SUMMARY:

• Accomplished business and information technology professional with 18 years of overall Information Technology experience in the Healthcare / Insurance industries.
• Data warehouse design and implementation experience and systems analysis and design, database design and modeling: 8+ years.
• Strong Systems Development Life Cycle (SDLC) experience.
• Working experience using Scrum process as a Systems Analyst; working experience using agile methodology as a Business Analyst.
• Strong experience in delivering business process requirements and use cases.
• Excellent communication skills; able to communicate with technical and business audiences.
• Ability to work across functional teams, successful record of accomplishment as a liaison on cross - functional teams, regional/national projects.
• Experienced with Project Management lifecycle, project management office, development and maintenance of project documentation.

PROFESSIONAL EXPERIENCE:

Confidential, Denver, CO

Senior Business Analyst

Responsibilities:

• Lead the customer through steps of SDLC associated with the delivery of Business Intelligence solutions; Requirements, Design, Development, System Test, User Acceptance Test and Operations.
• Defined and documented business requirements in Requirements Analysis Document that can be verified throughout the SDLC using Requirements Traceability Matrix.
• Organized and facilitated joint application design meetings with user groups, department heads and project stakeholders to define business requirements.
• Facilitated source to target data mapping exercises for data sources.
• Documented "as is" business process models and defined "to be" business process models.
• Used TOAD and SQL Developer to run SQL queries and analyze data.
• Clarified issues relating to scope and business requirements for project team (including technical implementation team, project management and client management).
• Facilitated data quality program to evaluate, report and remediate data quality issues.
• Developed test plans to verify system met business requirements and aided user community in user acceptance test planning and execution.
• Provided on-site support (e.g., client inquiries, requests for ad hoc reporting assistance, miscellaneous research, advice on analytic methods) and training to end users.
• Defined business requirements for change requests, investigated issues/defects and defined remediation requirements.

Care Management Business Analyst

Confidential, NJ

Responsibilities:

• Became knowledgeable with the business rules and created test data in the IBM Cúram application and created test scripts / user verification documents for user acceptance testing.
• Independent Contractor (through SLAIT Consulting) at Anthem

Migration Architect

Confidential,VA/Remote

Responsibilities:

• Facilitated and led the development of detailed scope statements and high-level business requirements in development efforts in support of California Medi-Cal Migration from legacy systems to FACETS 5.01.

Confidential

Interfaces Team Lead

Denver, CO

Responsibilities:

• Worked as the Interfaces technical team lead for the Colorado Enterprise Resource Planning (ERP) upgrade project, managing a team of ETL developers within a larger project team composed of functional / technical team leads, business analysts, programmers, functional analysts, subject matter experts, training staff, technical writers.
• Managed a team of ETL interface developers to design, create and unit test interface code in XMS; also performed code review.
• Prepared meeting materials (agenda, field mapping document, meeting notes) for outreach sessions with the state.
• Facilitated in-person and web conferenced technical field mapping sessions with state end users, managers and other decision-makers and publishing meeting minutes on the project SharePoint afterwards.
• Facilitated additional month-long interfaces workshops to assist client understanding of the necessary coding changes for the upgrade to the new web based application. Also provided in session application demonstrations as necessary.
• Assisted with interface development and documentation as needed and provided interfaces development training to the state’s interface development team; provided best practices expertise on how to unit test code and text files.
• Frequently partnered with the functional team/subject matter experts to provide testing and application configuration and best practice guidance to the state client.
• Edited and managed technical team design documentation / deliverables, coordinating with the Project Management Office (PMO) on timely submission of deliverables to the state client.

Confidential, Baton Rouge, LA

Member Management Team Functional Lead

Responsibilities:

• Worked as the functional team lead for the Member team, managing 2 full-time business analysts, within a larger team composed of other functional team leads, business analysts, programmers, functional analysts, subject matter experts, training staff, technical writers, and testers on the replacement of the Louisiana
• Medicaid Management Information System (LA MMIS) project.
• Provided functional leadership of requirements gathering for Member / Patient Portal and Provider Portal.
• Provided ICD-10 impact analysis on assigned areas - Member Management and Prior Authorization.
• Managed reports design process for the Member Management team, providing the reports design template and the guidance to business analysts; facilitated the reports design review session with the state client, capturing notes and additional requirements.
• Created detailed use cases, development and design updates and updated project design documents with and relevant notes; published the revised drafts to the project SharePoint for Project Management Office (PMO) review and approval.
• Confidential (Kaiser Foundation Health Plan and Hospitals)

Systems Analyst

Confidential, Aurora, CO

Responsibilities:

