Vivian De La Gándara's Location
Lake Worth, Florida, United States, United States
Vivian De La Gándara's Contact Details
Vivian De La Gándara work email
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Vivian De La Gándara personal email
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About Vivian De La Gándara
Vivian de la Gándara is the President of MMISME LLC a small Medicaid consulting firm located in Lake Worth, Florida. She began her Medicaid career in the State of Florida in 1999 by working for one of the state's previous fiscal agents. With 25 years Medicaid experience in the private and public sector and work in 13 states, DC and in the US territory of Puerto Rico, she has been successful in slowly growing her certified Minority and Woman Business Enterprise (MBE/WBE) by partnering with clients to provide Medicaid related consulting services that adds value and help them achieve success.Relevant experience includes:• Operations Management• Provider Relations• Provider Enrollment • Claims Operations• Provider and Member Call/Contact Centers• Provider Subsystem Design• Provider and Member Web Portal Design and Development• Project Management• User Acceptance Testing • Provider Acceptance Testing• MMIS DDI Transition Planning• Operational Readiness Testing • MMIS Implementation• Strategy and Planning • Technical Writing including IAPDs, IAPDUs, OAPDs, RFPs, Proposals and Project Deliverables• MITA State Self-Assessments (SS-A)• MES Certification MECL/MECT/MEET/Outcomes Based Certification (OBC) Pilots and SMC on MES and E&E Systems• CCWIS Certification with ACF• SNAP Certification with FNS
Vivian De La Gándara's Current Company Details
Vivian De La Gándara Work Experience Details
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Business Owner/PresidentMmisme Llc Feb 2009 - PresentBoynton Beach, Florida, UsResponsibilities: Serve as an agent of the company as a director, decision maker, leader, manager, executor as it relates to all day-to-day operations and strategic matters. This includes human resources management, negotiating, securing and executing contracts and subcontracts, financial responsibilities such as processing payroll, invoicing in addition to other fiscal management related tasks needed to forecast needs and secure new funding sources. With experience in 15 different Medicaid programs and counting, Vivian’s 21 years of unique experience from strategy to operations in the public and private sector provides her clients with a variety of insights to help them achieve success on various MMIS related projects.
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Certification Lead (Consulting Services)Ey Mar 2024 - PresentLondon, Gb -
Mita Lead (Consulting Services)Ey Jan 2023 - Jun 2024London, Gb
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Certification LeadCloud And Things Jun 2023 - PresentTroy, New York, UsServe as Certification Lead as a subcontractor in the state project management office (PMO) where Berry Dunn is the prime contractor on the West Virginia Peoples Access to Health (PATH) project. Responsible for overseeing the certification process of the integrated eligibility solution which includes the eligibility and enrollment, comprehensive child welfare information system (CCWIS), child support enforcement system and supplemental nutrition assistance program (SNAP). -
Consulting ServicesCambria Solutions Oct 2017 - Dec 2022Sacramento, Ca, UsResponsibilities: Provide MITA Lead as well as SME support and related services to support the following projects and roles:• Florida Agency for Healthcare Administration (AHCA) MES on the Strategic Enterprise Advisory Services (SEAS)-Certification Manager• District of Columbia (DC) Department of Health Care Finance (DHCF)-MITA Lead• Mississippi Division of Medicaid (DOM) MMIS Replacement Project (MRP) PMO Certification Manager• Louisiana Department of Health (LDH) PPMO Project-Certification Lead -
Mita Sme/Mmis Certification Lead/Sme/ConsultantIntervoice Jan 2016 - Oct 2021San Juan, San Juan , PrResponsibilities: • Provide Certification and MITA related expertise and guidance to the project• Support PRMP while participating and achieving federal certification using the Outcomes Based Certification (OBC) Pilot• Assist the PMO in developing project status reports for the Puerto RIco Medicaid Program (PRMP) • Assisting in the preparation of the CMS biweekly status reports and presentations for the monthly Steering Committee. • Responsible for documenting and tracking action items, risks and decisions• Providing technical writing services to support the development and approval of planning documents for PRMP including the Implementation Advanced Planning Document (IAPD) necessary to obtain Federal funding for the Puerto Rico MMIS Module 1 and 2 DDI project and the operational advanced planning document (OAPD) in preparation for Go-Live -
Mita SmeBriljent Sep 2019 - Jun 2020Fort Wayne, In, UsProvide SME Services to support the MITA 3.0 Assessment of the Alaska Department of Health and Social Services (DHSS) Medicaid Enterprise. -
