Summary

A fast track, hands on professional with 29 years of experience successful in the design, development, management, and deployment of technological applications. Extensive experience in project management, development, analysis, and business requirements of complete healthcare IS, operations, and administrative teams. Thorough knowledge and a complete understanding of healthcare applications including all phases of multiple large-scale technology rollouts, all stages of development, BPMN diagrams, Use Cases. cost analysis, planning, vendor selection, testing, customer service, and acquisitions applying various methodologies including Summit-D SDLC , Plan View, Agile/Scrum, and Rational Unified Process RUP . Diverse background includes extensive application and database development, the Internet and infrastructure, seamless integration/interfaces and mappings, including EDI/HIPAA, X12/XML, and HL7 and the emerging technologies in a large user community. Expansive thinker with an outstanding record of achievement implementing new business concepts, delivering and deploying innovative business solutions, and facilitating operations with a high level of achievement all within required budgets and timelines.

Confidential

Senior Business Analyst/Architect Specialist Consultant

• Work directly with the CTO, Director of Finance, Enterprise Architects, vendors to gather business needs and requirements to match up with the technical needs and requirements.
• Use Agile/Scrum Methodology for group collaborations, user stories, and working structures by implementing CMMi for continuous quality improvement of monthly product deliverables.
• Responsible for business and technical requirements to integrate and communicate with e-commerce techniques for exchange of financials, processing and payment inquiries, scheduling, and eligibility through proper and accurate matching of insurance plans sold.
• Managed project scope and reported revised directions of future iterations to project team.
• Created architectural diagrams to envision high-level scoping including integration to Amisys, EMR/MPI including ETL, and NEHEN.
• Created requirements documentation and deliverables using toolsets such as Caliber.
• Created iteration modeling that described the domains, usage, and user interfaces
• Documented all HIPAA EDI mappings and specific guidelines compliance documents for X12 4010A1/5010 834, 835, 837, 270, 2271, 276, 277, and 278 in corporate streamlined data movement and component based SOA, integration with XML, XSD, and Web Services
• Analyzed current architecture and provided recommendations/solutions to integrate new solutions designs including those from third party vendors to access critical capabilities
• Use Visio to develop and maintain enterprise-wide architectures including BPMN context diagrams, swim lane diagrams, and models along with accompanied documentation to facilitate meetings, discussions, and design architecture scrums.
• Managed vendor relationships, Edifecs and Tibco, details specifications, expectations, problem solving, resolution follow-ups, interfacing toolsets, and integrating applications.
• Mentored others on the overall vision and functional concepts of EDI financial processing, requirements, and the deliverable activities.
• Worked directly with customers to elicit their needs and requirements, under their work flow patterns, and tied directly to the new architecture through interface and integration points.
• Use agile iteration to implement the highest priority work items, chart team velocity to streamline estimates, deliver monthly demonstration working models, and planned releases.
• Developed quarterly releases plans in accordance to the greatest business value
• Created documentation storage methods and rule sets for long term safe keeping of all documentation into an enterprise-wide document repository.
• Integrated all repository documents for internal/external viewing through the use of Wiki internet/intranet link. This provided full exposure to all levels the details of each project and the progress of each project through use of burn down charts, availability charts, tasks list, and assignment. Real time updating of these provided for dynamic reporting.
• Developed testing documentations, results for UAT and design to test, and training material, including the use of Test Director for immediate feedback to development and traceability.
• Create project plans and resource allocations for PMO for work load balancing of projects, 10M budget plans, estimations, P/L, ROI, for final CIO approval including subcontractors.

