HARRY REAVES
Cranston
Summary
I am an accomplished project/program manager with a wealth of experience in program governance, executive stakeholder communications, and financial analysis. My expertise lies in managing expansive program portfolios, often exceeding multi-million dollars, across diverse industries such as Healthcare, Telecommunications, and Greenfield development. My leadership roles encompass strategic planning, system/application implementation, and business process re-engineering. Throughout my career, I have successfully led teams of varying sizes, from small project groups to large PMO matrix teams, with a primary focus on driving service excellence, risk mitigation, and cost control. Focused Project Manager adept at planning, directing and maintaining continuous operations in various departments. Experienced in directing manufacturing employees and keeping efficient production in accordance with quality standards. Applying creative and analytical approach to operations for continuous process improvement. Skilled at identifying or anticipating problems and providing solutions. Excels through mentoring, training and empowering team to excel in performance. Resourceful Project Manager with [Number] years of expertise in organizing business operations, financial oversight and resource management to achieve smooth flow and project operations. Leads procurement of resources including equipment and supplies. Monitors projects by adhering to production schedule and budget, managing production team, identifying problems and providing targeted solutions. Knowledgeable in accounting principles, bookkeeping, budget, and financial management.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Project Manager
WellSense Health Plan
01.2024 - 06.2024
- In my capacity as the PM/BA for WellSense Health Plan, I held a pivotal role in overseeing the Utilization Management (UM) and Pharmacy work streams
- I collaborated closely with our compliance and legal teams to address any changes in Prior Authorization (PA) approvals for the New Hampshire Federal exchange in which this involved navigating the complex landscape of regulatory requirements and ensuring alignment with our health plan’s guidelines
- Working in tandem with our IT team and the ZeOmega vendor, I meticulously oversaw the implementation of PA changes within our system
- I forged a strategic partnership with our Rx vendor to optimize drug coverage and leveraging Express Scripts recommendations, we fine-tuned our formulary to enhance cost-effectiveness and clinical outcomes
- My multifaceted role encompassed legal compliance, system precision, and strategic vendor collaboration, all aimed at delivering high-quality healthcare services to our members.
Project Manager
Capital District Physicians' Health Plan, Inc. (CDPHP)
06.2023 - 12.2023
- In my role as a Project Manager for Capital District Physicians' Health Plan, I was responsible for overseeing the entire process of regression testing for the CDPHP De-Identification project
- This involved meticulously managing the scope, approach, and coordination required for the testing to ensure the accuracy and effectiveness of the de-identification process
- One of my key priorities was to guarantee that the data stored within the managed cloud service provider (MCSP) met all the necessary requirements outlined in the Protected Health Information (PHI) regulations and the recently enacted New York State Health Insurance Program (NYSHIP) regulations
- Additionally, I worked diligently to ensure the Referential Integrity of the production data systems, which involved safeguarding the relationships between different data elements within the systems to maintain data consistency and accuracy.
Project Manager
Healthfirst Health Plan
01.2023 - 06.2023
- In my role as a Project Manager for Healthfirst Health Plan, I had the crucial responsibility of overseeing the AMISYS Upgrade and Surround/Interface Impact Discovery projects
- My primary focus was to ensure that these projects were completed on time to align with the Healthfirst Health Plan implementation go-live date
- I provided leadership, strategic planning, and leveraged my extensive business expertise to drive the successful implementation of new systems and applications, as well as the re-engineering of business processes
- As part of my supervision of the ETL process, I managed the extraction of data from the enterprise data warehouse and various sources, including reports, open queries, and Excel files connected to the legacy servers
- The data underwent thorough cleaning, standardization, and mapping of fields from the old system to the new AMISYS servers, ensuring compatibility
- Finally, the transformed data was loaded into the target database, which consisted of the upgraded AMISYS servers.
Project Manager
Sentara
07.2022 - 01.2023
- In my role as a Project Manager at Sentara, I was tasked with overseeing the complex migration of provider, member, and broker data from the outdated CSC claims system to the newly implemented QNXT claims system
- As part of my oversight of the ETL process, I oversaw the extraction of data related to providers, members, and brokers from the outdated CSC claims data warehouse
- Ensuring seamless extraction while considering technical constraints, I structured, cleaned, and enriched the data to align with the QNXT claims system
- This process addressed stakeholder requirements, including those of internal teams and external partners
- Finally, I loaded the transformed data into the newly implemented QNXT claims system, striking a balance between technical precision and stakeholder satisfaction
- This involved meticulous planning, thoughtful consideration of potential challenges, and clear communication at all levels to ensure a smooth and successful transition to the new system.
