PROFILE

Business analyst with more than 16 years of Title XIX industry experience. Skilled in a variety of subsystems including provider, claims, recipient, reference, prior authorization, and TPL. Has extensive experience in implementations, end-user training, testing, support and documentation. Communicates effectively with local and remote project members including clerks, end-users, business analysts, project managers, system engineers, providers, and client executives. Key contributor to large MMIS integrated projects such as NPI, and more recently supporting the development and implementation of the nationally recognized web-based Core MAPIR application, and implementing MAPIR at the State level for Indiana XIX.

PROFESSIONAL EXPERIENCE

Confidential

• Lead Business Analyst II and Core MAPIR Subject Matter Expert in support of the Indiana XIX MAPIR implementation. Responsibilities while in this remote support role included:
• Organize and facilitate cross-functional team meetings for requirement determination of state customizations
• Organize and facilitate daily project meetings to review progress, discuss issues, concerns, and solutions
• Manage client expectations and scope of project
• Actively participate in the construction and review of the Master Business Design and Technical Design walkthroughs
• Responsible for the development of the Testing Strategy and comprehensive Test Plan
• Facilitate IN XIX networking with other MAPIR collaborative states and members of the Core MAPIR team
• Organize team strategy to complete testing within the confines of the aggressive schedule and created testing tools
• Establish test data and execute the Test Plan
• Facilitate, conduct, and track testing of access into the State web portal, creation of applications, processing of internal and external NLR interface files, processing of the internal MMIS interfaces, and the processing of Adjustments for both initial and multi-year Meaningful Use payments
• Document the test results
• Communicate any potential downstream affects that may impact testing
• Escalate any differences or gaps in testing and proposed back up plans to accomplish testing
• Organize MAPIR training for internal HP staff
• Assist internal client with User Acceptance Testing as needed
• Participate in Core MAPIR Steering Committee meetings
• Post-implementation, serve as resource for problem resolution
• Edit existing IN XIX Business Analyst Training documentation
• Serve as information resource, sharing relevant Medicaid topics
• Corporate presenter for HP Healthcare University. The virtual classes gave an overview of the Provider subsystem and were open to a wide spectrum of employee job codes across the United States

Confidential

Business Analyst II

• Responsibilities while in this remote support role included:
• Participate in the construction and review of the Master Business Design
• Document the requirements for the National Level Repository NLR interface files
• Design and rolled out the project templates for team minutes and test case results
• Meet daily with project team to review progress of the project, discuss issues, concerns, and solutions
• Establish test plans and test data per business requirements for the NLR interface files
• Create NLR B-6 interface files for testing preparation
• Create and test provider incentive applications via the web portal services test the Core MAPIR application processing with MMIS and NLR interfaces
• Facilitate, conduct, and track testing of the NLR interface files and the processing of Adjustments
• Document the test results
• Communicate any potential downstream affects that may impact testing
• Escalate any differences or gaps in testing and proposed back up plans order to accomplish the testing
• Participate in testing walkthroughs for other tracks
• Assist Pennsylvania client with User Acceptance Testing as needed for NLR interface testing
• Participate in Core MAPIR Steering Committee meetings
• Document testing procedures for NLR interfaces to be used by the thirteen state collaborative
• Corporate presenter for HP Healthcare University. The virtual classes gave an overview of the Provider subsystem and were open to a wide spectrum of employee job codes across the United States

Confidential

Business Analyst II

• In support of the NH Title XIX account, took on a role as a Provider Relations Specialist due to diminishing account project work and the need to cross-train other account team members. Responsibilities while in this role included:
• Call Center Support Responsible for working with and educating providers on how to resolve billing issues and understanding how and why their claims adjudicated in a particular way. This frequently involved very specific support in the completion and submission of claims
• Maintain a positive and pleasant disposition to facilitate communications with Providers and the NH client
• Provide timely and accurate responses to Providers and the NH client to promote trust and accuracy in reporting
• Responsible for the creation and submission of Model Office claims and to supply the NH client with the required documentation
• Utilize Denial Analysis Reports to identify claim trends and the need for outreach provider education
• Participate in Account Productivity and Innovation brainstorming sessions
• Participate in Card Sorting session of Provider Management Business Area
• Assist in the efforts to prepare providers previously receiving paper remittance advices to be able to access .PDF versions of their remittance advice on-line
• During this time, also supported the NH AIM Base Systems Team in a Business Analyst role, as needed, providing insight on previous projects, testing considerations, and participating in testing reviews as needed

