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OPWDD EHR 2017 RFP Attachment 24 – Key Personnel Forms Page 1 of 36 Bidder Name: _____________________________ Name ONE consultant for each of the RFP Key Personnel positions. Using the chart below, describe clearly and accurately how the consultant meets or exceeds the Desired Specifications, addressing each and every specification. Do not submit résumés in lieu of completing this form. Type to expand response areas on the form. Notes: A. Bidders can have one person fill more than one role, unless otherwise noted. If a person will fill more than one role, the Bidder should clearly identify how the role duties will be separated. B. Not all of these positions require the person to work full time on this particular project. C. Responses to this Attachment will be scored. Table of Contents Engagement Manager................................................... 2 Project Manager...................................................... 4 Information Security Officer.........................................7 Clinical Solutions Architect / Business Analyst......................9 Pharmacy Solutions Architect........................................11 Technical Solutions Architect.......................................13 Data Architect...................................................... 16 Test Manager........................................................ 19 Training Manager.................................................... 23 Financial Solutions Manager.........................................26 RETURN THIS PAGE AS PART OF RFP RESPONSE 1

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Page 1: Engagement Manager - OPWDD Web viewUsing the chart below, describe clearly and accurately how the consultant meets or exceeds the Desired Specifications, addressing each and every

OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 1 of 27

Bidder Name: _____________________________

Name ONE consultant for each of the RFP Key Personnel positions. Using the chart below, describe clearly and accurately how the consultant meets or exceeds the Desired Specifications, addressing each and every specification. Do not submit résumés in lieu of completing this form. Type to expand response areas on the form.

Notes:

A. Bidders can have one person fill more than one role, unless otherwise noted. If a person will fill more than one role, the Bidder should clearly identify how the role duties will be separated.

B. Not all of these positions require the person to work full time on this particular project.C. Responses to this Attachment will be scored.

Table of Contents

Engagement Manager.................................................................................................................................2Project Manager..........................................................................................................................................4Information Security Officer........................................................................................................................7Clinical Solutions Architect / Business Analyst.............................................................................................9Pharmacy Solutions Architect....................................................................................................................11Technical Solutions Architect....................................................................................................................13Data Architect............................................................................................................................................16Test Manager.............................................................................................................................................19Training Manager......................................................................................................................................23Financial Solutions Manager......................................................................................................................26

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Engagement Manager

The Engagement Manager is responsible for managing the contractual relationship with the State and oversight of the delivery of services and is the primary point of contact for the Lead Project Managers. The Engagement Manager is accountable for the successful completion of all aspects of the resulting Contract.

The Engagement Manager shall possess the following experience:

A. Minimum of five (5) years of experience in leading major consulting engagementsB. Minimum of ten (10) years of relevant professional experience. That experience must include work

similar in scope to that outlined in the EHR Scope of Work Overview section.C. public sector experienceD. experience leading consulting engagements for clients with multiple locations

Engagement Manager

Proposed Consultant: _________________________

Desired Specification A: Minimum of five (5) years of experience in leading major consulting engagementsDates (month/year) of Proposed Consultant Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities related to <desired specification A>:Desired Specification B: Minimum of ten (10) years of relevant professional experience. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s professional experience with <desired specification B>:Desired Specification C: public sector experienceDates (month/year) of Experience:

Client Name(s):

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Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification C>:Desired Specification D: experience leading consulting engagements for clients with multiple locationsDates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification D>:

Educational Qualifications:

Other Certifications:

CERTIFICATION: I hereby certify that: (i) all statements made on this form are true and complete, to the best of my knowledge, including the verification of any experience; (ii) to the best of my knowledge, the consultant will be available for the duration of the engagement.

Authorized Signature: ____________________________________________________

Typed or Printed Name:       Date: Click here to enter a date.

