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Lead Ba Resume

SUMMARY:

  • Confidential Ibekwe has over 10 years of experience involving; consulting, application development and project management in different application areas. His experience additionally includes delivering complex systems and business integration projects.
  • Most recently, Confidential has worked for Confidential ; a leading Healthcare Insurance company; as a Lead Business Analyst.
  • His focus has been on both the delivery and long - term support of business solutions

EXPERIENCE:

  • Project Management
  • Business Analysis
  • Healthcare Products
  • Pharmacy Benefits Management
  • Product Management
  • SDLC/Agile/Iterative/Scrum
  • Defect Management
  • Automation Frameworks

PROFESSIONAL EXPERIENCE:

Confidential

Lead BA

Responsibilities:

  • Lead the analysis, development, documentation, and communication of functional and non-functional business requirements
  • Represented business/stakeholder interests by understanding and driving business needs and value to implementation
  • Worked with the Business Solutions Leads and Business Architects to understand business strategy and translate into product requirements
  • Validated business requirements are met during the project delivery process
  • Drove business value through the successful delivery of assigned projects
  • Enhanced delivery and operational effectiveness and efficiency by completing the transition of critical processes from legacy to proposed versions

Confidential

Software QA Trainer

Responsibilities:

  • SME in software testing with in-depth knowledge of QA
  • Delivered instructor-led classroom and online training to end-users
  • Concisely conveyed technical content to a broad range of users
  • Created and managed a module based e-learning portal, courses, learning path creation from facilitation to evaluation of exercises and web-based tutorials
  • Enhanced training team goals and objectives
  • Constantly modified and improved the course content

Confidential

Business and Technology Delivery Associate Manager

Responsibilities:

  • Lead and coordinated work stream activities for Confidential Pharmacy Benefits Management(PBM) updates
  • Planned, executed and coordinated all testing activities across all Medicare Part D and Commercial Pharmacy Benefits products
  • Supported the delivery of the Medicare and Commercial work streams code changes
  • Coordinated with Confidential and Confidential pharmacists to implement code changes for Pharmacy Benefits Products, Formulary Management, Specialty drugs, Prior Authorization, and the Adjudication process
  • End to End delivery management for Confidential 2015 Medicare Formulary Management: Drug Coverage, Generic Drugs, Quantity Limits, Step Therapy, Drug Tiers, Mail Order drugs

Confidential

Business and Technology Delivery Consultant

Responsibilities:

  • Lead and coordinated work stream activities for Confidential Pharmacy Benefits Management(PBM) updates
  • Planned, executed and coordinated all testing activities across all Medicare Part D and Commercial Pharmacy Benefits products
  • Supported the delivery of the Medicare and Commercial work streams code changes
  • Coordinated with Confidential and Confidential pharmacists to implement code changes for Pharmacy Benefits Products, Formulary Management, Specialty drugs, Prior Authorization, and the Adjudication process
  • End to End delivery management for Confidential 2015 Medicare Formulary Management: Drug Coverage, Generic Drugs, Quantity Limits, Step Therapy, Drug Tiers, Mail Order drugs

Lead Consultant

Confidential

Responsibilities:

  • Managed planning activities for Product Test, Performance Test, and User Acceptance Test
  • Coordinated the availability and support for up and downstream applications/systems required for testing
  • Reviewed the development process to ensure that defect tracking (identification, fixing, re-testing and migration of defects) was properly addressed
  • Managed testers; worked throughout test plan development and test execution to ensure that testing was on time and within budget
  • Measured and monitored progress during each test to ensure that the application is tested, validated, and piloted on time and within budget, and that it met or exceeded expectations

Confidential

Systems Integration Lead Consultant

Responsibilities:

  • Led successful launches of Confidential benefit plans based on comprehensive understanding of benefits testing process
  • Confidential Medicare Part D products ownership (design to implementation)
  • Confidential Commercial products ownership (design to implementation)
  • Managed Formulary Management code migration and testing; Prior Authorization, Quantity Limits, Step Therapy, Claims Adjudication
  • Liaised with the functional pharmacy team to define updates of pharmacy drug list and testing of claims, out of state retail specialty network management, and claim issue resolution; interfacing with the specialty vendor, updating the specialty medical fee tables, drug access and pricing.
  • Designed Test Plan that insured the integrity of the Benefits, Pharmacy Network, Formulary and other modules applied to Confidential configuration for claims processing
  • Analyzed claims adjudication results against requirements; determined accuracy of Adjudication Configurations and approved data changes from the test environment to production
  • Managed 7 Confidential personnel in conjunction with third-party vendors in a complex, multi-project environment
  • Thoroughly and continuously trained all testing staff on the Confidential PBM tool and processes

Confidential

Systems Integration Consultant

Responsibilities:

  • Project lead responsible for the initial Pharmacy Benefit System (PBM) data migration from Confidential legacy to Confidential
  • Led successful launches of Confidential benefit plans based on comprehensive understanding of benefits testing process
  • Confidential Medicare Part D products ownership (design to implementation)
  • Confidential Commercial products ownership (design to implementation)
  • Managed Formulary Management code migration and testing; Prior Authorization, Quantity Limits, Step Therapy, Claims Adjudication
  • Liaised with the functional pharmacy team to define updates of pharmacy drug list and testing of claims, out of state retail specialty network management, and claim issue resolution; interfacing with the specialty vendor, updating the specialty medical fee tables, drug access and pricing.
  • Designed Test Plan that insured the integrity of the Benefits, Pharmacy Network, Formulary and other modules applied to Confidential configuration for claims processing
  • Analyzed claims adjudication results against requirements; determined accuracy of Adjudication Configurations and approved data changes from the test environment to production
  • Managed 7 Confidential personnel in conjunction with third-party vendors in a complex, multi-project environment
  • Thoroughly and continuously trained all testing staff on the Confidential PBM tool and processes
  • Pilot Lead and project manager for a consumer and client behavior pilot in for Capital Markets Survey Kenya
  • Crafted RFPs for the technical solution and led proposal evaluation and contract negotiation teams
  • Coordinated integration with client’s existing back office systems to support the pilot implementation
  • Pilot Lead and project manager responsible for mobilization and operation of the project management office for the client’s Implementation Projects
  • In coordination with client, tailored delivery methodology to support work streams
  • Worked with each team leadership pair to refine project work plans and to resource load and level the plans
  • Generated weekly metrics off the plans and reported to project leadership
  • Managed issues, risks, and change requests for the Project

Confidential

Training Consultant

Responsibilities:

  • Provided technical and procedural direction to development of the and Training Needs Assessment and Training Manuals and modules for six (6) rollout sessions of office administration training for Confidential staff on behalf of Confidential - Under the direction of the Lead Consultant
  • Developed and designed the training assessment and training process report
  • Managed all functions of the authorization process including intake, initiation, tracking and status follow-up for patients to ensure authorization and re-authorization for coverage of services
  • Verified Medicare, commercial insurance and Medicaid coverages and requested initial authorization and re-authorization of home health visits
  • Supported the training team by providing business process and change impact knowledge. Coordinated and documented formal handoff of required documentation to the Business Owners, such as business process designs, procedures, metrics, etc.
  • Collected and analyzed information required by the insurance companies to render authorization decisions
  • Provided direction and management of a billing team that is responsible for enterprise billing and collections.
  • Ensured company billing practices adhere to applicable governmental and payor regulations and policies.
  • Responsible for leading workshops and documenting process flows
  • Worked with key stakeholders to identify change and organization impacts and business tasks associated with business and IT process changes
  • Played a role as SME for various IT procurement programmes

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