Experience

Under contract with Diversified Services Network (DSN) provided Medicaid subject matter expertise and business process analysis services. Supported the NTTDATA IES Tech Refresh PMO team. Worked closely with Illinois DOIT managers and staff to facilitate meetings, deliver meeting records and to coordinate the production and delivery of project status reports. Provided Medicaid Subject Matter Expertise to assist Illinois program and IT staff to understand the need for and ongoing status of Tech Refresh activities. The Tech refresh activities included regular status reporting to CMS staff responsible for oversight of the IES operation and continued financial support of the ongoing IES development and operations. Promoted improved team member understanding of Medicaid programs and the Medicaid Enterprise System (MES).

Providing Medicaid subject matter expertise and business process analysis services to produce As-Is documentation for current Medicaid systems. Working closely with DOH managers and staff to refine the As-Is documentation and to produce To-Be business process documents. Working to assist DOH policy and systems oversight staff to better understand current as-is processes and to consider the impact of proposed to-be processes on the Medicaid programs the Medicaid Enterprise System (MES) supports.

Worked as a sub-contractor with Intervoice Puerto Rico to provide MMIS implementation and certification lessons learned and to assist with ongoing planning activities to support the MMIS and Eligibility and Enrollment (E&E) system initiatives.

Provided Medicaid Enterprise operations oversight and knowledge transfer services to explain the scope of the Medicaid Enterprise System (MES) and to support the Puerto Rico Medicaid Management Information System (PRMMIS). Worked closely with the PRMMIS operations oversight team to assist PRMP managers with producing evidence artifacts to define and comply with the PRMMIS CMS Outcomes Based Certification (OBC) tasks.

Providing Medicaid enterprise operations and Design, Development and Implementation (DDI) quality assurance services. Serving as project manager of the eMedNY QA focus area. Also serving as subject matter experts to support the Medicaid Administrative Services (MAS) focus area and the Medicaid Data Warehouse (MDW) QA focus area. Providing technical assistance to assist Office of Health Insurance Programs (OHIP) staff to plan integration and maintenance activities between the MMIS and related systems including the Medicaid Data Warehouse, the New York State of Health (NYSoH) Health Insurance Exchange, the Provider Incentive Payment Management system, and the Welfare Management System. Providing HIPAA security and privacy compliance assessment and technical assistance. Providing Medicaid subject matter expertise to assist the OHIP to ensure ongoing compliance of the Medicaid enterprise systems and programs with the Affordable Care Act and other applicable Federal regulations.

Providing requirements definition, meeting facilitation, and documentation consulting services to assist the New York State of Health (NYSOH) insurance exchange to define and build an improved Provider Network Data System (PNDS). Working with NYSOH administrators, health plan administrators, and consumers to review previously developed requirements documentation and to adjust and add requirements to meet the current and future needs of PNDS stakeholders.

Performed Independent Verification and Validation (IV&V) services over the MEP component of the overall HIX solution. Serving as part of a larger IV&V team assisting the Commonwealth and CMS to implement the HIX.

Provided Medicaid enterprise operations quality assurance services. Played a lead role in the completion of the DOH Medicaid Information Technology Architecture (MITA) State Self-Assessment (SS-A). Also provided technical assistance to assist Office of Health Insurance Programs (OHIP) staff to plan integration and maintenance activities between the MMIS and related systems including the Medicaid Data Warehouse, the Health Insurance Exchange, the Provider Incentive Payment Management system, and the Welfare Management System. Provided ongoing HIPAA security and privacy compliance assessment and technical assistance. Provided Medicaid subject matter expertise to assist the OHIP to ensure ongoing compliance of the Medicaid enterprise systems and programs with the Affordable Care Act and other applicable Federal regulations.

