Jason Duhon

• Led team that assisted state Department of Mental Health (DMH) Mental Illness Division with developing a Permanent Supportive Housing (PSH) Strategic Plan, which is a five year strategic plan that aims to maintain, increase, and better utilize PSH for persons with SMI • Led teams that performed multiple claims systems and claims operations assessments • Led teams that assisted multiple state behavioral health teams with utilization reporting and performance measure selection

• Assisted state Medicaid agency with transitioning their MMIS from a fee-for-service (FFS) delivery system to a managed care environment. With state staff, developed a strategy for the design and implementation of a managed care model, building on the infrastructure of the existing Medicaid Management Information System (MMIS). Collaborated closely with both the Medicaid agency and its fiscal agent to document the detailed requirements to the following subsystems: claims adjudication, claims payment, claims reporting, benefit plan, prior authorization, managed care, member, provider, reference and federal reporting. Supported Joint Application Development, Detailed System Design, and data configuration sessions and developed detailed recommendations to support the agency’s program and system design decisions for the delivery of system transformation. • Co-led team assessing a federal agency's healthcare processing systems. Reviewed technology, processes and procedures for program nationally. Along with Grant Thornton, issued a report of finding and recommendations to congress for improving payment accuracy and timeliness to providers. • Led assessment for a state Attorney General's office of their vendor’s healthcare claims adjudication system for litigation matter. Reviewed the vendor contract and provided guidance on additional Service Level Agreements (SLAs), based upon national best practices. Team reviewed defect logs, IV&V reports, technical documentation, User Acceptance Testing (UAT) plan and data produced by the system as part of the system assessment. Our team reviewed materials produced by the vendor to assess the likelihood of federal certification. Team also evaluated the roadmap for implementing deferred items as part of the system review as well. Team provided guidance on the Corrective Action Plan submitted to the state by the vendor.

• Assisted state Medicaid agency with transition from a per diem based inpatient claim payment system to an APR-DRG based prospective payment system. Performed pricing simulations using SAS programming language and performed comparisons of historical payment amounts to projected APR-DRG payment amounts. • Assisted several commercial and public healthcare payers evaluate avoidable cost, PMPM, Physician Variation and other analytics, certain projects also partnered with large physician or hospital organizations in the commercial payer's service area. Performed simulations using SAS programming language and performed comparisons of claim datasets between the payer and provider claim datasets to identify cost savings and other opportunities. • Assisted large Managed Care plan serving a Medicaid population with review of HEDIS® measures. Conducted on-site interviews, analyzed claims and other data, and created process flow mapping demonstrating flow of claims and HEDIS® information through the plan

• Payer-side Healthcare Claims processing Subject Matter Expert (SME) on core business team for Enterprise project, a SOA JAVA/J2EE/Oracle MITA-aligned payer-side healthcare claims processing system • Worked on application modernization of health care claims processing system by mining COBOL source code for business requirements for creating for new SOA JAVA-based Enterprise system—documenting the legacy code's requirements ensured that the new system maintained current functionality • Combined business requirements from legacy system with business requirements for new system functionality to create process flows, use cases, business rules catalog, user interface specifications and report specifications—the technical staff used these as the primary instruments to create UML, to generate all other technical documentation and to code the system • Supported staff matrixed into multiple accounts by analyzing their requirements and helping them fit their clients' requirements into the core system through configuration and data changes when possible—this lessened the development effort by reducing the coding changes required • Responsible for providing knowledge transfers to clients, client-facing staff, testers, internal and off-shore technical teams • Led claims demonstration of Enterprise product on two orals capture teams, including creating the claims demonstration strategy and creating all scenarios demonstrated

• Led team of subject matter experts responsible for creating requirement documents, reviewing technical design documents, presenting business requirements for clients, developers and testers on the Enterprise project.

• Led Joint Application Design sessions to gather business requirements producing general and detailed system design documents, system configuration and data setup and other deliverables for new Healthcare system

• Managed, reviewed and coordinated team members' responsibilities related to the development and maintenance of the New Mexico Medicaid Management Information System (NM MMIS), a relational database application that processes over one million claims per month, paying over $200 million per month

• Performed research, analysis, design, development, testing, implementation and documentation for dozen of projects per month