Highly skilled Business Analyst with extensive system design, writing technical specifications and testing applications. Able to work directly with operating business group directors and managers. Maintains a strong technical programming background with most high level programming languages and operating systems.
Amisys, Q/Care, Claims, HMO, Health Care Authorizations, Securities Lending, Re-Insurance, Financial A/R, A/P through G/L, travel, order processing, R D, Inventory management, Banking, Sales analysis, Union activities, Invoicing, Office automation and application packages for the IBM PC. Web development, ASP, E-Commerce and HIPAA.
CICS, BMS, COBOL, VSAM, DB2, MS Office suite, Access, Gentran, RPG, IDMS, Basic, Pan Valet, JCL, Xpediter CICS, PC Dev Enterprise, FOCUS, EASYTREIVE, Dbase, IBM VisualAge CICS/COBOL, Microfocus Cobol Workbench , Mercator, Lotus SmartSuite, FrontPage, ASP, HTML and Adobe Acrobat, EXL's MaxMC, Topdown's Client Letter, Robelle Suprtool, Cognos Quiz/Quick/QTP, Transaction Server,
MS Windows, IBM: Z/OS, VM/SP, OS/MVS, HP MPE/IX and OS/2.
- As part of a team, provided business analysis to convert Medicare program for PPO on Amisys systems to the GHI PPO mainframe. This included requirements from the business / vendors plus program specifications to transfer membership/claim/provider data to the PPO.
- Supported all conversion efforts from Amisys systems to HIP's mainframe Q/Care and Data Warehouse system. This included business, I/T and vendor requirements. In some cases, I wrote specifications for the programming staff to affect all data transfer from Amisys to Q/Care. This included data analysis.
- As part of the business analysis team, I gathered requirements, performed data analysis on the company's data warehouse and prepared reporting / file extract specifications. This was done to support the business reporting which included membership, claims and provider systems.
- Provided business analysis support for EXL's MaxMC and Topdown's Client Letter vendor products . This included gathering business requirements and testing solutions. MaxMC housed member and provider information which was used to produce authorizations for services to be performed by a physician for a member. I also specified technical requirements for programming staff to deliver authorizations to members via email.
- Provided Business Analysis support to projects as assigned. I was responsible for assisting in determining risk to the business, developing system requirements, performing analysis specified program design. This includes system flowcharts, providing full IS/IT project plans, and documentation.
- I worked with the configuration area to assist with changes to Amisys, work with software vendors / trading partners as required for requirements / testing, manage in house resources to perform the programming effort, define test cases with the user directors, manage UAT and the production install.
- Regulatory Projects that include FHP Plan Changes, MEDICAID/FHP ROSTER LOAD CHANGES, EOBs Billing NYS DOH projects X12 837I and 820 HP Interface , 820 File Changes, Produce EOBs for ABF, Denial Letters, OB Referral and Medicare Renewal for 2005
- U/M Medical Mgmt. projects that include: Interqual U/M, QSHR U/M and CHPs Kids: Design of PC based system for tracking children.
- Enterprise wide programs for: Healthy New York, Service area expansion and SSC Implementation.
- Implementation of new or enhanced programs.
- As part of a team, I performed an Amisys Pre-Scrub in Preparation for Upgrade to Amisys Advance. This included installation of vendor utilities to perform data scrubbing analysis, interfacing with ASI to set up required infrastructure for our site, preparing test cases, producing reports and managing the programming effort to correct data.
- I assisted with the planning process and participated in the execution support as a team member at the vendor site for Disaster / Recovery.
- Provided business analysis support to production issues and short-term projects. This included oversight on CAI consultants and staff members for various implementations. Some of the implementations were batch load of membership to Amisys, ASI service requests, Abends, Provider address correction, ESI ID card loads, SNP/HNY billing, mail/merge, census reporting, fee schedule loads and protected membership.
- Implemented a CICS OLTP background claims adjudication function to process WEB MD Professional HCFA , Facility UB92 and OCR HCFA claims to HIP. I was responsible for all phases of project lifecycle that included analysis, design, specifications, new coding/enhancements to current systems, testing and implementation plans. This process allows the customer to reduce the current 'Batch' processing at night and bring them closer to a 24/7 CICS environment.
