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Curriculum Vitae Ken Wiens 2014
- 1. Ken R. Wiens 192 Clanton Lane Wartrace, TN 37183 ken.wiens@sssadvantage.com 787-620-1919 x2010 ken.wiens@hotmail.com 787-508-3399 Mobile EXECUTIVE CIO PROFILE Creative, results oriented, and interdisciplinary senior healthcare insurance executive with twenty years of total Information Systems management experience, including five years at an IPA, nine years as the CIO of a healthcare software development company, three years with the largest healthcare COB and cost containment vender, and now seven years with a Medicare Advantage organization. Recognized for strong leadership, team building, and strategic management skills. Has extensive experience introducing and managing change at the unit and the enterprise level. Mr. Wiens is comfortable using technology as a competitive advantage to achieve a better healthcare experience for our members. Has the ability to listen and communicate with the other members of the senior team and other key constituents. Information System Management Infrastructure Management Data Center Management Expense Reduction IT Governance and Portfolio Management Global IT Delivery & Operational Readiness Strategic Analysis and Internal Consulting Architecture and Infrastructure Planning Enterprise-wide Change Management Budget Management and Cost Control SOX ITGC Control Management Vendor negotiation and management Data security and HIPAA security officer BCBSA Blue Card Program EDI, & MTM Legal and Regulatory Compliance Application, System Development, Integration Capacity planning and related architecture Disaster Recovery PROFESSIONAL EXPERIENCE CIO and VP of Infrastructure 2011- Present Triple S Advantage - Blue Cross/Blue Shield of Puerto Rico San Juan, Puerto Rico Triple S Advantage(TSA) (NYSE: GTS) acquired American Health Medicare on February 7, 2011 and is now the third largest Medicare plan in the Puerto Rican market with 112,000 members, 911 regular employees and gross revenues of $1.1 B. Mr. Wiens is accountable for the following areas under his direct management: Provide executive leadership and accountability as a member of the Senior Executive team reporting to the CEO Built strong trusts with all senior management by involving them in IT Governance where they participate in the technology solutions selection and prioritization to insure business needs are being met. Work with Corporate Legal to managed and negotiate contracts with our 3rd party vendors. I am responsible for $3 Million dollars in contracts for Medicare services. Accountable for over 40 IT applications. Work with Corporate IT to ensure best purchase position across all of the Triple S Groups. Life, Property, Commercial Health, and Medicaid. ITGC SOX Controls - Accountability for all ITGC Controls. These include Security, Computer Operations, Change Management, and New Development. Manage IT Team of 34 Professionals in both Development, Infrastructure, and Help Desk. Managed all IT external vendors with emphasis on the Primary Platforms, Clearing Houses, HIE for Lab Data and EMR. Responsible for the IT Budget of 6.8 Million for Professional Services, Maintenance, Software Licenses, Payroll, and Capital Expenditures. Manage monthly accruals and quarterly budget status with seasonality variations. Work with the IT Governance team to create the 1 and 2 year strategic plans for New Development, Change Management, and Software Acquisition.
- 2. Evaluate and manage our vendors for Best of Class in servicing our AVAYA and ASPECT systems. Maintain Policies and Procedure to ensure Security, HIPAA, Patch Management, DR, Backups, Business Continuity, Virus Updates, Internet Usage, Email Usage, Limited Data Set, SDLC, and Software Acquisition, New Development and Log monitoring. Develop a yearly training program to keep staff ready for the new technology challenges, and to enhance retention. CMS Security Officer As the Security Officer, Mr. Wiens is responsible for all Provisions of the HIPAA Security regulations. He reviews and updates Policies and Procedures, both conducts internal Assessments and contracts for external Assessment and Analysis of the Security regulations. In the event of a breach, Mr. Wiens must manage a complete Assessment, Analysis, and Breach Management Plan. BCBSA Blue Card-Inter Plan Program EDI, & MTM Manage Data Exchange Delegated Entities and contracted 3rd party venders o Labs, EMR, EDI, PBM, Revenue Management (Inovalon), Partially and fully capitated entities, Predictive modeling, Physician profiling, Patient profiling o CMS.gov for Daily Enrollment Submissions and TRRs, PDEs, RAPS, & EDPS Encounters Primary Data Processing Platforms o Healthsuite, Cactus, EDI Interchange Grid Wovenware, AVAYA, ASPECT, Microsoft Dynamics CRM o DW, Pre-Auths, Referrals, and