Provided Medicaid subject matter expertise and Independent Validation and Verification technical assistance as a subcontractor to Berry Dunn of Portland Maine. Responsible for support of the State MMIS implementation and provided quality assurance and independent verification of project deliverables including system requirements, project management reporting, and systems and user acceptance testing. Produced weekly and monthly status and deliverable assessment reports for distribution to the project Executive Steering Committee and to the Federal Centers for Medicare and Medicaid Services (CMS). These reports contained strengths and weaknesses of project deliverables, and recommendations for improved project management activities and deliverable contents. Worked closely with State staff and MMIS implementation vendor staff and provide advice to help complete work tasks to ensure the quality and timely implementation of the Maine Integrated Health Management System.

Supported the State SMHP team to develop a ‘current state’ environment scan and to document the extent to which Electronic Health Records (EHR) have been adopted among providers across the Commonwealth of Massachusetts. Developed documents and recommendations to assist the State to decide how best to implement provider incentives to increase the use and acceptance of Health Information Technology (HIT). Developed a road map that the State is using to plan for technology purchases and the future vision of HIT in Massachusetts.

Reviewed the updated Medicaid Information Technology Architecture State Self Assessment (MITA SS-A) as a guide to develop an IAPD to support the AHS plans to procure and implement an advanced Medicaid Enterprise Solution. The MES is supported by a modern Service Oriented Architecture and improved Medicaid Management Information System (MMIS) functionality.

EKOLU served as a subcontractor to Electronic Data Systems (EDS) and as a members of the MMIS implementation management team. Responsible for producing high level Medicaid business process documents and desk level procedures. Responsible for producing training plans, training materials, training delivery staffing plans, and presentation of training courses to DHS staff. Provided Medicaid systems and program expertise to the project team. Worked closely with the project Business Process Improvement and Testing Managers to ensure the quality of project deliverables.

Responsible for specific business areas including Electronic Document Management, Contract Management, Managed Care, Eligibility and Enrollment, and Benefits Administration. Served as subject matter experts providing program and technical support to the project team. Also served as a members of the project quality assurance team.

Served on the System Integration Test (SIT) team. Worked closely with EDS testers to review system test cases and test results to ensure the results were complete and that any known defects were fully documented. Provided advice to testers to determine the severity of defects based on the impact the defect had on Medicaid business processes. Assisted the Quality Assurance Manager with improvements to testing procedures and documentation.

Served on the User Acceptance Test (UAT) team. Worked with business scenarios provided by DHS business units. Responsible for organizing test cases and updating step by step test procedures to assist DHS staff to carry out their UAT tests, document expected outcomes, record defects, and organize test results and action plans.

Developed configuration data and benefit plan administration data to track information shared between the DHS TANF eligibility system and the MMIS and set up claims processing rules and exceptions. Worked closely with DHS business managers to ensure the TANF, Mental Health, Developmental Disabilities, Child Welfare, and Elder and Adult Services source data was properly shared with the MMIS to meet DHS business requirements.

Managed the delivery of the Medicaid Management Information System Training Plan and training materials for the early implementation of the DHS Electronic Document Management System (EDMS). Oversaw the delivery of EDMS training to operations staff and to the users who access the system to resolve claims and track financial transactions. Managed the subsequent full MMIS implementation training effort, including the development of the training delivery team, the delivery of web based and standard training lesson plans and training materials, and the training schedule.

EKOLU worked as a subcontractor with FourThought Group and as a member of the Georgia managed care contract procurement evaluation team. Provided industry knowledge and guidance to the team. Responsible for producing a formal written Managed Care Plan proposal evaluation summary report together with the FourThought project lead.

