SUMMARY:

Experienced, knowledgeable, and results oriented Information Technology Professional with success directing a broad range of initiatives in Healthcare, E - Commerce and Manufacturing-Distribution System applications. Proven experience leading all stages of Project Management, Systems Development, IT Data Center Operations, Production Support, QA Testing and Systems Implementation.

TECHNICAL SKILLS:

Operating Systems: Windows NT/2000/XP, HP3000 MPE - IX/UX, IBM AS400, IBM OS-DOS/VSE, Oracle 11G

Languages/ERP: SQL Server, TOAD SQL, XML, ABAP, COBOL, PERL Scripting, FTP/SFTP Scripting, SAP, Trizetto QNXT Health Trio and SAP

EDI/FTP Software: BizTalk 2010, Gentran (GIS/NT/UNIX/AS400/Windows), Edifecs Spec Builder/Ramp Management, IBM Globalscape, Ipswitch SFTP Server, and NEHEN, HL-7

Applications/Tools: Microsoft Office Suite, SharePoint, PowerPoint, Access, Visual Studio, SSIS

PM + Helpdesk Applications: Microsoft Project, Visio, IBM Clear Quest, JIRA, and HEAT

QA Tools: Trizetto Claims Test Pro (CTP), QTP ALM

HEALTHCARE/E-COMMERCE INDUSTRY PRACTICE AND EXPERTISE:

• Medicaid, Medicare, Healthcare Information Exchange (HIX).
• Healthcare Enrollments (EDI 834), Healthcare Claims (EDI 837) and Payments (EDI 835).
• CMS Reporting (Claims Encounter Medicaid, Medicare) submissions to State and Federal agencies under Affordable Care Act (ACA) programs.
• BI Analytics/Reporting, translating business needs into actionable intelligence and scalable solutions.
• E-Commerce Order Fulfillment and Warehousing solutions (AWCS)

DELIVERY MANAGEMENT AND LEADERSHIP SKILLS:

• Managing the entire life cycle process of delivery engagements from Planning and Initiation, Business & Technical Requirements gathering through System Implementations, QA Testing and File Acceptance/Delivery.
• Providing guidance to business stakeholders, steering committee, and end-user communities.
• Setting project goals and objectives.
• Evaluating and resolving complex technical, business, operational issues and problems.
• Assessing business risks, and mitigation planning.
• Managing relationships with internal, and external software vendors/partners.

PROFESSIONAL EXPERIENCE:

Confidential, Boston, MA

EDI Technical Solutions Engineer/Business Analyst

Responsibilities:

• Technical Solutions Engineer fully engaged in the Project Management, Business/Technical Requirements process, Operational Design, QA, Customer Service and Implementation of Healthcare - based Claim Encounter/Enrollment data exchanges.
• Project Lead with ownership responsibilities including Requirements Gathering/Drafting, ETL Development, Operational Solutions design, software QA Testing and Implementation/Deployment/Production Support efforts.
• Design and develop mappings of HIPAA/CMS-compliant X12 and Proprietary data exchange files between Beacon partners, clients, and Regulatory entities.
• Drafting of Business/Functional/Technical specifications and mapping requirements.
• Collaboration with ETL Team to review and interpret Business/Functional/Technical specifications, ensuring Development process standards were consistent met.
• Facilitation of status meetings to provide timely and accurate communications to all Project stakeholders including Client's Business and IT Teams, as well as internal Beacon Business Units.
• Consistently assured the timely and accurate delivery of outbound encounter data files to multiple client sites on a daily/weekly/monthly basis (per Service Level Agreements).
• Partnered with Technical Operations Team to design and monitor ftp connectivity channels.

Confidential, Boston, MA

Business Analyst

Responsibilities:

• EDI/IT Business Analyst responsible for gathering requirements from end-users to clearly define information needs, and then translating those requirements into technical specifications for Development. Primary Liaison for Claims, Enrollment and Quality Teams.
• Performed Business/Application Analysis of the Trizetto QNXT core systems, and all relevant business processes/applications in order to become SME for the EDI Team.
• Gathered Business Requirements, created BRD's and functional/technical specifications for IT and cross - functional NHP Business Unit projects.
• Worked with ETL Team to develop solutions to align data between "real time" transactional systems and Monthly Data Warehouse Accumulator feeds.
• Redesigned EOB statements to include Maximum Out-of-Pocket and Deductible dollar amounts for plan members.
• Partnered with NHP Business Units to design, prepare and execute test plans for new implementations, application upgrades and system enhancements.

Confidential, Waltham, MA

EDI Analyst II/Project Lead

Responsibilities:

• Led Migration project of 100+ Trading Partners from 4010 to 5010 X12 standards.
• Creation and publication of new Implementation Guides for 5010 standards, including Workers Compensation and Automobile Medical claims.
• Production Support and Monitoring of Inbound/Outbound data exchanges for key Confidential Production Trading Partners.
• X12 Transaction sets included 277, 834, 835, 837, 997 and 999.

Confidential, Medford, MA

EDI Business Analyst/EDI Specialist

Responsibilities:

• Designed and executed QA Testing plan for Claims Repository database creation.
• Application/Business Analysis of NWH core systems
• Installed and configured NEHEN software. X12 Transaction sets included 277, 834, 835, 837, 997 and 999.
• Built data exchange interfaces for HL-7 data feeds using SQL, SSIS + Biztalk 2010