Confidential

EDI Systems Analyst / Business Systems Specialist Consultant

• Conduct extensive interview all stakeholders from each corporate entity to determine their business, reporting, and technical requirements in order to develop a technical business model.
• Collaborate on the project scope pertaining to the business requirements, technical requirements, and communication details for electronic payments and data reconciling of all inbound and outbound X12 835 e-payments transaction, XML/XSD schemas, and PDF print formats.
• Responsible for the ePayment and Remittance Automation and integration nationally all providers with payers and banking institutions for electronic payments, data reconciliation, and BI data marts for alerts and graphical reporting/presentations.
• Utilized SDLC, Agile and Waterfall, to document all business, technical, and data requirements incorporating Use Cases and UML to obtain approval/sign-offs from all stakeholders.
• Create Visio BPMN diagrams of data work flow movement, reconciliation points, attributes, key data elements, and UML representations.
• Create Word deliverable documents for review with stakeholders, project champions, and project managers to confirm the scope of the project, the requirements gathered, the technical readiness, in compliance with Agile methodologies.
• Develop Data/System Architecture, Data Models, SOA, Web Services, Data Warehousing, ETL, and EHR/MPI solutions for enterprise system and architectural detail designs, data flows, points of integration, data warehouse designs, data marts for BI reporting, and XML/XSD schemas for system integration to SQL/Oracle database including SeeBeyond for ETL Java/SOAP integration.
• Develop data mappings for e-payment reconciliations, SLA commitments, alert triggered events, and Netcool integration escalation procedures.
• Performed data modeling and the creation of new data tables to normalize the integration into the current systems and for expansion into future 3rd party systems using Oracle 10g platform, unix based operating systems, and SQL stored procedures.
• Perform Gap Analysis against production database, new data models, system communications, and system architectural designs.
• Developed new SLAs by designing system required alerting mechanisms by improving and designing new work flow procedures.
• Develop BI reporting from the architected Data Mart for public displaying of real time charting and graphing on strategic systems viewed in locations via large screen panels for both internal customers and externals customers.
• Work close with corporate accounting to assure all aspects of the enterprise system designs are covered under Sarbanes-Oxley compliant standards.

Confidential

EDI Project Manager / Business Systems Specialist Consultant

• Meet with stakeholders and project champions on a regular basis to confirm business requirements, report project status, and updates to the new workflow.
• Perform the business analysis and business requirements internally to best integrate with current business solutions.
• Determine scope of the project pertaining to the technical details for communicating inbound and outbound transactions.
• Responsible for the national eBill EDI middleware interface connecting nationally the HIPAA standard X12 formats used by healthcare to communicate Workman Compensation and FMLA between TPAs and national clearinghouses. All eBill work is being performed at the largest 3rd party claim processing center in the country in corporation initially with the state of Texas.
• Communicate with the client/third party vendors to collect requirements and the system designs, application coding, and implementation solutions to meet the quality requirements.
• Create project deliverables to obtain sign-offs and milestones for project tracking and accountability.
• Perform the mappings between the Worker's Compensation/FMLA to the Federal HIPAA standard X12 837, 835, 997, 824, and the 277.
• Document the data tables, gap analysis, and BPMN work flow diagrams, and Use Cases for the XML schema interfaces and testing.
• Lead technical discussions communicating with other 3rd part vendors, clearinghouse, and state governments to produce resolution agreements.
• Created deliverables consisting of project plans, releases, requirements, test plans, test labs, and defect tracking using Project, Word, Visio, and Excel
• Performed all test cases consisting with teams members in-house and remote offices, vendors, clearinghouse, state governments, satellite offices, and financial institutions using HP Quality Center Enterprise Edition / Mercury Test Director.
• Maintain version control using Tortoise SVN
• Develop Oracle interface tables using tools by Toad
• Create SQL scripts for testing Oracle database elements.

