Title/Role: System ID: 286936
Business Analyst
Skills

Business analysis, financial analysis, and business process reengineering experience in the health or health information fields Required 8 Years 3 – Expert

15+ Expert

2012

3-Expert

Business intelligence implementation experience in health care information field Required 2 Years 3 – Expert

7+ Expert

2012

3-Expert

Experience and high degree of proficiency with Excel and PowerPoint Required 5 Years 3 – Expert

10+ Expert

2012

3-Expert

Experience designing and generating reports, graphs, and dashboards using business intelligence and reporting platforms Required 2 Years 3 – Expert

7+ Expert

2012

3-Expert

Experience implementing health care billing and scheduling systems in major hospital or health insurance providers Required 2 Years 3 – Expert

7+ Expert

2012

3-Expert

Experience in area of financing health care products or companies Required 2 Years 3 – Expert

7+ Expert

2012

3-Expert

Experience in one of the following business domains: Medicaid/Medicare Billing; Health Care Finance; Hospital operations Required 2 Years 3 – Expert

7+ Expert

2012

3-Expert

Exp. in leading executive level meetings and/or presentations Required 3 Years 3 – Expert

15+ Expert

2012

3-Expert

Exp reengineering bus. processes identifying/reducing operational inefficiencies in a health care provider, hospital, or health care information field Required 5 Years 3 – Expert

7+ Expert

2012

3-Expert

Master’s Degree is required for this job

Master’s Equivalent

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Education & Certifications:
M.Ed. equivalency, Special Education Program Management 3.87/4.0 GPA, 2002
Confidential,

BS, Management Science (Operations), Minor: Business Intelligence, 1991 Confidential,

Employment History:
Confidential,
Baltimore, MD March 2011—Present
Direct Care Counselor, Therapeutic Behavior/Psychosocial Rehabilitation Specialist

Professional level rehabilitation counseling and case management and provides wrap around employment services for all clients. This includes Intakes, assessments, resume building, interview preparedness, interviews, placement, job coaching and long-term post-employment support services.

• Manage caseload budget, assign providers to complete various parts of rehab plan.
• Monitor progress of plan of care, participate with case analysis.

Behavioral Care Advocate (Medicaid)

• Making patient assessments and determining appropriate levels of care
• Obtaining information from providers on outpatient requests for treatment
• Determining if additional clinical treatment sessions are needed
• Managing inpatient and outpatient mental health cases throughout the entire treatment plan
• Administering benefits and reviewing treatment plans
• Working toward maturing and institutionalizing theBusiness AnalysisGroup and its processes.
• Coordinating benefits and transitions between various areas of care
• You can improve the health of others and help heal the health care system.
• Management functions include case management and utilization review of behavioral health and substance abuse services.
• Created reports andgraphsthat reported on the productivity Using BI Tools..
• Provides case management services through review and evaluation of inpatient and outpatient behavioral health treatments for medical necessity, emergency status, and quality of care.
• Performs within an innovative culture that's focused on transformational change in the health care system.
• Managinghealthcare billing-processing, adjusting and resubmitting of claims while adhering to current healthcare industry regulations and policies; and complying with insurance procedures and allotted benefit coverage.
• Requirements gathering for internal and external projects,business analysis
• Lead abusiness process reengineeringproject for a large department of an international media company. Worked closely with Executives, Managers and subject matter experts to create detailed process workflows and departmental policies.

RESULTS: Delivered business processes, requirements, recommendations, and solutions that guided high-level resource decisions and retooled initiatives and operations.
RESULTS: Established a variety of helpful theories and models provided an overview to the budget development process and expenditures of allocated funds to ensure compliance with federal, state, and local guidelines with the primary objectives of increasing student achievement.
TECHNOLOGIES: CaseWise, Visio, Excel, Requisite Pro, Wiki-Docs

Confidential,
Department of Disability Services August 2010 – January 2011 Quality Assurance, Medicaid for Intellectually Disabled (ID)
Senior Medicaid Process Analyst functioned as a Subject Matter Expert (SME) in collaboration with State and Federal business regulated by the Centers for Medicare and Medicaid (CMS) providing expertise, guidance, and oversight for complex business requirements for Medicare/Medicaid data. Manages and analyzes complex business requirements and translated system requirements and the creation and maintenance of relevant Systems development life cycle (SDLC), orSoftware development process artifacts in collaboration with the project team and customer.

