Summary

• Program management and operations manager with Master of Business Administration MBA from Capella University supported by a tradition of performance excellence in participating in delivering complex, global and multi-million dollar initiatives. Proven ability to lead complex projects from initial conception to successful implementation while delivering company value, project quality and corporate profitability through expertise in project planning, workflow organization and operational solutions. History of delivering projects within specifications, time-frame and budget. Experienced in setting direction and driving continuous improvement initiatives and leading large-scale development projects committed to providing internal and external customer satisfaction at all times and striving for excellence in the project's outcome.
• Possess strong team leadership and problem solving strengths able to maximize resources, meet aggressive deadlines and build consensus among disparate groups in support of objectives. Demonstrated ability to adapt to new environments and project specifications. Reputation for high levels of efficiency, integrity, loyalty and focus committed to exceeding corporate and customer expectations.

Skills

• Business Analysis Process Improvement Business Requirements Proprietary Software
• Business Rule Development Requirements Analysis
• Eclipse Smoke Testing Tool Requirements Gathering
• EDI ANSI X12 SDLC System Development Life Cycle
• EDIFECS Software Documentation
• HIPAA Systems Analysis
• System Implementations ClearQuest
• System Testing and Quality Assurance Smoke Testing UltraEdit QueryPath
• Management of Residential and Commercial Properties MMIS
• Microsoft Office Suite including Project Visio
• Project Design, Development and Implementation ReqPro
• Technical documentation

Experience

Contract Operations Consultant Self Employed

Contracted to assess business performance and operations by small businesses through to Fortune 500 companies. Evaluate business performance unannounced and announced to assess performance. Provide reports to businesses on assessment and deliver process improvement strategies. Provide social media and marketing consultation and development. Design websites and assist small businesses with self-sufficiency and cost effective solutions.

Confidential

• Responsible for the Third Party Liability TPL implementation and client installation of the Montana Medicaid System Design, Development and Implementation DDI . Responsible for collaborating with product delivery teams to focus on the State Government's first implementation and delivery of a MITA compliant system. Managed the implementation of the TPL department, and coordinated with other department requirements and their effects on TPL requirements and process. Reviewed work/project plan tasks to ensure implementation remains on track. Provided direct leadership for several employees/contractors across multiple verticals in order to get project implemented on and offshore.
• Operational development of new MMIS system for fiscal agent for TPL Department
• Redesign and create desktop procedures and process flows as a new fiscal agent for a new MMIS system account
• Analyze current MMIS system, identify gaps and develop solutions to improve efficiency
• Requirements gathering, designing and development of business rules for Third Party Liability and claims/financial processing
• Conduct JAD sessions, perform UAT testing based on sessions to identify achievement of solution
• Test new business rules and assess/report possible impacts from changes
• Maintain SLA service level agreements levels for client

Systems Business Analyst

Confidential

• Responsible for the implementation and client installation of the New Hampshire Medicaid System MITA compliant solution. Responsible for collaborating with product delivery teams to focus on the State Government's first implementation and delivery of a MITA compliant system. Managed implementation focusing on Security requirements and Smoke Testing system testing of specific scenarios and scripts to determine functionality effects and/or defects of deployments to analyze the entire Enterprise system.
• Operational development of new Enterprise MMIS system as the fiscal agent for Claims/TPL/Resolution Departments
• Redesign and create desktop procedures and process flows as the new fiscal agent for the new Enterprise MMIS system for Document Control Dept., Claims Exam Entry Dept., Claim Resolution Dept. and Regional OCR Claims Processing
• Monitor and control security access to the Enterprise MMIS system
• Analyze current MMIS system, identify gaps and develop solutions to improve efficiency
• Conduct JAD sessions, perform UAT testing based on sessions to identify achievement of solution
• Requirements gathering, designing and development of business rules for claims processing, and security
• Smoke test business rules and assess/report possible impacts from changes
• Ensure system functionality and client requirements are met
• Maintain SLA service level agreements levels for client
• OCR Claims Manager / Systems Business Analyst Confidential
• Responsible for the implementation and client installation of the New Hampshire Medicaid System MITA compliant solution. Responsible for collaborating with product delivery teams to focus on a State Government's first implementation and delivery. Managed implementation across Provider, Member, Benefit Plans, TPL, Claims and Service Authorization teams. Reviewed work/project plan tasks to ensure implementation remains on track.
• Operational development of new MMIS system for fiscal agent for Claims/TPL/Resolution/Document Control Departments
• Create procedures as a new fiscal agent for a new MMIS system account for the Document Control Dept., Claims Exam Entry Dept., Claim Resolution Dept. and Regional OCR Claims Processing
• Conduct JAD sessions, perform UAT testing based on sessions to identify achievement of solution
• Develop business rules and test business rules and assess/report possible impacts from changes
• Maintain SLA service level agreements levels for client
• Continue to support Montana account for Regional OCR Claims Processing Hub
• Consult on business rule design, analysis and implementations for Regional OCR States

Regional Claims Operational Manager

Confidential

• Managed day to day operational functions of the Montana Claims Department, Document Control Department, Resolution Department and the Regional Hub Claims Processing Center for Hawaii, New Mexico, Maryland, Wyoming and Washington DC.
• Awarded corporate Hustle Award, March 2007 Design and Implementation for new payroll system
• Awarded corporate Spot Award for cost saving measures, April 2007 Regional Claims Processing Hub
• Managed the Document Control Dept., Claims Exam Entry Dept., Claim Resolution Dept. and the Regional OCR Claims Processing Hub with over 20 reporting staff
• Implement OCR Claims Processing Hub with new states within ACS
• Develop and maintain business rules for claims processing for all states participating within the Regional Hub
• Develop and modify desk level procedures and operational processes
• Troubleshoot issues with claims processing and OCR issues
• Conduct JAD sessions, write new business rules, perform UAT testing and assess possible impacts from changes system wide
• Maintain SLA service level agreements levels for client and OCR Claims Processing Hub
• Use of multiple proprietary software programs

EDI Business Analyst / Supervisor

Confidential

• Managed day to day operational functions of the EDI electronic data interchange area of the Provider Relations Department. The EDI Department managed both the state of Montana and Washington provider and submitter electronic submissions.
• Supervise EDI Call Center Staff
• Interpret X12N transactions for compliance and identify issues
• Performed testing and resolved EDI compliance issues for Providers/Submitters
• Develop and modify EDI Call Center procedures
• Review and prepare weekly/monthly reports and agendas
• Participate in JAD sessions, perform UAT testing
• Assisted in implementation of web portal and develop test cases
• Used multiple proprietary software programs
• Provide excellent customer service
• Other duties as assigned