the Provider Portal Infrastructure o Manage all services to maximum uptime. Manage the Virtual Server Environment for maximum efficiency and uptime. o Vulnerability and Intrusion Analysis (NESSES). Manage Email, Desktop, and Laptop Encryption o Enterprise Mobility Management - AirWatch o DR & Business Continuity, VDI, and Remote My Documents for those not using VDI CIO and VP of Infrastructure 2008- 2011 Socios Mayores en Salud (d.b.a. American Health Medicare) San Juan, Puerto Rico Mr. Wiens was appointed to the CIO position by the Board of Directors. Tasked with improving top line revenue, maximizing claims accuracy, improving Information System General Controls, and bringing stability to the AHM network and systems. When hired in April of 2008, the company had completed a 409A Valuation which determined the stock to have a value of $0.06. Triple S purchased AHM for $0.74 per common stock acknowledging a twelve times increase in 34 months. Mr. Wiens worked with the Senior Executive team to help accomplish the following changes in 34 months where Information Systems had the primary role: Increased top line revenue through appropriate member risk score identification, documentation and RAPS submission from $842 PMPM in 2008 to $907 PMPM in 2010 o In 2008 AHM received $22 Million additional revenue by implementing correct taxonomy and RAPs rules. The Additional Revenue lowered the MLR from 90.2% to 85.7% by Dec. 2008 Managed and designed IT projects that decreased claims backlog from 107K in 2008 to 23K including adjustment volume in 2010 with 95% adjudicated in 7 days and 99% within 30 days Oversaw the creation of a Data Warehouse from the Legacy Claims system database including our data files from CMS, the sales CRM system, and the Finance data Designed and oversaw the creation of our Provider Portal with advanced functionality including best of class Health Risk Assignment tool, provider reconciliations tools, local Medicaid functionality for duals, and a Stars Alert system to increase HEDIS screen test results. Increased EDI from 40% (2008) to 77% (2010) Implemented Call Management System and replaced under-configured switches, upgraded the VoIP system and improved call quality and reliability for all departments. Mr. Wiens earned the maximum allowed bonus in 2009, 2010, & 2011, with an additional non-contracted bonus in 2010 for results above expectations awarded by the board of directors.
- 3. PREVIOUS PROFESSIONAL EXPERIENCE Healthcare Consultant 2007- 2008 Edmund Jung Associates Woodland Hills, CA Edmund Jung and Associates, Inc. (EJA) is a healthcare consulting company that focuses on small to midsize health plans supplying their clients with application design, development, implementation and maintenance of critical applications focusing primarily on MC400 clients. Senior Account Director 2005-2007 Health Management Systems (HMS) New York, NY HMS leads the nation in Medicaid cost containment, coordination of benefits, and program integrity services for government healthcare programs. HMS identifies other insurance coverage, coordinates benefits, and recovers overpayments. Ken was the Senior Account Director for the Kaiser Account in California and then the United Health Account. Chief Information Officer 1996-2005 OAOT Woodland Hills, CA OAO Health Care Solutions was a wholly owned division of OAO Technology (www.oaot.com). Its mission was to provide reliable, full function, and high availability Managed Care applications to Health Plans, TPAs, Taft Hartley, PPO, Medicaid, and Medicare Health Plans. Director of Information Services 1992-1995 Sant辿 Health IPA Fresno, CA Sant辿 Health Plan is an Independent Practice Association that began providing health care services to Central California patients in 1988. Sant辿 is Central California's largest physician's group and represents more than a dozen Healthcare Payers for the greater Fresno area for 120,000 members. Prior to 1992 Earlier in Kens career he worked for IBM in Cali, Colombia with their Midrange Systems Division.. Mr. Wiens later took a position with a Coal Extraction company and developed the first Coal Extraction Suite of programs for vertical coal veins. Mr. Wiens has been a speaker at the Healthcare Information and Management Systems Society (HIMSS), as well as a speaker at various IBM systems conferences. Speaker for RISE (Risk Adjustment Imitative Society for Education) 2011. EDUCATION Masters in Health Administration, University of Phoenix. 2007 with Cum Laude Honors Bachelor's degree in Mathematics with an Emphasis in Computer Sciences, San Jose State University in California 1977 Received Awards and Bonuses for Leadership, Outstanding Vision, and Service in 2000, 2001, 2002, 2003, 2004, 2006, 2008, 2009, and 2010. Languages English Native, Spanish Read and Write Fluent