Medicaid ConsultantClient: Health Law Network (Hln) Feb 2013 - Dec 2017Responsibilities: Provided Medicaid related research and consulting services
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Medicaid ConsultantCsg Government Solutions Mar 2011 - Sep 2016Chicago, Il, UsResponsibilities: Served in various subcontracting roles for various CSG clients including: • Centers for Medicare & Medicaid Services (CMS)• Florida AHCA• Indiana FSSA • Minnesota DHS• Virginia DMAS• Kentucky CHFSRoles included serving lead analyst and technical writing roles on MITA, ICD-10 and re-procurement related projects. -
Medicaid Provider Enrollment ConsultantClient: Youth Advocate Programs, Inc. Apr 2011 - Jul 2012Harrisburg, Pa, UsResponsibilities: Provided Medicaid consulting services assisting the organization with provider enrollment and credentialing initiatives across the nation -
Medicaid Provider/Member ConsultantClient: Accenture Llp Dec 2010 - Aug 2011Dublin 2, IeResponsibilities: Provided Medicaid consulting services related to provider and member services. Worked on business development including assisting in preparing proposals, capturing new business and participating in preparing and delivering oral presentations required in the proposal bidding process. -
Project Manager/Business Analyst/Medicaid SmeGeorgia Department Of Community Health Feb 2009 - Nov 2010Atlanta, Georgia, UsResponsibilities: Served in a DCH staff augmentation role as a member of the DCH IT Project Management Office (PMO) where I was responsible for daily project management duties for Provider, Web Portal, Rules Engine and Workflow functional areas for Georgia's design, development and implementation (DDI) transitioning DCH from ACS (now Conduent) and its Multi Health Net (MHN) MMIS to HP (now DXC) and it's Interchange MMIS solution. -
Medicaid Business ConsultantHealthcare Resource Group (Hrg) Oct 2008 - Feb 2009Spokane Valley, Washington, UsResponsibilities: Assisted HRGs client-Kaiser Permanente complete the Medicaid provider enrollment and credentialing process. Kaiser Permanente wanted its providers to become Medicaid providers in order to offer additional physician specialty services to eligible Medicaid members in the Atlanta area. This included assisting Kaiser Permanente enroll its physicians and other clinicians into the Medicaid Program as well as assisting in creating processes and procedures pertaining to systems and operations in order to support the organization's community initiative. -
Senior Operations ConsultantXerox Sep 2005 - Oct 2008Norwalk, Connecticut, UsResponsibilities: A consulting position assisting internal ACS clients improve operational areas and become more efficient. Also, assist in writing proposals as well as planning and implementation of new projects. Assignments completed included work on the following state Medicaid MMIS contracts:• Colorado• DC• Montana• New Hampshire• New Mexico • North Dakota • TexasAdditionally completed work on the New Jersey Enrollment Broker and Eligibility Contract. -
Director Of Customer CareXerox Feb 2005 - Sep 2005Norwalk, Connecticut, UsGeorgia Medicaid's Fiscal Agent MMIS ProjectResponsibilities: A senior leadership position overseeing all fiscal agent outsourced customer service operations which serviced Georgia Medicaid members and providers on behalf of the Georgia Department of Community Health (DCH). Had functional responsibility for 105 employees which included three direct reports. (two managers and two coordinators) which consisted of the following eight units:-Provider Call Center-Member Call Center-Web and EDI Technical Support Helpdesk-Grievances-Written Correspondence-Escalation and Research-Training and Publications-Provider Education and Outreach Field Operations
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Claims Operations ManagerXerox Jul 2004 - Feb 2005Norwalk, Connecticut, UsGeorgia Medicaid's Fiscal Agent MMIS ProjectResponsibilities: A management position overseeing the fiscal agent outsourced claims operations functions which processed claims for Georgia Medicaid members on behalf of the Georgia Department of Community Health (DCH) which received paper and processed paper and electronically submitted claims from Georgia Medicaid providers for services rendered to Georgia Medicaid members. Had functional responsibility for 80 employees and responsible for four direct reports.(an assistant manager, two supervisors and a claims analyst)The department consisted of the following six units:-Claims Resolutions-Voids and Adjustments-Mail Room Operations-Coordination of Benefits (COB) -File Maintenance-Financial Dispositions
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Provider Services ManagerXerox Jul 2003 - Jul 2004Norwalk, Connecticut, UsGeorgia Medicaid's Fiscal Agent MMIS ProjectResponsibilities: A management position overseeing the fiscal agent outsourced provider training, communication and outreach related functions for Georgia Medicaid providers on behalf of the Georgia Department of Community Health (DCH). Had functional responsibility for 54 employees also responsible for four direct reports (two managers, a supervisor and a coordinator) and had functional responsibility for the following four units within the department: • Provider Enrollment• Escalation and Research• Training and Publications • Provider Education and Outreach • Field Operations
