Candidates About

Loretta D Altman-Pollack

Driven, creative and accomplished mid-senior level Project Manager and Scrum Master professional offering multi-year experience in a variety of industries (e-Commerce, Health Provider and Insurance and Banking).

Skilled and Diverse 

Efficient in different types of Project Lifecycles and Project Types (Agile and PMP methods) | Product-centric operations experience spanning myriad asset types and platforms |A data-driven approach to problem solving and scaling |A passion for operations and a thirst to do more with less, to work smarter not harder| Strong cross-functional and cross-cultural communication to both internal and external parties.| A tools-first mentality, reserving human activity for where judgement and communication is critical | I have been a: Paramedic to Mechanic to Landscape Architect to Technology Project Manager to Business Entrepreneur  

A Proven Asset

Resourceful, proactive and dependable | Strong and decisive decision making skills | Outstanding organizational skills with a keen eye for detail | A champion for productive change in aligning strategy with project objectives and focus.

Professional Experience

Ojai Food Taxi | Co-Owner | August 2015 – Present

Co Orchestrated and Transformed a small company earning 7K per year to a thriving business earning more than 50K+ a year. 

·         Implemented strategic marketing and relationship building with clients (Restaurants, Hotels, Inn’s, Bed and Breakfasts, Boarding Schools, etc.).  Catering to the famous, fascinating and everywhere in-between (even folks in campsites or on trails that need supplies).

·         Improved the structure and process of how the business is ran, by increasing the efficiency and reducing costs (modeling the technology and process like GrubHub, PostMates, etc. and hiring/managing Independent Contractors instead of employees. The profits and business increased.

Anthem Blue Cross | Technical Project Manager, Sr / Scrum Master | August 2013 – Present

Leading as a Senior Project Management and Scrum Master focused on implementing varying sized projects (50K-1 Million), including operational lights on in wide range of systems and applications.

·         Spearheaded complex system issues within multiple Provider Care Management Systems, Finance systems and data warehouses using Agile and Kanban methodology with tools: Jira (Kanban), Confluence (Statistical and Bus Value information) and Sococo for “in-person” virtual team meetings.

·         Manage daily technical Lights On issues and small projects for high profile provider’s sites, projects ranging from 50K- 300K, new configuration management process implementations, process improvements for issues management, executive report and presentations; communicate escalations and issues details accordingly.

o   Partnering with business to work with technical teams to fix production lights on system issues and service requests.

o   Lead full Development and Administration teams to a new Configuration Management ClearCase Enterprise Standard for multiple platforms. 

o   Leading/Executing SSCR (Small Projects 300k) while improving the process around delivery and execution.

·         Co-lead the building of a new process and built standard operating procedures within the IT PMO for with Enterprise (EDWard) Data Warehouse Department, to improve the Intake and Execution process.

·         Provided end to end support and project management of Data Integrity issues;

o   Intake and/or through Execution [Software Development Life Cycle] of 200+ Data Integrity issues in the following portfolios: Provider Analytics [Provider Contracting], Government Health Care Economics [Medicaid & Medicare], Client Analytics [Marketing, HIPPENDS, Sales, Mandates], Clinical Analytics [Clinical, HEDIS, RHI & Medical Mgmt.] & WIAP/Decommissioning [Pharmacy, Balancing, ESI & Decommissioning]. 

·         Provided budget controls for the Enterprise Data Warehouse issues that came in to create process to approve and manage (resource allocation) the production fixes.  

·         Successfully managed from Initiation to Closure challenging projects within a high profile enterprise program with millions in expected revenue over the next 1-2 years. 

o   Managed 650K+ budgets

o   Negotiated and controlled KPI’s to ensure variances, risks, etc. were mitigated.

o   Managed IT and Business cross-functional teams over multiple time zones, including offshore and vendor.

·         Managed a number of high profile Government (Medicaid) projects from Planning to Execution. Working closely with IT and Business cross-functional teams to ensure risks, issues, scope, timelines and budget were meet with success.

o   Managed budget of 500K

·         Developed, launched and managed a new streamlined Enhanced Personal Health Care (EPHC) production issues process to coordinate IT and Business cross-functional teams. For the resolution of post-production issues ranging from millions of dollars to millions of members and/or provider impacts if not resolved.

o   Systems include: WMDS, CHUB, PIMS, PCMS, ECC, Tri-MED, Avaliity, HRS, Access, EPDS V2, EDWard and SOA.

o   Lines of Business: All (Commercial, Medicaid & Medicare)

o   Secured and managed multiple budgets for the various efforts, from 100K – 1Millon.

Deloitte | Specialist Master (Manager) |April 2012 – August 2013

Provided strategy, approach and leadership to executive and primary teams I managed.

Client: Kaiser in Denver, CO

Role: Provider Inventory Strategy Manager
Technical Environment: SharePoint, XCleys (Claims Connect), Access and Business Objects.

