SUMMARY:

• Business analysis for project requirements, project scope definition, functional and technical design.
• Project management to deliver products and services within the constraints of scope, schedule, and cost.
• Accomplished in understanding business functions and processes.
• Proficient in communicating processes and technical concepts, and delivering presentations.
• Leadership, accountability, vision, and innovation within projects.
• Collaboration with organization's various leadership levels, clients, stakeholders, and development teams.
• Solutions development for process improvements, assessment and validation in achieving quality. and documentation for development teams, peers, clients, and stakeholders.
• Agile SDLC software development methodology using SCRUM method, and SOA architecture.
• Rally Agile Portfolio Management for alignment of business strategy and development.
• Design, development, and implementation of small and large applications.
• Business Intelligence analysis, design, and development.
• Successful deliverables record as a self - taught professional and leader.
• Competent to work independently, or in small and large groups on multiple tasks.
• Telecommuted for 6+ years without supervision.
• Transitioned from Confidential to IBM platform without experience.
• HIPAA ASC X12 EDI 835 Health Care Claim Payment/Advice experience including ASC X12 EDI 837 Health Care Batch Claims Submission and 277 Claims Status Response.
• Medicare, Medicaid, and Third-Party insurance applications development.

TECHNICAL SKILLS:

MS Software/Database/Others/Tools: COBOL, CICS, REXX, DFSORT, VSAM, Image Database, VPLUS, QUIZ, QUERY, SUPRTOOL. Visual Basic, SQL, Oracle PL/SQL, Oracle Database, Oracle SQL*PLUS, and Oracle SQL Developer,. Microsoft Word, Excel, Access, and Viso. PowerTerm, TSO, ISPF, IBM File Manager, Endevor, JCL. IBM Z/OS, IBM DOS, HP3000, Tandem CLX 700 and Himalaya. JAVA, Web Design and Programming training in progress.

EXPERIENCE:

Confidential

Business Analyst/Senior Programmer Analyst

Responsibilities:

• Work remotely and independently without supervision on Medical Billing Information System projects.
• Participate in Agile System Development Life Cycle (SDLC) projects.
• Manage and prioritize software development projects within SDLC framework.
• Elicit, analyze, refine, and define business requirements.
• Establish the project's scope and approach.
• Iteratively interface with stakeholders to accomplish business objectives.
• Obtain project requirements using job descriptions/flows, program analysis, and new business scenarios.
• Prepare project design documentation based on business requirements for stakeholders' sign-off.
• Estimate level of effort for development and assignment of developer resources.
• Develop functional and technical design specification documents.
• Interface with developers and subject matter experts during the technical design phase of project modules.
• Present briefings to project managers and project leads on complex technical design issues.
• Research, develop and propose ideas for improvements and enhancements.
• Plan, prepare, and deliver functional and technical specifications to developers for coding and testing.
• Train and manage software developers.
• Render technical consultation and to peers for software development and testing.
• Review and approve peer project modules for implementation.
• Perform baseline and benchmark testing.
• Produce unit and system acceptance test cases.
• Conduct and manage testing for stakeholders' acceptance and approval.
• Develop project implementation strategies.
• Prepare post production review and support plan.
• Manage project implementation in production environment.
• Analyze critical problems to identify the root cause and develop solutions.
• Provide customer service to business managers for inquiries about application systems and operational issues.
• Analyzed 200+ Third Party Billing System modules for International Classification of Diseases version 10 (ICD10) upgrade. Identified modules for enhancements, and planned and applied the upgrade procedures.
• Developed a centralized ICD10 diagnosis code validation engine to provide validation results in XML type format.
• Introduced a single source for collecting, storing, and updating diagnosis codes for health insurance claims.
• Developed and wrote multiple project design, technical design, and functional specification documents for the ICD10 Business Rules project. Distributed the documents to on-shore and off-shore developers for module coding and testing.
• Devised, designed, and created an ICD10 diagnosis code selection process to provide diagnosis code prioritization flexibility on insurance claims to comply with the payer adjudication requirements for reimbursements.
• Established mastery over the diagnosis code selection process for billing claims, and became the sole point of contact for I.T. personnel and business managers.
• Studied the EDI Insurance Claims Remittance System and became the subject matter expert. Wrote documentation with flowcharts.
• Educated peers about the EDI Insurance Claims Remittance System's technical and operational aspects.
• Initiated, conceived, designed, and developed an EDI Business Intelligence System to support an online Remittance Check Tracking System and a WEB based Patient Claims Inquiry System.
• Researched and analyzed the EDI Insurance Claims Remittance System for HIPAA 5010 EDI upgrade. Prepared a project plan to meet the prescribed development, testing and implementation for over 150 insurance carriers. Developed the technical design and functional specifications for the project team.
• Participated in Quest Diagnostics' Billing System and platform conversion process from Confidential to IBM.
• Created an automated Insurance Eligibility Verification System for patient insurance coverage.
• Conceived, designed, developed, and implemented an automated Windows based FTP process to transmit patient claim files to external insurance carriers for three business units.
• Designed, planned, coded, and implemented an Insurance Claims Rebilling System for unpaid claims for three business units.
• Investigated the HIPAA 4010 Claims Remittance System. Developed new adjudications maps to categorize claims for analysis and resolution of claim adjudication issues related to physician supplied diagnosis codes.

Confidential

Programmer Analyst

Responsibilities:

• Responsible for eleven Aircraft Maintenance (Image and Text) Catalog, and Digital Provisioning information systems.
• Develop, maintain, and support applications to generate parts, material, equipment data for aircraft's scheduled and unscheduled maintenance as well as establish, maintain, and optimize spare parts inventories for customer's main base and line stations to sustain their fleet operations.
• Interpret airline operator's requirements with customer liaison personnel to define and build parameter data to facilitate customization of parts provisioning data.
• Assist internal customers with application system functionality and operation.
• Collaborate with technical support staff to identify and remedy production system and Xerox forms control issues.
• Identify and rectify production scheduling issues with production control staff.
• Planned, designed, created, and implemented eight Airline Parts Provisioning Systems for a ten month project to fulfill product delivery schedules.
• Enhanced mathematical models to calculate part's usage rate to determine required parts quantity using Poisson tables to support customer's aircraft fleet operations.
• Created a plan to develop data for part number records containing procurement and technical data, and parts application records to identify parts' specific catalog sequence number for effective aircrafts.