SUMMARY:

• Experienced Business Analysis, Data Analyst, Business Systems Integration with wide - ranging progressive experience in Healthcare, Clinical, Financial Services, Digital / Mobile, Regulatory Compliance lines of business in planning, developing, and implementing state-of-the art business processes and complex cross functional solutions leading cross-functional teams with diverse business and technical backgrounds; adept at consensus building, crisis and risk management, problem solving and negotiations.
• Medicaid, Medicare, Healthcare Information Exchange (HIX), Healthcare Revenue Cycle lines of business
• Healthcare Enrollments (EDI 834), MMIS Eligibility, Healthcare Claims (EDI 837) and Payments (EDI 835)
• NCQA Quality Improvements Process (QIP) and Rating of Payers for Critical Care Patients
• Health Level Seven (HL7) Integration and Interoperability: HL7 interface integrations with Hospital Enterprise Systems, PBM Pharmacies, PACS Radiology, and Clinical.
• Responsible for the setup, implementation, management, and tracking of Stryker programs / projects / protocols within the Siebel Clinical CTMS application to ensure quality and consistency in accordance with divisional priorities, GCP/ICH and internal standards.
• Work closely with clinical project team(s) to plan and manage clinical trials within approved timelines.
• Support the clinical divisions by managing and maintaining the Siebel Clinical Trial Management System (CTMS) as well as other Clinical applications. Perform all Sr Business Analyst responsibilities within the Global IT group to support the needs of the business divisions.
• CMS Federal Risk Adjustment (Claims Encounter Medicaid, Medicare, and Unify Dual Data) submissions to State and Federal CMS agencies under ACA - Affordable Care Act programs.
• Clinical and Physicians Workflow, Clinical Vitals Data, Clinical Analytics Data Warehouse
• GxP and 21 CFR Part 11 Compliance Regulations

TECHNICAL SKILLS:

Methodologies: Fidelity FSDM, IBM RUP Rational Unified Process, EDS Waterfall SDLC, Joint Application Design (JAD), AGILE Scrum Methodology.UML Use Cases, User Stories, Storyboard, Wireframes, Business Process Re-engineering, Workflow analysis, Data Mapping and Conversions / Migrations, Data Modeling, ER (Entity Relationship) Modeling, Kimball Dimensional Modeling techniques, Data Warehousing, BI Analytics, Cognos and Crystal Reports

Databases: IBM DB2, SQL, Sybase 12, Sybase 15, Oracle 9-11g, MS SQL Server, Decision Support / Data Warehouse systems, Informatica ETL, Teradata, SQL, Oracle OBIEE

Software and Tools: MS Project, MS Visio, MS Office Suite, Microsoft SharePoint. ITG Mercury and Clarity Planning and Budgeting, JIRA and Confluence, IBM RRC Rational Requirements Composer, RTC Rational Team Concert, JAZZ Agile tool, Clear Case, Requisite Pro, XML, Sales Force CRM.

Software QA and Testing: HP Quality Center ALM (Application Life Cycle Management) - Software Quality and Defect Management, User Acceptance Test (UAT) planning, test execution, testing objectives, and certification.

PROFESSIONAL EXPERIENCE:

Confidential

Functional Lead - Lead Business Systems Analyst

Responsibilities:

• Led cross-functional MassHealth, CCA State Agencies; hCentive product and OPTUM integration vendors to conduct information needs analysis and JAD sessions to document Integrated Eligibility requirements gathering and GAP analysis in MassHealth’s MMIS (Medicaid Management Information System). Identified system enhancements and determined development impacts to current system processing.
• Provide demo presentations to Stryker divisions and outside contractors on the Siebel Clinical CTMS application as requested.
• Managed and maintained Phase 2 and 3 clinical trial lab data for ZOSYN, including implementing an oracle database while verifying clinical results with antimicrobial data from domestic and international testing sites.
• Led data discovery and implemented Enrollments (EDI 834) for the electronic exchange of member enrollment information, including benefits, plan subscription and employee demographic information. Identified and resolved reconciliation of members’ enrollments and payments. Worked with software engineers and end-users to validate accuracy of enhancements and results.
• Updated training materials and user manuals and prepared documentation for assigned products. Provided daily on-going production issues resolution and support to assigned systems to identify production problems and resolves systems problems.
• Worked with MassHealth and CCA agencies coordinating efforts with hCentive and OPTUM to ensure the successful implementation (scope, quality, business value, and business risks) of short term tactical solution goals for OE2016 (Open Enrollment 2016) and long term strategic reporting and Data Warehouse and analytics BI solution.

