David Wolfrom Email & Phone Number

Led effort for California MSO to create a new staging database and processes to support ETL of eligibility data from seven health plans supporting Medicare Advantage, Commercial, and Medi-Cal into the local QNXT claims system. This included data integrity checks, QA test case building, and end-to-end data consistency checks. Also supported advanced troubleshooting of QNXT claims system issues related to claim processing, auto-adjudication, sub-capitation processing, downstream system data consistency processes, data analysis, and claims processing reporting/trending. Supported provider data improvements for claims payment, member-pcp attribution, IPA reporting, and downstream system processing.

Remote

Served as consultant to the CEO and Executive Management Team on implementations, IT security, process improvements, data strategies, roadmap prioritization, and organization structures. • Spearheaded investigation into enrollment system failures. Sponsored project ensuring a highly accurate and controlled methodology was used to correct data issues. • Mentored project management and technical staff in roles and prioritization, work breakdown structure, and risk management. • Founded new project team charged with implementing encounter management system. • Provided strategic direction, consulted on projects, introduced operational efficiencies, identified project risks and assisted with risk mitigation planning.• Served on DHMSO Executive Leadership Team.

Leader over IT Operations and Support, Development/Business Intelligence, EDI/Automation, and Project Management Office. Technology leader for HIPAA Privacy, Security, and Regulatory Compliance.• Guided IT operations team through a complete overhaul of the IT infrastructure environment, accelerating the growth from a small single-office organization into a national health plan with locations in multiple states.• Established SDLC methodologies and best practices in the IT Development and Business Intelligence team. Set new expectations for requirements gathering. Introduced quality assurance and testing standards. • Established new project management and business analyst team. Organized company goals and solutions into a strategic multi-year project roadmap including budgeting, resource management, and timelines. • Sponsored multiple large implementations, delivering on: QNXT claim system; Trizetto enrollment system, Edifecs encounters solution, Optum Insight risk adjustment, Washington State All Payers Claim Database, data warehouse implementation, and dozens of other vendor solutions.• Served as technology lead through entire acquisition by parent company including due diligence collaboration, alignment with technology and security standards, and integration initiatives. • Member of Executive Leadership Team and co-sponsor of the IT Steering Committee, Project Governance Team, and Business Continuity Committee.

Federal Way

Stabilized Development and IT Operations/Support team while breaking down barriers between IT and business departments to increase compliance and operational efficiency. Implemented complex Medicare systems including enrollment, EDPS, and 5010 837s.

Tacoma, Wa

Founded new information services company serving over 50 small businesses in the area. Served as technology lead for customers, consulting with CEO’s, business owners, and executive teams. Industries ranged across healthcare, financial services, banking, and legal.

Network Administrator and Warranty Services.

• Created technical support department for small development company supporting over 500 machines in the U.S. remotely. • Designed and developed replacement music demo system into an Internet-based streaming and caching system, changing business model from a hardware/software company into a subscription service and increasing new customers by over 200% in first year.