Large healthcare insurance payer
- Managing an initiative to identify how our client can expand delegated capitation FFV models across geographies, and government and commercial lines of business
Large healthcare insurance payer
- Led a four-year, $26 million, large scale business process improvement and software implementation project for one of the nation’s largest healthcare insurance companies
- Implementation of a technology platform to improve medical claim fee-for-service processing and associated performance based financial settlements between payer and providers
- Key role in functional design of the technology platform to allow business flexibility and extensibility
- Oversight of testing strategy to verify that over $35 billion in gross hospital charges are reimbursed accurately
- Implemented solution included the following components:
-Custom Java based applications for production operations and modeling “what if” scenarios
-Rules based (IBM JRules) calculation engine and rule authoring and monitoring application
-SAS analytics engine
-Legacy system/future-state system data conversions, integrations, and cut-over processes
-Business intelligence capabilities including 100+ Cognos reports and self-service analytics data mart
Large healthcare insurance payer
- Led a project designed to update contract reimbursement systems to be ICD-10 compliant, which included:
-Deriving new identification rules for ICD-10 based claims
-Assist the business with managing contract updates
-Analyze reimbursement impacts due to ICD-10 - Designed and managed implementation of business processes and technology to manage new provider network and contracting scenarios including:
-Narrow and tiered networks
-Global risk agreements - Designed and developed a contract inventory methodology, application and data base to deconstruct and store contractual pricing terms
- Managed requirements and development of a ILOG JRules based proof of concept to demonstrate rules based pricing
- Testing design, planning and execution of a large data conversion and testing effort, which converted over eight years of medical paid and reimbursed claims data.
Healthcare compliance
- Created a technology roadmap for mid-size heath care compliance firm with technology initiatives designed to improve and scale our client’s business
- Managed the implementation of key technology initiatives identified on the roadmap, including:
-Creation of a customer facing web portal for reporting and document management
-Custom medical record and claim auditing tool
-Implemented governance practices
Major derivatives exchange
- Managed a project to build a software application and testing capability for a new financial derivatives model
- Managed a team of 15 client, vendor and consulting resources
- Incorporating systems development lifecycle (SDLC) methodology to provide project structure and control
Major credit bureau
- Designed and implemented a custom software application to derive annual pricing increases for a set of over 50,000 customers based on a large number of client dimensions
- Assisted our client to derive pricing methodology to increase price and transaction volume across subscriber base. First year increases were greater than $2 million.
Manufacturer of heavy mining equipment
- Managed project which focused on capacity planning and throughput improvement in a major manufacturer of large scale mining equipment
- Led a team, which built a suite of models designed to quickly test loading scenarios in each of our clients’ manufacturing areas, from fabrication, welding, machining, to assembly.
Compliance and due diligence
- Internal auditor preparing clients for information system assessments for Sarbanes-Oxley compliance.
- Assisted clients with due diligence and reverse due diligence to assess the technology capabilities in an organization
Large telecommunications provider
- Managed the development of detailed test metrics tools to track distribution workforce efficiency.
- Assisted telecommunications clients with improving and consolidating their application testing organizations.
- Designed and executed performance and concurrency testing of large-scale load balanced systems using Mercury LoadRunner and TestRunner toolsets
- Implemented large-scale custom-built information technology solutions for large telecommunications clients.