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Er&r Analyst Resume

SUMMARY:

  • A career in Information Technology with seven years as a healthcare business analyst and more than thirty years as a contractor or employee COBOL programmer analyst. Many short and long term assignments, some with small project and team lead responsibilities. Now my primary focus is government healthcare applications.
  • Varied experience including Medicaid (MMIS, MITA, MECT), Medical Billing (Champus), Medicare, Eligibility Information Systems (EIS, ISD2) Hospital and Professional Applications (UB92, UB04, and CMS1500), and General Insurance (Health Claims). Other: Public Utility (CIS, Plant Property, Rates), Child Support Enforcement (CSE), State Government (DES, DHS, DSS) and Financial Applications (AP, AR, Banking)
  • HIPAA ASC X12 Confidential Transactions (270/271, 276/277, 277CA, 277PS, 278, 834, 820, 835, 837 P,I,D, TA1 and 999) knowledge and working experience. Worked extensively in MMIS claims and payment areas
  • MITA 2.0 SSA Experience and MITA 3.0 / MECT Experience
  • MITA 2.0 State “As Is” and “To Be” assessment experience
  • Confidential 1104 and CAQH/Core Compliance Rules experience Phase I and II
  • HIPAA ASC X12 4010A1 to 5010 Standards Confidential Analyst
  • ICD9 to ICD10 mapping, remediation, and testing
  • DRG, HCPCS, CPT, Confidential - 9, Confidential -10 Code Knowledge, UB04 and CMS1500 claim forms
  • HIPAA compliant training current as of 2014
  • Confidential knowledge in regards to a new income based (MAGI) test for CHIP and Medicaid, although categorically eligible groups remain, federal match varies by old and new eligibility categories. Understand and map the differences
  • Database analysis and design experience including hierarchical, network, and relational constructs. Many involved conversion and migration projects
  • Experienced using Conceptual Data Modeling and Mapping using Data Analysis techniques of Entity-Relationship (E/R) Mapping, Attribute Analysis, Data Flow Diagrams (DFD), and Normalization of Data
  • Familiar with Project Plans, Process Flows, Procedure Documentation, Requirement and Functional Specifications, Requirements Traceability Matrix (RTM), Use and Business Case, Rules Definition, Gap Analysis, Calculation Validation, Audit Validations, Impact Analysis, Use Case Diagrams, Activity Diagrams, Swim Lanes and other Business Analyst foundations like Waterfall, Modified Iterative Development, and Agile / Scrum
  • Experienced using test methodologies and the software development lifecycle. Have the ability to evaluate comprehensive test strategies and plans
  • Understand and leverage existing manual and/or automated test cases; where needed, design and develop new test cases in line with the test strategy and plan, and identify possible candidates for automation from existing test cases
  • Experienced with software testing strategy development including Master Test Plan, Unit Test Plan, Function Test Plan, System Integration Test Plan (SIT), User Acceptance Test Plan (UAT), Installation Test Plan and Test Team Leadership
  • Capability Maturity Model Integration (CMMI) process improvement approach
  • Trained to SEI Levels 2 & 3 CM, CMM/SQA, SCM, Project control, Project Tracking. ISO 9002 QA.

TECHNICAL SKILLS:

Hardware: IBM 370/390 series, IBM 308X, 309X, ES9000, z Series, and System z/9 series. Also Amdahl Mainframe Series, DEC and SUN mid-range servers, and IBM or compatible personal computers.

Software:

IBM: Z/OS, OS/390, MVS/ESA TSO/ISPF, DB2, MQ Series 5.0, IMS/VS, ISPF, CICS, PROTERM, TELON, FileAid, Startool, Xpediter, Intertest, Smartest, TSO Edit, VSAM, OS/JCL, JES2, JES3, ENDEVOR, Librarian, Panvalet, FOCUS, SyncSort, IBM Utilities, FTP, NDM, Broker Data Exchange, MoveIT Central, and BETA42, CA-7, CA-11, OPC/ESA, TWS, Control-M, RACF, ACF2.

