Healthy Outlook

Kenneth has 14 years of healthcare experience in government and private industry. Over eight years of experience managing healthcare IT projects, operations, contracts, and personnel. His work experience includes project management, contracts and procurements, data analysis, claims adjudication, business writing, and business process modeling. Kenneth was certified in 2006 as a Project Management Professional.

Healthcare is one of the few industries in the United States that has grown during the recession. The trend shows no sign of stopping, and project work is plentiful throughout the industry. There are new initiatives and new requirements from the government that will have to be implemented. There is always new work being done in the private and commercial sector designed to improve services and outcomes for the ultimate customer--patients.

Government work in healthcare revolves mainly around Medicare and Medicaid. The federal government operates Medicare, but each state has their own Medicaid agency. The Center for Medicare and Medicaid Services (also known as CMS) is the lead federal agency for Medicare. CMS also works with individual states on their Medicaid programs and provides federal dollars for the Medicaid programs and operations. Medicare and Medicaid operations involve provider enrollment, creating benefit agreements, claims adjudication, financial reimbursement, data repositories and many other areas that must be maintained to provide healthcare to their members.

Commercial healthcare involves insurance companies such as Blue Cross Blue Shield, Aetna, United and many other companies. These companies provide health insurance to employees based upon contractual agreements with their employers. These companies run the same type of operations as Medicare and …

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