Geisinger Health Plan
Provided leadership and project management services for a FACETS systems implementation project. Provided acting Scrum master, FACETS Architect, and IT PM services to oversee the integration of critical business functions within the FACETS framework and guided the migration from legacy Amis systems to new platforms. Managed a cross-functional team of BAs, SAs, and Developers while coordinating the development and deployment of integrations (Close to 2000 integration points) across multiple technologies, including Informatica, .NET, BOE/Qlik, OutSystems, and TIBCO Web Services.
Key project activities included:
- Overseeing requirements gathering, solution design, and development oversight.
- Coordinating the integration of various technologies into the Facets framework.
- Facilitating Agile processes such as sprint planning, daily stand-ups, and retrospectives.
Ensuring project milestones were met on time and within budget.
Sutter Health Plus
Provided a comprehensive assessment of automated and manual processes, data exchange mechanisms, and governance structures integrating HealthRules (HealthEdge) and Tapestry (Epic) systems.
Key projects included:
- Group New Sale Fulfillment: Reviewed the end-to-end process from pre-sale to ID card generation, documented process flows, interviewed business owners, and identified areas for improvement.
- HealthRules Upgrade and Configuration: Evaluated versioning and assessed HMO configurations against industry standards to identify gaps and recommend enhancements.
- Broker Commissions Process: Documented the existing manual processes, reviewed new features introduced in the HealthRules upgrade, and gathered relevant documentation to support process optimization.
- Provisioning and Security: Evaluated the current access setup and approval processes, reviewed provisioning forms, and identified opportunities for improved security management.
Key project activities included:
- Conducting a gap analysis to identify inefficiencies and areas for improvement.
- Reviewing current workflows and assessing their alignment with business objectives.
- Developing recommendations for future state processes aimed at enhancing operational efficiency.
- Focusing on automating manual processes to reduce workload and errors.
- Improving data synchronization to ensure seamless information flow across systems.
- Planning for system migrations to support future scalability and business needs.
Blue Cross of Idaho
Conducted a targeted assessment to evaluate the current configuration of their Facets system. Identified key functional areas that could benefit from further optimization and estimated the potential return on investment for a broader IT and Facets optimization initiative.
Key project activities included:
•Summarizing and providing detailed report back to Leadership
•Reviewing provider pricing, claims processing (EDI and batch), benefits configuration, ASO billing, commissions, and capitation.
•Analysis of these areas to provide insights on where deeper assessments could drive operational improvements and cost efficiencies.
Blue Cross and Blue Shield of North Carolina
Engaged to assess the configuration of their Facets system and to evaluate their ticket backlog. Developed a strategic plan for transitioning the ongoing configuration support from an external vendor to in-house teams, as well as redesigned and remediated the Facets Medical Plan configuration based on the assessment results.
Key project activities included:
•Analyzing the existing setup and identifying areas for improvement
•Creating a roadmap for the successful transition and optimization of the Facets system.
•Enhancing system efficiency, streamlining support processes, and aligning the configuration with future business needs.
Health Alliance Plan
Provided reporting support along with Facets Data Model and Cognos training.
Key project activities included:
•Developing and maintaining over 150 SQL reports for ongoing and ad-hoc business needs.
•Designing and implementing more than 25 customized Cognos reports for different departments.
•Leading comprehensive training sessions on the Facets Data Model to enhance team proficiency and system utilization.
Visiting Nurse Service of New York
Provided operational and Facets configuration support, focusing on enhancing efficiencies and aligning processes for the migration of Diamond business and Unison plans to the Facets CSP platform. Evaluated the current design, existing configuration in Facets, business requirements, and manual processes including policies, procedures, and SOPs. Based on these insights, delivered actionable recommendations aimed at optimizing processes, automating configuration maintenance, and increasing claims throughput.
Key project activities included:
•Onsite audit of TMG, the Visiting Nurse Services’ Cognizant hosted FACETS site
•Assessing the changes needed in people, processes, and tools to improve configuration, including job observations, SOP evaluations, reducing pends, increasing configuration release activity, minimizing handoffs, and enhancing quality.
•Identifying potential issues that could impact current and future migrations to the Facets CSP platform, while evaluating the alignment of configuration processes with the broader organizational structure.
•Assessed the division of duties between business and technology teams, production update processes, configuration change control, and quality audits.
UnitedHealth Group
Engaged for operational and Facets configuration support, focused on enhancing efficiency in preparation for migrating Diamond business and Unison plans to the Facets CSP platform. Required evaluation of the current configuration design, existing Facets configuration, business requirements, and manual processes, including policies, procedures, and SOPs.
Key project activities included:
•Observation and recommendations for actionable improvements to optimize configuration processes, emphasizing automation, ease of maintenance, and increased claims throughput.
•Identifying necessary changes in people, processes, and tools to improve configuration, including job observations, SOP evaluations, reducing pends, increasing release activity, minimizing handoffs, and improving quality.
•Providing further insight on significant issues that could affect current and future migrations to the Facets CSP platform
•Assessing the alignment of configuration processes with the organization’s overall structure, considering business versus technology needs, division of duties, production update processes, configuration change control, and quality audits.
CVS Health
Provided consultation for a fast-track enrollment reconciliation project, collaborating with CMS to validate audit results.
Key project activities included:
•Overseeing the reconciliation process for 2 million members across three lines of business: Group, Individual, and Medicare (Supplement, Prescription Drug, Medicare Advantage).
•Providing secondary support for letters and outputs associated with the project to ensure accurate and efficient reconciliation.
Blue Cross and Blue Shield of Louisiana
Provided an Enterprise Technical Architect, overseeing all aspects of enrollment, product, billing, and rates for the Facets System. Managed all Facets data tables, including identifying and assessing business needs, developing and executing programs, and facilitating interviews and walkthroughs.
Key project activities included:
•Gathering and evaluating evidence and test results, documenting and communicating findings and recommendations, and creating comprehensive final reports.
•Designing, building, and testing SQL stored procedures and used SSIS and SSRS.
•Training, mentorship, and development support to business partners and technical colleagues.
•Writing custom interfaces for inserting data directly into Facets backend tables, ensuring seamless integration and functionality.
Cigna
Provided Facets Architect and SCRUM Master services, as well as leadership and operational support for a Facets upgrade implementation for Medicare line of business. Reported and collaborated with business and development teams to facilitate a smooth upgrade process.
Key project activities included:
•Providing operational and Facets upgrade support throughout upgrade process
•Overseeing business requirements gathering, solution design, and development oversight to ensure timelines were met
•Focusing on automating manual processes to reduce workload and errors after upgrade implementation
•Weekly reviews with entire project team to achieve project goals and verify requirements were completed according to project guidelines
•End-to-end Provider tracking and fallout data analysis to assist with Go-live migration
•Model Office parallel validation claim tracking through member-provider fallouts, Gateway, AWS, and Facets
•Implementing and creating 100% enrollment reconciliation validation between EAM and Facets
Blue Cross Blue Shield Kansas City
Engaged to provide TCS Architect and Facets Architect services. Created a project plan for Facets upgrade implementation and assisted in TCS upgrade to 6.1R4. Assisted with Sybase/SQL database migration. Worked with senior management to write queries for claims data, saving over $10M.
Key project activities included:
•Assisting with TCS template buildout, TCS data migration and Hotfixes during the upgrade to TCS 6.1R4, as well as Zena job buildout
•Providing Facets data model training
•Implementing Provider address standardization for Melissa data
•Working with business management to act as liaison between business and development team