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3 years ago

Response to RFP No. MED13002 State of West Virginia ... - DHHR

Response to RFP No. MED13002 State of West Virginia ... - DHHR

Previous Work Experience

Previous Work Experience Production Analytics/Service Delivery Manager • EarthLink, Inc. Responsible for managing decision strategies with database reporting and analysis functions o Developed and implemented SDLC error injection and detection root cause analysis for production break/fixes o Managed ITIL process areas and resources; directed process improvement efforts and compliance monitoring o Drove continuous improvement initiatives based on business impact (downtime cost modeling) and key performance indicators (KPIs) • Coached and mentored direct reports to grow their analytical and technical capabilities Senior Process Manager Lead ERP Instructional Designer • S1 Corporation, Atlanta, GA Managed Software Quality Engineers and Metrics Center teams across global Centers of Excellence o Participated in CMM/CMMI assessment; specifically in the Decision Analysis and Resolution, Measurement and Analysis areas o Standardized project metrics, design and development processes, and communications artifacts across development and consulting project teams • Led Best Practices Team to determine strategies and standards for quality assurance deliverables and process improvement initiatives Geac Computer Systems Inc, Atlanta, GA. • Managed Customer Service and Incident Reporting Web site for Upgrades and Maintenance PRGX USA, Inc. – Eileen Ansley 2

PATRICIA DEAR, RN, CCRN, CCM Code Staff Manager Over 35 years of experience in the healthcare industry. She has worked with the Department of Justice in several states providing resource and industry experience. Her specific healthcare experience includes Federal/HCFA healthcare regulations and OIG compliance initiatives; compliance risk assessment, and investigative billing and coding audits; acute, post‐acute, rehabilitation and long‐term care organizations; case management, managed care contracting and implementation. Professional Certifications/Licenses • RN/ Registered Nurse (Florida #1257862) • CRRN/ Certified Rehabilitation Registered Nurse (1990) • CCM/ Certified Case Manager (1993) • GCM/ Geriatric Case Manager (1995) • CPC/ Certified Professional Coder (1999) • AAPC/PMCC Certified Instructor (2001) PRGX Responsibilities • Responsible for designing and implementing audit strategies pertinent to specific contracts ensuring achievement of contract and company goals. • Staff recruitment, selection, training, education, development and evaluation; • Data analysis and project development; workload management ensuring compliance with timeliness standards; • Ensures accurate, consistent and defensible review decisions; budget planning and management; • Communicates with providers, regarding review results, questions/concerns, etc.; • Supports and works with other Directors to identify opportunities for increased efficiencies, etc. Previous Work Experience Senior Associate/Director Healthcare Practice • Kroll Lindquist Avey, Atlanta, GA Responsible for the development and direction of the Healthcare Practice of KLA. The practice provides litigation support services to defense, plaintiff, and government (DOJ) legal counsel. These services included; fraud and abuse investigations, provider risk assessments, medical billing and coding audits and compliance planning. Providers have ranged from individual physician practices, multi‐specialty physician groups, a national physician practice management company, hospitals, and third party medical billing companies. PRGX USA, Inc. – Patricia Dear 1

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