Code: COBOL, COBOL II, OS/COBOL, COBOL/390, EASYTRIEVE PLUS, CICS (TS), BMS, DB2 /SQL /SPUFI /QMF, FOCUS, DYL280, REXX, TELON, SAS, TOAD

PC: Windows - Microsoft Office Suite products WORD, EXCEL, POWERPOINT, VISIO, and PROJECT. Also SilkTest, Mercury Test Director, Remedy 7.5, IBM's ManageNow, Lotus Notes, SharePoint, Visio, DocuTraxx, ReqTrace, MedStat, others.

PROFESSIONAL EXPERIENCE:

Confidential

ER&R Analyst

Responsibilities:

  • Support to ensure individuals are successfully enrolled on a timely basis
  • Proper accounting to the Centers for Medicare & Medicaid Services (CMS), the States, and QHPs
  • Individuals, taxpayers, and policymakers with proper accounting through CMS, the States, and Quality Health Plans (QHP)
  • Assistance to the entire community of stakeholders to improve enrollment processes and systems
  • Fix enrollments that break
  • Address discrepancies in reconciliations of enrollments

Confidential, Newark, DE

MMIS Technical Analyst

Responsibilities:

  • Confidential Lead analyst for interface capture quality assessment project
  • Member of team to establish interface criteria and standards for secure communication of data within and outside the enterprise
  • Establish and maintain tight controls over technical requirements
  • Attend and document Requirements Validation sessions
  • Provide Claims and Financial technical analysis and expertise
  • Business lead for Confidential Requirements Validation (RV) Sessions
  • Lead analyst for interface capture quality assessment

Confidential, Seneca, SC

Business Analyst

Responsibilities:

  • This BA position entailed providing Claims expertise for testing COBOL programs renovated for processing ICD10 Diagnosis and Procedure Codes.
  • Analyze and document Confidential Claims business rules, edit rules, audit rules, to create and process unit and string test cases to verify and validate updated programs.
  • Also entered test cases to validate ICD10 data capture screens. Wrote file compare routines to ensure on-going changes in legacy were correctly applied to renovated programs.

Confidential, Warwick, RI

MMIS Business Analyst

Responsibilities:

  • MMIS Business Analyst contract to provide subject matter expertise in Medicaid for the Affordable Care Act ( Confidential ) 1104 Compliancy Project.
  • CAQH/Core Rules analysis completed.
  • HIPAA privacy and security training for HP completed. Statement of Work (SOW) completed for project.
  • Business Detail Design (BDD) turned over.
  • Analyzed impact of CMS Seven Standards and Conditions and reported on same.

Confidential, Ashland, OR

MMIS Financial Business Analyst

Responsibilities:

  • Contract technical BA position in the Medicaid Financial area hired to ensure the Quantum Choice solution and Operations staff complied with Generally Accepted Accounting Principles (GAAP) as promulgated by the Government Accounting Standards Board (GASB), Federal and State rules and regulations, and to provide the internal controls necessary for continued segregation of duties.

Confidential, Raleigh, NC

MMIS Confidential Business Analyst

Responsibilities:

  • Reviewed CAQH/Core Rules Analysis for Phase I and II.
  • Analyzed and documented Confidential business rules, policies and procedures for gap analysis and mapping changes for vendor development.
  • Member of State MITA 2.0 “As Is’ Assessment Team.
  • HIPAA compliancy training completed for 2012.

Confidential, Providence, RI

Production Control Specialist

Responsibilities:

  • This production control (PC) position required CA-7 and CA-11 subject matter expertise for submitting, monitoring and correcting mainframe and server applications.
  • Responsible for responding to Remedy tickets; contacting developers when required; and creating daily status reports.

Confidential, Washington, DC

MMIS Technical Team Lead

Responsibilities:

  • This MMIS system technical team lead position encompassed the transition of a legacy MMIS application using VSAM files to Confidential application based on DB2 with a Web Portal interface.
  • Provided guidance and mentoring to a team tasked with implementing the MMIS upgrade.
  • Additionally, provided DB2 programming support and analysis for the Provider subsystem.
  • HIPAA compliancy training completed for 2009.

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