Health Insurance Specialist, Program Manager, Contracting Officer'S Representative (Cor)
CurrentI was promoted to the Medicare Enrollment & Appeals Group to: -Lead IT, operations, and security projects throughout the life cycle for the Medicare Appeals System (MAS), and other Appeals Operations Contracts. -Develop statements of work (SOW) requirements and monitor contract deliverables for multi-year contracts. -Review contract proposals for technical, cost, information security, and operational feasibility with a focus on modernization, cost effectiveness and improvements to productivity. -Oversee 3 Program Directors and 4 technical contributors in up to ~4 simultaneous projects and serve as primary liaison with diverse technical teams and stakeholders across Finance, Operations, IT, Contracts, and Security. Perform budget forecasting and monitor key project deliverables, Schedule, Budget, Burn Rate, and user feedback. -Perform as lead for system security and privacy operations in adherence to CMS and HHS policies and National Institute of Standards and Technology (NIST) guidelines as well as Federal Information Security Management Act (FISMA) compliance. -Develop Requests for Proposals (RFPs) for appeals processing contracts. Highlights of my Achievements Include:§ Executed 2 pilot projects inclusive of developing APIs and enhancing existing Portals to achieve cost savings, appeals operational efficiency, and simplify provider experience to address process improvement at the Agency Level. § Developed technology change requirements and reported impact for the multi-year project to replace Social Security Health Insurance Claim Numbers to Medicare Beneficiary Identifiers for Medicare appeals transactions. § Expanding the user base of the Medicare Appeal System to include all Part A adjudicating contractors.