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Project Manager

The Project Manager shall manage the provision of services under the Contract. The Project Manager serves as the primary point of contact for the NYS Project Manager(s) and is responsible for the project management activities specified in Section 3.1.1 of the RFP. Responsibilities include:

The project manager shall report to and receive direction from NYS. The project manager shall manage the scope of the Project to ensure successful implementation

and completion of the contracted services and deliverables on schedule and within budget. The project manager shall utilize the project management methodology and NYS best practices. The project manager shall create and maintain Project documentation and perform the project

management for the activities specified in Section 3 of the RFP The project manager shall monitor the Project schedule and notify NYS and appropriate parties

if any changes to the schedule should arise. The project manager shall ensure that the team clearly understands the objectives of the project

and that the resulting process and program meets all the business requirements. The project manager must perform in accordance with schedule that shall contain clearly

identifiable deliverables and milestones.

The Project Manager shall possess the following experience:

A. Minimum of five (5) years of experience in project management B. Minimum of seven (7) years of relevant professional experience. That experience must include work

similar in scope to that outlined in the EHR Scope of Work Overview section.C. Public sector experienceD. Experience managing projects for clients with multiple locationsE. Superior English language written and verbal skills.F. A valid Project Management Professional (PMP) certification

It is preferred that the Project Manager possess experience with ITIL, SDLC, and service lifecycles.

Project Manager

Proposed Consultant: _________________________

Desired Specification A: Minimum of five (5) years of experience in project management

Dates (month/year) of Proposed Consultant Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

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Description of Consultant’s roles and responsibilities related to <desired specification A>:

Desired Specification B: Minimum of seven (7) years of relevant professional experience. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s professional experience with <desired specification B>:

Desired Specification C: Public sector experience

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification C>:

Desired Specification D: Experience managing projects for clients with multiple locations

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

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Description of Consultant’s roles and responsibilities in relation to <desired specification D>:

Educational Qualifications:

Other Certifications:

CERTIFICATION: I hereby certify that: (i) all statements made on this form are true and complete, to the best of my knowledge, including the verification of any experience; (ii) to the best of my knowledge, the consultant will be available for the duration of the engagement.

Authorized Signature: ____________________________________________________

Typed or Printed Name:       Date: Click here to enter a date.

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Information Security Officer

The Information Security Officer (ISO) researches, develops, implements, tests and reviews the organization's information security in order to protect information and prevent unauthorized access. The ISO informs users about security measures, assesses and plans for current potential threats, plans software upgrades to address security concerns, implement security measures and monitors networks.

The ISO is responsible for gathering information necessary to maintain security and establish functioning external barriers such as firewalls and other security measures. The ISO defines, creates and maintains the documentation for certification and accreditation of each information system in accordance with NYS requirements. The ISO also assesses the impacts of system modifications and technological advances and reviews systems in order to identify potential security weaknesses, recommend improvements to amend vulnerabilities, implement changes and document upgrades.

The ISO shall be dedicated full-time to the security role within the Bidder’s organization.

The Information Security Officer shall possess the following experience:

A. Minimum of five (5) years of comparable work experience in a security role. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

B. Superior English language written and verbal skills.C. A bachelor's degree in computer science, mathematics, engineering or related field

It is preferred that the Project Manager possess a valid Certified Information Systems Security Professionals (CISSP) certification according to the International Information Systems Security Certification Consortium.

Information Security Officer

Proposed Consultant: _________________________

Desired Specification A: Minimum of five (5) years of experience in a security role. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

Dates (month/year) of Proposed Consultant Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities related to <desired specification A>:

Educational Qualifications:

Other Certifications:

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CERTIFICATION: I hereby certify that: (i) all statements made on this form are true and complete, to the best of my knowledge, including the verification of any experience; (ii) to the best of my knowledge, the consultant will be available for the duration of the engagement.

Authorized Signature: ____________________________________________________

Typed or Printed Name:       Date: Click here to enter a date.

