Jim Swoben has over 20 years of experience implementing systems in hospitals, medical groups, and health plans. He has led clinical implementations for multi-hospital systems and EMR applications for physician groups. Most recently, he has consulted on compliance and risk adjustment software selection and implementation for health plans serving Medicare and Medicaid patients.

1. Jim Swoben4100 E. Broadway #5 Long Beach, CA 90803 562-439-5993 jswoben@aol.com
Summary 20 year experience; in systems implementation in hospitals, medical groups and
health plans and integrated delivery systems Provided leadership in clinical implementations for
multi- hospital systems, EMR applications for physician groups and lead revenue cycle
applications which incorporated medical records documentation requirements for care and
management of chronically and acutely ill patients to assure eligibility, prior authorization, case
management and risk adjusted payment by health plans.
Health Insurance Experience
Health Systems Consultant November 2012- current Compliance consultant to Health plans
engaged in Medicare and Medicaid services. Engaged to select risk adjustment software,
contractors and implement oversight and compliance activities. Evaluated physician
documentation in medical record systems made recommendations to improve risk adjusted
revenue cycle performance. Developed strategies for ICD-10 physician training
Requirements Consultant Cornerstone Data Strategies April-2012- October 2012
Lead the requirements phase Claims system replacement project Managed a team user specialist
to and prepared requirements documents for conversion of LA Care Health Plan systems to
Trizetto QNXT, Care Advance, and constituent web services products. Conducted design
reviews with user representatives, prepared requirements for interfaces, test and acceptance
requirements and reviewed implementation sequence alternatives for LA care product lines.
Prepared requirements for Medi-Medi Duals reporting and accounting
Interim Director of Information Technology Gold Coast Health Plan Ventura CA. Nov. 2010-
May 2011.Reporting to the CEO. Managed Systems projects for a startup Medi-Cal health plan
operation. Managed an outsourced team of Xerox implementation staff. Procured and installed
Multiview accounting software, web site content management system, and the CQS medical
management application. Lead implementation of the IKA suite of system and Kwik customer
service application. Managed schedule, budget scope and resources. Procured hardware
Consultant 7/2008- Oct 2010 Independent consultant to health plans and providers
Molina Healthcare Reviewed clinic physician based systems and documented system
specifications for an in-house development and prepared training materials for physician
users.
DaVita Dialysis- Revenue Cycle Consultant Reviewed and implemented processes
improvements to eligibility, authorization, contract management and claims
clearinghouse services. Procured Ingenix EDI series for eligibly processing for the 1500
Dialysis clinics. Enhanced billing features for PPO billing and scheduling of contracted
services to patients. Maintained schedule scope an budget for procurement. Utilized
Agile development methodology
Medical Data Exchange 10/2006- 6/2008 Risk Adjustment Product Manager
Under the direction of the CEO lead the product definition and system specification for a web
based risk adjustment application to enhance medical group and health plan financial

2. performance through the clinical profiling of physician practices and the identification of patients
for intervention by case managers and physicians. Lead and Agile software development in .Net
of a cloud based solution for clients Provided specification for the enhancement of the VChart
electronic medical record product to improve the risk adjusted revenue cycle features. Completed
successful alpha and installation of three client sites and measured financial benefits.
Project managed the implementation of software in client sites and enhancement. Defined
schedule, scope , resources and alternatives for customers. .
Manager of Encounter Data, Healthcare Informatics Scan Health Plan 3/2004- 9/2006
Processed 1 million EDI 837 Claims into the health plan data warehouse . Developed clinical
data base application to improve physician documentation of disease for the Medicare risk
adjustment revenue cycle model. Managed relationship with clearinghouse services for 40
medical groups and 50 hospitals for the collection of claims data. Developed and implemented
physician clinical summary for use by medical groups and physicians to improve clinical
documentation for the Medicare risk adjusted payment system. Project managed the deployment
our Risk Check application which included schedule, budget, scope and documentation
training in 40 client sites. Used an Agile development methodology for software development
and release.
Manager Health Plan Systems, Caremore Insurance Services 7/2002-12/2003
Under the direction of the Chief operating officer and Health plan general manager led a cross
functional team thought the upgrade and re-configuration of systems to become a Medicare
Advantage health plan. Project managed the development of a membership system with and
Agile methodology and to upgrade of the claims payment system with controls for schedule
scope and budget. Provided program management of the suite of health plan applications and
managed medical group revenue cycle applications Upgraded professional billing systems and
scheduling application for office practice locations.
Health Systems Program Manager 9/2001-8/2002 Community Health Partnership of Santa
Clara County Implemented Revenue cycle model with an EDI solution to provide improved
electronic interchange of data between affiliated clinics and the county health system. Reduced
the cost of claims rework with a contract management application which defined contacted
scope of services for health plan contracts. Implemented a web based lab results system for
physician use. Installed practice management billing and scheduling systems
.
Medical Group Consulting Engagements
La Vida Medical Group 10/99-9/2001 Project managed the Installation of the Millbrook
Physician Revenue Cycle systems for the for 5 clinic locations system. Procured and installed
the Ezcap clams payment and 4Medica Web based clinical information system in five clinic
locations. Installed the Millbrook billing and patient scheduling systems.
Automated Case Management Systems 4/1/99- 9/25/99
Implemented a case management system for the Dade County Department of Audit and
Management Services, Miami Florida. Administrator of a 200 user PC based system for 32

