SUMMARY:

• Medicaid Mgmt. Information Systems: 8 years IT PM, lead BA, technical and analyst; MECT 2.3, OBC, MITA 3.0
• Blue Cross, Other Healthcare Payers: 12 years Enrollment, provider portals, claims mgmt., call center mgmt. in MA, NC, DC, CA
• Key Federal Government Agencies: 20 years Confidential, Confidential ., Confidential, Confidential . ( Confidential )
• Key Corporations and Associations: 20 years Confidential & Confidential, Confidential, Confidential, Confidential, Confidential
• Hands - on Technical Team Leadership: 20 years T product manager, product owner, requirements manager and analysis team lead
• Business/Systems/Technical Analysis: 20 years Expert in agile user stories, use cases, business, and functional requirements, UML
• Business Analyst /Mentoring 20 years Have educated many analysts on basic and advanced business analysis techniques
• Microsoft Visual Studio Programmer: 20 years Customer relationship management (CRM), case tracking, solutions

PROFESSIONAL EXPERIENCE:

Medicaid Management Information Systems (MMIS) Product Manager

Confidential

Responsibilities:

• Led all business and process analysis, as well as requirements definition work to define the future state software solution.
• Created conceptual, context, use case, and business process modeling notation (BPMN) diagrams specifying the To-Be state.
• Guided Joint Application Requirements (JAR) Sessions with the NC DHHS Medicaid Provider Operations Business team.
• Organized the development and hierarchical structuring of the solution’s large requirements traceability matrix (RTM).
• Assembled evidence to support the product’s by the Centers for Medicare and Medicaid Services (CMS).
• Created product feasibility study, researched vendor solutions, participated in creating Advanced Planning Document for CMS.
• Regularly presented deliverable documents and plans to the MES program and departmental governance/steering committees.
• Developed the solution Product Requirements Document, which incorporated the product vision and implementation strategy.
• Presented developed artifacts before the Department’s Medicaid Executive Team, receiving rapid approval of the proposal.
• Designed, developed, and received governance team approval for the 47-page MES program Requirements Management Plan.

Medicaid Requirements Manager / Product Manager

Confidential

Responsibilities:

• Defined system integration requirements and data models for enterprise service bus, common services, and module integrations.
• Created business requirements (BRD) and functional requirements (FRD) documents, as well as system design documentation.
• Managed and maintained automated traceability between requirements using Jama, Atlassian Jira, and Atlassian Confluence.
• Performed the product owner role for the implementation of both Jama and Jira, as requirements tools for the enterprise.
• Developed requirements management and tool processes that guide the business analysis work for vendor analyst teams.
• Performed Joint Application Design (JAD) sessions; created requirements and Unified Modeling Language (UML) models.
• Trained and mentored multiple MMISR modular software contractor business analysis teams in MMIS requirements processes.

MMIS Lead Business Analyst / CMS Lead Technical Analyst / MMIS Technical Analyst

Confidential

Responsibilities:

• Provided project management, business analysis, and technical analysis for the Provider Enrollment and Management (PMM), Care Management, Pharmacy Benefits Management (PBMS), and Electronic Visit Verification (EVV) modular MMIS projects.
• Created end-to-end visual models, including context diagrams, as well as UML use case and activity diagrams.
• Developed ‘as is’ and ‘to be’ solution requirements (diagrams, text use cases, and agile epics/features/user stories).
• Managed and traced requirements and test artifacts in the state’s SpiraTest requirements and test management tool.
• Reviewed, approved, or sent for remediation, vendor-created requirements, design, and quality assurance artifacts.
• Developed comprehensive requirements management plans for projects, covering State/vendor responsibilities.
• Interpreted complex CMS and other federal policy guidance, translating those criteria into MMIS solution requirements.

MMIS Product Manager / Agile Lead Business Analyst

Confidential, Calverton, MD

Responsibilities:

• Collaborated with CEO and other C-level executives to ideate new products and convert concepts into working prototypes.
• Performed extensive analysis of business rule engine, enterprise document management, MMIS module competitor products
• Designed an English-language rules engine solution based on Oracle Policy Administrator. Defined policy business rules.
• Designed service-oriented architecture (SOA) solutions integrating MMIS modules, ESBs, and common services (e.g., MDM).
• Developed 200+ user stories and use cases, plus user acceptance test (UAT) cases supporting remote product development.
• Managed a team of 3 business analysts. Coordinated the work of 15 remote developers (in Ukraine) using JIRA/Confluence.

Lead Requirements Tool and Agile Requirements Process Coach

Confidential, Durham, NC

Responsibilities:

• Developed requirements automation processes supporting both Scaled Agile for the Enterprise (SAFe) and waterfall SDLCs.
• Conducted JAD sessions and stakeholder interviews to elaborate requirements for new, enhancement and COTS projects.
• Created software tool to import over 1,000 Affordable Care Act (ACA) federal regulations, tracing them to enterprise projects.
• Performed requirements definition in support of TriZetto FACETS claims solution and a supporting Salesforce application.
• Created agile themes, epics, user stories, use cases, UML diagrams, functional requirements, and system architectural designs.
• Trained and mentored over 300 users on various projects in the use of the IBM Rational Requirements Composer (RRC) tool.
• Configured RRC to support agile themes, epics, features, user stories, success criteria, test case creation, and traceability.
• Developed a three-hour business analyst introductory course and a 2-hour stakeholder course for requirements tool users.