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Provider Support ManagerXerox Nov 2001 - Jul 2003Norwalk, Connecticut, UsFlorida Medicaid's Fiscal Agent MMIS ProjectResponsibilities: A management position overseeing the fiscal agent outsourced provider support related functions for Florida Medicaid on behalf of the Agency for Healthcare Administration (AHCA). The Provider Support Department serviced all Florida Medicaid providers. Had functional responsibility for 75 employees also responsible for four direct reports(a manager and three supervisors) and functional responsibility over the following five units:• Provider Enrollment• Provider Inquiry Call Center• Research and Written Correspondence• Training and Publications• Provider Education and Outreach • Field Operations
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Provider Field Services ManagerXerox Jun 2000 - Nov 2001Norwalk, Connecticut, UsFlorida Medicaid's Fiscal Agent MMIS Project.Responsibilities: A telecommuting management position overseeing the fiscal agent outsourced Provider Education and Outreach related functions in the field for Florida Medicaid on behalf of the Agency for Healthcare Administration (AHCA). The Provider Field Services Department serviced all Florida Medicaid providers. The position oversaw a professional staff of 18 remote provider field representatives located across the state of Florida. Responsible for consistently communicating vital information from the home office to field staff. Ensured that all services rendered to large physician group practices, hospitals and other Medicaid providers as well as provider associations located across the state of Florida were completed accurately and promptly.
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Provider Field Representative (Area 4)Xerox Apr 1999 - Jun 2000Norwalk, Connecticut, UsFlorida Medicaid's Fiscal Agent MMIS ProjectResponsibilities: A telecommuting position supplying fiscal agent outsourced Provider Education and Outreach related services in the field for Florida Medicaid providers on behalf of the Agency for Healthcare Administration (AHCA) Area 4 field office. The Area 4 Provider Field Representative was responsible for training and helping all Florida Medicaid providers in Nassau, Duval, Clay, St. Johns, Flagler and Volusia counties on Medicaid billing policy as well as troubleshoot denied claims. Served as a liaison between the the Medicaid Fiscal Agent and AHCA. Represented the fiscal agent at local provider association meetings.
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Marketing CoordinatorTower Hill Insurance Group 1997 - 1999Gainesville, Fl, UsResponsibilities: An in house marketing position responsible for Marketing Tower Hill insurance products to independent insurance agents located in the South Florida region.
Vivian De La Gándara Skills
Medicaid
Process Improvement
Project Management
Training
Leadership
Business Analysis
Healthcare
Management
Analysis
Vendor Management
Business Process Improvement
Hipaa
Sdlc
Management Consulting
Healthcare Information Technology
Business Development
Strategic Planning
Insurance
Change Management
Provider Relations
Team Building
Healthcare Management
Customer Service
Medical Billing
Edi
Project Planning
Operations Management
Hospitals
Medicare
Claim
Managed Care
Mmis
State Government
Provider Enrollment
Technical Writing
Fiscal Policy
Call Center
Claims Operations
Workflow Management
Uat Coordination And Tracking
Contract Negotiation
Mita
Mmis Web Portal
Fraud Deterrance
Provider Outreach
Call Center Management
Contact Center Management
Fiscal Agent Services
State Self Assesments
Bilingual Spanish And English
Vivian De La Gándara Education Details
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University Of FloridaJournalism -
Santa Fe Community CollegeJournalism
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Coronado High SchoolGeneral
Frequently Asked Questions about Vivian De La Gándara
What company does Vivian De La Gándara work for?
Vivian De La Gándara works for Mmisme Llc
What is Vivian De La Gándara's role at the current company?
Vivian De La Gándara's current role is Business Owner/President at MMISME LLC.
What is Vivian De La Gándara's email address?
Vivian De La Gándara's email address is mm****@****ail.com
What schools did Vivian De La Gándara attend?
Vivian De La Gándara attended University Of Florida, Santa Fe Community College, Coronado High School.
What skills is Vivian De La Gándara known for?
Vivian De La Gándara has skills like Medicaid, Process Improvement, Project Management, Training, Leadership, Business Analysis, Healthcare, Management, Analysis, Vendor Management, Business Process Improvement, Hipaa.
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