher and author of the project’s Market Research Analysis.Lead on collection, documentation, and consolidation of all mid-level functional requirements for analysis to remove duplicates and document gaps to be used for identification of alternative technical solutions.Co-lead on the creation of the multi-year financial analysis associated with the proposed alternative solutions presented for DHCS and Agency review.The project scope was expanded by the State to not only include data systems and management but to incorporate all aspects of business process redesign related to behavioral health services for California Medi-Cal. Role expanded to include harmonization with CalAIM behavioral health initiatives.Team lead on business process documentation, in conjunction with behavior health product owners, to drive and develop to-be business processes based on the proposed alternative solution. In-depth interviews and use cases development related to behavioral health policy development, local governmental finance, analytics and reporting, audits and investigations, county, state, and federal compliance, licensing and certification, and federal grants management.

Senior Business Project Manager tasked to integrate the 400,000-member Promise Medi-Cal Managed Care Health Plan’s product lifecycle into the Blue Shield Product Development organization. Resulted in standardized and optimized processes, reduced product defects and increased regulatory compliance. Concurrently created the needed infrastructure for strategic Medi-Cal growth and expansion within California.Working as project lead and senior business analyst, delivered cross-functional current state assessment and future state design for benefit configuration, build and testing, implemented processes for Medi-Cal managed care bulletins, legislative mandates, regulatory filings with DHCS and DMHC and the creation and distribution of Evidence of Coverage, erratum, Member Handbook and associated downstream member documents.As lead business analyst, created, documented and implemented a scalable business and operating model, improved and streamlined operational performance with touchpoints to 75 stakeholders/internal processes and 25 internal IT applications/systems. Documented processes and upgraded policies, procedures and training.

Planned and implemented the cross-functional business process re-engineering needed to ensure that the Nebraska Medicaid eligibility and enrollment business processes and systems were compliant with the provisions the Affordable Care Act (ACA). Coordinated planning and implementation work with the System Integrator and IV&V in the replacement of a legacy system with a state-of-the-art COTS, ACA and MITA compliant eligibility and enrollment system.Primary liaison to CMS for ACA certification gate review and operational readiness reviews. Creation of advanced planning documents (APDs), mitigation plan, presentations and operational and performance indicator reporting.Project lead and core member of the State's CMS modular MMIS and E&E enterprise certification team. Project lead on MMIS Provider Management modular implementation and certification project. System certified by CMS.Contract management responsibilities for Independent Verification and Validation (IV&V) contractor working on multiple projects.Project lead on Provider Rates and Reimbursement Project including cost containment and avoidance business process documentation and redesign.

Integrated business, clinical and operational expertise to help expand the data sources, clinical analytics and information sharing capabilities of the statewide Medi-Cal Data Warehouse and Decision Support System with the goal of providing better care for individuals, better health for populations while reducing costs. Performed business and clinical analytics related to the integration and implementation of the CMS 1115 Waivers and Medicaid-related provisions of the Affordable Care Act (ACA), American Recovery and Reinvestment Act (ARRA), HITECH & HIPAA.Implemented and trained state case management teams on clinical software and analytic tools used for population identification, creation of disease registries, risk stratification and evidence-based medicine used for community based coordinated care programs to reduce hospital readmissions under a CMS grant.

Authored and applied to the Centers for Medicare & Medicaid Services (CMS) seeking regulatory approval to offer these new Medicare Advantage Plans. Approved by CMS on initial submission.

Successfully lead the communication and collaboration on strategy and projects between Kaiser Permanente Information Technology and Kaiser Health Plan Business Operations regarding consistency in regional and national benefits administration corresponding with their EPIC and Diamond system implementations.

Recruited by Senior Vice President to evaluate, recommend, develop, and implement the infrastructures and modifications necessary for the financial and operational turn-around of Kaiser Permanente’s largest contracted physician and healthcare network in Northern California.

Implemented systems, policy, procedure and clinical workflow redesign at five community-based primary care centers in the Seattle area into a medical home model. Implemented chronic disease registries for identification and management of selectively targeted patient populations within the newly integrated multi-disciplinary primary care teams.

Operational and business management of FHP-TakeCare’s HMO and PPO contracted healthcare delivery networks in Los Angeles. Specialized expertise in Medicare risk contracting, medical and case management, health plan, IPA and medical group operations.