• Performed intermediate and advanced system analysis to recommend solutions to business problems and system inefficiencies.
• Presented findings (in the form of a technical document or PowerPoint presentation).
• Identified business questions to be answered; identified business rules; translated business rules into system design;
• Researched and understood how data was created and utilized by various systems.
• Performed analytical research.
• Reviewed and wrote technical documentation.
• Performed intermediate and advanced system analysis to support implementation of new functionality, programs, and applications for CIDS’ operations.
• Researched complex new functionality, programs and applications to support business needs.
• Performed intermediate and advanced system analysis to analyze and research newly submitted ideas, project changes and identified specific system or workflow changes.
• Documented the changes required to systems, applications and programs with the conversion to ICD-10, including, but not limited to the main electronic health record (EHR) system, Epic Systems, or KP HealthConnect;
• Reviewed SAS programs for remediation of ICD-9 to ICD-10 conversion and discussed the necessary changes with clinical staff and programmers
• Collected and analyzed the project’s business requirements and transferred the same knowledge to the development team.
• Evaluated and performed gap analysis of the data collected through task and business process analysis, data flow diagrams and interviews.
• Prepared accurate and detailed requirement specifications documents, and functional specification documents.

Confidential

Senior Business Analyst

Trenton, NJ / Remote

Responsibilities:

• Documented and analyzed information for New Jersey’s MMIS clients’ clinical, financial and business processes and information systems for replacement options for an integrated Enterprise Data Warehouse solution.
• Collected, documented, and analyzed information concerning New Jersey’s Medicaid Management Information System (MMIS) clients’ current clinical, financial or business processes and information systems, replacement options for an integrated Enterprise Data Warehouse solution.
• Developed requirements gathered from joint application requirements sessions.
• Composed content and requirements for the replacement MMIS Request for Proposal (RFP), including technical requirements, use cases, As Is and To Be data flow diagrams in Microsoft Visio, and Joint Application Requirements sessions notes write-up.
• Performed and created a technical gap analysis document based on analysis of (facilitated) As Is, and To Be sessions with various departments, as well as based on the state’s long-term technology, strategy and business goals.
• Identified and documented deficiencies and dysfunctionality in existing business processes and MMIS.
• Developed alternatives for solutions to problems and assisted in suggesting improved business processes and automated systems.

Confidential, Downers Grove, IL

Business Analyst

• Created test cases for the Quality Management, Underwriting & Actuarial, Analytics and Reporting functional areas; assisted with test strategy for the data warehouse and the Optum reporting suite of applications.
• Created and executed test cases and assisted with test strategy for data warehouse, Ingenix (now called Optum) suite implementation (Impact Intelligence, Impact Provider, Impact Pro).
• Created business validation scenarios for business users in various functional areas (Quality Management, Underwriting & Actuarial, Analytics and Reporting).
• Performed data analysis and data validation of ETL scripts and transformed data
• Led business requirements gathering and solution proposals by working with IT staff, internal customers and external clients. Accountable for providing leadership and direction to ensure the appropriate collection of data, documentation of information, and presentation of findings.
• Provided mentoring and guidance to staff.
• Conducted analysis of client business processes and functional requirements. Prepared appropriate documentation to communicate and validate the information.
• Reviewed and developed the analysis, lead the evaluation of existing application products, and recommends efficient, cost effective solutions which supported client business processes and functional requirements.
• Provided leadership and direction to staff and customers to ensure that the business requirements were appropriately defined and that an enhancement or project is warranted.
• Coordinated and led cross-functional task forces to identify and document functional requirements, work flow, information sources and distribution paths, and system specifications.
• Reviewed the development of business cases to ensure the cost, service, and benefit dimensions of proposed large, complex IT projects are appropriately reflected.
• Applied expert technical and business knowledge to analyze client requirements in project areas such as: IT testing and product acceptance, new business operating models with innovative approaches to IT solutions support, market research of emerging or available product functionality, and operational readiness assessment.
• Performed knowledge transfer to other staff.

Confidential, Pierre, SD

Program Integrity Management Team Lead

• Performed project management functions to direct complex analysis, design, testing, and implementation of the SD MMMIS Program Integrity module, which included Utilization Management and Care Management.
• Prepared and monitored estimates of time, cost, and personnel for timely completion of team responsibilities; understood and followed project and system technical standards, policies and procedures; planned and monitored project activities for the team, which included systems requirements analysis, design, development, documentation, integration, testing and implementation; and received customer requests and assigned and reviewed team members’ work.
• Managed issues, risks, change requests, roles and responsibilities, project plan updates, and status reporting.
• Designed test procedures and assisted with the testing of the SD MMIS for validity and reliability using IBM Rational ClearQuest.
• Met with customers and team staff to discuss project tasks and resolve technical problems; examined/monitored federal and state laws, rules and regulations.
• Worked with the customer to identify and discuss operational problems, what the customer wanted the system to do, training, and other physical or data items that are generated by a user to ensure compliance with federal and state mandates and to accommodate the business work flows of the affected entities.
• Recommended solutions to be considered.

