Summary
Overview
Skills
Work History
Education
References
Work Preference
Languages
ee
Lisa Riordan

Lisa Riordan

Frisco,TX

Summary

IT professional with extensive experience in Medicaid Enterprise Systems, combining technical skills with business insight to drive IT solutions that meet organizational objectives. Proven ability to lead teams through all phases of the systems development lifecycle (SDLC), ensuring successful project execution. Expertise in data analytics, requirements gathering, software development, project management, and quality assurance, resulting in effective system implementations and modernization. Recognized for strong communication skills and a detail-oriented approach, focused on optimizing healthcare IT solutions and enhancing operational efficiency while ensuring compliance with industry standards.

Overview

35
35
years of professional experience

Skills

  • Medicaid Enterprise Systems
  • Project management and leadership
  • SDLC management
  • Quality assurance and compliance
  • Data analytics and modeling
  • EDI, HIPAA X12 standards
  • SQL, PL/SQL
  • C, Unix, Microsoft NET
  • Training, coaching, and mentoring
  • Analytical thinking and problem solving
  • Process improvement and optimization
  • Excellent written and verbal communication

Work History

Senior Consultant and Data Analyst, TennCare

NTT DATA Services
Plano, TX
04.2021 - Current
  • Recognized subject matter expert in claims and encounter processing, pricing, MMIS data schema, and HIPAA X12 standards, providing critical technical and business insights across enterprise areas.
  • Reviewed artifacts for key account initiatives, including the transition of fee-for-service claims processing to Managed Care Organizations. Identified defects and gaps, enabling vendors and the state client to mitigate risks, enhance claim payment accuracy, and meet critical milestones.
  • Collaborated with TennCare and solution vendors to validate requirements for Encounter Processing (EP), Member Enrollment, and Financial Management Core Module enhancements/replacements. Provided expertise in EP design sessions, advising on encounter specifics, edits, audits, and X12 transaction standards.
  • Analyze new and trending errors from the T-MSIS operational dashboard, conduct research, and recommend corrective actions to mitigate data quality issues.
  • Develop ad-hoc SQL queries and reports to generate analyses that drive data-driven decisions.
  • Participate in Implementation Advance Planning Document Update (IAPDU) reviews, offering input on project scope, and funding allocations.
  • Contribute to monthly executive status updates, showcasing NTT's value-added efforts and impact.
  • Actively engage in project-focused and industry workgroups, fostering collaboration, and driving forward Medicaid Enterprise System improvements.
  • Play a key role in TennCare meetings, including T-MSIS status sessions with CMS, ensuring alignment with federal standards, and continuous data quality enhancements.
  • Proposed, developed, and co-presented a well-received T-MSIS data quality prevention presentation at the 2022 Medicaid Enterprise Systems Conference (MESC), strengthening client trust, and highlighting Tennessee as a model state in Medicaid data integrity.
  • Delivered presentation on T-MSIS to certification and compliance consultants, emphasizing its significance in system certification and securing enhanced federal funding.
  • Supported education initiatives by contributing content to the Medicaid 101 Training series as a subject matter expert in multiple functional areas.
  • Build and maintain strong relationships with clients, vendors, and peers, fostering collaboration and a culture of mutual respect.
  • Recipient of NTT STAR Performance Awards in Teamwork and Clients First/Customer Satisfaction, demonstrating a strong commitment to collaboration, leadership, and excellence.
  • Featured in NTT DATA spotlight video on work/life balance, and the mission beyond technology.

Technical Functional Area Lead, MMIS Core

Gainwell Technologies
Plano, TX
03.2005 - 03.2021
  • Contributed to the design, development, and implementation (DDI) of state-specific Medicaid Enterprise Solutions for Wisconsin, Georgia, Massachusetts, and Mississippi, ensuring seamless deployment and functionality.
  • Provided ongoing maintenance and support, optimizing system performance, and addressing evolving state requirements.
  • Led cross-functional teams of batch and UI MMIS developers, guiding them through all phases of system development, while fostering collaboration and technical excellence.
  • Honed expertise in multiple functional areas, including Claims, Reference Data Management, Benefit Plan Administration, and EDI.
  • Mentored functional area resources, providing hands-on support in solving complex technical challenges, designing targeted training programs, and ensuring professional growth within the team.
  • Managed work plans, balancing shifting priorities, and aligning tasks with Gainwell and client objectives, ensuring on-time delivery and adherence to project requirements.
  • Facilitated requirements determination and design sessions, collaborating with stakeholders to identify, evaluate, and influence critical application changes, while ensuring project scope integrity.
  • Provided accurate estimates for technical design and development, assisting in strategic planning and execution of complex projects.
  • Conducted in-depth technical walk-throughs, enforcing best practices, maintaining adherence to standards, and rigorously inspecting deliverables for completeness and correctness.
  • Provided technical design oversight for high-impact system-wide projects such as ICD-10 remediation, ensuring seamless implementation and compliance.
  • Developed comprehensive Desk Level Procedures (DLPs) for Claims, Reference, and Provider subsystems, improving operational efficiency and standardization in production support activities.
  • Guided Reference and Claims data conversion efforts, ensuring accuracy and reliability in system transitions.
  • Contributed to RFP and new business pursuits, supporting strategic growth and engagement opportunities.
  • Responded to critical project demands, such as DRA drills and CMS certification efforts, ensuring compliance and operational readiness.
  • Supported employee performance management, providing feedback to resource managers and contributing to talent development.
  • Actively participated in MMIS Tech Lead forums, sharing insights, lessons learned, and process improvements to enhance industry knowledge and innovation.
  • Served as a University of Healthcare Instructor to expand application and industry expertise across teams.
  • Recognized for exceptional leadership, collaboration, and impact, earning distinctions in categories like Making a Difference, Living Our Values, Collaborating Without Boundaries, and Results Through Teamwork.

