SUMMARY OF QUALIFICATIONS AND EXPERIENCES

Extensive professional healthcare experience, all in diverse, complex environments. Progressive Healthcare Services experience in Healthcare Informatics, Health Insurance Industry, Long term care, Pharmaceutical industry, Data Analysis, and Quality Improvement, HIPAA compliance and implementation rules, and Prospective Payment System (PPS). Skilled manager and knowledgeable in policy analysis as well as program management and marketing. High initiative and evaluative aptitude with excellent analytical skills and outstanding written and oral communication skills. Ability to interface well at all organizational levels; and work harmoniously with team members.

EDUCATION: M.P.H., Health Planning, Confidential University 
B.S., Biological Sciences, Health Planning, Confidential University, 
Strategic Marketing Management, Confidential University (non degree training) 
Six Sigma, initiated

RECENT TRAINING:

• Information Management/Information Technology
• Department of Defense:
• Operational Architecture
• IM/IT Investment Portfolio
• Cost, Schedule, and Implementation Documentation
• Development of Initial Business and User Requirements
• Functional Requirements Refinements and Solution Implementation
• American Red Cross:
• Residual Risk Assessment
• IT Project Management
• IT Solutions Delivery
• Requirements Management
• Test Engineering
• Use of Defect Assessment Protocol for Software Problem Reports
• Managing Software Parameter and Report Changes
• Vangent, Inc.
• HHS Enterprise Architecture Business Process Modeling
• Computer Sciences Corporation-Community Care Rx
• Pega Systems Business Architect Essentials (Certified)

EXPERIENCE:

Business Analyst. May 2009 to Present. Confidential.

Business Analyst supporting the Office of Information Systems (OIS) for the Centers for Medicare and Medicaid Services to revise, update and document business process models in anticipation of the requirements of the American Recovery and Reinvestment Act of 2009 (ARRA), the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the electronic health record and other health care reform mandates. Support the Enterprise Architecture team to increase the value of business process modeling for CMS and its business owners. Elicit business-focused diagrams from customer supplied documentation, research and meeting discussions that are visually clear and understandable while capturing all necessary process detail. Promote the use of the business process diagrams by stakeholders for legislative impact, requirements development and analysis, and change management.

Conducted survey, inventory and analysis of Value Based Purchasing and other Quality programs, demonstrations and projects across CMS to establish the program baseline for the VBP Forum and future program development. Participated in conducting, assessing and processing the interviews of the division heads as an environmental assessment of the current state of Value Based Purchasing initiatives in the agency. Contributed to the development of the planning framework for the VBP Forum.

Sr. Data Quality Assurance Analyst, September 2008 – May 2009, Confidential

Lead Data Quality Analyst for the Statistical Contract for the Payment Error Rate Measurement (PERM) Medicaid Contract for the Centers for Medicare & Medicaid Program Integrity initiatives. Managed a production environment to ensure the accuracy and completeness of state data extracts created from Medicaid, Medicare and SCHIP data (state and federal data). Expertise included knowledge of data structures, quality assurance techniques and health care data management in a SAS environment.

Sr. Consultant/Task Lead, July 2007 – September 2008, Confidential

Task Lead for the redeployment of monthly payment withholding and reconciliation of premium payments for Medicare Part D, a sub-system of the MARx System redesign. Responsibilities included management of the Project Schedule, coordination of multi-disciplinary tasks, and progress reporting. Also responsible for functional team support for the project, requirements management and documentation, as well as CMMI coordination, metrics development, tracking and supporting activity and quality assurance for multiple processes.

Sr. Business Analyst/Lead, January 2007 – July 2007, Confidential

Elicited, wrote and managed functional and technical requirements for a Medicare Part D Plan (Community Care Rx). Planned software releases, member of and support to the Change Management Board, researched and triaged Change Requests, assessed the business impact, identified the affected business processes in a PegaSystems environment (utilizing BPM tools such as PRPC and IAC); interpreted, decomposed and documented high level requirements from the Centers for Medicare and Medicaid. Monitored Medicare Modernization Act Operational Compliance for Part D operations and participated in the CMS Users Group. Identified and documented CMS policy changes that required modifications to plan operations. Managed special projects as assigned.

Sr. Business Process Systems Analyst, June 2006 – December 2006, Confidential

Managed Donor Management functional requirements components of the eProgesa™ blood banking system (IT). Elicited, wrote and managed functional and technical requirements for Donor Management. Prepared all relevant documentation, including legacy system (interface) documentation and mapping to meet the standards of a FDA 510K regulated product in an iterative requirements development environment. Lead for change management activity, issues tracking and escalation, meeting facilitation, Requisite Pro requirements submission and tracking.

Senior Analyst, February 2006 – June 2006, Confidential

Analyzed, designed and documented business process, rules and business logic and data flow for Medicare Part D for the Community Care Rx Program. Collected, organized and managed procedural, product, instructional and related information to ensure quality and accuracy; created and managed a prioritized list of potential process/application improvements Researched data discrepancies involving utilization of CMS resources to clean data (MBD, MARx and other CMS data sources), developed process and data flows for use by consultants. Developed and documented Quality Assurance processes for eligibility validation, SXC Claims Extract and Coordination of Benefits. Participated in the Medicare Part D Systems User Group and the MA/PDP Operational User Group.

