SUMMARY

• Experienced Systems Analyst with a focus on healthcare information technology. Strengths include systems analysis and data mapping using an Agile/Scrum framework as a member of a Scrum team, report writing, workflow design, statistical analysis, quality improvement and time/cost estimation.

SKILLS

• Jira
• SQL
• MS
• Sybase
• Oracle
• MS Office
• Microsoft Word
• Microsoft Excel
• PowerPoint

PROFESSIONAL EXPERIENCE

Confidential

IT Systems Analyst/Senior Systems Analyst

Responsibilities:

• Provide analysis, data extract and report design, data profiling, implementation support, time/cost estimates and documentation for complex data warehouse projects using an Agile/Scrum framework as a member of a Scrum team. Create source to target mapping documentation, mock - ups and test files as applicable. These includes incoming and outgoing data feeds as well as reports utilized by key business areas. Provide analysis, design, configuration, testing, implementation, documentation and staff training for software and interfaces that support core business functions.
• Pharmacy manufacturer coupon discount program for high cost specialty drugs (Agile/Scrum):
• Help identify new product backlog and write user stories and task cards for product backlog and sprint backlog that impact FARE data warehouse. These include updates to current reports and invoices, new detailed group invoice, updates to extracts for multiple departments and vendors, e.g., Rating/Underwriting claim extract and the1700 Byte claim file for accumulator synchronization sent to PBM vendor (Express Scripts - ESI).
• Create time/cost estimates.
• Assist the team with Agile/Scrum knowledge and provide guidance and advice on the Sprint schedule.
• Complete the analysis artifacts, and work with developers and testers to deliver completed product increment at the end of each Sprint.
• Systems analysis and implementation support for data warehouse data model changes and new or modified reports and extracts in support of major and minor business initiatives. Either Agile/Scrum framework or Waterfall methodology is utilized as directed by Blue Cross leadership. Agile/Scrum is increasingly becoming the methodology of choice.
• Member eligibility extracts (Agile/Scrum)
• Medical claim extracts (Agile/Scrum)
• Pharmacy claim extracts: both PBM and carve-out (Agile/Scrum)
• Design and development of invoices and reports for self-funded groups line of business (Agile/Scrum)
• Open enrollment and new product initiatives - reports and extracts (both Commercial and Medicare Advantage business categories)
• Provider extracts (Agile/Scrum)
• Care management/utilization management extracts (Agile/Scrum)
• Health assessment survey extracts (Agile/Scrum)
• Risk extracts (Agile/Scrum)
• Web-apps for updating user data tables (Agile/Scrum)
• Consolidated Medicare Advantage explanation of benefits (EOB)
• Medicare Advantage extracts and reports (Agile/Scrum)
• National Health Care Reform reports and extracts, to include:
• Cost Share Reduction (CSR) annual extracts for CMS and related reporting
• Analysis and re-adjudication processes of claims used to populate CSR extracts
• 820 extracts, RCNI, RCNO
• Advance Premium Tax Credit (APTC) reporting
• National Association of Insurance Commissioners (NAIC) Annual Statement
• Group/Membership stats
• Claim stats
• Prior Authorization stats
• Accumulator overage report and design of on-line tools used to correct accumulator balances in Facets (deductible limits and out of pocket maximums)
• Analysis and design of new interfaces and modification of existing interfaces
• Administrative Simplification changes to 270/271 Blue Exchange HIPAA transaction code
• Real-time interface between Express Scripts and BCN to update Facets integrated accumulators for pharmacy transactions (deductible limits and out of pocket maximums)
• Member Portal web-app to replace Member Self-Serve and provide a unified member facing view of BCN and BCBSM coverage
• National Health Care Reform regulatory changes to interfaces, servicing applications and various automated processes
• Caremark/CVS batch process to synchronize accumulator balances and update Facets for Caremark pharmacy transactions for MSU HSA members.
• Business Requirement Documents, Analysis and Design Documents and Data Mapping Documents for multiple projects to include high level design, workflow diagrams and use cases.
• Developed close working relationship with business personnel through formal and informal means, ranging from simple phone calls to requirement JAD sessions and on Scrum teams. (Agile/Scrum)
• Coordinated with the IT Testing team on test cases addressed by the Sprint backlog. (Agile/Scrum)
• Developed rough order of magnitude (ROM) estimates.
• Developed high level time/cost estimates for initiatives and project requests.
• Developed detailed time estimates for user story cards and IT tasks. (Agile/Scrum)
• Provided release implementation support. (Agile/Scrum)
• Lead and mentor a team of Systems Analysts (SAs) as an SA lead and subject matter expert.