Project Manager
MultiPlan
01.2022 - 07.2022
- During my time as a Project Manager at MultiPlan, I was tasked with the vital responsibility of applying industry best practices, principles, and techniques to effectively plan, organize, and oversee the implementation of various projects
- This entailed the meticulous preparation and management of project documentation, deliverables, milestones, resource allocation, and schedules
- Additionally, I collaborated closely with the IT team to ensure seamless communication and adherence to the rigorous standards and processes of the Software Development Life Cycle (SDLC).
Project Manager
Massachusetts Executive Office of Health and Human Services
03.2020 - 01.2022
- During my tenure as a Project Manager at the Massachusetts Executive Office of Health and Human Services, I was entrusted with the pivotal role of spearheading the implementation of the Transformed Medicaid Statistical Information System (T-MSIS) project
- This substantial initiative aimed to bring into effect the state Medicaid Datawarehouse reporting standards mandated by the Centers for Medicare & Medicaid Services (CMS)
- I orchestrated the extraction of data from diverse internal systems and data warehouse containing Medicaid encounter claims
- The ETL approach involved mapping source fields to the required CMS format and seamlessly loading the transformed data into a CMS-compliant system, ensuring punctual monthly submissions
- This data, presented in a standardized format dictated by CMS, encompassed an average of 6,310,000 Medicaid encounter claims every month
- In addition to overseeing the seamless transmission of this vast volume of data, I undertook the responsibility of orchestrating the project to transition the legacy proprietary file format of encounter claims to the mandated EDI X12 837 Post-Adjudicated Institutional, Professional, and Dental transaction ("EDI X12 837 post-adjudicated transaction") formats
- This meticulous conversion process had a significant positive impact, contributing to a marked enhancement in both the quantity and quality of the data furnished to CMS monthly.
Project Manager
Blue Cross Blue Shield of Massachusetts
10.2019 - 01.2020
- During my tenure as a Project Manager at Blue Cross Blue Shield of Massachusetts, I oversaw a diverse team comprising Big Data analysts, developers, engineers, architects, and testers
- I managed the ETL process which extracted data from the enterprise data warehouse and various systems, including the Operation Data Hub (ODH) and Enterprise Analytics Hub (EAH)
- Ensured data quality by cleaning, enriching, and structuring it to maintain consistency and relevance
- Coordinated data transformations, merged datasets, and generated data extracts and collaborated closely with the Data Review Team and Data Pod Product Owners to prioritize strategic initiatives
- My role also involved spearheading the data ingestion pipeline and collaborating closely with the Data Review Team and Data Pod Product Owners to prioritize initiatives.
Project Manager
Emblem Health
10.2018 - 10.2019
- During my tenure as a Project Manager at Emblem Health, one of my key responsibilities involved overseeing the successful implementation and delivery of Administrative Services Only (ASO) capabilities to clients of Emblem Health and ConnectiCare (CCI)
- This involved utilizing the Facets claims system and a bridge network to ensure a seamless and consistent experience for our clients
- I played a crucial role in identifying the specific business drivers and requirements for this initiative and engaged in strategic discussions with both internal and external stakeholders, including senior executives
- This high-level engagement allowed me to ensure that the project aligned with the overall strategic objectives of the organization and met the needs of our clients
- Additionally, I took charge of managing the delivery of the ASO portal by the EXL Service vendor
- This involved ensuring that new clients could effectively access and utilize the portal to view ASO claims reports, perform ad-hoc data analysis, and download necessary data
- My oversight was instrumental in guaranteeing that our clients had the necessary tools and resources at their disposal to make informed decisions and manage their ASO capabilities effectively.
Project Manager
Tufts Health Plan
06.2018 - 10.2018
- While working as a Project Manager for Tufts Health Plan, one of my key responsibilities involved overseeing and reporting the progress of the Provider legacy system conversion
- This was crucial in ensuring that we would meet the deadline for the implementation of the Tufts Health Plan Mass HealthRules system
- Throughout this process, I was also tasked with troubleshooting and documenting potential short-term solutions for the HealthRules Payer and Optum location issue that emerged during the conversion efforts with the legacy system.
Project Manager
Blue Cross Blue Shield of North Carolina
02.2017 - 05.2018
- In my role as Project Manager, I was tasked with overseeing the successful execution of the Avalon Healthcare Solutions Lab Benefit Management program
- This program had a specific goal of reducing medical expenses and as part of my ETL responsibilities, I managed the extraction of data related to medical expenses, claims, and other relevant information from the enterprise data warehouse
- I ensured the smooth integration of the vendor Claims Editor into both Facets and Power MHS environments
- Additionally, I transformed policy-related data and loaded it into Facets and Power MHS, aiming to achieve the $90 million savings target over five years
- Furthermore, I was involved in managing the business configuration activities for Individual Affordable Care Act (ACA) products introduced by any BCBSNC Enterprise Initiative or Health Care Reform (HCR)
- This was crucial in ensuring that customers received the ACA mandated products.
