Business Operations lead for West H&PS Business. In this role, I help shape our overall business strategy, drive operational improvement initiatives, and support our H&PS Leaders and teams.

Responsibilities include:Program Manager responsible for coordinating two RFP responses for cross functional IT teams including Claims processing, Mail Order processing, Beneficiary Contact Systems, and Enterprise Warehouse groupsManaged portfolio of projects through the requirements, solution design, and estimation phases during the RFP responses

Led v5010 remediation for Institutional and Professional inbound claim transactions (837), electronic remittance advice (835), and outbound claim encounter for Arizona Medicaid line of business. The project included updating core claims processing system to capture new data elements received on a v5010 claims transaction, working with clearinghouses to ensure each is able to transmit a 5010 compliant claims, and updating existing processes to transmit necessary data to generate a 5010 compliant 835 and 837 Encounters. Each transaction was managed from requirements gathering through deployment.Responsibilities Included: Managed four client vendor teams that were utilized to complete development work for the different transactions Completed Gap Analysis for each transactions interpreting the 5010 regulations and defining how they impacted the client systems and operations Developed Business Requirements and Functional Designs for each transaction based on identified gaps Coordinated project timelines and deployments for each team to mitigate risks from having multiple teams complete development work in a single environment. Managed two resources responsible for completing system and user acceptance tests for 837 and 837 transactions. Assisted Test Lead with developing testing Methodologies utilized on project.

The Claim Services Initiative project consisted of updating claims core processing system to increase claim auto-adjudication rate, lower cost per claim and increase claim payment accuracy. Responsible for completing testing activities for four claim system remediation projects including: Medicare/Medicaid member claim replication, capturing additional claim elements from inbound claims, front end claim processing system, and claim scrubber application for Arizona Medicaid line of business. Responsibilities included: Developed test plan and scripts for each project based on Functional Designs. Identified and gathered test data for each project Conducted system and user acceptance testing for each project, including defect reporting and retesting. Assisted with client resource training for front end processing system and Arizona Medicaid claim scrubber. Provided status on test execution for each project.

Responsibilities included:Overseeing retroactive enrollment processDevelopment of a tracking tool to monitor submission progress and report status to client teamReviewed Center for Medicare and Medicaid Service guidance and assessed impact to current processGathered and documented requirements for 2009 Call Letter ProjectDevelopment of Test Scripts to support Call Letter testing