Working with DXC on the development of the Provider Management Module for Virginia.

Providing assistance to states with mapping their data to the CMCS TMSIS file. Assisting states with testing the interface after the data is mapped, and resolving error conditions.

This project aims to support reporting around Enrollment and Eligibility requirements of Medicaid expansion as part of ACA. The goal of the project to “productionalize” this current setup and build analytical reports using SAS Enterprise Business Intelligence (EBI) suite using the data provided by the states. Cindy is part of the project team and understands Medicaid policy specifically around Medicaid expansion and enrollment/eligibility due to ACA.Experience 10 years of experience ensuring information systems are HIPAA-compliant 24 years of experience leading teams of business and systems analysts on public sector IT projects. 22 years of experience working with MMIS 11 years of experience working as part of state government agencies, including the State of Mississippi Departments of Public Safety and EducationExpertise Medicaid Management Information Systems (MMIS) Health Insurance Portability and Accountability Act (HIPAA) Electronic data interchange (EDI) User acceptance testing (UAT) National Council for Prescription Drug Programs (NCPDP) Durable medical equipment (DME) Extract, transform, and load (ETL)

Business and Technical Analyst supporting CSG’s Healthcare and Human Services practice. Was engaged in MS SHOP Marketplace project for PPACA. Role was Senior Business Analyst in the Project Management Office (PMO). Serving as a technical resource for reviewing CCIIO required planning documents created by the COTS vendor for the Mississippi SHOP Marketplace including:o MS SHOP Marketplace Carrier Test Plano MS SHOP Marketplace System Test Plano MS SHOP Marketplace System Security Plan and SSP Workbooko MS SHOP Marketplace Implementation Plano MS SHOP Marketplace Hosting Environment Strategyo Product Reviewso MS SHOP Marketplace Call Center Training Writer for the Privacy Risk Assessment (PIA) for the Mississippi SHOP Marketplace as required by CCIIO. Writer for the MS SHOP Marketplace Program Integrity Plan Created MS SHOP Marketplace Requirements Traceability Matrix (RTM) Writer for the Financial Management Plan for the Mississippi SHOP Marketplace and the Audit Procedures and Protocols document. These deliverables include aggregated premium payments for employers and issuer user fees. Decisions made regarding reinsurance, risk corridors, and risk adjustments.  Serving as EDI SME to ensure adequate Issuer testing documentation is provided for the 834 and 820 EDI transactions. Meeting actively with the Mississippi Issuer. Meeting weekly with COTS vendor for status reporting Meeting bi-weekly with Mississippi Department of Insurance, the COTS vendor, and the Mississippi Comprehensive Health Insurance Risk Pool Association. Meeting with CCIIO as required for deliverables. Working with the UAT team to address defects and/or deficiencies.

Consultant  Served as a Lead for State Engagement on a Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) project to collect eligibility and enrollment data from each of the state’s insurance exchange (09/2012 – 05/2013).  Created X12 834 Enrollment transaction map for testing incoming data. Performed work on CMS Program Integrity and Office of Financial Management (OFM) Use Cases with a team of CMS and Oak Ridge National Laboratory (ORNL) designated staff (04/2012 – 09/2012).  Assisted scientists with identifying data fields from CMS National Claims History that were relevant to the Use Cases, including identifying the data source, definition, and valid values. Met with CMS OFM staff to discuss reports and explain any anomalies found in the data.   Served as Systems Integrator on the Centers for Medicaid Services/Centers for Program Integrity One Program Integrity (PI) project (06/2011 – 04/2012). Met with the contractors supporting Part A, Part B, and Durable Medical Equipment Regional Carrier (DMERC) claims to ensure HIPAA compliance for the 837I and 837P transactions used to populate a Shared Systems database and Integrated Data Repository.  Reviewed the Shared Systems Data Model to recommend columns to be consolidated. Also recommended columns required to support the integration of Medicaid claims in the IDR.  Worked on the High Level Design for Business Objects for Part D claims and a T-MSIS review of data elements to ensure all data needed to support Program Integrity tasks are found in the interface

Led the remediation of the 4010A 270/271 and 276/277 EDI “real-time” transactions to the 5010 mandated version. Also remediated pharmacy claims in National Council for Prescription Drug Programs (NCPDP) 5.1 and NCPDP 1.1 formats; to the NCPDP D.0 and NCPDP 1.2 versions, respectively. Managed the work of four senior systems analysts and one database administrator (DBA) to accomplish these tasks. For the earlier HIPAA implementation (implementation of 4010A), led the upgrade to 5.1 for Pharmacy, implemented the 278 transaction for Prior Authorization, and implemented the 837I for Long Term Care. Served as Team Lead with selection of Louisiana as a pilot state for the implementation of the NCPCP 1.1 Medicare Crossovers. Interaction with GHI the CMS Coordination of Benefits Contractor (COBC) was required.Served as Team Lead for the implementation of National Provider Identifier (NPI) for Pharmacy Point of Sale claims adjudication, eligibility verification transactions, real time Claims Status Inquiry.

Served as Claims Team Lead and On-site Team Lead for the implementation of electronic claims and remittance advices, and State Liaison for system change requests for the claims subsystem. Provided work assignments and supervision to seven full-time employees as well as three contract programmers.Implemented the electronic claims conversion to the Uniform Billing Form 92 (UB92) format working with both the systems staff and representatives of the provider community to validate all software changes. Served as Lead Analyst for implementation of Mississippi’s first pilot Managed Care project. During tenure as Claims team leader, reduced the backlog of system change requests by 75%.

Consultant to Computer Sciences Corporation for the development and implementation of the New York Medicaid project eMedNY. Served as Front End Team Lead for the Client, Provider, and Third Party Liability (TPL) applications development. The new system utilized a relational database structured as DB2 tables. Screens were developed as graphical user interface (GUI) window presentations. Interfaced with the state Core Team Leads for Client, Provider, and TPL to document requirements and resolved issues. Submitted a bi-weekly project status report to the state with updates, issues, and a progress report supported by graphs of project metrics from the Work Plan. Provided direction and assignments to a staff of 24 programmer/analysts residing in both Albany, New York and Petersburg, Virginia. For each application area, project deliverables included a Business Design Document, Technical Design Document, and Spending Plan that detailed hours expended on each program developed. These deliverables were submitted on time as required.