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 ( Confidential, 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)
• Confidential 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 Confidential 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
• ACA 1104 and Confidential /Core Compliance Rules experience Phase I and II
• ASC X12 4010A1 to 5010 Standards Confidential Analyst
• ICD9 to Confidential mapping, remediation, and testing
• DRG, HCPCS, CPT, ICD - 9, ICD-10 Code Knowledge, UB04 and CMS1500 claim forms
• Confidential compliant training current as of 2014
• ACA 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
• 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.

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

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

PROFESSIONAL EXPERIENCE:

Confidential, Newark, DE

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 Confidential 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.
• Confidential compliancy training completed for 2014.

Confidential, Warwick, Confidential

Business Analyst

Responsibilities:

• Business Analyst contract to provide subject matter expertise i
• Confidential privacy and security training for Confidential completed.
• Statement of Work (SOW) completed for project.
• Business Detail Design ( Confidential ) turned over.
• Analyzed impact of MITA 3.0 Seven Standards and Conditions and reported on same.

Confidential, Ashland, OR

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 ( Confidential ), Federal and State rules and regulations, and to provide the internal controls necessary for continued segregation of duties.

Confidential, Raleigh, NC

Confidential Business Analyst

Responsibilities:

• This Confidential BA consultant position entailed providing subject matter expertise in Medicaid for the Confidential mandated Confidential 4010A1 to 5010 conversion. Validated Confidential mapping and documentation and companion guides for correct formats and values.
• Reviewed Confidential /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. Confidential compliancy training completed for 2012.

Confidential

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

Technical Team Lead

Responsibilities:

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

Confidential, Pierre, SD

Business Analyst

Responsibilities:

• This Confidential BA position entailed exercising subject matter expertise in Medicaid and MITA. Responsible for the Business Relationship Management (BRM) function and Team Lead for the Confidential interfaces function. Reviewed and validated requirements and supplemented as necessary.
• Entered Use Case and Requirements into a Requirements Traceability Matrix (RTM) software product ReqTrace. Wrote and published the Requirements Validation Document (RVD).
• Member of Confidential MITA 2.0 “As Is’ and “To Be” Assessment Team. Confidential compliancy training completed for 2008.