Senior Project Manager
DST Health Solutions
09.2016 - 01.2017
- In my role as a Senior Project Manager, I had the crucial responsibility of overseeing the management of the First Carolina Care contract with DST Health Solutions
- This involved providing comprehensive support for their growing Medicare Advantage (MA) Line of Business through the utilization of DST’s Business Process Outsourcing (BPO) services
- The expansion initiative encompassed the establishment of two significant partner relationships
- The first partnership involved onboarding approximately 3,000 new members across six counties, while the second partnership focused on integrating around 1,000 new members in Wake County, NC.
Program Manager
Molina Healthcare, Inc.
02.2016 - 09.2016
- As a Program Manager, I was responsible for overseeing the entire administration and execution of the client relationship, program solution, and program lifecycle
- Specifically, I played a key role in planning and implementing all stages of the Molina Marketplace Product State expansion, CMS Cost Share Reduction Reconciliation, CMS 834 EDI Enrollment Reconciliation, and CRM escalation system enhancements across the Molina Marketplace Line of Business (LOB)
- This involved closely managing the coordination of various teams, ensuring smooth execution, and driving the success of these critical initiatives.
Senior Project Manager
CareFirst BlueCross BlueShield
03.2015 - 02.2016
- As a Senior Project Manager, I oversaw a dedicated team of 5 Quote to Bill (QTB) Business Analysts who were responsible for in-depth research and resolution of escalated Healthcare Exchange (HIX) consumer web portal EDI enrollment issues
- These issues primarily involved bridging communication gaps between CareFirst and either the DC Health Benefit Exchange or Maryland Health Benefit Exchange enrollment systems
- The primary objective was to ensure a seamless and reliable enrollment process, ultimately enhancing customer service satisfaction and assurance for all parties involved.
Project Manager/Business Process Improvement (BPI)
Blue Cross Blue Shield of North Carolina
06.2014 - 03.2015
- In my role as a Project Manager/Business Process Improvement (BPI), I undertook the important responsibility of overseeing the Business Readiness activities associated with the introduction of Small and Large Group ACA HIPAA compliant products as part of an Enterprise Initiative or Health Care Reform (HCR)
- This involved ensuring that customers received the mandated products outlined in HCR
- To achieve this, I meticulously developed and formulated comprehensive process plans that encompassed detailed outlines of any changes in processes, conceptual future state maps, and high-level process impact analyses.
Project Manager
Blue Cross Blue Shield of Massachusetts
03.2013 - 05.2014
- In my role as a Project Manager, I was entrusted with the crucial responsibility of spearheading the implementation of organizational change in accordance with the Affordable Care Act (ACA) which came into effect on January 1, 2014
- This involved overseeing the intricate process of payer claims processing and adjudication for Duals/Demonstration/Medicare Medicaid program, Pediatric Dental, Out-of-pocket accumulations, and for Qualified Student Health Plans
- It was a multifaceted effort that required careful coordination and strategic leadership to ensure compliance with the ACA's mandates.
Project Manager
WEA Trust
08.2012 - 03.2013
- As a Project Manager overseeing the HealthRules (HR) Interface claims Implementation, I demonstrated strong leadership and strategic acumen
- My responsibilities were to Develop a comprehensive project charter that outlines the project’s purpose, scope, objectives, stakeholders, and success criteria
- Collaborate closely with business stakeholders to assess their needs and gather detailed requirements
- Analyze existing processes and identify gaps or areas for improvement
- Configure the HealthRules system to align with business processes and customize it as needed for the enterprise data warehouse
- Operating within an Agile framework, create an iterative work plan that includes sprints, user stories, and backlog items
- Define project milestones, deliverables, and timelines and Establish governance structures, roles, and responsibilities
- Rigorously test the HealthRules interface to identify and resolve any issues and ensure data accuracy, system functionality, and compliance with industry standards
- Launch the system in production, closely monitoring its performance and provide ongoing support to users, addressing any post-implementation challenges.
Project Manager
CareSource
11.2011 - 08.2012
- In my role as a Project Manager, I had the responsibility of overseeing the development and implementation of various enhancements for the Facets version, which included workflow improvements, Configuration Migration Utility, eCOB CRM, and other enhancements that were not part of recent application upgrades
- Additionally, I oversaw managing the SaaS Vendor HIPAA EDI transactions and claims processing add-on applications for the existing system setup
- This involved collecting crucial data from the enterprise data warehouse on eligibility, enrollment, program details, utilization, and expenditure for the Medicaid and CHIP programs.
Project Manager
Blue Cross and Blue Shield of Minnesota
06.2011 - 11.2011
- In my role as a Program Manager, I was responsible for providing comprehensive guidance and oversight for all aspects of ICD-10 testing, including partner testing with the NASCO claims payer system
- This encompassed a wide range of tasks, such as defining the scope of the testing program, conducting testing to support ICD-9 to ICD-10 mapping and integration, addressing application remediation testing for impacted systems, and overseeing business user acceptance testing
- Moreover, I was tasked with developing a thorough Test Strategy and Test Approach, which involved identifying the underlying assumptions and constraints of the testing program, as well as delineating the different types of testing required
- Additionally, I had to define the respective roles and responsibilities for each testing type to ensure a comprehensive and effective testing process.
Project Manager
Blue Cross and Blue Shield of Tennessee
02.2011 - 06.2011
- As a Project Manager, I held the responsibility of overseeing the implementation and standardization of the essential competencies required for clinical mapping between ICD code sets
- This included establishing governance to effectively manage code sets, related maps, and assessing the impact of their utilization within the enterprise
- One of my key achievements was undertaking the process of identifying, evaluating, and procuring a code mapping tool from preferred vendors approved by BCBSA
- I ensured that the selected tool was configured to align with the ongoing mapping and governance needs of BCBST, leading to the successful delivery of new code mapping competencies essential for seamless operations.
Project Manager
Sterling Health Plan
06.2010 - 02.2011
- As a Project Manager, I played a key role in developing comprehensive project plans for the seamless implementation of HIPAA 5010/ICD-10 standards organization-wide
- This initiative aimed to optimize operational processes by leveraging standardized HIPAA transactions, enhanced enterprise architecture, and the implementation of a robust Data Warehouse
- Additionally, I contributed to the successful merger of Sterling and Windsor's managed care platforms by overseeing file data conversion, setting up eligibility feed systems, and ensuring the accurate loading of contract data to facilitate claims processing in alignment with contractual terms.
Project Manager
Computer Sciences Corporation
06.2006 - 11.2009
- I have extensive experience as a Project Manager (FTE) with a proven track record of delivering successful projects for a range of clients
- During my time at Blue Cross and Blue Shield of Rhode Island in Providence, RI, I led the implementation of the FACETS claims payer system as part of the multi-release three-year, multi-vendor BlueTransIT program
- This involved effectively utilizing the Software Development Lifecycle to ensure seamless integration
- I was responsible for creating and managing an integrated project schedule involving 32 client, company, and vendor Project teams
- At Blue Shield of California in El Dorado Hills, CA, I was tasked with delivering the Integrated Project Plan for the Legacy Modernization (LM) claims payer program
- Managing a team of 13 client, company, and vendor Project teams, I set clear expectations and meticulously managed the integrated project schedule in alignment with the project timeline, milestones, and deliverables outlined in the Master Project work-plan for the FACETS implementation
- My role at ChoicePoint in Alpharetta, GA, involved the project management of a Greenfield Full File Disclosure re-architecture project
- This project aimed to build a single application for extracting and pulling data from the data warehouse while replacing the manual ordering method for consumer insurance claim disputes
- Lastly, at GHN Online in Dallas, TX, I oversaw the implementation of Microsoft BizTalk server to establish the infrastructure for connecting the existing diverse GHN Online applications
- This initiative was designed to provide a 360 electronic transaction in Revenue Cycle Management.
Project Manager
Bellsouth
01.2006 - 06.2006
- As the Application Architect Project Manager for the BellSouth Rip N Read rapid development project, I employed a modified agile rapid development process to update the BellSouth.com e-commerce website
- My responsibilities included managing a team of US and Offshore Rip N Read developers, maintaining project plans and budgets, conducting requirement walkthroughs, creating development estimates, overseeing user interface design approvals, coordinating testing, and managing work requests and defect fixes between US and India resources.
Project Manager
Comcast
10.2005 - 01.2006
- In my role as a Project Manager, I resolved around 100,000 Digital Voice Directory Listing errors nationally, involving Comcast and other telecom providers
- I worked with a team to analyze data, define requirements, and re-engineer operations processes
- I developed metrics to track error resolution and categorized each error type, identifying root causes and potential failure points
- I assembled and defined the skill set requirements for the reconciliation team and evaluated existing methods and procedures to reduce resolution time
- Finally, I presented the findings of the root cause analysis, which included potential changes to address the issues.
Project Manager
AT&T
11.1995 - 11.2004
- As a Project Manager, I oversaw various business areas using my extensive knowledge of local and long-distance telecommunications, videoconferencing, business services products, and support systems
- I possess excellent oral and written communication skills, strong leadership abilities, as well as project and process management skills, along with exceptional interpersonal skills
- Responsibilities: Project/Product Manager - Managed the product development of the Local Network Service Footprint Tool to provide coverage for sales and provisioning
- Led the development and update of the tool for $10 million AT&T Unbundled Network Element Platform footprint expansion
- Possessed detailed knowledge of the AT&T Local footprint, including product, switching, signaling, and transport
- Collaborated daily with IBM and AT&T Labs on the delivery of new system developments and data maintenance for the Local Footprint Tool
- Implemented organizational changes and system improvements to align with Telecom industry changes and FCC rules
- Introduced the All in One-Local Metered Usage project to address gaps in the All-in-One offer and generate an annual revenue of approximately $225,000
- Project Manager - Managed the transition of AT&T Digital Link customer orders from the legacy ordering system to the new system, resulting in an estimated cost savings of $1 million per month in vendor expenses
- Coordinated the development of Local Business Customer Care processes supporting Directory listings for each specific Local Exchange Carrier
- Senior Technical Project Manager - Provided telecommunication and Videoconferencing support to AT&T Executive Officers for international and interstate videoconference meetings
- Managed technicians providing depot services and remote work office maintenance for AT&T Executive Officer’s virtual office equipment
- Offered helpdesk support for AT&T Executive Officer’s desktop/laptop and telecommunication issues
- Global Customer Service and Sales Specialist - Handled proactive and demand account support for AT&T Global customer business accounts
- Coordinated customer project requests for AT&T integrated services end-to-end through the service order lifecycle
- Addressed escalations related to billing issues and account inaccuracies for customer and revenue retention
- Managed billing and listing inquiries, adjustments, bill reprints, and volume discounts
Education
Bachelor’s degree - Marketing
South Carolina State University
Orangeburg, SC01.1994
Skills
- Project Management
- Project Planning
- Project planning and development
- Project Scheduling
- Client Relations
- Stakeholder Communications
- Budgeting and forecasting
- Risk Management
Certification
Project Management Masters Certificate (CPM), Stevens Institute of Technology, Hoboken, NJ
Timeline
Project Manager
WellSense Health Plan
01.2024 - 06.2024
Project Manager
Capital District Physicians' Health Plan, Inc. (CDPHP)
06.2023 - 12.2023
Project Manager
Healthfirst Health Plan
01.2023 - 06.2023
Project Manager
Sentara
07.2022 - 01.2023
Project Manager
MultiPlan
01.2022 - 07.2022
Project Manager
Massachusetts Executive Office of Health and Human Services
03.2020 - 01.2022
Project Manager
Blue Cross Blue Shield of Massachusetts
10.2019 - 01.2020
Project Manager
Emblem Health
10.2018 - 10.2019
Project Manager
Tufts Health Plan
06.2018 - 10.2018
Project Manager
Blue Cross Blue Shield of North Carolina
02.2017 - 05.2018
Senior Project Manager
DST Health Solutions
09.2016 - 01.2017
Program Manager
Molina Healthcare, Inc.
02.2016 - 09.2016
Senior Project Manager
CareFirst BlueCross BlueShield
03.2015 - 02.2016
Project Manager/Business Process Improvement (BPI)
Blue Cross Blue Shield of North Carolina
06.2014 - 03.2015
Project Manager
Blue Cross Blue Shield of Massachusetts
03.2013 - 05.2014
Project Manager
WEA Trust
08.2012 - 03.2013
Project Manager
CareSource
11.2011 - 08.2012
Project Manager
Blue Cross and Blue Shield of Minnesota
06.2011 - 11.2011
Project Manager
Blue Cross and Blue Shield of Tennessee
02.2011 - 06.2011
Project Manager
Sterling Health Plan
06.2010 - 02.2011
Project Manager
Computer Sciences Corporation
06.2006 - 11.2009
Project Manager
Bellsouth
01.2006 - 06.2006
Project Manager
Comcast
10.2005 - 01.2006
Project Manager
AT&T
11.1995 - 11.2004
Bachelor’s degree - Marketing
South Carolina State University
Project Management Masters Certificate (CPM), Stevens Institute of Technology, Hoboken, NJ
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