Data Warehouse Lead, Business Analyst - Member Management (Recipient) /

Confidential, Pierre, SD

• Facilitated mapping of “to-be” processes aligned with the Medicaid Information Technology Architecture (MITA) and maturity model and the Medicaid Enterprise Certification Toolkit (MECT).
• Assisted with and facilitated mapping of “to-be” business processes that were aligned with the Medicaid Information Technology Architecture (MITA) and maturity model and the Medicaid Enterprise Certification Toolkit (MECT).
• Created use cases and process flow diagrams to document To-Be processes as well as conducted gap analysis; facilitated gap analysis work group sessions with the State on current as-is legacy business processes and technologies to assess changes needed for the To-Be java-based and data warehouse/reporting & analytical solutions for future functionality.
• Assisted with and facilitated the process for requirements validation that followed the MITA process/sub-process business model.
• Recommended revised and improved business processes for the new SD Medicaid Management Information System implementation.
• Identified and assisted with the management of related tasks and activities within a given process and sub-process business area.
• Collaborated with the customer to develop acceptance test criteria.
• Collaborated with the customer to execute user acceptance tests to confirm SD MMIS functionality and performed defect tracking using IBM Rational ClearQuest.
• Created documentation (e.g., requirements validation documentation, business and technical design documentation, and training materials).
• Captured logical flow of system/business through use case documentation.
• Provided training and knowledge transfer during design and JAD sessions with the customer.
• Collaborated with the project team to achieve State customer and team objectives.
• Reported status to management.
• Assisted with various cross-functional projects including database design and development in Microsoft Access and Visual Basic for Applications, requirements tracking tool support, and report development for requirements tracking tool.

Confidential, Englewood, CO

Clinical Data Analyst

• Was responsible for the research and analysis of clinical data requirements and issue resolution as they related to the design, development, testing, implementation and support of the CHI data warehouse.
• Researched changes or enhancements for multiple existing or new features; applies analysis concepts, techniques, tools and standards to support assigned projects by maintaining professional knowledge of current trends and developments in the information systems and healthcare fields, especially in the area of data management.
• Participated in / facilitated data requirements definition (e.g. extracts, sourcing, reporting) and design sessions; wrote and maintained detailed technical documentation to record the architecture and development for system data projects.
• Prepared and maintained data for Core Measures reporting; provided all standard and ad hoc quarterly reports including data analysis and graphs. Researched changes to core measure definitions and ensured continuity of reporting in light of those changes.

Confidential, South Sacramento, CA

Business Analyst

• Worked at LifeMasters, a Disease Management company, in support of a healthcare analytics, data warehouse environment. Mapped fields for membership, eligibility, provider, lab and pharmacy files. Code sets included procedure codes (CPT), diagnosis codes (DRG), revenue codes, etc., for government programs (e.g. Medicare, Medicaid), retirement health plan providers.
• Project / Focus: Data Integration and Quality Assurance
• Process Documentation
• Process Improvement
• Quality Assurance of data, data mapping, data mapping auditing in various standard healthcare format
• SAS / SQL Server 2005, SQL Server Management Studio querying of database tables
• In-house ETL tool: Pervasive
• Data warehouse testing and test case creation.

Confidential, Aurora, CO

Business Analyst

• Supported the daily processing of HL7 messaging and troubleshooting errors
• Was responsible for verification, support and monitoring services for release implementation of EPIC technologies.
• Provided ongoing support of EPIC system product platforms and interfaces after initial deployment of new applications (troubleshooting user issues and documenting resolutions).
• Assisted with documenting processes, including gathering and calculating metrics from the EPIC Bridges interface to analyze message activity for each of 14 interfaces/queues. These metrics would later assist the team in assigning automatic paging parameters (via Remedy) for unusual activity, or message queues/interfaces that stopped unexpectedly.
• Performed auditing of documented versus non-documented processes and centralized and compiled documents with hyperlinks in an Excel spreadsheet.