EKOLU served as a sub-contractor to FourThought Group and as members of the FourThought Group Engagement Management Team serving the DHS. Responsible to produce the Security Risk Analysis Report, the Risk Management Plan, and the Justifications Document required under the HIPAA Security Rule. Assisted the Engagement Manager and FourThought Group staff to produce the Security Awareness Training, and Business Contingency Plan required under the Rule. Worked closely with The State of Hawaii DHS managers to finalize the HIPAA mandated security management documents and to manage the technical remediation of security risks. Provided business process analysis across multiple DHS Divisions to ensure appropriate security standards and best practices were integrated into the DHS Security Project deliverables. Responsible to produce the Business Contingency Plan required under the HIPAA Security Rule. Assisted the FourThought Group staff to perform quality assurance tasks to ensure the Project Plan, Security Risk Analysis Report, Risk Management Plan and project status reports were clear and correct. Worked closely with The State of Hawaii DHS managers to analyze response procedures and ensure contingency Notification, Interim Operations, Recovery, Reconstitution, and Post Event Cleanup steps were fully documented. Performed business impact analysis to identify business critical work tasks and assist the DHS to address critical business processes to achieve HIPAA compliance.

Served as a sub-contractor to FourThought Group to perform MMIS requirements analysis. Responsible for producing a Requirements Analysis Report. Also responsible for developing Request for Proposal (RFP), Advanced Planning Document (APD) and procurement evaluation plan (PEP) outlines. Assisted the State team to prepare procurement document content and to ensure that quality assurance measures were integrated into the RFP. Prepared the cost benefit analysis for the APD and met with State financial staff to look for ways to maximize Federal Financial Participation (FFP) for the project. Met with CMS Region 10 representatives to discuss their current interpretation of Federal procurement guidelines and to verify the approach being taken for the procurement and development of the new MMIS. Participated in Steering Committee meetings and assisted with the development of materials for presentation to the Steering Committee and the Washington State Information Services Board, an executive level information technology planning and oversight organization. Educated the combined State and contractor project team relative to the Federal CFRs and transferred lessons learned to prepare the team to evaluate vendor proposals and manage the Design, Development and Implementation (DDI) of the MMIS.

Worked closely with the Department’s lead mental health program manager and his project team to prepare for and facilitate meetings across New York to gather requirements and design business processes for the implementation of the Department’s new intake, referral, and treatment planning (case management) system. Worked with County Administrators to address county specific needs for reporting, data retention, and system interfaces. Worked with the State’s New York City mental health office to specifically address unique business challenges that the volume and complexity of the service distribution system in the City required. Assisted with the development of business processes and testing strategies to ensure the State wide system produced appropriate reports for the Albany central office, county staff, and providers. Developed the SPOA high level orientation materials designed to convince County Commissioners and other stakeholders to buy-in to the Department’s plans.

Overall management of the Career Readiness Program, including career readiness class, job development, job placement, outreach, and community relations in Schenectady County. Hired and supervised staff. Provided direct services to consumers. Successfully implemented a database system to track the demographics and success of the participants who received services. Participated in community-based initiatives, including Better Neighborhoods, Schenectady Embraces Diversity, and the Community Technology Initiative. Represented SCAP in monthly meetings with Workforce Investment Board (WIB) to define the needs of workers in multiple counties. Worked closely with the local WIB One-Stop to ensure the success of unemployed worker services and to prevent the duplication of services. Participated in community focus groups to support SCAP as a leading employer as well as a leading not for profit agency in Schenectady County. Facilitated workshops for career readiness classes in the subjects of financial management and small business start-up. Participated in monthly meetings around the State of New York with the Displaced Homemaker Association to plan and implement change management. Met with and educated legislative officials about the career readiness program and the impact of the program statewide. Initiated and implemented changes to the classroom structure to meet the changing employment situation. Performed fiscal planning and grant application management for the Career Readiness Program and SCAP. Assessed and monitored the welfare needs of consumers in the Schenectady and Albany, counties. Advocated, on behalf of consumers and their families, to obtain needed Medicaid, WIC, food stamps, housing, legal, and mental health services. Mediated between consumers and state/county agencies to ensure communication was clear and to ensure that consumer rights were protected. Worked with Family Court, Child Protective Services and other agencies to keep children in school, placement, and at home.

