Kim Downing
Digital Demand Manager @Anthem Blue Cross and Blue Shield
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WORK HISTORY
Digital Demand Manager @Anthem Blue Cross and Blue Shield
Tech Project Manager / PMP Consultant, Shepard the Commercial Large Group Tier Network Product Implementations through the complete project life cycle. New ACA Healthcare Exchange Claims submissions to CMS to validate federal reimbursement (820 EDI) interfaces for subsidized and unsubsidized Exchange Members is the current product deliverable being implemented. Restored a slipping timeline to deliver a new tier medical healthcare plans in two states that provided tiered pricing to large group membership while leveraging providers who demonstrating consistent patient performance with financial rewards. Membership and claims were imported into big data engine for plan performance via reporting. Developed scope refinement for three federal mandated projects for Health Care Exchange (ACA) in supply of claims to HHS with reimbursement in return via 820 feed from HHS. All transactions were manage via the big data repository which reports individual membership plan performance.
EDUCATION
Purdue University Indianapolis
BS, Electronic Engineering Technology
ABOUT KIM DOWNING
Core Competencies Include:* Strategic Planning & Leadership * Project Management Life Cycle * Program Management * Productivity, Workflow, & Efficiency Improvement - Quality - Green Belt Six Sigma Quality * Project Management Methodology (PMI, Critical Chain)* Application Development (SDLC, Agile)* Infrastructure Consulting * Profit & Loss Responsibilities * Resource Allocation * Customer Relations * Exceptional Problem Solving Skills * Employee Relations * New Product / Service Development * Vendor Management / Negotiation * Software Development/Computer Validation - GXP’s Federal Regulations - 21 CFR - ER / ES Part 11 * Policies & Procedures * Training & Program Development * Team Management / Virtual Team * Project Management 2002 Server * Systems & Network Design
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