Reduced provider issues inventory by 5000+ and meet sustainability and compliance metrics. |Lead in the development and implementation of process improvement in both interim and future state solutions that will sustain provider claims inventory management and reimbursement; along with developing turnover analytics reports to successfully drive issues management going forward. | Lead in the approach, framework and deployment of Resource Management Plan, which lead to client being able to meet sustainability with escalated provider claims issues. | Worked with all Core Administration Departments (Provider Relations, Contracts and Benefits Configuration, Eligibility, Accumulators, Medical Review, Authorization, Adjudication, Adjustments, Member and Provider Call Center and Provider Reimbursements); to improve internal processes for effective claims reimbursement for Providers and Members.

Client: Catholic Health Initiatives in Tacoma, WA
Role: Testing Manager
Technical Environment: Epic Systems Revenue Cycle, Inpatient, Ambulatory and Interfaces.

Built a Testing Strategy Plan and while leading the team of 80+ including Vendor, through the initial approach and execution for an Implementation of Epic Inpatient, Ambulatory and Revenue Cycle applications including interfaces, medical devices and transcription technology.

Insight Global | Project Manager II |September 2011 – November 2011 (3 months) Assignment - NASCO – Remote

Managed NASCO team to implement ClaimsXten (CXT) 10 new custom medical policy rules on the Horizon Blue Cross Blue Shield of New Jersey system (referred to as Stage 2). Goal of the project: The Stage 2 Project is to ensure the NASCO Processing System (NPS) can process the claims processing recommendations that it receives for the 10 new CXT rules that are implemented to Horizon’s CXT release.

Syntel | Technology Project Manager | September 2009 – July 2011 (1 year 11 months) Assignment: Anthem Blue Cross (WellPoint)

Lead a team to build a blue print feasibility study on multiple in-house mainframe systems (ACES (Anthem Consolidated East System), WGS 2.0 (Wellpoint Group Systems), and FACETS) using the Syntel - Automation Framework solution to automate provider contract migration to facilitate the pricing engine on NetworX Pricer (Trizetto Product) to apply the configured pricing rules to determine claim pricing and configured routing rules during claim processing from the mainframe systems.

Performed leadership responsibility in training a new team on WGS and STAR (Small Group Membership and Billing System) systems for integration and migration purposes. Strategically lead team in aligning the Q/CARE (BCBS Georgia Mainframe Backend) migration to WGS, for multiple regions. This includes being a key partner in the enterprise wide discovery team, to build and support the “Lean IT” and “Build a Better WellPoint” initiatives. In addition, modeling the requirements within the Rational Requisite Pro tool.
Lead team (on and offshore) for eWPD (Enterprise WellPoint Product Database) Health Programs Product Communication and Setup new design, system use cases, data modeling and implementation. Also involved with the Rules Engine requirements gathering and analysis. Manage Technical Team for Senior Business Product CMS (Center for Medical Services) Annual filings; this is for Annual Changes of Coverage and Explanation of Coverage mandated CMS changes. This includes running queries, reports for temporary maintenance. Also includes managing a technical team to build a full automated solution (full SDLC) between the Senior Business Product Managers and CMS application.

Computer Science Corporation | Technology Project Manager |February 2008 – September 2009 (1 year 8 months) Assignment: Kaiser

Managed the deployment of hardware and software build of 100 “Self-Service Kiosk’s” to the Regional Medical Centers throughout Southern California. To build functional/non-functional specifications and logical application design flows, architectural flows, UAT Implementation plans, context diagrams, security waiver requirements and build package requirements. Successful implementation of software component: HealthConnect (Epic Modules).

Managed teams to develop claims billing system Resolute utilizing the vendor EPIC for specific subject matter input to over solution design for a number of EPIC modules on the Institutional, Clinical and Professional sides; specially the Inpatient, Ambulatory, IP OpTime, Resolute and Bridges modules/interfaces.

Lead a team effort to analyze impacts of HL7 version upgrade within the clinical systems and its effects on the Electronic Health Record (EHR) exchange. The goal was to upgrade the system, and fulfill a larger % of the EHR nationwide and regionally. After successful analysis, some messages where combined and split in addition to providing the additional features that version 3 had, and roll it out. This was successfully completed. Provided project leadership for a Revenue Cycle Mega project emphasis on SOX compliance with a team of 40 + including EPIC Vendor management for end to end solution design with Epic: Inpatient and Ambulatory, including interfaces and legacy systems. This included addressing the NPI provider billing implementation.

California Deductible Product Platform Performance Improvements Lead project team in an end to end Legacy (Foundation Systems), ETL and Diamond major multiple system performance upgrades. Successful optimization of key benefits engines systems.