- I assisted with the program analysis, coding and testing of modules that interface with HIPAA transaction set 837 for Professional and Facility claims processing at the batch and on line program levels.
- Specified and developed enhancements to the Member system to automate subscriber benefits information between CICS and Microsoft 'COMTI' programs based on specified criteria. This adds additional functions to pre-existing CICS programs as well as new programs.
- As part of the production support area, I worked with various groups to resolve program 'outages' for On Line and Batch systems. This includes but is not limited to Claims, Member, Provider, Provider Contracts, Billing and other reference systems within the organization.
- Lines of business included Commercial, Medicare and NYS Medicaid.
- Confidential Page content web site. This includes managing all SDLC process lifecycle from requirements gathering, design, development and implementation.
Health Management Systems
- Managed a development project to implement HIPAA compliance at the transaction ANSI X12 level for Claims 837 , Payment/Advice 835 and Eligibility 270/271 .
- My responsibility included gathering user requirements, creation of project plans, gap analysis, system design, interface with user and vendors, data mapping between various file formats and ANSI standards, development effort with a staff of 12 people. This includes Commercial, Medicare and Medicaid lines of business in a CICS/Gentran/VSAM and DB2 environment.
Creating and maintaining project plans using MS Project.
- Assisting with design efforts of changes to in-house applications.
- Helped with certain compliance issues such as data security and privacy. The security of data was at the system level and transaction level to shape policy with regards to transmission. The privacy portion involved analysis of screen changes and reporting functions to determine the level of information presented to users based upon their need to access data.
- Analysis of current data structures to determine the scope of changes, enhancements and additions to current systems. This included new screen design.
- Helped with the ANSI X12 data mapping effort from the company's VSAM data structures to the standards required by the government. This included assisting with the mapping of in house data structures claims files to the 276/277 Health Care Claim Status Request and Response and 837 Health Care Claim Institutional and Health Care Claim Professional data structures. Interfaced with outside vendors to insure that all products could operate in a CICS and batch environment.
- Attended meetings with various user groups Provider, Member, Claims, etc. to help define requirements and perform gap analysis.
- Creating company Intranet for the purpose of informing staff of project plans, HIPAA information, presentations, etc.
- Attended numerous meetings with other member organizations at NYS SPARCS - Statewide Planning and Research Cooperative System. The meetings were used to discuss various aspects of HIPAA for security, privacy and transaction set issues. Some of the issues revolved around HIPAA identifiers including NPI.
- I developed CICS TCP/IP socket service programs that interact with the Client using Microsoft's COMTI. The modules included claims, member services and provider functions.
- Enhanced Claims Data Entry On-line and developed new modules for Scanned Claims to prevent duplicate entries from entering the batch system for adjudication.
- As part of an application re-engineering project I used the facilities of the LE Cobol environment. This includes but is not limited to CICS 4.1 enhancements to programs, Y2K conversions and internal consulting to the MIS staff regarding new technologies. Policies for change management were established for all CICS test regions 20 , user acceptance regions 4 and production 5 as well as batch. This includes source check in / check out procedures run-time manuals and day / night support documents. The user approved all test plans and signoffs were obtained before production install took place.
- As part of a project team, I participated in the design and development of New York State mandated UB92 claims system.
- I analyzed, designed developed CICS modules to facilitate hospital claims adjudication functions for hospitals outside of the Q/Care system. This expedited the payment process via on-line claims pending report.
- Set up an extensive help function for pre-authorization, provider and claims with AssistGT / CICS.
- Analyzed, designed and coded interface between Q/Care and DRG Grouper/Pricer from 3M corp.
- I developed programs to support the Q/Care functions in the batch system. The areas of support included member services, pre-authorization functions and claims processing.
Various Consulting Assignments
Responsible for systems design, programming and implementation of various projects, including insurance, consumer products and media type applications. In most cases created the complete design from user specifications.