CAREER SUMMARY

• I have over 10 years experience in business operation functions and as a Senior Business Analyst/Project Manager in requirements analysis/definition, design, testing, implementation, and documentation of computer systems in the healthcare industry. My experience in healthcare, initially from an operations side and most currently from a systems perspective, has allowed me t develop substantial field knowledge and technical skills. I work well independently as well as part of a team, and am a recognized problem-solver with a dignified work ethic. I am able t effectively manage and execute multiple projects and have excellent communication skills with clients and staff at all skill levels.
• I am currently seeking an opportunity as a tester of front end software, business analyst, billing agent, or office associate in the Denver area. I am willing t work remotely and/or travel up t 50 .

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PROFESSIONAL EXPERIENCE

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Professional Services/Business Analyst Supervisor

• As the Professional Services/Business Analyst Supervisor, I provide guidance, support, and maintain resources t complete Customer Service Requests CSRs for the customer. I am responsible for ensuring all business functions are tested, implemented, and processed correctly in the system for all enhancements/modifications as well as maintenance activities while enforcing the Systems Development Life Cycle SDLC . During this time, I've supervised nine permanent and three contractor Business Analysts. A few of my day-to- day responsibilities als include:
• Providing management and functional leadership.
• Coordinating the integration of functional and business requirements int the Medicaid Management Information System MMIS .
• Directing the research, testing, implementation and documentation of functional solutions for the account.
• Overseeing the completion of customer solutions and strategies based on the analysis of the customer's business requirements.
• Assisting the Project Management Office PM with creation of proper project/work plans.
• Facilitate meetings with the customer.
• Enforcing deadlines, document and communicate project delays, and escalate delays.
• Training personnel and assisting with hiring and firing personnel.

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Sr. Professional Services/Electronic Data Interchange EDI Business Analyst Contract Re-procurement Project Manager

During the first year of employment I managed a seven month, 2.8 million dollar contract re-procurement for the Fiscal Agent State Medicaid Services. During this project I was responsible for overseeing the following:

Full systems conversion and implementation of the Prescription Drug Card Service PDCS System from the X1 t the X2 system.

Implementing five system enhancements t the Medicaid Management Information System MMIS .

Researching, purchasing, implementing, training and ensuring account wide utilization of tw new software tools TechSmith's Camtasia and Microsoft's Enterprise Project Management ePM .

Upon the completion of my Project Management activities, I assumed my Sr. Business Analyst responsibilities as the Lead Business Analyst over the Claims, Prior Authorizations, and EDI Subsystems, including all inbound and outbound HIPAA X12 transactions.

Worked as the MMIS Business Analyst EDI Lead on HIPAA X12 transactions and EDI processes for nine Business Analysts and thirteen Programmer Analysts. Please reference the attached Skill Set s for a full list of HIPAA X12 transactions.

Managed and executed Customer Service Requests CSRs with the Client, Colorad Department of Healthcare Policy and Financing HCPF and program staff through all stages of the System Development Life Cycle SDLC including Requirements, Test Plan, Technical Specifications, Coding, Unit Testing, UAT testing, System Documentation, and other Misc. Deliverables.

Managed all internal and external communications between the Fiscal Agent, EDI, and the Client. Functioned as the Liaison between Business Analysts, EDI, and HCPF on CSRs which included an EDI component.

Managed the Business Analyst Research/Production Defect ticket system by resolving tickets and/or delegating research tickets t the proper Business Analyst based on Subsystem.

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Sr. Business Analyst

• Worked on tw major client implementations, implementing DirectLink, Gateway, and Facets systems for three clearinghouses.
• Played a key role in upgrading thirteen of our twenty-three clients from version 3.11 t 4.31 of the Gateway and FACETS systems.
• Provided primary production support and system enhancements for three large FACETS clients and five QicLink clients.
• Worked as the primary contact between clearinghouses and FACETS/QicLink clients for EDI X12 transaction support and clarification/interpretation.
• Provided 24/7 monthly on call support t twenty-three clients. Including debugging scripts, rerunning jobs and working with scheduling staff.
• Worked with Trading Partners/Clearinghouses, clients and technical staff in developing and/or support customer applications.
• Sr. Business Analyst-
• Testing with clients t migrate EDI healthcare transactions from proprietary formats t HIPAA compliant X12 formats.
• Monitor fifteen daily production jobs, fixing mapping and other failures as warranted.
• Provide customer service and support t over 100 clients.
• Working with contracted Trading Partners t set up and terminate payer ids as well as work through compliance issues t ensure ClaimsLink is receiving and passing compliant data mandated by federal regulations.
• Working with multiple departments within TriZetto, which ClaimsLink feeds EDI transactions, in efforts t succeed in providing clients with a full integrated solution.
• Assisting with month end billing.

Veteran's Health Administration Contract

• Worked with the client and programmers t document business requirements, design, test plans.
• Executed test plan, documenting appropriate articles for sign off by the client.
• Created full system user guides by documenting all user screens with easy t follow instructions and clarification.

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Sr. Analyst

• Produced a variety of critical system deliverables for the Health Insurance Portability and Accountability Act HIPAA remediation project, including business solutions and technical crosswalks for transaction types 835 and 837
• Worked on a HIPAA team of ten t successfully implement ANSI X12 transactions, which include 270/271, 278, 820, 834, 835, and 837.
• Worked closely with EDI vendor in the mapping and processing of Medicaid electronic claim data. Extensive work with all ANSI X12 HIPAA Compliant Transactions including 270, 271, 278, 820, 834, 835, and 837.
• Provided training and served as a resource while advising new and existing Business Analysts and Programmer Analysts on HIPAA in general and specifically in 837 and 835 transactions.
• Systems Consultant Sr. Analyst for Electronic Data Interchange EDI , Provider, and Claims subsystems.
• In depth knowledge and experience working with OmniCaid Medicaid Management Information System MMIS .
• Worked with client staff through all stages of the System Development Life Cycle SDLC including requirements, test plans, testing, deliverables, and documentation.

Business Operations Manager Trainee

• Under the role of Business Operations Manager in Training, I performed such functions as the EDI liaison between the EDI vendor and the customer, while helping resolve issues in a timely manner. I als served as the Third Party Liability TPL and Prior Authorization acting supervisor for a staff of eight individuals, exempt and non-exempt staff, in the Prior Authorization and Third Party Liability divisions.
• Created Access Databases for major projects such as, but not limited to, PCP Re-enrollment verifying credentials of providers , Trading Partner Management validation. The Access Databases als provided formatted queries and reporting features, which would extract and provide statistic information and progress of the project.
• Responsible for providing weekly, monthly, and yearly statistical data t upper management by setting up an excel spreadsheet which had predefine formulas t calculate and graph desired data.

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Skill Sets: