Jennifer Campbell

Innovative Senior Healthcare and IT Management Consultant with over 27 years of experience in the healthcare sector, including a decade in management roles at a State Department of Health and Human Services. Specializing in Managed Care and Fee-For-Service policy development, strategic planning, procurement, contract management, negotiation, legislative monitoring, regulatory compliance, business process optimization, and Medicaid enterprise system modernization. Key player in establishing quality assurance and continuous improvement protocols for the healthcare field, overseeing major implementations for healthcare agencies and managing budgets exceeding $2 billion.

• Medicaid Managed Care and Fee-for-Service (FFS) Operations
• MMIS Transformation and Modernization – Visioning and Roadmap Creation
• Regulatory Compliance – Medicaid Policy (SSA, CFR, HIPAA, State Government)
• Enterprise System CMS Certification (IV&V, SMC/OBC)
• Medicaid Enterprise Certification Life Cycle (MECL)
• System Development Life Cycle (SCLC) – Waterfall, Agile, Hybrid
• Requirements Gathering and Traceability
• Use Case Creation and testing (SIT/UAT)
• Medicaid Enterprise Certification Toolkit (MECT)
• Medicaid Information Technology Architecture (MITA) Framework
• Service Oriented Architecture (SOA)
• CMS Standards and Conditions
• JIRA, JAMA, SharePoint

NTT Data Business Analysis Practice Certification

· Assisted 8 different state health programs with modernizing and transforming their business and technology operations through various phases of the full project and system development life cycles

· Provided recommendations to a state health program for converting from the MECT certification process to the SMC/OBC process for their final certification review; most recommendations were followed, and certification successfully obtained with no corrective action

· Facilitated requirements gathering sessions with various functional areas within a state health program (Program Integrity, TPL, Encounters/Managed Care Administration, Capitation), identifying 899 potential functional, technical, and vendor requirements for inclusion in the RFP

· Served as a CMS Certification Lead for two IV&V projects over a 5.5-year period; drafted content, coordinated, prepared, and finalized all required quarterly, interim and certification review status reports and supporting documentation for submission to CMS

· Provided state health program with the implementation plans, tools, and roadmaps to formally execute implementation of a new document intake process (incorporating a scanner solution) and electronic file storage and retention tracking system

· Documented and redesigned business processes related to annual medical code MMIS system updates, resulting in a 50% reduction in time to complete updates from 1 year to 6 months within 6 months of redesign

· Developed eight future business process workflow tools for a highly complex Long-Term Care Services and Supports Fee-for-Service operation within a state health program to accommodate two new systems, integrated eligibility, and case management

· Assisted with converting the electronic format for encounter data submission from a proprietary format to the HIPAA compliant 837 transaction set; worked closely with the Enterprise System team throughout the SDLC to convert the proprietary format to the HIPAA compliant 837 format

· Monitored state and federal regulations, legislation, and policy concerning Medicaid and directed the interpretation, implementation and enforcement of state and federal policies and regulations to ensure compliance and effective service delivery system