• Acted as the Subject Matter Expert (SME) in Enrollee (Member/Client/Beneficiary/Recipient) business processes and system functionality.
• Developed and maintained system-wide training program developed and implemented Centers for Medicare & Medicaid Services (CMS) system-wide regulatory strategies.
• Implemented standardized policies and procedures that ensure all information is accurately abstracted and in full compliance with applicable rules for implementation relating to Plan(s) of Care (POC) or Individual Support Plan (ISP) for: Pre-Vocational; Day Services; Supported Employment Intake & Assessment; Job Placement, Job Training & Support; Residential Habilitation; Supported Living; Host Home; In Home, Respite Services and Assisted Living Facilities (ALF).
• Developed reports, charts andgraphsto analyze critical data
• Gathered, analyzed, digested, and documented complex business requirements and processes.
• Researched and resolved all data quality issues for managed data objects. Proactively reached out to business partners and stakeholders that ensured the integrity of master data consistency.
• Developed and implemented structured processes necessary that ensured captured data accuracy.
• Performed detailedbusiness analysisfor new development and system enhancements, user liaison functions, specifications and requirements documentation, workflow, scope documents and solution proposal writing.
• PreparedBusiness Process Reengineering(BPR) documents by interacting with SMEs.
• Worked with business partners and stakeholders that defined and documented key performance indicators, metrics, and measures.
• Develop process models and use cases, constructed conceptual data and process models, included data dictionaries. Conducted requirements management activities.
• Updated/maintained Requirements Specification and Detailed System Design documents.
• Participated in collaborative sessions to document Medicaid business processes.
• Led the design, development and implementation of the overall Quality Improvement (QI) Program.
• Analyzed, updated, and modified standard operating procedures and processes to continually improve QI Department services/operations.
• Developed and conducted Quality Improvement studies.

RESULTS: Conducted advanced technical and operations research and sensitivity analysis at both the strategic and tactical level for large complex organizations’ operating environments. Employed analytical rigor and predictive risk/portfolio analyses and iterate throughout the life cycle from concept through sustainment.
RESULTS: Created and exercised broad review/prioritization of capability concepts/outcomes and enhanced methodology that identified and described joint needs and capability gaps. Provided joint operations priorities and planned, programmed, and resource prioritizations.
TECHNOLOGIES: Desktop Support, SAP, QA Tester, PeopleSoft

Confidential,
Waldorf, MD November 2007—March 2011
Maryland State Department of Education
Quality Investigative Surveyor/Medicaid Document Reviewer

• Planned, developed, and coordinated Medicaid Quality Improvement Program.
• Provided direction for all quality improvement initiatives and implements effective quality improvement measures
• Performed requirements gathering andbusiness analysisof all aspects of the databases to identify and document all impacted reports, GUIs, tables, procedures, etc..
• Managed monitoring and compliance with specific regulatory and government programs related to healthcare quality improvement, Maryland State Department of Education (MSDE) in compliance with Code of Maryland Regulations (COMAR).
• Conducted executive level meetings and presentations for performance review
• Developed reports andgraphsthat reported on the productivity.
• Developed quality measurement systems and processes to include quality of care measures, customer feedback, and initiatives.