Technical Lead, Special Enhancements

Gainwell Technologies
Plano, TX
07.2004 - 03.2005
  • Led end-to-end implementation of a new Customer Request tracking system for Arkansas Medicaid, including design, development, and data migration efforts.
  • Created the relational data model using ERwin® and authored SQL schema statements to establish new database structures.
  • Developed the business logic layer via Oracle PL/SQL stored procedures, and supported front-end development using VB.NET.
  • Designed and executed data conversion routines, seamlessly migrating legacy data into the new application environment.

Software Engineer, MMIS Product Development

Gainwell Technologies
Plano, TX
01.2004 - 07.2004
  • Chosen to contribute to the re-engineering of the MMIS Core product (interChange) user interface, utilizing XML schemas and the C#.NET Framework to enhance system architecture.
  • Attended and completed .NET training provided by Microsoft for the start-up Core Team members.
  • Designed and developed business layer system object components for the Claims subsystem user interface.

Software Engineer, MMIS EDI

Gainwell Technologies
Plano, TX
12.2001 - 01.2004
  • Collaborated with the lead architect to design and implement database enhancements, enabling the capture and processing of X12 837 Health Care Claims, forming a lasting component of the core interChange MMIS platform.
  • Developed and maintained translation programs/maps for 837 and 835 (Claim Payment/Advice), laying the foundation for multiple state-level interChange implementations.
  • Strengthened expertise in ANSI ASC X12 EDI Transaction Sets, ensuring compliance with healthcare data exchange standards.
  • Created and maintained mapping documents for electronic and paper claims, ensuring accurate data transformation and integration.
  • Partnered with data capture vendor, RRI, to validate XML output specifications for paper claim forms, ensuring accurate data structure and seamless integration with the claims processing engine.
  • Designed system interfaces, including RRI-to-MMIS and MMIS-to-Atlantes case management, utilizing Unix shell scripting, XML, and XSLT.
  • Provided mentoring and technical training to EDI peers in TN, PA, NH, RI, and VT, fostering knowledge sharing and skill development across multiple states.

Software Engineer, Internal Systems

Electronic Data Systems (EDS)
Plano, TX
08.2000 - 11.2001
  • Provided production support for the EDS internal Activity/Cost Based Management tool, InPerspecta®.
  • Actively participated in the implementation and institutionalization of quality assurance processes and procedures for Internal Systems teams, supporting a goal of SEI CMM certification. Authored and co-authored project planning documents, including Scope Management, Risk Management, Configuration Management, and Project Standards.
  • Developed application code using PowerBuilder, Informix Stored Procedures, C, and Unix scripting.

Software Engineer, DePuy AcroMed

EDS
Raynham, MA
07.1999 - 07.2000
  • Provided on-site business and technical support for sales and marketing applications.
  • Maintained and enhanced application code using PowerBuilder, Oracle PL/SQL, and Unix shell scripting.
  • Independently created comprehensive documentation, including batch cycle processes, technical system documentation, and application overviews, improving on-call support efficiency, impact analysis, testing, and training.

Software Engineer, JJHCS

EDS
Plano, TX
01.1997 - 06.1999
  • Developed object-oriented GUI applications for Johnson & Johnson Health Care Systems (JJHCS) utilizing PowerBuilder 5.0 and 6.0 with PFC, SQL, and Oracle PL/SQL.
  • Led Joint Application Development (JAD) sessions and created functional prototypes to refine system design.
  • Provided mentorship and technical guidance on SQL*Forms, enhancing team expertise, and accelerating legacy system re-engineering efforts.
  • Created and delivered training sessions to JJHCS users, ensuring effective adoption and utilization of the applications.
  • Completed intensive 10-week technical training as part of EDS' Systems Engineering Development (SED) Program. Developed hands-on expertise by completing curriculum assignments using C, Microsoft Visual Basic, and SQL.

Various, Blue Cross Blue Shield of Massachusetts

EDS
Boston, MA
10.1990 - 01.1997
  • Position descriptions and accomplishments available upon request

Education

Bachelor of Arts - Psychology And Management

Boston College
Chestnut Hill, MA

References

References available upon request.

Work Preference

Work Type

Full Time

Work Location

Remote

Important To Me

Work-life balanceCareer advancementCompany Culture

Languages

English
Native language
French
Elementary (A2)
A2

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