Confidential, Greenwood Village, CO

Project Coordinator

• Assisted project managers by creating Project Impact Reports (similar to Requisition Requests), Earned Value reporting, Project Status reporting, performed daily/weekly project plan maintenance activities (project plan base-lining, updating resource allocations, adding and removing resources and resources’ Estimated Time to Completion hours from project plan, etc.) using Clarity’s project management application, Workbench.
• Assisted with process improvement initiative by tracking and analyzing Remedy action request ticket metrics data using Remedy, Excel spreadsheets, and reporting status four times daily to various project managers, technical team leads, and the CIO.
• Supported and assisted three teams within the Software Configuration Management (Software Configuration Management, Environment Management, and Configuration Data Migration teams) with various projects (e.g., project auditing, project plan documentation updates, and tracking issues related to resources tasks’ and time allocation) relating to large Facets system implementation.
• Updated the Deliverable Tracking Matrix with the SCM teams’ projects’ package information (e.g. update information on when each component is promoted or demoted to each state) on a regular basis.
• Performed Harvest audits (using Harvest’s Admin tool) to update lifecycle, repository, user groups, forms, and files in Harvest, so that Harvest projects followed the standard/updated templates across projects. Additionally, checked that access, approving users, user groups, and email notifications were set properly in Harvest.

Confidential, Greenwood Village, CO

Business / Technical Application Analyst

• Successfully scheduled trouble-shooting telephone calls with clients who reported errors that were apparently client-side; was able to walk several clients through the process to set up capture logs; reviewed the capture logs and researched errors to resolve issues, escalating to and working with various groups (e.g., Development, Technical Support).
• Experience with TriZetto’s Facets Application Groups / Modules: Claims Processing, Customer Service, Guided Benefit Configuration, Medical Plan, Medical Provider Agreement, Pricing Profile, Provider, Subscriber/Member, Utilization Management, Workflow Configuration
• Attended two-week intensive training on the Facets v.4.3.2 enterprise software application in preparation for re-creating and solving client’s errors and report fixes in Onyx (ticket-tracking system);
• Integrally involved in the upgrade of Capital Blue Cross (CBC, +85,000 members) upgrade and go-live activities in an aggressive 3-month timeframe. The go-live ended with week-long support activities beginning on a holiday weekend so that the client end-users could begin testing the application after the weekend holiday;
• Updated client’s environment portfolio spreadsheets with information such as IP address mapping, schema information, and web server, application server, and batch server information in various environments--development, test, and production environments.
• Updated client’s physical and logical diagrams with current go-live, post-production information.
• Had system admin access in Facets to add users, set users’ access levels and rights.
• Responsible for updating the risks and issues log on a daily basis and also attended daily issues conference calls with client and with TriZetto’s project team members.
• Performed batch job maintenance, troubleshooting, and scheduling using Tidal scheduler.

Confidential, Northbrook, IL

Technology Research Consultant

• Managed the 2005 Competitive Intelligence Project, managing a team to conduct market analysis and produced two deliverables examining competitors’ technology strategies, product portfolio and financial strength, which was widely distributed and well received by Allstate’s senior leadership.
• Met with project sponsors (Senior Vice President, Chief Technology Officer, and the Director of Enterprise Technology Strategy & Planning).
• Attended Project Management Boot Camp on Controlling & Estimating techniques;
• Conducted interviews with senior leaders and with various subject matter experts across Allstate to gain buy-in and support of project phases and initiatives
• Attended facilitated brainstorming / planning sessions, technical architecture meetings with enterprise architects, project managers, business analysts, etc. on Allstate’s five-to-ten-year technology roadmap;
• Produced deliverables for the Allstate Technology Strategy project: Emerging Trends in Agency-Facing Technologies white paper, and Executive Summary in PowerPoint which was used by senior leadership.

Confidential, Chicago, IL

Information/Data Conversion Specialist

• Worked in progressively technical positions (Data Library Analyst, Processing Specialist, Conversion Specialist) in the Risk Management Technologies department in support of a proprietary risk management system called STARS (now called csSTARS).
• Main responsibilities included gathering client requirements for system and code conversion projects; converting code from various source providers' formats into an Oracle database backend and updating the client's database on a set schedule according to the Service Level Agreement.
• The contractually set turnaround time for all clients (for updates, i.e., refreshes) was 3 days after the data was loaded into the system.
• Successfully managed 55 concurrent client conversion/data projects, including updating project documentation, technical troubleshooting, and client support and issue resolution;
• Selected to serve on the department's Project Management Office initiative;
• Promoted twice into progressively more-responsible positions within the department.
• Met with clients to gather data conversion requirements, claims coding preferences (e.g., nonstandard / standard cause codes, transaction codes, location codes, etc.).
• Regularly performed trending analysis to identify and correct unusual amounts of claims activity (i.e., to prevent duplicate claims from being added to the system, or to prevent inaccurately reported financial transactions—payments, reserves, etc.). Trouble-shot and documented errors and worked with source data providers to resolve and correct data issues.