Confidential

Principal Business Analyst

Responsibilities:

• Led planning, design reviews, requirements gathering to document business and technical requirements, use cases, data, process, and workflow diagrams using Joint Applications Design (JAD) Scrum Agile methodology.
• Established configuration of Benefit Plans, Benefit Categories, Rules, and Provider Contracts.
• Create and manage BA documentation for current and future integrations as well as ongoing system upgrades (Test Scripts, User Requirements, Project Management Plan, Project Charter, Project flowchart, Deviation log, Change Control QCC, Testing strategy, Traceability matrix, Testing summary report, Design document, Migration log).
• Liaison between the business stakeholders and the IT technical teams to recognize business needs and processes including understanding the complex business processes, eliciting and documenting requirements, and coordinating clear communication among various business groups and IT technical teams.
• Define and document clear and testable requirements and drive solutions used for system implementation or upgrades.
• Create process mapping for various projects to be presented to the business and IT technical teams.
• Subject Matter expert / System Administrator / Certified Trainer for the Siebel Clinical CTMS application including coordinating and managing training for all divisional users within the system.
• Responsible for the setup, implementation, management, and tracking of Stryker programs / projects / protocols within the Siebel Clinical CTMS application to ensure quality and consistency in accordance with divisional priorities, GCP/ICH and internal standards. Work closely with clinical project team(s) to plan and manage clinical trials within approved timelines.
• Provide demo presentations to Stryker divisions and outside contractors on the Siebel Clinical CTMS application as requested.
• Coordinated with iHealth Technologies (iHT - Analytics vendor) to establish payment policies and guidelines to configure Benefit Categories and Rules and re-engineered Claims processes, procedures, and systems.
• Led data Integration to automate processes that supported ongoing interoperation, periodic settlement with iHT vendor. Worked with Product Pricing, Claims Research to support and provide timely, accurate Payers and Clinical relevant data and conduct Claims Audit and Reconcile payments based on Payment Fee Schedules.
• Supervised User Acceptance Test (UAT) planning, test execution, testing objectives, and certification.
• Acted as interface between business and technology regarding deliverables and status. Managed logistical support, operational administration, and execution of tasks to ensure operations are prioritized. Provided management and escalation point support to ensure successful delivery of critical components within established time frame.

Confidential

Senior Business Systems Analyst

Responsibilities:

• Collaborated with cross-functional Columbia Management and Confidential Marketing, Finance, Investment Management, Compliance, and Legal Business Stakeholders to document Business-level Application and Functional Requirements (FSD), UML Use Cases, Data and Process flow diagrams for SEC Compliance requirements.
• Led systems integration of Ameriprise Fixed Income System with Blackrock’s Aladdin Fixed Income platform.
• Developed integration-point-analysis of (Golden Source) Security Master with Ameriprise’ GIM, PACE, Bloomberg, CPS Pricing, Fixed Income, and Investment Compliance systems.
• Worked with technology Data Hub teams to convert and consolidate data originating from multiple sources into Golden Source Data Warehouse system to provide an accurate and consolidated database.
• Reviewed the client's business rules, file layouts, and data conversion structures to develop automated routines using Informatica ETL for ongoing integrity of data transformation processes to ensure the consistent conversion of data into SEC statistical regulatory compliance reporting, and risk management systems.
• Supervised User Acceptance Test (UAT) planning, test execution, testing objectives, and certification. Obtained necessary approvals, and implemented technology projects to ensure goals are accomplished within prescribed time frame and cost. Worked closely with management to understand and prioritize business goals and information needs to develop and align project initiatives in concurrence with business.

Confidential

Technical Product Lead - Clinical Vitals Beta Product Lead

Responsibilities:

• Facilitated Clinical Vitals Workflow sessions with business owners and end-users to elicit, create, and verify current state workflows of Clinical Vitals.
• Defined future To-be state of Clinical Workflows using Joint Application Design (JAD); Scrum AGILE Methodology to document Business-level Application and Functional Requirements, Use Cases, Data and Process flow diagrams.
• Led commercial off-the-shelf (COTS) Motorola Handheld Devices and Confidential ’s IDX Care Cast / Care-Fusion products integration and vendor management.
• Worked with cross-functional teams and departments to improve software and business processes, deployed Clinical products, developed necessary documentation with the goal of increased scalability, supportability and availability.

Confidential

Principal - Business Analysis and Business Process Re-Engineering

Responsibilities:

• Led planning and execution of strategic and operational Systems Integration, Re-Engineering of Data and Interfaces across multiple initiatives and processes.
• Led operations; provided guidance to business stakeholders, steering committee, and end-user community setting goals and objectives.
• Evaluated and resolved complex technical, business, and operational issues and problems.
• Worked with technology Data Hub teams to convert and consolidate data originating from multiple sources into GCAS Data Warehouse system to provide an accurate and consolidated database.
• Reviewed the client's business rules, file layouts, and data conversion structures to develop automated routines using Informatica ETL for ongoing integrity of data transformation processes to ensure the consistent conversion of data into GCAS statistical regulatory compliance reporting, and risk management systems.
• Supervised User Acceptance Test (UAT) planning, test execution, testing objectives, and certification.
• Obtained necessary approvals, and implemented technology projects to ensure goals are accomplished within prescribed time frame and cost.
• Worked closely with management to understand and prioritize business goals and information needs to develop and align project initiatives in concurrence with business.

Confidential

Project Manager - Software Engineering Management

Responsibilities:

• Provided leadership and expertise in implementation best practices and standards and ensured that the Best Practices are effectively implemented and adhered to.
• Managed cross program conflict and interdependencies.
• Managed program risks, proposing appropriate mitigation and contingency plans.
• Proposed workable solutions to problems by analyzing business and technical trade-offs among alternatives, and used objective judgment and influence to formulate and drive consensus on recommendations.
• Managed relationships with internal, external commercial off-the-shelf (COTS), and Infosys Indian vendor.
• Managed logistical support, project operational administration, and execution tasks to ensure operations are prioritized and resourced.
• Established team dynamics, fostering teamwork and collaboration.