Summary
Overview
Work History
Education
Skills
Systems
Timeline
Generic

Kerrie Richards-Knowles

Marlborough,Massachusetts

Summary

An experienced leader and team player specialized in client management, operational management, project management and technical management in the Electronic Data Interchange / Information Technology (EDI/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). Other leadership roles in the service and dispatch capacities in the lumber trading and liquid propane industries.

Overview

36
36
years of professional experience

Work History

Office Manager

Suburban Propane
11.2022 - 07.2023
  • Directly managed day-to-day activities of customer service call center including customer walk-ins for propane delivery requests including taking customer payments
  • Managed 5 office staff, including recruiting, interviewing, hiring, training, and performance improvement coaching
  • Focused on learning and enforcing compliance through procedures and protocols, specifically safety, financial, human resources, billing, liquid inventory, onboarding and retaining customers
  • Responsible for managing petty cash, ordering supplies, overseeing cleaning services and waste management, and vendor invoice processing.

Senior Operations Manager

Conduent, Inc.
05.2022 - 10.2022
  • In a client-facing role, oversaw the day-to-day operations for client, Commonwealth of Massachusetts for Pharmacy Benefits Management
  • Directly managed small team consisting of Provider Relations Lead, Clinical Business Analysts, Senior Technical Writers, with indirect management of Pharmacy Rebate Lead, Pharmacist Analysts, and database and programming roles
  • Coordinated cross-functional team activities to support client-related change control board deliverables
  • Ensured monthly invoicing and financial reporting were submitted accurately and timely, in addition to provider outreaches for escalated issues
  • Submitted client-approved messaging to internal Customer Service Center’s knowledge-base about key messaging including Pharmacy Facts distributions
  • Provided coaching and mentoring to direct and indirect staff.

Senior Manager, EDI

LogixHealth, Inc.
03.2021 - 02.2022
  • Oversaw the day-to-day operations for payor website administration, patient demographic data file processing, and submission of electronic eligibility, claims submissions, remittance advice and acknowledgments (270/271, 276/277, 837P, 835, 999/TA1, including SOAP) with a large volume of trading partners nationally
  • Built and lead overall EDI team through extensive recruiting, training, and mentoring of 30 staff and offshore EDI department in India
  • Responsible for making recommendations for a new product, electronic claims status (276/277)
  • Implemented password management metrics through a helpdesk system and hunt group call center.

Manager, Electronic Data Interchange (EDI) and Trading Partner Testing (TPT)

MAXIMUS, Inc.
01.2014 - 12.2021
  • 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
09.2013 - 01.2014
  • 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
02.2013 - 08.2013
  • Led the implementation of concurrent clinical/IT projects in a hybrid PM/BA role.

Project Manager / Leadership (contract)

Public Consulting Group
04.2012 - 12.2012
  • 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
12.2009 - 04.2012
  • 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
01.2009 - 10.2009
  • 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
04.2007 - 01.2009
  • 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.
05.2005 - 04.2007
  • 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
09.2002 - 01.2005
  • 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.
04.2001 - 01.2002
  • Implemented and supported an Employee Benefits Administration system for Fortune 500 clients

Manager, Information Technology

Akibia, Inc.
01.1999 - 04.2001
  • 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.
01.1998 - 01.1999
  • Provided mentoring on best practices of project management, managed project issues, time tracking, budgets

EDI Project Manager

Harvard Pilgrim Health Care
01.1996 - 01.1998

Project Manager

The MathWorks
01.1993 - 01.1996
  • Sales & Marketing Software Implementations

Programmer / Graphic Designer

Graphic Harmony
01.1988 - 01.1993

Education

Bachelor of Science in Management -

Northeastern University
01.2010

Project Management Professional (PMP) -

Project Management Institute
01.2003

Skills

  • 1
  • 2
  • 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
  • ASC X12 5010 Transaction Sets: 270/271, 276/277, 837I, 837P, 820, 834, 835, 278, 999/TA1, ADT HL7 in 4010 and 5010 schemas 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

Allscripts Practice Management, 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)

Timeline

Office Manager

Suburban Propane
11.2022 - 07.2023

Senior Operations Manager

Conduent, Inc.
05.2022 - 10.2022

Senior Manager, EDI

LogixHealth, Inc.
03.2021 - 02.2022

Manager, Electronic Data Interchange (EDI) and Trading Partner Testing (TPT)

MAXIMUS, Inc.
01.2014 - 12.2021

Project Manager / Leadership (contract)

Elderhostel / Road Scholar
09.2013 - 01.2014

Project Manager / Business Analyst

Tufts Health Plan
02.2013 - 08.2013

Project Manager / Leadership (contract)

Public Consulting Group
04.2012 - 12.2012

Project Manager / Technical Analyst (contract)

Fresenius Medical Care
12.2009 - 04.2012

Sr. Integration Analyst

CaseNET
01.2009 - 10.2009

Director, Client Technology and Operations

Curaspan
04.2007 - 01.2009

Director, Information Technology (contract to hire)

L.R. McCoy & Company, Inc.
05.2005 - 04.2007

Manager, Project Management Office

Provider Service Network
09.2002 - 01.2005

Project Manager

Workscape, Inc.
04.2001 - 01.2002

Manager, Information Technology

Akibia, Inc.
01.1999 - 04.2001

IT Project Analyst

Private Healthcare Systems, Inc.
01.1998 - 01.1999

EDI Project Manager

Harvard Pilgrim Health Care
01.1996 - 01.1998

Project Manager

The MathWorks
01.1993 - 01.1996

Programmer / Graphic Designer

Graphic Harmony
01.1988 - 01.1993

Bachelor of Science in Management -

Northeastern University

Project Management Professional (PMP) -

Project Management Institute

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Kerrie Richards-Knowles