Professional Documents
Culture Documents
PROFESSIONAL EXPERIENCE
EMBLEMHEALTH SERVICES, LLC, New York, New York ? 2003-Present
Provider of health coverage ? parent company of HIP Health Plan of New York and
Group Health Inc., serving 3M+ members across the tri-state region.
Assistant Director ? HIM (2005-Present)
Manager ? HIM (2003-2005)
Oversee all IT aspects of Electronic Health Records (EHR) projects ? provide gui
dance and expertise on development of interfaces between internal and external s
ystems required for optimum workflow. Partner with medical directors to create a
program to ensure uninterrupted operability of EHR systems. Document and patrol
adherence to HIM policies and procedures, and actively monitor relevant legisla
tive changes and accreditation standards. Control all aspects of electronic medi
cal records management and audits. Prepare and deliver key ICD-9 analysis report
s to senior medical directors for risk management pertaining to CMS audit filing
s (including Sarbanes-Oxley).
Direct key components of software development and implementation, from root caus
e and systems analysis through to coding maximization. Consult with key faciliti
es and regulatory agencies on matters including release of information, privacy/
confidentiality, information security and storage, and record management, as wel
l as authentication of health record documents. Collaborate with IT team to deve
lop/maintain optimum configuration for EHR testing, hardware/software installati
on, and integration with other systems. Assist and manage yearly budget.
Key Client Contributions:
? Advanced operations through direction and implementation of EmblemHealths elec
tronic health record (EHR) program, partnering with consultants and IT specialis
ts to ensure adherence to CMS guidelines and ROI milestones; additionally, direc
ted product upgrades to the application.
? Spearheaded a business transformation initiative, utilizing Lean Transactional
Businesses Processes to develop EHR for use in forecasting and budgeting activi
ties with Project Management Office (PMO).
? Achieved 15% savings from overall budget variance from 2007-2009 through targe
ted initiatives to improve invoice reconciliation processes.
? Expertly managed all interaction required for audits of ancillary departments
(QM-Prenatal Beta Blocker audit, Claims-Cost Outlier, Medicare-CMS Audit, Deloit
te & Touche).
1.
THOMAS GIMLER ? Page 2 ? tgimler@optonline.net
Technical Consultant
Expertly incorporated PERT (Project Evaluation and Review Technique) modeling to
manage planning, development, coordination and operations of initiatives in ord
er to deliver on timelines and expectations ? teamed with accountants and attorn
eys to translate business and financial objectives into practical applications.
Negotiated and implemented software contracts,
Key Client Contributions:
? Drove 10-15% market penetration increase through successful implementation of
business plans, and end to end web development of SharePoint website.
? Designed and end-to-end user process for querying legal resources.
? Designed and developed project plans and assumed responsibility for profit and
loss margin.
? Developed business cases with the emphasis on NPV and ROI.
? Served as a client manager to implement client server applications and seconda
ry legal solutions.
? Executed program management processes, cost management, and effectively manage
d budgetary requirements mandated by end users.
? Provided project turn-around expertise at the client site with the emphasis on
retaining client confidentiality.
? Managed the transition from Solutions Implementation to Client Support while m
aintaining a regional P&L schedule.
EDUCATION