Assignments include:Business Analyst for the Ohio Department of Medicaid Procurement Support Services Project to assist the State of Ohio in its effort to develop vision, plan strategy and procure the needed products and services to implement a modern, modularized enterprise system. Specifically providing subject matter expertise with the application of HIPAA Transactions and Code Sets regulations and Electronic Data Interchange (EDI) operations in developing the Requests for Proposals for the EDI and Single Pharmacy Benefit Management (SPBM) modules. Played a primary role in facilitating requirements elicitation meetings.Business Analyst for the Missouri Eligibility Determination and Enrollment System (MEDES) Project Management Office (PMO), a project to modernize and integrate the systems used to manage the E & E services associated with Medicaid, Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) and similar programs. Specifically contributed to the project team's effort to manage requirement traceability and assist with the preparation of budgets and Advance Planning Document (APD) filings for the ~$250M project.Lead Business Analyst for the Iowa Medicaid Enterprise Medicaid Integrated Data Administration Solution (MIDAS) Project Oversight, Management and Integration (POMI) Services team, a Medicaid Management Information System replacement and upgrade project, concentrating effort on the Pharmacy Point Of Sale (POS) system implementation.Health Benefit Exchange Integratator, a supplemental oversight role for the Iowa Department of Human Services (DHS) implementation of its integrated eligibility system compatible with the requirements of the Affordable Care Act. Senior Business Analyst working with a CSG Project Team to identify strategies for the implementation of a Health Benefit Exchange (a.k.a., Health Insurance Exchange or HIX) for the State of Iowa.

Standardization Committee Co-Chair 2005–2006, 2013-PresentMaintenance & Control Work Group Co-Chair 2003–2005,2007–2013

I was the NCPDP Subject Matter Expert of the HIPAA 5010, NCPDP & ICD-10 Project team. We provided full project management for the Iowa Medicaid Enterprise, including gap anaylsis, mitigation strategies, business requirements development, and testing oversight to assure compliance with the updated transaction requirements. Project was completed in advance of the January 2012 deadline.I was also engaged with the Quality Review vendor for Nevada Medicaid's preparation to integrate a new Pharmacy POS system with its legacy MMIS as a result of the replacement of it Fiscal Intermediary. My role was as a SME of both the NCPDP Standards and operations of the SXC RxCLAIM system.Lastly, I was engaged for the last quarter of 2011 to assist the IV&V vendor's review of California Medicaid's preparation for HIPAA compliance. I was able to successfully redirect the Payer Sheet development toward something much more consistent with the NCPDP template and industry expectations.

Primarily responsible for the external representation of SXC and SXC client needs in the development and maintenance of industry technical standards and the internal representation of changing industry standards to all SXC divisions. This includes active participation in NCPDP Work Groups and Committees and interfacing with CMS associates involved with the Medicare Part D program.

Providing focused consultation in HIPAA Standards and Regulations, NCPDP Standard transactions, real-time pharmacy claim processes, and RxCLAIM systems setup, operations and enhancement requests. Contracted to assist a former employer with technical analysis and support of their daily PBM operations. I have also had the opportunity to assist both Medicare and Medicaid programs with their NCPDP Standard use and modification requests.

I was responsible for the day-to-day operations, maintenance and enhancements of the core business systems, network infrastructure, telephony, desktop resources and facilities of a PBM serving over 2 million beneficiaries. The position required me to be a very “hands on” analyst, as well as manager. Some milestones with the organization include:Directing the HIPAA Transaction and Code Sets compliance effort. Working with the RxCLAIM system vendor and internal staff, I was able to facilitate the implementation of the NCPDP v5.1 and ASC X12N 835 standards.I established new procedures to assist departments in executing queries against and maintaining the data in several adjudication system databases and external tables used for MAC pricing, prior authorization extensions, preferred drug lists and other related needs.Implementation of a new rebate management system, including the development of procedures to support the integration of external claims data with data.

On contract with Systems Xcellence / ComCoTec (now SXC Health Solutions), I worked with a team of other consultants and employees to implement HIPAA mandated upgrades on their client's (AdvancePCS, now part of Caremark) customized RxCLAIM system. My participation included:Gap Analysis – Evaluating the current system and documenting changes for the development team. I also assisted in the analysis of an internal NCPDP version translation capability.Installation Planning – Tracking file conversion requirements and coordinating with developers and system operators to optimize processing.Parallel Testing – Monitoring upgrade processes and validating that upgrade installations are not generating negative side effects to claim adjudication.Enhancement Specification – Working with the client’s product development team, I assisted in laying the groundwork for new capabilities possible with newer transaction standards.

I was on assignment with the Transaction Services unit of WebMD (previously ENVOY, now Emdeon) that operates one of the nation’s largest EDI networks for healthcare claims transactions. My responsibilities on this project centered around HIPAA preparation and included:Supporting implementation of new connectivity with submitting pharmacies and receiving claims processors. (This includes an effort to consolidate redundant data centers.) Required application setup/configuration, testing and installation in a real-time environment.Upgrading internal testing tools for compliance with the NCPDP v5.1 standard.Providing second-level technical support to assist the Pharmacy Call Center.

I managed a team of 6 to 7 analysts, programmers and operators. This team began by being responsible for daily operations of an internal pharmacy claim adjudication system which processed as many as 150,000 transactions per day for more than a dozen internal and external health plans with a total membership of about 3 million lives. After a transaction which divested the claims adjudication system and external PBM business to Advance Paradigm (now part of Caremark), the team evolved to support the daily data flow into a corporate pharmacy claims data warehouse.

Major milestones included:Two relocations of an online pharmacy claims adjudication system, each with no more than a few hours of total down time.Supervised and assisted in the migration of a financial and reporting system from an AS/400 to a large MVS system, including an automated data collection and distribution subsystem. Development and analytical support of an OLTP application, both as a primary programmer/analyst and as the supervising analyst, supervising a staff of 1 to 3 programmers.Implementation of a pharmacy rebate management system and development of one of the first pharmacy-centric disease state management systems in the nation. Evaluated and managed the installation of a new pharmacy claim adjudication system (ProCare Rx). We quickly became the largest installation of this system.

Completed the development of and continuing enhancements to the Worker's Compensation pharmacy claim billing system that formed the core of this organization for nearly 10 years. Also supervised a team of four programmers and analysts supporting development of a third party pharmacy claims billing and receivables reconciliation system.

Developed and enhanced customized tools for the automation of project estimating, contracting and budgeting applications. Developed applications to support "lights out" operations tasks during off-peak hours. Developed and maintained in-house and on-site desktop computer systems and local area networks. Established policies and procedures for system backups, desktop system procurement and PC applications support.

Support of desktop computer systems and peripherals. Development of the company's first local area network, archival and employee training standards. Light-duty programming.

Highly customized application development for small businesses using desktop personal computers. Applications included such things as order entry, inventory control, accounts payable, and accounts receivable modules.