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Clinical Solutions Architect / Business Analyst

This position will report to the Consultant/vendor’s PM and is responsible for the overall development of the clinical portion of the OPWDD EHR solution. This position will be responsible for leading the collaborative assessment, design and configuration for all clinical end user interfaces and customization of the EHR for the OPWDD. Responsibilities include:

A. Develop, contribute product knowledge, and integrate OPWDD feedback and requirements into development of the EHR functionality features and functions

B. Work collaboratively with the OPWDD team to ensure appropriate transfer of knowledge of the existing OPWDD processes, forms, and reports

C. Ensure the incorporation of business and clinical workflows into the EHR.D. Manage the deployment of the EHR functionality and implementation process and ensure that

existing processes are incorporated as neededE. Participate in implementation planning and successful transitionF. Collaborate with the EHR team to develop support process, policies and procedures including

escalation proceduresG. Collaborate with vendor’s training staff.

The Clinical Solutions Architect / Business Analyst shall possess the following experience:

A. Minimum of ten (10) years of relevant clinical experience. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

B. Minimum of five (5) years of experience implementing, configuring or using EHRs. C. Superior English language written and verbal skills.

It is preferred that the Clinical Solutions Architect / Business Analyst possess:

A. Medical Degree (RN, or other).B. Master’s degree in a clinical field of study

Clinical Solutions Architect / Business Analyst

Proposed Consultant: _________________________

Desired Specification A: Minimum of ten (10) years of relevant clinical experience. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

Dates (month/year) of Proposed Consultant Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

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Description of Consultant’s roles and responsibilities related to <desired specification A>:

Desired Specification B: Minimum of five (5) years of experience implementing, configuring or using EHRs.

Dates (month/year) of Proposed Consultant Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities related to <desired specification B>:

Educational Qualifications:

Other Certifications:

CERTIFICATION: I hereby certify that: (i) all statements made on this form are true and complete, to the best of my knowledge, including the verification of any experience; (ii) to the best of my knowledge, the consultant will be available for the duration of the engagement.

Authorized Signature: ____________________________________________________

Typed or Printed Name:       Date: Click here to enter a date.

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Pharmacy Solutions Architect

This position will report to the Consultant/vendor’s PM and is responsible for the overall development and implementation of the pharmacy portion of the OPWDD EHR solution. This position will be responsible for leading the collaborative assessment, design and configuration for all pharmacy end user interfaces and customization of the EHR for the OPWDD. This position will also manage the data migration and application deployment for e-Prescribe. Responsibilities include:

A. Develop, contribute product knowledge, and integrate OPWDD feedback and requirements into development of the e-Prescribe functionality features and functions

B. Work collaboratively with the OPWDD team to ensure appropriate transfer of knowledge of the existing OPWDD pharmacy application and technical architecture

C. Ensure the incorporation of business and clinical workflows into new product developments.D. Manage the deployment of the e-Prescribe functionality and implementation process and ensure

that existing pharmacy practices are incorporated as neededE. Participate in e-Prescribe implementation planning and successful transitionF. Collaborate with the EHR team to develop support process, policies and procedures including

escalation procedures for e-Prescribe

The Pharmacy Solutions Architect shall possess the following experience:

A. Minimum of five (5) years of relevant pharmaceutical experience. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

B. Minimum of five (5) years of experience using EHRs.

It is preferred that the Pharmacy Solutions Architect possess a Certified Pharmacy Technician, Licensed Pharmacist or Pharmacy Degree.

Pharmacy Solutions Architect

Proposed Consultant: _________________________

Desired Specification A: Minimum of five (5) years of relevant pharmaceutical experience. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

Dates (month/year) of Proposed Consultant Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

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Description of Consultant’s roles and responsibilities related to <desired specification A>:

Desired Specification B: Minimum of five (5) years of experience using EHRs.

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s professional experience with <desired specification B>:

Educational Qualifications:

Other Certifications:

CERTIFICATION: I hereby certify that: (i) all statements made on this form are true and complete, to the best of my knowledge, including the verification of any experience; (ii) to the best of my knowledge, the consultant will be available for the duration of the engagement.

Authorized Signature: ____________________________________________________

Typed or Printed Name:       Date: Click here to enter a date.

