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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
RETURN THIS PAGE AS PART OF RFP RESPONSE 1
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 2 of 27
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):
RETURN THIS PAGE AS PART OF RFP RESPONSE 2
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 3 of 27
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.
RETURN THIS PAGE AS PART OF RFP RESPONSE 3
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 4 of 27
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):
RETURN THIS PAGE AS PART OF RFP RESPONSE 4
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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):
RETURN THIS PAGE AS PART OF RFP RESPONSE 5
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 6 of 27
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.
RETURN THIS PAGE AS PART OF RFP RESPONSE 6
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 7 of 27
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:
RETURN THIS PAGE AS PART OF RFP RESPONSE 7
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 8 of 27
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.
RETURN THIS PAGE AS PART OF RFP RESPONSE 8
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 9 of 27
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):
RETURN THIS PAGE AS PART OF RFP RESPONSE 9
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 10 of 27
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.
RETURN THIS PAGE AS PART OF RFP RESPONSE 10
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 11 of 27
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):
RETURN THIS PAGE AS PART OF RFP RESPONSE 11
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 12 of 27
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.
RETURN THIS PAGE AS PART OF RFP RESPONSE 12
OPWDD EHR 2017 RFPAttachment 24 – Key Personnel Forms Page 13 of 27
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.
RETURN THIS PAGE AS PART OF RFP RESPONSE 15
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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.
RETURN THIS PAGE AS PART OF RFP RESPONSE 18
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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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