Media Trust | Sr Technology Project Manager | July 2008 – September 2008 (3 months)

Brought on board to consolidate and streamline business practices and processes. Build new PMO office and align company around PMI practices and values. Managed company ecommerce, and digital advertising projects.

Managed project timelines and budgets. Created detailed project work plans from the estimated scope of work. Delegated project tasks to team members. Provided project planning and scope estimation. Track project status and provide status reports to the Director(s). Track and manage all project related issues. Provided leadership and mentorship to project team members. Assisted in the implementation where possible.

Computer Science Corporation | Lead System Solutions/Technology Project Manager | March 2008 – July 2008 (5 months) Assignment: Kaiser

Lead Infrastructure Project: Strategy and Approach to executives and primary resources. All content managed through SharePoint. Managed infrastructure environment builds (Dev, QA, UAT, LOAD and PROD) on new LPARS (Logical Partition – virtual computing platform) in shared environments, lead testing (Unit, Performance, Regression, and Load) with multiple interfaces, databases, applications (middleware) and web.

Managed effort to obtained NCAB and SCAB (Northern and Southern California Regional) committee review and approvals, provide lessons learned, decommission old LPARS and Frames. Working with vendor (IBM) to procure hardware required for the new data center, creating change requests for moves of hardware, software and middleware, interfaces and Oracle Databases for upgrades/installs, server relocation and server environment relocation.

Clinical Decision Support and Rules Engine Systems (Multi-Regional). Lead a team to capture and build a complex (several integration points within various systems) and comprehensive Request for Proposal. To be utilized in obtaining funding for project that will eventually be pushed out to all regions. Purpose: Total population management, highly accurate risk stratification, data conversion and prospective analysis for a better benefit design. Lead the planning and project charter creation.

Lead a team of systems and business analysts for region wide General Ledger and Supply Chain Management system (Vendor: PeopleSoft) integration, for SOX controls and compliance and to streamline transaction processing to provide a scalable foundation for decision support and business intelligence objectives to address: CPT/HCPCS (Procedure Codes), ICD-9 (Diagnosis Codes), Modifiers, Revenue Codes, NDC (National Drug Code) and applying Assembly and State bills applications to the system.

Countrywide (Bank of America) | Sr Software Systems Analyst | November 2005 – February 2008 (2 years 4 months) Simi Valley, California

Managed and implemented a $20 million dollar revenue generating system for company space rental agreements applying full PM lifecycle with 120% project audit review.

Lead a successful implementation of web portal and content management system with corporate governance restrictions, security and workflows.

Identified and created documentation for Business Intelligence dash boarding projects (Siebel and Business Objects). Provided Project Leadership in: Scope definition, budget control, planning, development and implementation of Business Objects software; to provide company with a decision support system.

Collaborated with technical teams in the design, implementation, and deployment phases of build and buy solutions. Including performing Vendor Management with Aitent.

Lead the integration of new applications, hardware (i.e. Servers) and process modifications for a major and high profile compliance preference management system, coordinating and performing Vendor Management (Initiate).

Lead the creation a complete system end to end process flow document, for high profile data warehouse called CM2 (Customer Master Database – Customer Relationship Management). This involved describing with Use Cases and work flow diagrams for multiple distributed environments and technologies.

For all SDLC projects, created extensive business and functional specifications providing easy bridge to build technical specifications and models for each of the systems and/or applications affected (upstream and downstream).

WellPoint Health Networks | Business/Systems Analyst | July 1996 – November 2005 (9 years 5 months)

Lead the claims operations team to solve complex daily claims issues via: researching Assembly, State and Federal bills, regulations, policies and laws, data analysis (pricing, CPT, HCPCS, ICD-9 and LOCAL codes) for CMS (Medicare and Medi-Cal on WGS 2.0) Provided leadership in the implementation of Medicare D program; under the guidelines of the Medicare Modernization Act, working closely with the pharmacy teams to implement the drug benefits into Pharmacy System.

Lead systems/business analyst and project manager for a project initiated by new CMS pricing guidelines, for non-participating providers reimbursed from fee schedule on professional services rendered in the Emergency Room, Family Planning and Sensitive Services. Lead the analysis for the claims system impacts on WGS 2.0 claims system. After final approval from Legal Department to ensure appropriate compliance with state regulations with the Department of Health Services (DHS); schedule was successfully implemented.

Performed ICD-9 coding analysis for pricing rates from CMS and DHS, for state sponsored lines of business. Created training manual updates for the State Sponsored Business customer service department for correct and efficient processing and pricing of claims on both STAR and WGS 2.0 systems.

Lead system integration project of new technology for local Scanning/Imaging process (Filenet, Captiva and Panagon software) to replace existing legacy microfilming process; company-wide. Built and lead feasibility study analysis with positive ROI validated. Managed vendor and internal resources and successfully implemented a document content management imaging system in multiple locations. This provided accurate and faster imaging of paper claims into the system for processing.