Summary

• Along with 4.5 years of BA experience, I have 15 years as a Business Management Consultant to offer you in addition to being a highly motivated and organized professional, who is outgoing and energetic individual with a passion for problem solving. I am a critical thinker with positive attitude and excellent communication skills, successful record of meeting challenges through creativity and determination.
• Previous planning, creating and documenting policies and procedures, managing database, detail oriented to track and manage auditing processes, work plans, along with implementation in training of those guidelines. Meticulous regarding details to meet requirements and regulations validate all documentation, assurance for completion/compliance.
• Seeking a challenging position that will utilize my proven record for building strong team relationships, continually exceeding the client expectations and providing exceptional customer service and being an invaluable asset to the organization.

Experience

Business Management Consultant

Confidenital

• I prefer to keep continuous contract and or permanent opportunities as my full time profession. In between contracts I work with personal clients utilizing business management services in developing their small business needs and offer my culinary services.
• Developed and own a Business Management Consulting Service, provide exceptional client services and retention.
• Restructure of existing business practices, development and implementation of business systems and policies, on site logistic.
• Develop and implement business practices and personnel management, policies and procedures.
• Responsible for training, supervision and performance reviews, as well as, implemented successful cross training.
• Generated all accounting processes and successfully improved overhead, by decreasing expenditures. Execute and streamline financial reporting, accounts payable / receivables and operation of the business.
• General sales and marketing, fund raising campaigns and limited web design services.
• Develop, manage and operate a Niche Culinary Service on the side / or in between contract assignments.

Product Consultant

Confidenital

• Part of a team of three QNXT 5.01 product consultants, developed processes and procedures to streamline the upgrade process.
• Works with the Upgrade Center team to coordinate implementation of QNXT upgrades/change packs by providing clients a proven implementation process.
• Implementation includes reviewing and training clients on the upgrade enhancements as well as assisting the technical team with implementation.
• Assists in development of test scenarios as well as the testing cycles to mitigate any business risks for the upgrades.
• Works with other TriZetto teams: Implementation Center to convert new clients to QNXT , QA team to test both new and existing clients as needed to provide subject matter expertise.

Business Analyst

Confidenital

• Business Analyst for specific project documenting the Business Critical systems and BCW move.
• Served as a liaison between stakeholder and technical teams - professional verbal communication skills and persistence when necessary.
• Responsibilities included working with the Configuration team updating and maintaining the CMDB for Critical Business system service items, perform Gap Analysis, research and validate data which was critical to move systems and servers and documented new business processes
• Develop, maintain and complete related action items - where applicable utilizing complex matrices to determine correct data to apply.
• Track, develop and work actions items required to update CMDB and the BCW move within SharePoint.

Business Analyst

Confidenital

• Business Analyst primarily for post MMIS implementation issue resolution in area of Contracts.
• Responsibilities included working with the provider enrollment team within QNXT research, analysis and documentation of the current contractual arrangements attach new contracts or correct existing contracts where applicable utilizing complex matrices to determine correct contract to apply.
• Review workflow documents to determine EPSDT, PCCM and PCP provider selections and State approval document notes in workflow as contracts added, complete work objects. Locate appropriate contract on complex matrix / attachment spreadsheet.
• Maintain daily spreadsheet of contract changes/updates detailing exact changes/updates per provider by Pay To, with NPI's and noting service location and provider types and specialties for reference by date.
• Attach contracts for special projects such as PCCM Queue and Missing Contracts Report. Document, run extracts and submit CR's as needed to correct contracts unable to correct through the UI Need DBA assistance.
• Run claims reports for corrected contracts to submit to claims department for reprocessing.
• Work the objects documents in Workflow which require contracts, either new or corrections changes may be due to corrections from provider's updated maintenance cases or CLIA levels review, make appropriate changes, document in workflow notes and QNXT memos, log on daily spreadsheet, close work objects.
• Work jointly with Provider Enrollment to quickly resolve enrollment issues in order to meet SLA's for getting contracts attached and provider enrollment issues resolved.
• Work within the Maintenance PCCM Queue to validate and or correct contracts per information provided by provider and PCCM Queue, document in Workflow and QNXT, log on daily spreadsheet, close work object.

Business Analyst

Confidenital

• Business Analyst for MMIS data conversion project for Idaho State. The Idaho legacy database was replaced by the HealthPAS QNXT system. Primary responsibility - Provider and Contracts, Dental Health SME.
• Analyze business documents such as user manuals, technical manuals, requirement documents, and M.I.T.A business model related to documenting requirements for test cases.
• Worked on documentation and maintaining the taxonomy crosswalk from AIM to Health PAS provider types. Including PCP, PCCM, and Atypical documentation.
• Create and execute all project test plans test as defined by Idaho Medicaid business requirements related to Provider during Unit, System, UAT, Pilot testing and initial implementation phase to ensure successful and on time completion, validated the results satisfied the detailed design goals.
• Troubleshoot and research identified defects to provide solutions, while working with developers for configuration and code changes. Tracking with in Clear Quest.
• Create and implement, defect management process. Create and manage detailed reports to log test results and test data for tracking purposes within SharePoint.
• Worked on and tested selected areas of Member, Claims Processing, Workflow - Process manager, Letter manager - traceability roster, IVR Contact manager. Configuration mostly with in affiliation of provider relationships.
• Developed and streamlined the business polices and procedures for this process to cross train fellow team members.
• Communicate and coordinate with internal stakeholders and SME to resolve project requirements and deadlines.
• Established a close working relationship as a direct point of contact for the client, IDHW and co-workers. Identified new business processes as well as issues with the existing ones.
• Held and conducted progress meetings with the stakeholders on the results of the test cases and status of the project.
• Submit status reports to the higher management and stakeholders on the progress of the project on a regular basis.

Business / Account Manager

Confidenital

• Hired to assist with the transition and process of an existing practice.
• Possessing strong organization skills used in developing and implementing policies and procedures.
• Business Manager / Office Manager / Manage Employees, Restructure Office - Existing Practice to New Patient and Treatment Coordinator
• Bookkeeper: A/R, A/P, Insurance, Financial and Collections, Payroll, Assist Quarterly Taxes
• Create and implement Employee Manuals, Employee Training and Orientation