MICHAEL D.

WATERS
413 Beauchamp Circle
Franklin, TN 37067
615.828.4455
mw14dcc3@westpost.net
SENIOR EXECUTIVE - HEALTHCARE IT
Operations... Information Technology... Claims Operations
Accomplished IT leader offering more than 15 years of rich career experience ach
ieving established goals. Recognized for leveraging strong time management and o
rganizational skills to consistently exceed expectations. Agile/creative thinker
with strong problem solving skills, high level IT acumen, employee supervision
successes, and proven career track record. Demonstrated success guiding sophisti
cated outsourcing project in collaboration with Accenture during tenure of emplo
yment at CIGNA. In addition, trained team of 30 individuals on effective pended
claims management methodologies immediately impacting timeliness and quality.
Bachelor of Science in Business Administration (BS) with concentration in Comput
er Information Systems
Appalachian State University; Boone, NC
COMPETENCIES
* Operations Management
* HIPAA Regulations
* Business Process Outsourcing (BPO)
* Sarbanes Oxley (SOX) Compliance
* Business Continuity Planning (BCP)
* Process Improvement
* Top Talent Team Management
* Computer System Utilization (EMR)
* New Technology Implementation
CERTIFICATION
* Six Sigma - Yellow Belt
TRAINING
* Claim Fraud Awareness and Privacy Training
* PMI/PMP Certification Training
AWARDS
* National Pended Claim Champion Award; CIGNA
* Vice President Gore's Hammer Award; McKessonHBOC
AFFILIATION
* Business Networking International (BNI)

CAREER CHRONOLOGY
Implementation Account Manager
Onlife Health, Inc. - Franklin, TN
National lifestyle health coaching, health risk assessment, and fitness center m
anagement company employing approximately 230 individuals
Recruited to implement and manage accounts, spearhead account operation activiti
es, and prepare outcomes and other metrics reports for clients. Supported senior
level decision making efforts by providing information relative to ROI and part
icipation rates during "portfolio review" type presentations. Supervised 1 imple
mentation manager. (2009 - 2010)
* Improved product stability and sales success by implementing 3 beta clients on
new beta coaching portal to measure feedback received as basis for product enha
ncements.
* Delivered customer satisfaction ratings of 95%+ while retaining customers year
-over-year in a highly competitive marketplace.
* Supported process improvement efforts by testing new reports, providing valuab
le recommendations, and facilitating online resources utilization training.
* Recognized by internal constituents for developing and delivering a two-sessio
n Outlook class instrumental in broadening user skills.

Director, Health Plan Data Management and Claim Operations

MedSolutions, Inc. - Franklin, TN
National radiology cost management organization
Embraced challenging opportunity to develop and coach cross-functional team of 4
0+ employees, streamline operations and training on effective use of front-end a
uthorization tool (UI) and new claims system, and oversee Health Plan Data Manag
ement to ensure accuracy and validity of data against health plan membership and
provider data. Managed budget of $1 million, 4 direct reports and 40 indirect r
eports. (2007 - 2008)
* Slashed claim turnaround 82% (to 6 days from 34 days) while rejuvenating deter
iorated relationships with providers by reorganizing claims department structure
and implementing streamlined claim processing protocol eliminating multiple sta
ff interaction.
* Decreased daily interface rejection errors from 11% to 3% by steering numerous
process improvement efforts related to electronic authorization transfer to cli
ents.
* Drove workflow and collaboration synergies to deliver higher monthly claim A/R
collections while improving claim processing and customer service levels by up-
training staff and reorganizing claim processing, claim customer service, and ac
counts receivables.
* Reduced workforce 30+ FTEs by developing and deploying effective operational e
nhancements.

Assistant Director, Operations and Vendor Management

CIGNA Healthcare - Franklin, TN
Medical and dental insurance company with national footprint and ~25,000 employe
es
Earned promotions from Transformation Manager and Assistant Director of Informat
ion Management and Technology (Southeast Region) to reduce pended claim volumes
in collaboration with regional health plans from Tennessee to Georgia to Florida
by driving operational improvements using root cause analysis. Participated as
key member on various national projects as subject matter expert for Central Pro
vider File (CPF) and pended claims as well as national projects focused on impro
ving claim payment accuracy. (2000 - 2007)
* Catalyst in improving contract loading and pended claims processing by partner
ing with business process outsourcer, Accenture, to create workflows for impleme
ntation in Philippines in addition to facilitating pended claims training instru
mental in immediately improving KPI results.
* Improved claims payment accuracy and cut claims pending volumes as key team pa
rticipant challenged with gathering requirements, studying impacts, and testing
improvements to Central Provider File (CPF).
* Delivered improvements in claims processing efficiency and turnaround time by
forming a pended claims user group comprised of key contacts from each claim pro
cessing center and pended claim teams across the nation. Centralized all P&Ps an
d "tips and tricks" on SharePoint site dedicated to effective pended claims proc
essing.

Manager, Pharmacy Systems Implementation

McKessonHBOC - Durham, NC
Outpatient pharmacy automation manufacturer
Hired to implement outpatient pharmacy automation instrumental in improving work
flows and efficiency in prescription order fulfillment. Teamed with sales direct
ors to help close deals and educate potential customers on implementation method
s and system benefits. Conducted project reviews from $100,000 to $3 million and
managed direct report team of 2 installers, 2 application engineers, and 1 proj
ect coordinator. (1999 to 2000)

EARLIER CAREER EXPERIENCE

IT Administrator / IT Analyst / Senior Business Analyst
Glaxo Wellcome Inc. (now GlaxoSmithKline)

TECHNOLOGICAL INVENTORY
Operating Systems: Windows XP/Vista/7
Applications: MS Office Professional, Access, Visio, Project
Windows Networking: TCP/IP... DNS... ICMP... DHCP... WINS... SMTP/POP... SNMP...
NNTP... SFTP
Other Technologies: Windows Server 2003/2008 Active Directory... IIS... SharePoi
nt... Remote Desktop... SQL... HTML... Use Cases... SDLC... Functional UI... DBM
S... EMR... The SANS Institute (@Risk)... QuickBooks... UltraVNC... Microsoft Sh
aredView...Citrix...VPN