Confidential

EDI Product Specialist / Project Manager Permanent

• Determine scope of projects including initiating the project management, planning, architectural designs, RFP, requirements, business analysis, benchmarks, budgeting, scheduling, development, delivery, and completion through production.
• Responsible for all financial middleware development, implementation, support, and training on all EDI transmission applications involving the processing of over 5B annually in claims transactions, communication conversions, hipaa compliance with federal regulated 4010A1 mappings, claim processing, purchase orders, integrations, and interfaces.
• Work directly with user community to obtain change requests, business requirements, and functional requirements.
• Managed and lead all development/upgrades from NSF to HIPAA compliant ANSI mappings with completion 1 year ahead of schedule and fully in governmental compliance to 92 connections, directly to intermediaries, clearinghouses, end point adjudication centers, VANs, and various gateways.
• Lead and managed entire claim sets as defined by the Federal Government, State Governments, Medicare, Medicaid, and commercial arena as required by their X12 EDI specifications.
• Set deadlines, assign responsibilities, monitor and summarize project progress.
• Creates reports and conducted meetings in regards to current and ongoing expenses, project schedules, resource demands and requirements, milestone status', critical issues, challenges, and change controls.
• Create capital budgets, obtained approvals, administrative sign-offs, cost breakouts, expenses, and business valued justifications.
• Manage all resources, schedules, and communication notifications.
• Identify and setup close communication ties with project champions, sponsors, and owners to identify and scope all requirements, definitions, progress charting, impacts, and change controls methods.
• Created financial budgets, ROI, project timelines, milestones, resource balancing, and administrative reporting that assured on time and on budget tracking.
• The company wide expert in claims processing using SSI ClickOn and Direct clearinghouse for claim processing and billing to insurances companies nationwide all on a SQL backend.
• Work closely with vendors to supply needed tools, applications, integration solutions, and related architectural planning.
• Maintained version control, disaster recovery plans, and system/application specifications.
• Mentoring of colleagues, managers, and others on project management, methodologies, and system architecture/middleware.
• Project management methodologies using Visio, Project, Lotus Notes, Excel, following standard development life cycles SDLC .
• Design system architecture of n-tiered applications to integrate with McKesson HBO patient accounting, material management, with middleware to vendor products for electronic commerce.
• Integrated SAP Purchase Orders systems, MMIS, IDOCS, and integration engines developed and maintained in Peregrine/Invois TrustedLink running on Unix with an Oracle back end
• Communicated with developers, vendors, and internal management teams to delivery designs and strategies to successful bring into production enhancements and upgrades to the products.
• Developed migration paths, system architecture, project plans for database storage on Windows 2003 Servers Running SQL Server Enterprise including administration of the claims processing systems.
• Conduct brain storming meetings to meet needs of the facilities and company.
• Chair Person of weekly meetings with over 20 large city hospitals directing all future developments in accordance to federal regulations and newly planned and ongoing initiatives. Attendees include Business Office Directors, Managers, Leads, and VPs.
• Integrated prior system architecture with current and future development through integrating enhanced protocols such as SMNP, POP3, LDAP, VPN, JAVA, and SCRIPTS.
• Developed the architectural design and managed the development of all Claim processing, status inquiries, responses system developed in SQL, Visual Basic, Java, IIS, and various integration engines such as TrustedLink, all automated for batch processing to various insurance companies.
• Report on opportunities for additional LOBs, report on the full range of ROI, outline migration plans, produce project timelines which demonstrate inside detailed summaries, and implementation strategies.
• Administer all user access, support for users and the 24x7 data center, training, authorization, security, and disaster recoveries.
• Analyze all electronic transmissions, setup up all LOBs by partnering with other business' and/or enrolling into service agreements TPA , determine and setup all appropriate communication parameters, procure and apply integrations for transaction processing, reporting, reconciliations, accuracy, timeliness, verifications, adjudication, proper coding, and final payments,
• Created, administered, and maintained SQL tables and indexes for data warehousing of corporate wide claim processing and history databases.
• Worked with vendors to produce web site commerce and confirmations for tracking of electronic records.
• Work with all insurances, fiscal intermediaries, clearinghouses to assure daily processing for claims, payments, purchase orders, invoicing, remittances, inquiries, and responses. Mappings developed include ANSI 4010A1 837, 835, 276, 277, 270, 810, 820, 850, 855, 834, 997 for institutional, professional, and commercial.
• Negotiate contracts for costs, fees, implementations, integrations, and support, with vendors for new and/or improving current capabilities to either enhance or upgrade of the claims processing systems.
• Chairperson responsible for developing, chairing, and facilitating MidWest regional claims processing seminars, user groups, and seminars with attendances exceeding 100 and representing over 50 entities.
• Use Claredi verification system for development of new lines of business.
• Obtained hundreds of edi certifications in HIPAA compliance using various testing tools such as Claredi, Mercury, Washington publishing implementation guides, supplemental guides, vendor toolkits, and HIPAA plug-ins.
• Coordinated communication upgrade to Winbatch and WS FTP Pro from dial-up to ftp over secure web sites for hundreds of connections.
• Produce escalation of issues with supporting documentation, solutions, and new business procedures that resolve possible future repeated issues.
• Conduct and perform upgrades on claims, purchase order, integration engines, and on all applications that covered the entire scope of the system ranging from within the system itself such as SQL DB and administration there of all the way down to the end user access and use of the products.
• Use PC Anywhere, VNC, Remote Desktop, HyperTerminal, Win batch, WS FTP Pro, and WebEx for communications support sessions.
• Worked with edi integration engines Cloverleaf, Integrator, TrustedLink, Biztalk, RealTime, ClickOn, and Mercator.