Confidential,
Waldorf, MD
Baltimore City Health Department
Medicaid Specialist

• Determined guidelines for data management and attainment of corporate quality objectives.
• Worked with Medicaid program directors, agencies, and grantors to develop quality measurement systems and processes.
• Assisted in the design, development and testing of a custom Automobile Loan Origination package by performing requirements gathering andbusiness analysisof loan origination workflow processes in order to create a unique, highly flexible automated system
• Provides research and analytical support for strategic planning, training development, problem solving, quality management, financial analysis, andbusiness process reengineering.
• Provided Program and Planning Committee updates and status of corporate quality improvement programs and improvements to clinical and service outcome measures.
• Identified potential risk factors and coordinates and implements action plans to minimize liability and risk. Assisted Program Directors with development of plans for correction and aggressive follow-up on repeat, recurrent deficiencies.

RESULTS: Designed and streamlined a system to handle each step of this operation efficiently.
RESULTS: Processed 75-100 subsidies on a daily basis.
TECHNOLOGIES: MS Office, Excel, SharePoint, Visio, MS PowerPoint, MS Project.

Confidential,
Laurel, MD August 2005—August 2007
Special Education Program Specialist (ED, LD & AUTISM - 7th & 8thGrades)
Medicaid (3rd Party Billing)

• Supported quality improvement efforts throughout the organization.
• Collaborated with the management team and developed, implemented and evaluated performance improved Quality Review Improvement training programs for finding of fact Medicaid documentation and investigation methods.
• Used internal and external resources that determined performance improvement and training initiatives.
• Developed reports andgraphsthat reported on the productivity.
• Establish abusiness Analysismethodology around the RUP (Rational Unified Process).
• Maintained records to track employee required education and training as identified under CMS.

RESULTS: Launch into production mode with new commercial clients.
TECHNOLOGIES: MS Excel, MS Word, Flow Chart Analyzer, Adobe Acrobat.

Confidential,
Annapolis, MD
August 2004—August 2005

Special Education Program Specialist (ED, LD & AUTISM- 3rd - 7th Grades)
Medicaid (3rd Party Billing)

• Facilitated presentations regarding the Medicaid Quality Improvement program.
• Conducted on-site visits to monitor programs and improvement processes.
• Developed, evaluated, and recommended policies, procedures, and systems to improve program operations.
• Ledbusiness analysisand reviewed and validatedBA deliverables
• Provides research and analytical support for strategic planning, training development, problem solving, quality management, financial analysis, andbusiness process reengineering.
• Ensured that practices and procedures reflect current rules and regulations that govern organization systems and professional practice.
• Developed reports, charts andgraphsto analyze critical data
• Coordinated quality improvement efforts with program staff to ensure consistent implementation and management of all quality improvement and safety activities.

RESULTS: Delivered re-engineered business education processes and documentation on time, within budget, and to all stakeholder expectations.
TECHNOLOGIES: MSDE on-line IEP, Medicaid (CMS)/Third Party Billing, MS Office.

Confidential,
Towson, MD & Waldorf, MD
June 2002—November 2004
Educational Director, Birth to 3rd Grade & School Construction Project Manager

Educational Director of a tri-county Therapeutic Day service facility for mental health clients diagnosed from Birth to third grade; developed a Peer Support Program and hired all peer support staff.

• Served as the second most seniorteacherstep from the Principal Director (Head Master Teacher) trained several assistant heads, who acted as subordinatesto the Principal Director; managed the school in absence of the Principal Director.
• Ensure federally funded Medicaid regulatory standards for Plan of Care and quality improvement.
• PreparedBusiness Process Reengineering(BPR) documents by interacting with SMEs.
• Verified staff’s education and certification, training background in a Healthcare or Healthcare related facility or a Public Health program or agency.
• Coordinated customer satisfaction surveys to monitor quality of care and facility performance.
• Analyzed project expenditures for SharePoint implementation & presented cost-benefit options and managed client relationships for business strategy, workflow refinement, and user expectations.
• Prepared reports, charts andgraphsto analyze the statistics

Project Manager, equipped with education, experience as tools of the discipline in Project Management and planned, organized, secured funding, managed, led, and controlled resources to achieve specific goals (Therapeutic School Construction & Playground).