Senior Business Analyst

Confidential, New Carrollton, MD

Responsibilities:

• Senior agile business analyst on a short-term project defining data transaction processing functionality to support the Affordable Care Act (ACA) Coverage Data Repository (CDR) at the U.S. Confidential . CDR received monthly PPACA insurance coverage data transmittals from state and HHS health insurance exchanges (HIX) to support federal tax calculations.

Healthcare Payer Requirements Analyst

Confidential, Boston, MA

Responsibilities:

• Supported the development of a large-scale Business-to-Business (B2B) provider portal that manages information sharing between Confidential of Massachusetts (BCBSMA) and its community of 55,000 doctors and related providers.

Lead Requirements Management Automation Administrator

Confidential, Reston, VA

Responsibilities:

• Managed a database of over 60,000 telecom requirements supporting solutions in the US and five Latin Confidential nations.

Senior Requirements Analyst and Development Team Lead

Confidential, Cambridge, MA

Responsibilities:

• Defined a 100-page functional requirements specification for the SAS content management module, including UML models.
• Promoted to lead a 5-member content management development team using Microsoft .Net, Silverlight and SQL Server.

Senior Requirements Analyst / IBM Rational Tools Administrator

Confidential, Germantown, MD

Responsibilities:

• Administered the IBM Rational RequisitePro requirements tool. Conducted tool-related planning, control, and .

Senior Requirements Analyst

Confidential, Washington, DC

• Agile business analyst - created software requirements for a large-scale web portal application to roll-up monthly production and performance statistics reporting for U.S. Citizenship and Immigration Services field offices.

Healthcare Payer Solution Architect / Senior Requirements Analyst

Confidential, Durham, NC

Responsibilities:

• Elicited and developed requirements and created SDLC processes. Conducted JAD sessions and developed detailed business, functional, and data requirements regarding HIPAA 837 institutional claims, CMS 1500 professional medical/dental claims, and UB94 Institutional claims transactions. Supported BCBNC Data Warehouse and COTS product requirements initiatives.

Healthcare Payer Requirements Project Manager

Confidential, Boston, MA

• I.T. PMO requirements project manager. Collaborated with vendor Pega Systems to manage project operations and define business and functional requirements, use cases, and technical designs involving the Pega Rules Process Commander rules engine; Pega Healthcare Payer Framework, Service Oriented Architecture (SOA), and system integrations with existing platforms.
• Managed a complex legacy migration to the Web for a social services case management system. Conducted JAD sessions.
• Defined requirements and user interfaces for integrated social services benefit enrollment and case workflow modules.

Healthcare Payer Requirements Project Manager

Confidential, Owings Mills, MD

Responsibilities:

• Requirements project manager and lead business analyst. Conducted stakeholder Joint Application Design (JAD) sessions with enrollment, claims processing, billing, and other departments in support of the Portico Systems COTS technology solution in support of a federal requirement for integration of the National Provider Identifier (NPI) initiative. Facilitated JAD sessions.

Deputy Project Manager / Requirements Process Analyst

U.S. Internal Revenue Service Requirements, New Carrollton, MD

Responsibilities:

• Deputy project manager, senior requirements management, and development process subject matter expert. Provided expertise and day-to-day leadership to a team of five requirements subject matter experts in the development of a complete requirements management center of excellence (CoE) in support of the Requirements Management Office.

Senior Requirements Analyst / Use Case Analyst

Confidential, Washington, DC

Responsibilities:

• Developed requirements for a custom Work Opportunity Tax Credit (WOTC) application for a major corporate client. Created analysis artifacts for a Research and Development Tax Credit Application for a major corporate client.

Social Services Requirements Analysis Team Lead

Confidential, Washington, DC

Responsibilities:

• Managed requirements analysis team and performed requirements development for a large-scale social services project. Worked with key social services and other city department stakeholders to define requirements for the Consolidated Interview for Benefits application. Defined benefits application, eligibility, approval, and ongoing client tracking) functionality.

Project Manager / Senior Requirements Analyst / Life Cycle (SDLC) Process Mentor

Confidential, Arlington, VA

Responsibilities:

• Project manager of a team of five Rational Unified Process/tools experts; team requirements manager. Supported a 40-member development team for the Fastlane public and eJacket internal to NSF grants application workflow tracking systems.

Confidential, Washington, DC

Responsibilities:

• Documented as-is and to-be functionality supporting the migration of a legacy Visual Basic application used to manage paid and volunteer staff HR functions,, disaster management, and fundraising operations for 1,300 Confidential chapters.

Requirements Team Project Manager / Senior Requirements Analyst

Confidential, Arlington, VA

Responsibilities:

• Subject matter expert on requirements management and Rational technology for a team of 35 military HR specialists.