OBJECTIVE
To utilize my innovative thinking and professional acumen to deliver quality outcomes of goals and expectations for an employer who is progressive and aggressive in the technology industry

PROFICIENCIES
Microsoft Office Suite of Products – Project, Excel, Word, Access, PowerPoint; Microsoft Visio; MS SharePoint; SQL and VB coding; WinRunner; Mercury Test Suite; Compuware Suite of Products; RequistePro, RequisiteWeb; Database tools – Golden and Toad; Corel Suite of Products – Word Perfect, Paradox; Business Basics Programming Language (BBx); Unix and Oracle environments; Cognos ReportNet and Query Studio; Privia; Macromedia; HTML coding and development

SUMMARY

• 25 years Healthcare claims administration – Managed Care, TPA, Medicaid, Medicare, PPO
• 10 years Business Analysis – MS Project task management/project plans, application development support, end user training, marketing, documentation development, technical writing, data mapping/gap analysis, use cases, requirements gathering/management and application prototyping
• 10 years Systems Implementation – SDLC, CMM project management, configuration management, large scale claims administration system implementations and process improvement
• 7 years Supervisory Management – systems operations, member/provider services, claims administration, internal audits and quality assurance

EXPERIENCE

2007 – 2009 Sr. Implementation Specialist, Confidential, Atlanta, Georgia
2001 – 2007 Product Analyst, Confidential., Atlanta, Georgia

• Led implementations, JAD/RAD sessions, testing, training and support for business intelligence solution tools
• Led requirements gathering for BI reporting solutions for Data Warehouse/Decision Support Systems (DSS) development integrating Cognos management and administrative reporting report design;
• Nurtured relationships of technical staff and functional owners of multiple source systems throughout the application development Life Cycle (SDLC)
• Managed documentation and process flows for internal teams and client project teams
• Created system specification/technical documents and functional process documents
• Supported business owners in issue resolution, benefit plan discrepancies, plan utilization concerns and suspected abusive activity using online business intelligence applications, customized analytics, and BI report development
• Developed training material and trained staff; performed knowledge transfer and ongoing client support
• Evaluated process flows and procedures and user application interfaces
• Developed project plans, managed project resources, managed project status, managed time lines, deliverables and documentation, and managed client expectations
• Wrote proposal responses to RFPs and RFIs
• Supported users in developing reports for data analysis and trend analysis using Cognos Report Studio/Query Studio, MS Access, and Toad
• Worked with Data Models (Dimensional and Relational); performed data mapping and gap analysis; analyzed data to validate accuracy and quality of data for data mart loads (utilized database structure knowledge)
• Worked with large data sets from multiple sources using tools such as Toad and MS Access to insure data integrity and reporting capability, data analysis and data conversions
• Created use cases, test cases and testing strategies and validation of requirements; Created test plans (system, acceptance and regression) for data validation and application development
• Worked with Unified Modeling Language (UML) tools to develop behavioral and interactive diagrams and some structural diagrams.
• Managed processes for test plans, test plan execution, release management and defect tracking
• Monitored application utilization, identifying software bugs and quality testing implemented designs

1996 – 2001 Managing Consultant, Confidential, Atlanta, Georgia

• Provided consultative services to Managed Medicaid plans such as CHA Health Plan in Lexington, KY, Vandy Health Plans in Nashville, TN, Grady Health Systems in Atlanta, GA, HMS Health Plan in Metairie, LA, Mercy Health Plans in St. Louis, MO; as well as other MCOs such as BCBS of Florida, CL Frates and Company in Oklahoma City, OK, PROMINA Health Systems in Atlanta, GA, and VHA Hospitals Inc in Atlanta, GA in the areas of plan design, benefit application, systems design and set-up
• Successfully managed and implemented the HSD/Perot Diamond claims management system; developed operational processes, trained member and provider relations staff, developed process for utilization review and medical management, developed and trained claims personnel and developed reporting and operational strategies
• Provided operational and system consultative services with clients in Georgia, Florida, Missouri, Tennessee and Louisiana
• Specialized in the implementation of the Diamond 725/950 claims administration system while providing operational and system utilization solutions to Managed Medicaid Organizations, Managed Care Organizations, and Third Party Administrators developing online benefit plans, provider pricing schemas, member eligibility interfaces and other supporting functionality such as procedure/diagnosis codes interfaces, capitation rate application and authorization interfaces
• Mastered project management tools, techniques and modeling; Applied quality assurance principles and techniques
• Served interim leadership roles and operational responsibility in the areas of VP of Operations – Healthcare Solutions, Director of Quality Assurance, Claims Manager and System Design and Development Specialist managing staff in the areas of Internal Auditing and QA, Member Services and Provider relations with staff responsibility from as little as seven to as many as forty-five
• Led status and presentation meetings with organization leaders and operational staff while developing budgets, process improvement strategies, financial management and innovative solutions to business processes
• Managed staff of 5 Provider Relations Reps, 8 Benefit Administrators and 15 Member Services Reps
• Developed data conversion strategies and managed outcomes, tested results and implemented changes

1994 – 1996 Sr. Business Analyst, Confidential, Jacksonville, Florida

• Developed internal and external process for managing provider relations and member services for the Managed Medicaid MCO in Jacksonville, Florida
• Developed strategies involving the integration of medical management systems, enrollment systems and clinical auditing systems interfacing with the claims administration systems
• Developed member services process for enrollment management, HEDIS reporting and customer satisfaction surveys
• Developed provider network contracts and system management
• Led projects for re-design and re-implemented the Diamond 725 Claims Administration System
• Developed utilization strategies and module configurations for all Diamond system oriented functions

1991 – 1994 System Design and Development Specialist, Confidential, Atlanta, Georgia

• Solely responsible for the internal maintenance, development and utilization of the HSD Diamond Managed Care software. Defined Application testing and upgrade impact procedures through string tests, unit and regression testing
• Designed, developed and implemented internal auditing procedures for all claims administration departments
• Trained staff on internal processes, met with network providers and trained their staff on external processes
• Installed Diamond 725 and managed all upgrades and releases
• Provided client demonstrations on company services and abilities, as well as managed new business implementations and account management
• Supervised the Provider Relations Department and Network Development Team, new employee orientation and training, Claims and Member Services departments

EDUCATION
Confidential College emphasis on Marketing/Accounting