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Technical Solutions Architect

The Technical Lead serves as the Technical Solutions Architect is responsible for ensuring that the solution is implemented to meet all requirements

The Technical Lead shall possess the following experience:

A. Minimum of ten (10) years of relevant technical experience. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

B. Experience leading technical projects for clients with multiple locationsC. Minimum of five (5) years of experience on large-scale modernization projects, that included

replacing internal legacy systems with one that would be directly accessed by external users/stakeholders and support the transition to the new solution

D. Minimum of five (5) years of experience in solution assessment, transition and sequence planning, security planning, system integration, information architecture, or business process engineering to build or re-architect an enterprise-level solution

E. Minimum of five (5) years of experience using Business Process Management Systems (BPMS) F. Minimum of three (3) years of experience with CMS Standards.

Technical Lead/Architect

Proposed Consultant: _________________________

Desired Specification A: Minimum of ten (10) years of relevant technical experience. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

Dates (month/year) of Proposed Consultant Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities related to <desired specification A>:

Desired Specification B: Experience leading technical projects for clients with multiple locations

Dates (month/year) of Experience:

Client Name(s):

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Project(s) Name and Description (to include scope):

Description of Consultant’s professional experience with <desired specification B>:

Desired Specification C: Minimum of five (5) years of experience on large-scale modernization projects, that included replacing internal legacy systems with one that would be directly accessed by external users/stakeholders and support the transition to the new solution

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification C>:

Desired Specification D: Minimum of five (5) years of experience in solution assessment, transition and sequence planning, security planning, system integration, information architecture, or business process engineering to build or re-architect an enterprise-level solution

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification D>:

Desired Specification E: Minimum of five (5) years of experience using Business Process Management Systems (BPMS)

Dates (month/year) of Experience:

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Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification E>:

Desired Specification F: Minimum of three (3) years of experience with CMS Standards.

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification F>:

Educational Qualifications:

Other Certifications:

CERTIFICATION: I hereby certify that: (i) all statements made on this form are true and complete, to the best of my knowledge, including the verification of any experience; (ii) to the best of my knowledge, the consultant will be available for the duration of the engagement.

Authorized Signature: ____________________________________________________

Typed or Printed Name:       Date: Click here to enter a date.

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Data Architect

The Data Architect will design and implement the data architecture to meet all requirements. The Data Architect responsibilities include:

A. Establishes end-to-end EHR solution data vision including structure, flow, end points and delivery methods

B. Develops, builds, and maintains EHR solution normalized relational data modelC. Develops plans for data integration solutions which integrate with the existing EHR solutionD. Develops and maintains the complete EHR database solutions by designing proposed solution

changes, database physical structure and functional capabilities, security, back-up, and recovery procedures

E. Maintains database performance by identifying and resolving production and application development problems; calculating optimum values for parameters; evaluating, integrating, and installing new releases; completing maintenance; answering user questions.

F. Develops and executes data migration plans for data movement or data platform migration.

The Data Architect shall possess the following experience:

A. Minimum of eight (8) years designing and maintaining relational data models B. Minimum of five (5) years designing and maintaining Extraction, Transformation, and Loading (ETL)

solutionsC. Minimum of four (4) years delivering Business Intelligence (BI) solutionsD. Minimum of four (4) years delivering data migration and conversion solutionsE. Minimum of four (4) years implementing information management strategies, including master data

management solutions

Data Architect

Proposed Consultant: _________________________

Desired Specification A: Minimum of eight (8) years designing and maintaining relational data models

Dates (month/year) of Proposed Consultant Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities related to <desired specification A>:

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Desired Specification B: Minimum of five (5) years designing and maintaining Extraction, Transformation, and Loading (ETL) solutions

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s professional experience with <desired specification B>:

Desired Specification C: Minimum of four (4) years delivering Business Intelligence (BI) solutions

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification C>:

Desired Specification D: Minimum of four (4) years delivering data migration and conversion solutions

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification D>:

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Desired Specification E: Minimum of four (4) years implementing information management strategies, including master data management solutions

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification E>:

Educational Qualifications:

Other Certifications:

CERTIFICATION: I hereby certify that: (i) all statements made on this form are true and complete, to the best of my knowledge, including the verification of any experience; (ii) to the best of my knowledge, the consultant will be available for the duration of the engagement.

