TECHNICAL SKILLS:
LANGUAGES SOFTWARE OPERATING SYSTEMS FILE ACCESS METHODS
COBOL TSO/ISPF OS/390 DB2
CICS EASYTRIEVE OS/VS1 VSAM
ALC LIBRARIAN MVS DL/1
FOCUS Volle DOS TOTAL/ENVIRON1
EDI Transactions 837-I, 837-D, 837-P 270/271 276/277 278
Building & Validating 820, 834, 835 997
WORK EXPERIENCE:
05/04 - present
06/07 - 02/08 Senior Technical Project Consultant Humana Military
Healthcare System (HMHS)
Louisville, Kentucky via Awaken-To, LLC
Enhanced Humana Military Health System(HMHS) On-line Medical Review Systems
Designed and coded New Disease Management on-line tracking and reporting
systems
Modified HMHS Case Management system
Modified Military Treatment Facility Consult Fax system
Enhanced Prior Authorization system as outlined by EDI 278 guide and Trading
Partners
Responsible for Technical System changes for NPI implementation
Attended in-house NPI and meetings
Enhanced and developed code to produce the required government reports
Provided on-call support for HMHS IT systems
Perform CICS and Batch changes to DB2 programs
Project Lead Consultant State of Maryland
Department of Health and
Mental Hygiene (DHMH) MMIS-II
Facilitate all task associated with Recipient-Buy-In Subsystem
Design and implement a new state-of-the art Buy-in Redesign System
Coordinate the involvement of various departmental staff
Create and manage the project plan
Create a current Buy-In system assessment and project flow document
Manage the project tasks and personnel
Facilitate project meetings
Assist Information Technology (IT) staff with programming, testing and debugging
when
applicable
Create programming specification for IT staff
Create User documentation
Produce status report for shareholder and other applicable staff
Maintained an ongoing project issue log
Review project life cycle and time lines with managers at various level
Create and update batch job running schedule based on new design features
Conduct User and IT staff training
06/07 Project Manager Health Insurance Plan
of NY
Manhattan, NY
Worked with Trading Partner submission of the EDI transactions (837 I,D,P,
270/271, 276/277)
Assisted with required NPI Information Technology coding changes and Trading
Partner
upgrades
Update Trading Partner Companion Guide when applicable
05/04- 06/07
03/03-04/04
Senior Technical Project Consultant Humana Military Healthcare
System (HMHS)
Louisville, Kentucky via Awaken-To, LLC
Enhanced Humana Military Health System(HMHS) On-line Medical Review Systems
Designed and coded New Disease Management on-line tracking and reporting
systems
Modified HMHS Case Management system
Modified Military Treatment Facility Consult Fax system
Enhanced Prior Authorization system as outlined by EDI 278 guide and Trading
Partners
Responsible for Technical System changes for NPI implementation
Attended in-house NPI and meetings
Enhanced and developed code to produce the required government reports
Provided on-call support for HMHS IT systems
Perform CICS and Batch changes to DB2 programs
HIPAA Project Team Lead Unisys Corporation via Datatek Consulting Group
Kentucky Medicare Medicaid Information System
As HIPAA Team Leader, assisted the State programs staff with crosswalks for the
various HIPAA code-sets, billing instructions, companion guides in conjunction
with the EDI Implementation Guides.
Directed the technical staff on coding changes involved with processing the EDI
transactions for MMIS claim processing as well as creating EDI transactions on
the IBM Mainframe.
Assisted with building the EDI 837(I, D, P), 835, 277-U, 270/271, 276/277, 278
820 and 834 transactions processing flow from the Trading Partners to the
translator to the Mainframe and back to the Trading Partner.
08/02 – 02/03 HIPAA Operations Implementation Mgr First Health Service
Corp via Datatek
For the State of Alaska Consulting Group
As the Operations Manager for implementation of HIPAA, conducted the HIPAA Gap
analysis and performed an operations assessment of all functional areas within
the fiscal agent to determine the HIPAA impacts and recommendations.
