Business Analyst Resume

SUMMARY:

With over 30 years of experience in technical leadership, project management, analysis and design of complex IT systems. Experienced in all phases of SDLC. A strong team player with solid accomplishments in achieving development goals and client satisfaction.

TECHNICAL SUMMARY:

Platforms: MVS, Unix

Programming: SQL, JCL, COBOL, VSAM, CICS, MicroFocus Cobol, Easytrieve

Databases: DB2, Oracle, SQLServer

Development Methodologies: SDLC

Other: TFS, SVN, Endevor, Sharepoint, FileAid/FileManager, TSO/ISPF, ESMACSPUFI, QMF, Xpeditor, ZEKE, Control - M

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst

Responsibilities:

Responsible for creating business and functional designs for interfaces to/from trading partners of a Medicaid Enterprise System (MES) solution.
Created and executed system integration test plans.

Confidential

Lead Consultant

Responsibilities:

Responsible for gathering requirements, designing technical solutions, estimating effort, seeking client approval, creating test plans, reviewing unit and QA test results, initiating and scheduling migrations, performing post implementation monitoring and updating documentation.
Responsible for providing guidance to Pharmacy Benefit Management development teams in the areas of current business processes, technical designs, and implementation strategies.

Confidential

Application Team Leader

Responsibilities:

Responsible for direct contact with the fiscal agent providing technical and business analysis along with estimates for implementation of enhancements and triaging system defects for a Pharmacy Benefit Management system.
Oversight of all pharmacy adjudication processes including data flow of member eligibility, prescriber, provider, drug and pricing data from FDB, AAC pricing, rebate and claim information.
Primary resource for developing and implementing a configurable Morphine Equivalency component.
Maintain client Business Rule and Systems Manual ensuring accuracy and timeliness of delivery.
Assist in reconciliation efforts to meet SLA requirements of the State.

Confidential

Senior Consultant

Responsibilities:

Performing as a subject matter expert for a commercial insurance client.
Tasked with providing root cause analysis and correction to all lines of business to include, but not limited to, Commercial Auto, Workers Compensation and Business Owners policy administration.

Confidential

Senior Consultant

Responsibilities:

Knowledge in provider and prescriber enrollment processes specializing in assessing risk rules and regulations under the Affordable Care Act.
Implementing 340B Drug Pricing program within the pharmacy system. Provided detail system impact analysis, estimate of work, coding changes and testing with external entities.
Designing and implementing NCPDP Service transactions (S1/S2/S3).

Confidential

Senior Consultant

Responsibilities:

Providing services in code development, QA testing, requirements gathering, defect resolution, documentation, conversion and detailed analysis and technical specifications in the area of Pharmacy Claims adjudication for several State Medicaid programs.
Comprehensive understanding of current NCPDP standards in claims processing in both online and batch environments.
Expertise in MCO encounter claims processing, State Maximum Allowable Cost (SMAC) pricing development and implementation, and the import/export of claims information to and from various external and internal entities to support such processes as Drug Rebate and Data Warehousing.
Serving as subject matter expert (SME) in all areas of PBM claims processing.

Confidential

Senor Consultant

Responsibilities:

Assisted in providing Root Cause Analysis to various problem areas in policy administration to include coding, testing, table maintenance, client training and documentation.

Confidential

Senior Analyst

Responsibilities:

Served as the Quality Assurance Technical Team Leader for the initial implementation of an inventory system and retail data warehouse.

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