Authorized Signature: ____________________________________________________

Typed or Printed Name:       Date: Click here to enter a date.

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Test Manager

The Test Manager will be responsible for:

A. Providing testing subject matter expertise for EHR specific applications, business processes and policies.

B. Understanding the architecture and configuration of test environments and test scenario conditions/parameters by providing overall framework for all of the tests to be performed

C. Managing resources to appropriately support the type of testing required and to meet the level of effort required for timely completion of test events

D. Developing test strategy, test plan, test scripts and provide regular progress reports to client stakeholders

E. Managing User Acceptance Testing.

The Test Manager shall possess the following experience:

A. Minimum of five (5) years of experience in a test management roleB. Minimum 4 years of relevant Health IT Testing experience.C. Experience in managing and leading testing and evaluation activities for multiple sustainment and

new development releases concurrently in multiple test environments.D. Experience in developing, implementing, and managing test cases, and test scriptsE. Experience creating and using Requirements Traceability matrices to manage testing scope and track

defects.F. Experience designing, implementing, and conducting test and evaluation procedures to ensure

functional and non-functional requirements are met.G. Experience with and strong understanding of Electronic Health Record systems.

It is preferred that the Test Manager possess a Bachelor’s degree in IT or Engineering field.

Test Manager

Proposed Consultant: _________________________

Desired Specification A: Minimum of five (5) years of experience in a test management role

Dates (month/year) of Proposed Consultant Experience:

Client Name(s):      

Project(s) Name and Description (to include scope):

     

Description of Consultant’s roles and responsibilities related to <desired specification A>:

     

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Desired Specification B: Minimum 4 years of relevant Health IT Testing experience

Dates (month/year) of Experience:

     

Client Name(s):      

Project(s) Name and Description (to include scope):

     

Description of Consultant’s professional experience with <desired specification B>:

     

Desired Specification C: Experience in managing and leading testing and evaluation activities for multiple sustainment and new development releases concurrently in multiple test environments.

Dates (month/year) of Experience:

     

Client Name(s):      

Project(s) Name and Description (to include scope):

     

Description of Consultant’s roles and responsibilities in relation to <desired specification C>:

     

Desired Specification D: Experience in developing, implementing, and managing test cases, and test scripts

Dates (month/year) of Experience:

     

Client Name(s):      

Project(s) Name and Description (to include scope):

     

Description of Consultant’s roles and responsibilities in relation to <desired specification D>:

Desired Specification E: Experience creating and using Requirements Traceability matrices to manage testing scope and track defects.

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Dates (month/year) of Experience:

     

Client Name(s):      

Project(s) Name and Description (to include scope):

     

Description of Consultant’s roles and responsibilities in relation to <desired specification E>:

Desired Specification F: Experience designing, implementing, and conducting test and evaluation procedures to ensure functional and non-functional requirements are met.

Dates (month/year) of Experience:

     

Client Name(s):      

Project(s) Name and Description (to include scope):

     

Description of Consultant’s roles and responsibilities in relation to <desired specification F>:

Desired Specification G: Experience with and strong understanding of Electronic Health Record systems.

Dates (month/year) of Experience:

     

Client Name(s):      

Project(s) Name and Description (to include scope):

     

Description of Consultant’s roles and responsibilities in relation to <desired specification G>:

Educational Qualifications:

Other Certifications:

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CERTIFICATION: I hereby certify that: (i) all statements made on this form are true and complete, to the best of my knowledge, including the verification of any experience; (ii) to the best of my knowledge, the consultant will be available for the duration of the engagement.

Authorized Signature: ____________________________________________________

Typed or Printed Name:       Date: Click here to enter a date.