• Played a pivotal role in growing the company to a sophisticated structure 3-county area and zero (0) annual revenue to $4.2 increase in one central county by pulling those 3-counties together and in one-year R.O.I that was $0 excelled to $1.2 million R.O.I.

RESULTS: Delivered 2 application enhancements to user requirements.
TECHNOLOGIES: SPHS Quality Center, SPSS, Microsoft Word, PowerPoint, Excel, Access, and PeopleSoft ATAS, SharePoint, MS Project.

Confidential,
Confidential,
Washington, DC August 1999—May 2002 Special Education Officer, Program Analyst
Medicaid (3rd Party Billing)
Appointed to analyze potential client’s needs for specific reorganization, infrastructure management and consulting projects.Selected to manage, maintain, and facilitate the Business Infrastructure portfolio of projects; liaised with over 40 project/program managers & executive C-Level leadership to facilitate project documents and cost-benefit financial analysis and reporting.

• Reviewed with Principal and Budget Analyst weekly “TheState Children's Health Insurance Program(SCHIP) or also known more simply as theChildren's Health Insurance Program(CHIP) as a program administered by theUnited States Department of Health and Human Servicesthat providesmatching fundsto states forhealth insuranceto families with children.Ensured an understanding of the Third Party Billing Process and how the program was designed to cover uninsured children in families with incomes that are modest but too high to qualify forMedicaid.
• Identified opportunities in the school budget for client and service related improvement initiatives through Medicaid.
• Collect and analyze data requirements from different managers for Quality and Financereporting.
• Workedalong with theBusiness Process Reengineeringteam, analyzingthe existing system and creatinga detailed To-Do plan.
• Developed methods for solicitation of quality improvement suggestions from staff.
• Coordinated project initiatives and portfolio management activities across multiple departments; improved decision-making and efficiency, such assimulation,mathematical optimization,queuing theoryand other stochastic-process models.
• Employed Markov techniques from other mathematical sciences, such as mathematical modeling,statistical analysis, andmathematical optimization, operations research arrived at optimal or near-optimal solutions to complex decision-making problems and decision processes, econometric methods,data envelopment analysis,neural networks,expert systems,decision analysis, and theanalytic hierarchy process.

RESULTS: Initiated 5 completed consulting solutions for multiple businesses.
RESULTS: Ensured efficient execution & follow-through of monthly corporate finance meetings.
RESULTS: Delivered analysis, process, & strategy presentations for continuous improvement.
TECHNOLOGIES: Clarity, Remedy, Excel, Visio, MS Project, ITIL, Lotus, proprietary financial analysis software.

Confidential,
Baltimore, MD August 1991—August 1999
Special Educator
Medicaid (3rd Party Billing)

• Developed an educational program with Johns Hopkins University focused on the foundation that states may design their SCHIP programs as an independent program separate from Medicaid (separate child health programs), use SCHIP funds to expand their Medicaid program (SCHIP Medicaid expansion programs), or combine these approaches (SCHIP combination programs).
• The program was able to address AYP and receive enhanced federal funds for their SCHIP programs at a rate above the regular Medicaid match.
• Participated in quality networks, workshops and seminars to stay informed regarding current policies, regulations, procedures and guidelines prevalent in the industry.
• Provided Medicaid information on best practices to leaders.
• Collaborate in definingbusinessreportingneeds andprocesses,andindocumentation of systems requirements
• ConductedBusiness Process Reengineering(BPR) meetings andsettingup business rules with the help of existing or reengineered business process.
• All staff agreed to safeguard the privacy of clients’ protected health information from improper use and disclosure according to state and federal law.

RESULTS: Wrote, developed and presented for implantation Special Education Reference Guide
TECHNOLOGIES: 4GL Solutions, MS products, ACCESS, Excel, MS Project