Confidential

IT Application Technical Analyst/Systems Analyst

Responsibilities:

• Provided technical and analytical support of physician office information systems for 300+ clinics owned by Confidential NextGen Enterprise Practice Management (EPM), Misys/Allscripts EPM, NextGen Electronic Health Record (E.H.R.), Cerner PowerWorks E.H.R., Cerner PowerChart Office E.H.R. .
• Designed and wrote functional specification document for change management model and software delivery process using a Kaizen team approach.
• Created Disaster Recovery (DR) documentation which described in great detail the specifications and steps required of multiple teams to recover key systems (NextGen and Misys) at a Trinity DR hot-site.
• Implemented web-based Enterprise Content Manager (ECM) application for the Physician Office Services team.
• Responsible for Cerner PowerWorks Advanced Report writing (PAR), to include design, development and production scheduling.
• Performed systems analysis for clinical and practice management implementations, upgrades, and support.
• Provided system upgrade and service pack testing and deployment.
• Managed project status and assignments.
• Provided process engineering expertise in design of functional processes.
• Performed Workflow “gap” analysis of affiliated physician practices and clinics.
• Provided on-site support to physicians, nurses, and other staff through the critical weeks following information system go-live.
• Performed ongoing systems analysis and on-call support.
• Conducted statistical analysis.
• Supported Clinical and Practice Management team initiatives.

Confidential

Process Analyst,

Responsibilities:

• Implemented Cerner PowerChart Office electronic medical record system:
• Conducted “best-practice” process engineering for physician practices and clinics.
• Performed workflow and “gap” analysis with reengineering recommendations for twenty five (25) affiliated physician practices and clinics.
• Provided on-site support to physicians, nurses, and other staff through the critical weeks following information system go-live.
• Self-paced training program for physicians and residents.
• Conducted ongoing statistical analysis of return on investment.
• Implemented cost calculator tool.

Confidential

IT Project Analyst

Responsibilities:

• Implemented HIPAA information security:
• Made security enhancements to IT environment.
• Performed information risk assessments and created risk management program.
• Developed information security policies and procedures.
• Conducted information security awareness training.
• Enhanced the IT disaster recovery plan.
• Managed projects:
• Managed patient accounting system move from an outsourced firm to in-house.
• Provided information system go-live support.
• Worked on proposals and cost estimates for major projects.
• Managed vendor contracts.

Confidential

IT Project Manager/MIS Business Manager

Responsibilities:

• Developed information Security / HIPAA compliance policies for IT systems.
• Managed information system implementations and enhancements.
• Provided information system build and go-live support.
• Performed process engineering in conjunction with information system implementations.
• Automated paper-based systems.
• Conducted operational analysis and process reengineering of hospital and corporate workflows.
• Documented interfaces and information flow in support of strategic planning.
• Redesigned facility layouts for improved efficiency.
• Conducted statistical analysis in support of quality improvement teams.
• Also conducted statistical analysis to develop staffing patterns.
• Developed reports to monitor departmental performance.
• Worked on expense reduction projects.
• Strategic planning
• Reviewed proposals and developed pricing models.
• Handled customer and vendor contracts.
• Responsible for strategic planning.
• Performed budgeting and financial analysis.
• Developed information systems policies and procedures.
• Responsible for information systems purchasing and payables.

Confidential

Management Industrial Engineer

Responsibilities:

• Conducted process engineering in conjunction with information system implementations.
• Facilitated process improvement teams.
• Responsible for statistical process control. This included indicators of utilization management using benchmarks and control charts to track utilization of patient stays for various DRGs. This experience provided familiarization with the concepts of utilization management.
• Performed operational analysis and process reengineering of various hospital workflows.
• Developed and maintained productivity standards and monitoring system.
• Responsible for labor budgeting and financial analysis.
• Benchmarked operational and financial indicators.
• Worked on expense reduction projects.
• Provided information system build and go-live support.