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Training ManagerThe Training Manager is responsible for defining training needs, development and customization of training curricula, training materials and oversight of the Contractor’s delivery of training including hands-on practice sessions. Responsibilities include:

A. Functioning as the primary training and Implementation resourceB. Coordinating and participating in the assessment of the training needs of each OPWDD FacilityC. Designing and building a customized EHR training curriculum for the OPWDD needs, including a

combination of On-Site training, follow-up training, go-live assistance and Computer Based Training for new employees and refresher courses for all employees

D. Coordinating all activities related to Implementation and facilitate communication between the key participants

E. Developing and scheduling timelines for the training and Implementation aspects of the project; then consistently deliver milestones that meet those timelines

F. Traveling On-Site as needed to assist with various training activitiesG. Managing the development or modification of training materials and documentations, including on-

line manuals, and workflow documentation to meet the OPWDD needsH. Effectively communicating with all levels of the OPWDD organization

The Training Manager shall possess the following experience:

A. Minimum of five (5) years of experience in organizing and managing training for health care organizations

B. Minimum of ten (10) years of relevant professional experience. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

C. Public Sector ExperienceD. Proficiency in Word, Excel, PowerPoint, Microsoft Project, Microsoft Visio and Adobe AcrobatE. Superior English written and oral communication skills

Training Manager

Proposed Consultant: _________________________

Desired Specification A: Minimum of five (5) years of experience in organizing and managing training for health care organizations

Dates (month/year) of Proposed Consultant Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

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Description of Consultant’s roles and responsibilities related to <desired specification A>:

Desired Specification B: Minimum of ten (10) years of relevant professional experience. That experience must include work similar in scope to that outlined in the EHR Scope of Work Overview section.

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s professional experience with <desired specification B>:

Desired Specification C: Public sector experience

Dates (month/year) of Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities in relation to <desired specification C>:

Educational Qualifications:

Other Certifications:

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CERTIFICATION: I hereby certify that: (i) all statements made on this form are true and complete, to the best of my knowledge, including the verification of any experience; (ii) to the best of my knowledge, the consultant will be available for the duration of the engagement.

Authorized Signature: ____________________________________________________

Typed or Printed Name:       Date: Click here to enter a date.

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Financial Solutions Manager

Note: This position is optional based on the OPWDD decision regarding the Article 16/IPSIDD Billing and Collection Services.

The Financial Solutions Manager shall be responsible for providing billing and collection services for Article 16 Clinics and IPSIDD. Additional responsibilities include:

A. Responsible for leading and planning the Article 16 Clinics and IPSIDD billing operationsB. Responsible for designing, implementing and enforcing policies and proceduresC. Oversee and streamline billing and collections processesD. Month-end closing of the billing group informationE. Plan and implement quality assurance for all processesF. Field Operators’ problem escalation and customer serviceG. Assist with the implementation of the billing system

The Financial Solutions Manager shall possess the following experience:

A. Minimum of three (3) years of experience providing collections servicesB. Minimum of three (3) years of CMS billing experience

It is preferred that the Financial Solutions Manager possess a College degree in accounting, finance or business management.

Experience Design Lead

Proposed Consultant: _________________________

Desired Specification A: Minimum of three (3) years of experience providing collections services

Dates (month/year) of Proposed Consultant Experience:

Client Name(s):

Project(s) Name and Description (to include scope):

Description of Consultant’s roles and responsibilities related to <desired specification A>:

Desired Specification B: Minimum of three (3) years of CMS billing experience

Dates (month/year) of Proposed Consultant Experience:

Client name(s):

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Project(s) Name and Description (to include scope):

Description of Consultant’s professional experience related to <desired specification B>:

Educational qualifications:

Other certifications:

CERTIFICATION: I hereby certify that: (i) all statements made on this form are true and complete, to the best of my knowledge, including the verification of any experience; (ii) the specific consultant proposed on this form will be available to work upon the commencement of this engagement, and to the best of my knowledge, the consultant will be available for the duration of the engagement.

Authorized Signature: ____________________________________________________

Typed or Printed Name:       Date: Click here to enter a date.

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