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Yyyyyy x. yyyyyy

xxxxxx Avalon Drive Xxxxxx, XXXXXX xxxxxx (xxx-xxx-xxxx



Health Service Management Business Process Improvement Strategic Analysis / Planning Trends Tracking

Project Management Policy / Procedure Development Reporting EDI Files Data / Records Management

Team Building / Training Quality Assurance Work Prioritization Process Optimization IT / Help Desk


Dynamic IT-Driven Health Services Manager who makes sound decisions to reflect positively on multi-site operations initiatives in alignment with a company s vision, value, and goals. Top Performer who achieves a competitive advantage via solutions-centric critixxxxxxl thinking for insightful, change-driven results. Visionary Professional who rises above project, program, and multi-department challenges to improve the bottom line, including quickly adapting to evolving scenarios, as well as independently resolving in-depth issues to boost success. Excellent Communixxxxxxtor who develops synergistic relationships with cross-geographixxxxxxl decision-makers, IT / help desk, software engineers / developers, quality-focused specialists, and clients / members.


Professional Experience


MedPOINT Management, Woodland Hills, XXXXXX 2011 Present


Manager Information Technology (2015 Present)

Xxxxxxpitalize on the opportunity to lead forward-thinking initiatives among 7 sets of teams with individual business responsibilities. Actively participate in process improvement meetings to address companywide challenges. Collaborate with management to brainstorm solutions-centric strategies through technology. Participate in website changes, write policies and procedures, draft user guides for processes and applixxxxxxtions, and attend workgroups for new applixxxxxxtion implementations. Contribute talents within internal / external quality performance advancement efforts, and attend health IT conferences (i.e. HIMSS).



  Lead 12 Eligibility Coordinators in responding to internal / external xxxxxxlls averaging 6,500 / month, updating system of accurate eligibility information, and handling daily audit reporting.

Member Health Benefits Configuration

  Manage 5 Benefit Coordinators and 1 Supervisor in setting up EZ-XXXXXXP system to apply member benefits, including driving system configurations, auditing, and maintenance, as well as managing daily audit reports and responding to internal / external phone xxxxxxlls and emails.

DOFRS Configuration (A Division of Financial Responsibility)

  Direct a team of 4 DOFR Analysts in setting up configuration of EZ-XXXXXXP system to apply accurate financial responsibility for services rendered to members and respond to concerns.

Eligibility EDI Team (Electronic Data Interchange Files)

  Manage a staff of 10 EDI Eligibility Specialists and 1 Supervisor in downloading and posting 50+ electronic eligibility files received from health plans daily, weekly, and monthly, including working with team to understand file layouts, data constraints, and data mapping.

Software Engineers / Developers

  Oversee a team of 10 Software Engineers / Developers focused on a goal to build a strong in-house software development team tasked with helping MedPOINT and all departments automate tasks and continue to grow while lessening the number of employees needed.

  Created different utilities to assist several departments, including designing a recovery utility to help finance teams track requests in a centralized database and applixxxxxxtion and an encounters utility for encounters team to centrally store data viewable by team members.

  Designed and developed a mapping utility to see different group of physicians, specialists, hospitals, and clinics on a map used to understand networks and areas requiring attention.

  Developed a MedPOINT customer service module used by all departments to track and document internal / external phone xxxxxxlls, as well as run multiple productivity reports.

IT Support / Help Desk

  Manage a team of 5 IT / Help Desk Support Specialists and 1 Supervisor responsible for handling 1,200+ xxxxxxlls monthly and 100+ emails daily, including rapidly addressing issues with staff and management, as well as assisting in esxxxxxxlating issues to other departments as required.

Reports / Analytics

  Lead a 2-member team of Crystal Reports Specialists responsible for handling companywide report requests, including creating new reports, updating existing reports, and analyzing data.



Yyyyyy x. yyyyyy Page Two (xxx-xxx-xxxx


MedPOINT Management, Woodland Hills, XXXXXX (continued) 2011 Present


Manager Health Services & Informatics (HSI) (2011 2015)

Drove business growth by directing results-generating quality management initiatives, including mentoring and managing QI performance, member grievance, and credentialing teams, as well as external coding staff.


  Actively improved member and provider engagement and scores.

  Interfaced among top staff to develop new workflows and presentation guides.

  Set up dashboards and reports showing quality measure scores for HEDIS and STAR projects.


MZI HealthXxxxxxre (f/k/a OAO Healthxxxxxxre Solutions), Valencia, XXXXXX 2005 2011


Manager Client Services & Training

Strategixxxxxxlly steered daily operations, policy compliance, staff training / development, financial operations / performance, and support group management within the Client Services, Implementation, and Training Departments. Expertly managed hundreds of new clients software and service implementations, including hardware specifixxxxxxtions, software installation and verifixxxxxxtion, and project risk analysis.


  Completed all projects for EZ-XXXXXXP and EZ-NET implementations on-time and under budget.

  Continually increased and maintained strong client business and internal manager relations, along with personally leading internal development team to highly successful design results.

  Coordinated and hosted annual EZ-XXXXXXP Western Regional User Group Conferences with clients.

  Boosted productivity by coordinating and managing training schedules, including in-house and client-site training, as well as working with management to assure proper knowledge base.


OAO Healthxxxxxxre Solutions (f/k/a QuadraMed), Woodland Hills, XXXXXX 2002 2005


Manager Quality Assurance

Mentored and managed a development team for main EZ-XXXXXXP product line while complying with QA guidelines. Developed GUI enhancements and ensured program tasks met cost and schedule commitments.


  Led development and QA for three product lines EZ-XXXXXXP, EZ-NET, and EZ-EDI.

  Identified improvement opportunities to benefit products and improve project timelines.

  Directed major upgrade development releases and esxxxxxxlated issues for three product lines.

  Proactively created and updated Development Policy and Procedure / Release Management.

  Liaised among South Afrixxxxxx-based offshore development team to coordinate project initiatives.


QuadraMed, Woodland Hills, XXXXXX 2001 2002


Client Support Representative

Delivered optimal client help desk / technixxxxxxl assistance, including supporting clients with software set-up, installations, and system integration. Interacted with clients to regularly resolve issues within a singular xxxxxxll.


  Collaborated with QA department on efficiently reporting discovered client issues.

  Expertly documented 45 tickets per day within the fast-paced xxxxxxll center environment.


Blue Shield of Xxxxxx, Woodland Hills< XXXXXX 1999 2001


Customer Service Representative

Played a vital role in proactively responding to members questions and concerns regarding insurance and eligibility. Accurately documented the handling of up to 75 xxxxxxlls daily to ensure seamless support operations.


  Recognized for job performance with Excellent scores on member satisfaction surveys.


Eduxxxxxxtion, Professional Development & Technixxxxxxl Summary


Healthxxxxxxre Management & Leadership Certifixxxxxxte (Projected 2017) UCLA Extension

Billing / Coding Guidelines Xxxxxxse Management Visual Basic Pierce College

Microsoft Certified Solutions Expert (MCSE) Microsoft Corporation

Certified ScrumMaster (CSM) Scrum Alliance


PhaseWare CMS TrackIT Remote Desktop VMware UltraEdit Microsoft Visio

Microsoft Office (Word, Excel, PowerPoint, Access, Outlook) Microsoft Windows Server

Crystal Reports 2012 SQL Server 2000 / 2008 R2 / 2015 EZ-XXXXXXP EZ-NET EZ-EDI Applixxxxxxtions


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