Confidential

Business Analyst II

• Senior BA on the NH AIM Base Team. Primary responsibilities revolved around the facilitation of and participation in maintenance and modification projects through the various phases of NH's System Development Methodology SDM , which is a version of EDS' System Life Cycle SLC .
• Establish project teams, based on Control Memos filed by both internal and external clients, involving both internal HP/EDS and external State of NH client participants
• Schedule and facilitate project meetings
• Facilitate requirements determination meetings and document the requirements at both a High Level and Business Design level
• Manage client expectations and scope of projects, and work with the client to correctly identify control memos as maintenance or modification
• Work with the technical team to transition the Business Requirements into Technical Requirements
• Establish Test Plans and test data per Business Requirements
• Facilitate, conduct and track testing
• Document test results
• Present test results to both the internal project team and the NH client
• Facilitate project implementation, which included the establishment of reference data as needed
• Conduct and document Post-Implementation Reviews
• Subject matter expert for NH AIM Edit and Audit Testing
• Maintain solid rapport with both internal and external clients
• Execution of queries to facilitate an understanding of data between the Systems Team and internal/external clients
• Business Analyst on the NPI Assessment and Remediation projects. This project established a hybrid approach to processing NH Medicaid claims based on NPI submission.

Responsibilities included:

• Participate in review sessions with various State agencies and interface representatives to determine policy and data needs to support NPI and Taxonomy relationships within NH AIM
• Map Healthcare Taxonomy Code Set to NH-specific provider types and specialties, which facilitated the establishment of NPI to Legacy ID mapping rules
• Assist in the creation and review of various project documentation
• Assist in the design and testing of Provider, Claims, and Reference screens
• Assist in Post Implementation Review

Confidential

Business Analyst I

Responsibilities while in this role included:

• Claims Team Support
• Ran Denial Analysis reports used by both the Claims and Provider Relations Teams to identify claim trends and need for provider education
• Provider Relations Support
• Call Center Support
• Responsible for working with Providers to resolve billing issues. This frequently involved very specific support and education in the completion and submission of claims
• Maintain a positive and pleasant disposition which is necessary to facilitate communications with Providers and the NH client
• Provider education
• On-site provider visits
• Responsible for the creation and submission of Model Office claims and to supply the State with the required documentation

Confidential

Business Analyst I

• Responsibilities while in this role included:
• Provider Relations Representative
• Call Center Support
• Resolve customer issues
• Provider education
• On-site provider visits
• Maintain positive relationships with the RI client and customers
• Work closely with the client to help define requirements
• Requirements analysis
• Creation and modification of Requirements documentation
• Manage client expectations and scope of projects, and work with the client to correctly identify control memos as maintenance or modification

Confidential

Business Analyst I

• Responsibilities while in this role included:
• Call Center Support for the Recipient Eligibility Verification system REVS
• Organized and presented Provider Workshops
• Participated in Massachusetts client meetings
• Additional responsibilities included:
• Maintenance of Point of Sale POS devices including cleaning, trouble-shooting, loading software, inventory, and shipping devices to providers
• Loaded physician names on the Automated Voice Response AVR system
• Printed daily reports
• Daily courier runs to and from the client site
• Facilitate discussions with the client and technical team members as needed
• Requirements analysis
• Creation and modification of documentation

SOFTWARE:

Microsoft Outlook, Internet Explorer, Word, Excel, XML Editor, Soap UI, SQL, SQL Developer, Quality Center, NetMeeting, PowerPoint, WRQ Reflection Connection Wizard, Sharepoint, Visio, SnagIt, UNIX