Tara Parham Email & Phone Number

Columbus, Ohio Area

(contract ended) Provide management and business advisory services on the DDI for the Integrated Eligibility System (IES) project, Medicaid Expansion, MAGI, and the Healthcare Exchange Integration for the State of Ohio Department of Administrative Services.• Facilitate discovery sessions, focus groups and workshops with business stakeholders to identify business needs, including organizational change management and solution requirements.• Review program / project artifacts to provide recommendations on functional and technical aspects to ensure the solution is delivered in an effective and efficient manner.• Review and evaluate the accuracy and completeness the project plans, work products, and deliverables.• Evaluate the project’s operations, hardware, software, interfacing applications, documentation, policies, processes, procedures, and process products to ensure compliance with project critical success factors and goals.• Assess deployment readiness and assist with organizational change management activities, such as communications, training, defect work-around development, business readiness checklist, etc.• Facilitate the gap analysis process between the contractor’s COTS solution and the State’s solution requirements to identify customization needs.• Ensure contractor’s adherence to the SDLC process and provide guidance to resolution discrepancies, issues and risks.• Conduct functional and technical interviews and user reviews; inspections and audits; walkthroughs; and debriefings, as well as assist in developing interview questions and evaluation criteria for these activities.• Support maintenance and operations activities by independently assessing, identifying, and documenting of products issues / defects received via the incident and problem management processes.• Oversaw solution change management process to support user enhancement requests.

Baton Rouge, Louisiana Area

(vendor contract canceled)• Provided oversight and maintain focus on the Seven Conditions to incorporate in the solicitation for proposal (SFP) and certification planning for the procurement of a SOA, MITA-compliant Medicaid Management Information System (MMIS). • Managed efforts to define system, reporting, and component requirements for appeal & grievances, TPL, care management, and prior authorizations to procure a new MMIS that adheres to the State's future enterprise vision and incorporates ongoing State initiatives (i.e. HIE/HIT, Affordable Care Act (ACA)- Health Care Reform), Medicaid IT Architecture (MITA), and Medicaid Enterprise Technical Certification (MECT).• Developed Case Management/Care Management system functionality focused on existing business processes, efficiency, innovation, transparency, and person-centered care & outcomes for nursing home, ICF/ID, 1915c waivers, Medicaid managed care, and state plan Medicaid Home and Community Based Services (HCBS).

Carson City, Nv

(temporary Grant position)• Lead Business Analyst for Money Follows the Person (MFP) Grant. Partnered with developers for software and user interface design to implement efficient Health Information Technology (HIT) with focus on developing a single point of entry Case Management System, to be utilized across all agencies for the entire State of Nevada Medicaid. • Assisted in the implementation of a new Medicaid fiscal agent focusing on Service Level Agreements (SLAs) and Corrective Action Plans (CAPs).

Hartford, Connecticut Area

• Tripled recovery revenue within 6 months by developing and implementing a revised Connecticut Medicaid audit program.• Managed the entire program for the state of Connecticut and all 33 urgent care facilities: planning, scheduling, forecasting, performing audits, financial analysis, resolving provider disputes, troubleshooting errors, processing retractions & adjustments, follow-up, and reporting.• Assisted in developing and implementing the Connecticut Medicaid Provider Portal: user acceptance testing (UAT); creating technical training manuals and performing system training via webinar to vastly increase efficiency and bridge HMS (CT Medicaid Recovery Audit Vendor), Providers and MMIS operations. • Subject Matter Expert (SME): Mentored, trained, and assisted auditors with the implementation of the Medicaid Recovery Program in 4 other states.• Supervised healthcare data analytics process to identify payment errors and trends, resulting in increased revenue of $870,000 from one facility.• Administered the quality control functions; conducted on-site presentations to educate Provider Network on Medicaid and TPL policies & procedures.• Performed system analysis; tested and researched systems for potential errors; ensured proper claim payments, benefit, contract information, and recoupments were processed properly. • Demonstrated adaptability and quick technical learning skills by performing system and account analysis with-in a strict timeframe while utilizing various hospital software applications.

Hartford, Connecticut Area

• Upon entering the position, turned around key project that was in a 5-week backlog by creating an action plan, setting goals, and identifying obstacles, bringing it current within 4 weeks.• Analyzed and modified RFP's from third party corporations ensuring the companies’ short-term needs were also supporting the long-term growth and were in compliance with federal guidelines. • Managed control and crystal reports to help reduce financial exposure and identified potential system issues.

Hartford, Connecticut Area

• Recovered almost $1million in lost revenue in less than 6 months by performing reimbursement analysis and patient account reconciliation.• Successfully led team of account managers in establishing AIM in new hospitals by training staff on facility software, providing education to hospital personnel, and working to build positive relationships with senior management at hospitals.• Increased annual revenue by 68% monitoring error trends; testing and researching systems for potential errors on claim payments, benefit information, and contract information; and establishing reports to monitor and follow up on identified data.

Hartford, Connecticut Area

• Promoted after only 7 months from a Benefit Analyst to National Appeals & Compliance Analyst leading the National Appeals Pilot Program.• Reduced non-compliance from 46% to 8% in 7 months: created appeal and compliance business processes for all parts of business, analyzed state and federal laws, and developed system enhancements needed to ensure compliance. • Developed appeals database to drive efficiency in tracking and monitoring disputes, reducing non- compliance, and increasing productivity, which was recognized as a best practice and utilized across the division. • Identified, researched, and resolved all member and provider appeals for the Bristol Claims Office while staying in compliance with state and federal laws. • Pilot position resulted in creating, training, and auditing a new appeals and compliance team that consisted of 6 employees.