Senior Analyst, September 2004 – August 2005, Confidential.

Supported, represented and provided consulting, analytical and research support to Provision of Care (Clinical), Population Health (Medical Surveillance, Medical Readiness, Personnel Reliability Program) and Pharmacy Systems. Elicited, wrote and managed functional and business requirements, concept of operations (CONOPS and Initial Concept Delineation), work flows, from high level through development and deployment for the Composite Health Care System II (CHCS II, the military electronic health record), Provider GUI and Coding Compliance Editor. Member of and functional support for the Cost and Estimate Group for the Clinical Information Technology Program Office (CITPO). Facilitated clinical work groups through the concept, design, and workflow development. Researched and wrote White Papers, CONOPS, briefings, and other documents as required.

Senior Analyst, May 2004 – September 2004, Confidential.

Provided analytical support to the Military Health System Data Standards Configuration Management Board within the Information Management Technology & Reengineering Directorate (Health Affairs). Responsible for performing high-level impact analysis and presenting strategic data management issues to the Data Configuration Management Board for review and decision. Prepared Data Management and Migration Plans, prepared estimates of level of effort, and conducted detailed analysis of systems, workflows and business practices that are core to the Data Management Plan. Conducted routine quality assurance analysis to identify data issues and problems. Conducted annual review of data plans for compliance with data standards, including HIPAA, LOINC, SNOMED and others.

Also, provided analytical support to the Military Health System partnership in CHI (Consolidated Health Informatics), the federal government-wide health information interoperability standards program with the goal of a common enterprise-wide business and information technology architecture. Participated as staff for inter-agency committees including DOD Health Affairs and the Veterans Administration for data standardizing initiatives and tasks.

Senior Systems Analyst, September 2002 – May 2004, Confidential

Provided Health Care Informatics support to the Clinical Information Technology Program Office for the Military Health Services, Tricare Management Authority. Client support includes clinical systems development life cycle support, requirement elicitation, analysis, revision and management with automated tools. Supports definition of clinical information technology issues and solutions for implementation in Composite Health Care System II (CHCS II). A few of the significant programs implemented include Outpatient Billing, HIPAA Title II Electronic Transactions and Code Sets, IBWA and Provider GUI (interface with inpatient systems), Provide coordination, research and validation of workflow; analyzes and clarifies new functional requirements; develops screen mock-ups; and works collaboratively with systems engineers, software engineers, and logisticians who directly support CITPO. Participated in Integic CMM Level 2 Assessment.

Director for HIV/AIDS programs for a clinician-based organization involved in the research and development of country assessments and population treatment programs for HIV/AIDS (Kazakhstan - population scale disease management plan); clinical education for practitioners in addition to an internet-based medical education program to support an international HIV/AIDS organization; annual Whistler HIV/AIDS Update for the Pacific Northwest clinical community and related continuing medical education; focused market development for scientific leaders in genotype database research and treatment programs; general management including corporate initiatives, research and identification of strategic business solutions for information management and technology development, business development, proposal writing, budget development and monitoring, research, and software marketing.

Requirements Analyst for the $16.5 million data standardization project link to the legacy system with the next generation managed care electronic medical record hardware/software project (the Composite Health Care System II) for the Department of Defense medical facilities. Conducted and coordinated end user joint application development activity with a broad scope of functional managers for the purpose of eliciting, defining, documenting and managing systems requirements.

Business consultant and analyst for the Medicaid Statistical Information System (MSIS) for the Health Care Financing Administration (CMS). Work incorporated the design for the new data structure for Medicaid systems integration.

Business Consultant - Sub-Contractor, November 1998 – August 1999, Confidential

Consultant and analyst for the design and development of the National Long Term Care Data Repository interface (Skilled Nursing and Home Health Assessment Data) for the Health Care Financing Administration.

Managed a portfolio of Consumer Health diagnostic and therapeutic products including: commercialization and market strategies; research and development of disease management programs directing multi-disciplinary medical team, call center programs, interactive voice response programs; drug and non-drug programs including depression, OCD, obesity and others. Also functional project lead in medical call center and support system architecture; writing clinical protocols, management of clinical product development team.

Product Manager, Long Term Care Insurance, August 1994 – January 1995, Confidential.

Manager responsible for the revitalization of individual and group Long Term Care Insurance products including: compliance with regulatory guidelines, marketing plan development and implementation, consumer research and resolution of customer inquiries (call center and broker systems), management of reinsurance services, telemarketing staff, agents and brokers, and the development of new distribution channels, product publicity and corporate communications.

Principal & Consultant, May 1989 – July 1994, Confidential

Designed, managed and conducted market and consumer research studies for life and health insurers, annuity brokers and banks. Developed annuity products.

Marketing Officer responsible for life and health insurance and annuity marketing and planning including preparation of strategic plans, programs and budgets for new life, health, savings and investment products. Also monitored regulatory changes for new product development opportunities, and managed market and customer satisfaction research (focus groups, market research) for the international subsidiaries (Mediterranean, Africa, Caribbean).