SUMMARY:

• Agile Product Ownership 3 Healthcare Claims Payment Systems 10
• Supervisory or Team Leading Experience 5 HCFA & UB - 92 Claims Analysis 10
• Joint Application Design (JAD) Sessions 8 Full Life Cycle Development 12
• Process & Data Modeling/Mapping 8 Presentations & Facilitation 12
• Program, Project & Resource Management 9 Project Planning & Implementation 12
• Medicaid Management Information Systems 9 Systems Development Implementation 12
• Software Application Training & Development 10 CMM Concepts and Techniques 12
• Change Control & Change Management 10 HIPAA Implementation & Compliance 12
• UML & OO Methodologies 10 Business Analysis & Process Modeling 12
• Use Case Analysis 10 Iterative/Waterfall Development Methodology 12
• Risk Mitigation & Defect Tracking/Resolution 10 Process Improvement Initiatives and Analysis 12

TECHNICAL SKILLS:

• TFS - Team Foundation Server Microsoft Project
• