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Xecutive Ummary: Kerrie Richards

The document provides a summary of Kerrie Richards' qualifications and experience in information technology project management, business analysis, and client services roles, primarily within the healthcare domain. Richards has over 15 years of experience leading teams and managing projects involving electronic health records, billing, and clinical systems. She has a strong background in electronic data interchange standards and technologies.

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72 views4 pages

Xecutive Ummary: Kerrie Richards

The document provides a summary of Kerrie Richards' qualifications and experience in information technology project management, business analysis, and client services roles, primarily within the healthcare domain. Richards has over 15 years of experience leading teams and managing projects involving electronic health records, billing, and clinical systems. She has a strong background in electronic data interchange standards and technologies.

Uploaded by

ashish ojha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Kerrie Richards

229 Reservoir Street – Marlborough, Massachusetts 01752


774.463.6375 (cell) – [email protected] (email)

EXECUTIVE SUMMARY
An experienced leader and team player specializing in client management, operational management,
project management and technical management in the Information Technology (IT) Healthcare domain
for Fortune 500, non-profit and private companies as payors / health plans, billing intermediary,
clearinghouse, provider, software vendor and government vendor (Commonwealths of Massachusetts
and Washington, DC).

QUALIFICATIONS
Mentored direct staff, project and cross functional teams to define, implement, and support large
project portfolios of clinical systems, electronic data interchange (EDI) interfaces, claims adjudication /
processing and claims revenue management systems. Bridged the communications gap between IT,
business, clients, vendors and business constituents. Decreased data issues and software defects;
increased stakeholder satisfaction through effective project management, requirements management,
testing, and technical issue resolution best-practices. Lead teams to identify and document data
requirements, conduct testing activities and post-production support of inbound/outbound interfaces
and mapping (ASC X12 4010/5010 transaction sets, HL7 ADT messages). Directly managed staff to
implement and support technical solutions through a call center environment.

CORE COMPETENCIES
Team leadership and team building, portfolio / project management, client relationship management,
vendor management, process improvement, business systems analysis, technical analysis, operational
management and metrics, HIPAA, EDI, call center management, budgeting, health maintenance
organization, commercial health insurance, and Medicaid.

TECHNOLOGIES
ASC X12 5010 Transaction Sets: 270/271, 276/277, 837I, 837P, 820, 834, 835, 278, 999/TA1, ADT HL7 in
4010 and 5010 schema for plain text and HTML formats on different platforms: client server, web
applications and web services such as Simple Access Protocol / Web Services Descriptive Language
(SOAP/WSDL) and Hypertext Transfer Protocol (HTTP) Multipurpose Internet Mail Extensions (MIME).
Also included: Software as a Solution (SaaS), Single SignOn (SSO), Networking (WAN/LAN/VPN),
Telephony, PBX, Switches, Routers, Servers, Databases, and Data Centers.

SYSTEMS
Medicaid Management Information System (MMIS), Core FTP, Care Management / Disease
Management / Utilization Management, Pharmacy, Laboratory, Discharge Planning, Claims
Processing / Revenue Management, Health Benefits Management, Pharmacy Interchange
Management, CRM, Call Center, Financial, Reporting, Clinical Data, Data Management, SharePoint
Content Management System (CMS)

WORK EXPERIENCE
Manager, Electronic Data Interchange (EDI) and Trading Partner Testing (TPT)
MAXIMUS, Inc. – Boston, MA January 2014 – Present
MassHealth Customer Service Center (CSC)
In a client-facing role, built and directly managed small team of EDI Analysts to support MassHealth
trading partners in a call center environment per contractual service level agreements (SLAs) and
approved policies and procedures for eligibility, claims, claim status, electronic remittance advice (ERA)
and respective response files. Oversaw activities that included: testing with providers,
completing/verifying EDI enrollments, troubleshooting pre-compliance and compliance HIPAA file-
related issues, implementing and supporting system-to-system connections utilizing a SOAP / MIME
web services protocol, and outreaching providers with resolutions. Oversaw testing projects that
included ICD-10 testing, claims pricing related changes (APR/DRG and PAPE/APEC), SSN/MBI,
SOAP/MIME and EVSpc transition. Created and delivered slides through in-person presentations and
webinars at the Provider Association Forums (PAFs). Facilitated periodic client status meetings
regarding claim operations, interface issues, and TPT status; delivered operational client-facing reports.
Documented departmental policies and procedures and obtained buy-in from the client.

Project Manager / Leadership (contract)


Elderhostel / Road Scholar – Boston, MA September 2013 – January 2014
Charged with defining and implementing a Project Management Office (PMO) methodology and
project life cycle framework best-practices; managed IT projects with cross-functional teams and
vendors

Project Manager / Business Analyst


Tufts Health Plan – Watertown, MA February 2013 – August 2013
Led the implementation of concurrent clinical/IT projects in a hybrid PM/BA role.

