Experience Summary

Adam is a senior business analyst / requirements analyst who has extensive experience in producing high quality analysis artifacts for medium and large scale projects. Adam is effective at facilitating the elicitation of business requirements from executives, managers, team leads, and line level staff across business and technical domains.

Core Skills

• Business analyst / requirements analyst 15 years
• Hospital / clinical revenue cycle expertise 12 years
• Healthcare carrier payer domain expertise 3 years
• Agile methodology 3 years
• Waterfall methodology 3 years
• System development life cycle SDLC 3 years
• Requirements management tools use 2 years
• SQL queries 2 years
• eCommerce 1 year

Professional Experience

Senior Business Analyst

Role: Provided senior-level business analysis services to several large-scale system development life cycle initiatives managed by BCBSNC's Project Management Office and NTT Data's Community of Excellence.

Projects:

• Developed complex business analysis specifications to support the development of major software system enhancements in response to the regulatory requirements of the Patient Protection and Affordable Care Act.
• Created business requirements documentation in support of the 500 million North Carolina Topaz Integration Office NCTIO initiative by BCBSNC to modernize insurance plan design, benefits administration, and healthcare provider management through the integration of Commercial-Off-the-Shelf COTS applications developed by vendor TriZetto for BCBSNC's subsidiary company, Topaz.
• Elicited documentation to establish the framework for an eCommerce / customer relations management CRM solution that enables prospective customers to enter and navigate a web-based portal to shop and / or purchase healthcare insurance online

Accomplishments:

• Elicited requirements from business stakeholders through the use of individual interviews and Joint Application Design JAD sessions.
• Created business scope, business requirements, user stories, and functional requirements.
• Performed iterative rounds of requirements validation and updating of analysis artifacts.
• Developed requirements in IBM Rational Requirements Composer RRC , Excel, and Word.
• Developed user stories / backlog, participated in daily stand-ups, and completed assigned tasks within two-week sprints in an Agile / SCRUM environment
• Utilized SQL queries to extract, transfer, or load tables to / from the enterprise data warehouse EDW

Deliverables:

• Confidential Business Requirements Document in support of the Plan Sales module, including the specification of requirements that addressed Trizetto integrations with SalesForce.
• Confidential Business Requirements Document in support of the Enrollment module
• Confidential Business Requirements Document in support of Monaco-Callidus integration
• Sales and Marketing Project - Business Requirements Document in support of performing existing system enhancements that are known as the Membership Renewals Packet for 2014. This specification covered annual insurance renewal automated functionality related to BCBSNC's Medical, Dental, and Ancillary Insurance products.
• Blue Cross Blue Shield Association National Mandate Project Business Requirement and Functional Requirements Documents, and UML diagrams especially sequence diagrams in support of Inter Plan Programs Payment Innovations

Senior Business Analyst

Role: Provided senior-level business analysis services to a large-scale software development life cycle initiative managed by CSC on behalf of the NCDHHS

Project:

• Provided complex business analysis in the development of an operations manual as part of major software system enhancements for the North Carolina Replacement Medicaid Management Information System MMIS
• Created business requirements documentation in support of the 70 million North Carolina Replacement MMIS project to implement a new multi-payer system developed by CSC.

Accomplishments:

• Leveraged knowledge of the healthcare revenue cycle to help with the development of improved business processes
• Provided analysis of legacy artifacts that were used to create new medical Audits and Edits which were implemented into the Replacement MMIS

Deliverables:

• New medical Audits and Edits used to process incoming claims
• North Carolina Replacement MMIS Operations Manual

Business Analyst

Role: Provided business analysis services to small large-size rural clinics and acute care community hospitals nationwide

Project:

• Provided business analysis in the adjudication of healthcare claims
• Conducted business process analysis to research why healthcare claims had gone unpaid

Accomplishments:

• Reviewed business processes to identify breakdowns in the revenue cycle that delayed reimbursement
• Corrected claims errors resulting in increased facility revenue and reduction of accounts receivables
• Developed consultative solutions while traveling up to 100
• Provided training and guidance to client staff and fellow consultants

Deliverables:

• Created templates for letters to be generated and used by the business operations staff
• Documented procedures for billing healthcare claims that exceed 100,000

1 Business Analyst

Project:

• Provided business analysis in the adjudication of healthcare claims
• Performed onsite cash acceleration of Medicare, Medicaid, and various commercial healthcare claims

Accomplishments:

• Learned and utilized McKesson Paragon , Meditech Client Server, Magic, and LSS , and Siemens SMS patient accounting software to bill and correct healthcare claims
• Performed role of Interim Project Manager with several consultants working under my supervision
• Individually recovered up to 100,000 monthly in Medicare accounts receivables
• Recovered over 500,000 monthly in total managed care accounts receivables as part of a recovery team

Deliverables:

• Created templates for letters to be generated and used by the business operations staff
• Documented follow-up procedures for collection of Medicare and commercial healthcare accounts