3. agencies engaged in medical and social service delivery. Implemented clinic billing, scheduling
and case management systems.
Palomar Pomerado Medical Associates Consulting 6/98-4/99: Implementation of EZCAP
Managed care application Re-implemented enrollment, encounter and claims systems.
Implemented utilization management and case management applications.
James Swoben
San Ysidro Health Centers San Diego CA 9/98-4/99: System selection for a Medical billing
and managed care application. Replaced IDX system with a Unix based web enabled practice
management and managed care application. for the divestiture of the medical practice from the
HMO. Moved system reporting to a Unix based data warehouse
Family Health Network 11/97- 6/98 Start Up Medical services organization brought into
production in 90 days. Implemented a PC based client server managed care system for a 300
Physician Network Software vender: EZ- CAP
East Jefferson Medical Center Metaire, Louisiana December 1997 Developed and
implementation strategy for a senior risk contact. EZ CAP
UCSD Health Plan 5/97- 11/97Responsible for systems specification and implementation of
providers service network for direct contracting with HCFA as a Medicare choices
demonstration site. Prepared requirements documents and managed contract programming of
specifications IDX
Riverside Physician Network 4/96-4/97
Procured and installed systems for a 300 physician MSO under contract with 20 health plans for
commercial, senior and MediCal enrollment for 75,000 members CSC Merged Systems for two
organizations .Managed technical support staff and programmer analysts.
Manager of Professional Billing and Managed care a systems Scripps Health San Diego,
CA. 9/93-2/96 IDX System manager for the 300 physician Scripps Clinic and the 4 IPAs
associated with Scripps Health hospitals Managed interfaces to the hospital billing for ancillary
departments for an integrated delivery system which included 5 hospitals Managed a staff of 20
contactors during conversion and 8 in-house staff of programmers.
Hospital Experience
Project Manager Pioneer Hospital and Mullikin Medical Group Artesia, CA. 6/90-12/92
Reporting to the CIO, installed hospital, managed care and clinical systems for a 400 Physician
hospital based medical group integrated delivery system. IBM Mainframe; Invision and
Signature environment HL-7 interface engine. 40 Clinics 100 bed hospital
Project Manager American Medical International Information Systems Group 10/88-8/89
Implemented information systems for a new 300 bed hospital in Irvine CA. Contracted for
and installed HBO products. Prepared project plans HL7 interface specification and test plans for

4. systems integration testing. Implemented hospital revenue cycle applications: eligibility,
authorization electronic claims and remittance.
Manager of Medical Data Systems Los Angeles County Department Data Processing 4/87-
9/88 Medical Systems Division leader for 5 county hospitals. Selected and contracted for the
installation of all clinical systems for the 1,000 Bed LA County USC Medical Center . Used a
formal competitive bid process .with defined contract specifications, interface requirements and
test plans for acceptance testing to achieve project goals . Conducted formal design reviews as
part of a structured methodology for implementation management.
Revenue Cycle Consultant Superior Consultant Company West Bloomfield MI 9/85-2/87
Consultant to the IBM corporation for its Hospital Patient Accounting product. Provided release
management and QA services for their patient account product. Used formal systems
methodology for specification and regression testing of hospital accounting applications
Systems Engineer Electronic Data Systems Health Services Division Dallas TX 6/83- 9/85
Installed five hospital information systems in the western region. Prepared specifications for
HL7 interfaces. Prepared project and test plans and, developed procedures for application
management and trained staff in revenue cycle applications.
Management Analyst Veterans Administration 1/79-8/82
Provided procurement specifications for a hospital information systems for a replacement
hospital in Albuquerque NM.
Education
Masters Health Care Administration George Washington University 1980
Post Masters Information System University of New Mexico 1984
BA University of California San Diego 1977
Speaker Nation Managed Care Congress 1998 1999
Microsoft office and project proficient