Developed and maintained the necessary project plan to enable the state to meet
the designated testing and implementation dates.
For HIPAA, created EDI transaction crosswalk matrix to identify system
enhancements, translator requirements and companion guide information regarding
EDI transactions(837(I,D,P), 835, 820,834, 270/271, 276/277, 278).
Performed analysis to identify code-sets usage such as (HCPCS, CPT-4, IDC9, and
local codes).
11/01 – 07/02
HIPAA Coordinator & Technical Project leader Computer Science Corp. via
MD Department of Health and Mental Hygiene MTCI
Facilitated necessary HIPAA meetings to communicate pertinent information to all
parties and to resolve any outstanding concerns.
Conducted walkthrough meeting with the various state programs and technical
staff to ensure that all requirements are documented and understood.
Developed an issue log to properly record, track and update information
concerning all HIPAA issues.
Assisted the Claims team lead with a working definition for the use of national
modifiers.
Participated in the code set crosswalks with the state programs to ensure the
correct reporting of the FFP dollars would be maintained when the HIPAA requires
are implemented.
Reviewed the HIPAA EDI transaction based on the implementation guide
requirements(837(I,D,P),270/271, 276/277, 835). Perform GAP analysis for HIPAA
project.
Used Micro-soft Project to track task, deadlines and show timelines.
Designed new system requirements for maintaining national codes and modifiers as
updates are made.
Designed new system strategies to interact with the Pre-Auth system and the EDI
278 transaction.
Developed various approached of interactions with the translator vendor and MMIS
teams.
Attended the HIPAA conferences.
8/98 – 08/01 Senior Technical Project leader Datatek Consulting Group via MTCI
Maryland Department of Health and Mental Hygiene
Supervised the programming and analyst staff to ensure proper implementation of
customer service requests and problem corrections for Maryland’s Medicaid
Management Information System.
Interfaced with the user community to ensure that all system changes were
compliant with their requests. Provided necessary training for user and
programming staff.
Developed, coded and implemented system changes to increase productivity in the
user community.
Provided on-call support for production systems.
Performed technical writing when needed. Modified Maryland’s Medicare Buy-In
subsystem to handle CMS Third Party Redesign Modification.
Attended HIPAA meetings to discuss required compliance strategies required by
law for the Claims and Recipient systems. System areas included: Medicare
Buy-in, Third Party Liability, Cost Settlement, Maryland Children’s Health
Program, Recipient and BENDEX.
6/97 – 8/98 Principle Programmer Analyst / Senior Programmer/Analyst Unisys
Corporation
Kentucky Medicare Medicaid Information System
Supervised the programming and analyst staff to ensure the timely implementing
of service request from the MMIS user community.
Trained the technical staff in areas of debugging, software development, and
reporting tools for quick reporting and analysis.
Conducted technical interviews for new hires and contractual employees.
Provided on-call support for production systems.
Provided training for new hire, junior and entry level staff. MMIS subsystems
worked on: Recipient, Third Party Liability, Cost Settlement, Medicare Buy-in,
BENDEX, MARS and various Claims issues.
5/97 – 6/97 Senior Programmer/Analyst Clark Material Handling Co.
Modified DL/1 batch and on-line programs per user requests.
7/94 – 2/97 Senior Programmer / Analyst Masterpiece Software Solutions,
Frankfort, KY
For the State of Kentucky (Medicaid)
Converted Florida Medicaid Management Information System programs for use in the
Kentucky Medicaid system per user and state law requirements.
Converted client data to vendor specification. Responsible for Recipient, TPL,
Drug Rebate, MARS and Medicare Buy-In system implementations.
Developed and implemented a new on-line system.
Corrected and changed notification text for Food Stamp and Medicare systems.
Clients included: Commonwealth of Kentucky, Unisys/Frankfort KY.
11/92 - 7/94 Senior Programmer / Analyst Clark Material Handling Company,
Lexington, KY
Designed, coded, implemented, documented, enhanced and supported the following
systems: Envoy Process, PIN, G/L, Physical Inventory, Production Support, and
FoxPro sales.
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