Technical Project Lead designing and implementing optimal project performance and effective business outcomes for compliance, professional development, and systems management supporting the North American business market.• Design, plan, implement, maintain systems, and related processes for the North American cross-business market. • Reveal redundant and resource waste through continuous process improvement of established processes• Explore and teach new technologies• Create, maintain project-related data analysis, reporting, and dashboards using Excel, Power Query, Power BI, and Tableau.• Able to communicate complex system processes to technical and non-technical stakeholders for optimal collaboration through the planning and implementation process.• Recognized by management for technical expertise and project oversight as a Program Specialist and promoted to Senior Systems Administrator• Modeled, designed, implemented a PM operating system and global reporting process resulting in 245 deployment completions capturing $5,839,960.00 of annual productivity and scope creep within 6 months.o Forecasted to identify an additional $18-20,000,000 by fiscal year-end 2021.o Estimated full North American deployment completion 36 months prior to original date.o Utilized Lean Six Sigma methodologies as follows: Designed, delivered surveys, and conducted strategic group interviews for the Pareto Chart method across 9 business divisions and hierarchical leadership levels to identify deployment gaps. Managed in-depth, multi-team sessions utilizing the Complex Issues Leverage Matrix (CILM) method to identify multiple root-causes and develop efficient, cost-effective solutions. Standard Deviation and Regression Statistical methods were used for describing site statistics and contractual forecasting.o Utilized the Smartsheet application interfacing Power BI for reporting and dashboards.

• Provided Medicare/Medicaid Financial Risk Data and Business Analysis for Managed Care, Value-Based Medical Business, MSOs, and IPAs• Conducted Medicare Risk Adjustment (MRA) assessment for clinical appropriateness and financial optimization o Provided training to physicians and staff• Conducted capitation and surplus contract assessment for limited, full, and global risk contractso Provided strategically contractual and business guidance• Network assessment and development to support improved clinical outcomes and cost-effectivenesso Developed value-based Pain Management network for a Managed Care organization resulting in an estimated $15 million cost savings annually• Strategic redesign of operational systems supporting the value-based medical businesso Redesigned operational data workflow process for a primary-specialty network forecasting $6 million savings within two years of implementation. Assessed $8 million in excess costs over the previous two years:• Hospital Case Management support gaps negatively impacting Part B costs• Excess Part D costs prescribed by Specialty network• Aligned patient care assessments with managed care HEDIS requirements to improve ratings and potential for financial surplus awards (potential award unknown)

• Contracted, managed a Medicare Advantage Primary Care MSO with a Medicare and Dual-Eligible patient panel; 30% of the WellCare Medicare Treasure Coast, Florida population with a global risk, capitated contract ($3.9 million annually)• Provided monthly service funding and high-cost patient events with clinically and financially appropriate options for capitated/surplus driven contractual business for Medicare parts A, B, and D using health plan EDW• Developed and maintained a competitive contractual specialty and hospitalist network resulting in a continuous decrease in part A and B expenses.• Developed and managed hospital case management, referral authorization services, Medicare billing (EHR and clearinghouse support), and HEDIS processing (specific to the MA plan's focus).• Created and maintained remote HIPAA compliant data process for efficient and secure PHI processing with SharePoint.• Developed Rx consulting services supporting financially manageable part D expenses

• Managed the South Florida primary care Medicare Advantage affiliate provider network• Conducted monthly Medicare financial risk business and data analysis of service fund with access to the Enterprise Data Warehouse using Excel and PowerPoint to analyze, report, and create data visualizations.• Designed, created and implemented HIPAA compliant SharePoint claims and records transfer system resulting in a decreased claim processing time by 12 days and 104 weekly personnel hours• Increased the number of quality affiliate providers by 65%, in 3 months creating greater growth opportunities in the south Florida region.• Increased HMO membership by 83% in the South Florida region in 9 months• Contracted new cost-effective specialty network for Gastroenterology resulting in a 400% decrease in annual HEDIS required colonoscopy procedures for a patient population of 1,500.• Provided continuous Medicare Risk Adjustment (MRA) coding and HEDIS education to network physicians and staff resulting in improved HEDIS ratings for 68% of network providers.

• Transformed unprofitable medical center into an award-winning, profitable business with a $1.3M annual income within one year. Established financial discipline, restructured staff, instituted effective operating procedures, repaired community relations resulting in a Rising Star and 5-Star Awards for the center.• Stopped seven-year declining patient membership trend with a 6% net increase in Humana membership. • Grew 15 to 27 contracted providers within six months• Established business development, provider relations, MRA, HEDIS, and administrative staff policies and procedures for 14 Humana affiliate medical centers, 3 wholly-owned centers, and 11 Physician United Plan affiliate medical centers.