Served as Engagement Manager overseeing the DMA Replacement Medicaid System requirements gathering and procurement support process. Generated the draft MMIS requirements document, RFP, and Procurement Evaluation Plan to assist the DMA in defining and procuring an internally HIPAA compliant replacement MMIS. Managed the ‘current state’ business process analysis to facilitate claims and prior authorization business process improvement efforts. Directed the production of a gap analysis needed by the DMA to develop the HIPAA 278 prior authorization transaction processing requirements. Served as a member of the DMA project management committee to support cross communications between priority development projects including the MMIS requirements analysis, data warehouse development and eligibility system re-design. Oversaw HIPAA remediation support and data warehouse development support efforts.

Supervised State and contractor staff to carry out quality assurance monitoring of State and fiscal agent work product delivery under the guidelines of the fiscal agent contract. Played a key role in the Department’s same day eligibility and plastic card implementation project. Presented status of work projects and contract negotiations to senior Department managers. Managed over 40 State, outside consultant, and fiscal agent staff to prepare for and complete the Federal CMS MMIS certification review. Managed all daily Medicaid and Fiscal Agent operations related to the MMIS. Tracked all system change requests, system error situations and payment processing issues. Met regularly to present status and discuss processing issues with provider associations, hospitals and other stakeholders. Worked closely with DHHS Office of Finance and the Commissioner’s office to address provider payment-recoupment issues, county billing and the Federal 64, 416, 372 and other MARS, SURS and ad-hoc reports. Managed requirements analysis and system enhancement projects to improve the interface between the NH Welfare Management System (New Heights) and the MMIS to support the TANF program. Participated in the definition and implementation of the New Heights Electronic Funds Transfer and Electronic Benefits Transfer enhancements. Worked with Region 1 CMS staff and State staff to produce and present New Hampshire’s Medicaid APDs, RFPs, and contracts for State and Federal approval. Assisted with the development of the Division of Behavioral Health Prepaid Health Plan (1915b) waiver. Participated in the development of the Medicaid managed care (MCSYS) procurement and implementation.

Served as a member of the management team of New Hampshire’s Office of Community Support and Long-Term Care. Coordinated all of the Y2K project plans for the Division of Behavioral Health. Provided consulting services to bureaus within the Division to ensure procurement contracts and information technology staffing requirements were compliant with departmental and administrative guidelines. Managed the work team responsible for remedial intervention required to bring six behavioral health information systems into Y2K compliance. Worked with the NHH administration team to procure and implement a new hospital staffing management system, develop the JCAHO-ORYX data base reporting system, and to upgrade the client management and pharmacy management modules of the NHH Hospital Information System. Consulted with the State’s Division of Elderly and Adult Services project team to perform system integration and user acceptance testing of the adult protection system (DEAS Options). Set up the user acceptance test facilities and worked with the development contractor to ensure the testing environment was operational. Participated in the development and production of the State of New Hampshire Department of Health and Human Services Strategic Information Technology Plan. The plan was presented for departmental, legislative, and legal review to comply with State Division of Information Technology Management planning standards.

Managed nine State staff and 14 contractor staff to maintain the State of New Hampshire’s SACWIS. Worked closely with Children and Youth Services program managers and systems contractors to analyze, develop, test, and implement release-level software enhancements to the NH Bridges application. Managed requirements analysis and system enhancements to improve the interface between the NH Welfare Management System (New Heights) and the SACWIS.

Deaf Services, responsible for assessing and monitoring the welfare and needs of clients in the Southern region of New Hampshire. Communicated daily, using ASL, with Deaf co-workers and consumers. Advocated, on behalf of consumers and their families, to obtain needed Medicaid, food stamps, housing, and Mental Illness Management System (MIMS) services. Made recommendations to Psychotherapist relative to placement options for families and children. Provided ASL services in a mental health setting serving clients at the New Hampshire Hospital.