Project Manager / Leadership (contract)


Public Consulting Group – Boston, MA April 2012 – December 2012
Lead team of business and IT resources systems analysts providing business architecture, requirements
management and user validation while driving performance, budget, and schedule and lifecycle
maintenance. Improved existing processes and tools to manage and implement ASO Medicaid Claims
Clearinghouse SaaS (EZ-CAP) project portfolio for DHCF, District of Columbia, agencies and billing
vendors. Facilitated client status update meetings, prepared meeting agendas, updated project plans
and issues logs. Created documentation to confirm business and data requirements for agency billing
capabilities, claim validation rules, provider credentialing files, claims submission (837 X12 5010),
remittance advices (835). Acted as liaison between business and IT while following a newly adopted
Agile / Scrum methodology

Project Manager / Technical Analyst (contract)


Fresenius Medical Care – Lexington, MA December 2009 – April 2012
Responsible for processing Provider’s clinical financial data resulting in $700M monthly revenue
 Managed day-to-day operational activities for real-time (837, 835) claims management / revenue
system (Siemens Soarian Financials) through SQL queries, alerts, standard operating procedures
 Improved user experience, reduced web application latency, resolved interface related-issues by
troubleshooting JVM SnapUtility, Coradiant, IIS, JVMs, WebSphere, OPENLink (MsgSvcs/ STREAM),
eGate
 Improved claims data processing performance by modifying job scheduler activities (validations,
data output, frequency, timing, predecessors) and background processes (OLTP, OLAP, replication)
 Created detailed data processing flows and business rules for processing claims

Sr. Integration Analyst


CaseNET – Bedford, MA January 2009 – October 2009
Delivered client-facing documentation within a newly developing CM/DM/UM product in a service-
oriented architecture (SOA) for a Fortune 500 client in the Managed Health Plan market such as:
 EDI Companion Guide for 278 Request for Review and Response transaction sets
 Functional/technical concept documents: outbound faxing, telephony, McKesson InterQual with
Single SignOn
 Technical specifications, workflows, use cases, system entity diagrams

Director, Client Technology and Operations


Curaspan – Newton, MA April 2007 – January 2009
Directed successful SaaS implementations and operations to support discharge planning solutions
(eDischarge) at hospitals, payors, post-acute providers, transport (1300+ facilities). Directly managed a
team of project managers / business analysts.
 Reduced rollout timeline by 8 weeks after implementing project management methodology and
project life cycle framework of best practices of project, requirements management and software
development
 Reduced Call Center call volume by 10% after improving data quality in hospital ADT HL7 and
printing interfaces and resolving user/technical issues such as: access, connectivity, faxing, forms,
printing, census, data
 Created standard documentation including HL7 ADT Interface Requirements, Technical
Implementation Manual
 Partnered with SoftMed and MIDAS to engineer and support Single SignOn (SSO) and real-time
interfaces
 Directly managed and mentored employees, conducted performance reviews, handled day-to-day
performance and scheduling related issues, appropriately documented employee related issues,
built and managed the team through recruiting and exit strategies
 Facilitated JAD sessions with hospital clients to elicit data requirements and created client-facing
documentation through interactive whiteboard sessions
 Managed project and departmental budgets 

Director, Information Technology (contract to hire)


L.R. McCoy & Company, Inc. – Worcester, MA May 2005 – April 2007
Directed the implementation of an order processing / revenue management solution (bisTrack, Great
Plains, Crystal Reports), managed the day-to-day IT infrastructure and operations to 60 users over
WAN/LAN
 Significantly reduced duplicative, manual tasks by implementing a CRM environment for order
processing, inventory, billing, accounting, reporting
 Facilitated JAD sessions with cross-functional teams to elicit and document high-level / detailed
requirements through interactive whiteboard sessions
 Documented and obtained buy-in on test plans, training and support documentation
 Directly managed analyst and vendor resources
 Managed project and departmental budgets

Manager, Project Management Office


Provider Service Network – West Roxbury, MA September 2002 – January 2005
Implemented a Project Management Office (PMO) and best practices of SDLC; managed a portfolio of
clinical systems (Pharmacy, HEDIS/Quality Registry, Claims Audit); managed a team of project
managers and software development resources
 Significantly reduced software defects by implementing SDLC, including traceability requirements
management
 Lead and mentored team of business analysts
 Facilitated JAD sessions with cross-functional teams to elicit and document high-level / detailed
requirements, test plans, training and support documentation
 Directly managed project management and testing staff; mentored employees, conducted
performance reviews, handled day-to-day performance issues 

Project Manager
Workscape, Inc. – Framingham, MA April 2001 – Jan 2002
Implemented and supported an Employee Benefits Administration system for Fortune 500 clients

Manager, Information Technology


Akibia, Inc. – Westborough, MA 1999 – April 2001
Implemented a Project Management Office (PMO) and best practices of SDLC; managed project
portfolio; managed a team of project managers and software development resources

IT Project Analyst
Private Healthcare Systems, Inc. – Waltham, MA 1998 – 1999
Provided mentoring on best practices of project management; managed project issues, time tracking,
budgets

EDI Project Manager


Harvard Pilgrim Health Care – Lexington, MA 1996 - 1998

Project Manager
The MathWorks – Natick, MA 1993 – 1996
Sales & Marketing Software Implementations

Programmer / Graphic Designer


Graphic Harmony – Ashland, MA 1988 – 1993

EDUCATION
Bachelor of Science in Management
Northeastern University 2010

Associates in Business Management


Newbury College 1995

Project Management Professional (PMP)


Project Management Institute 2003

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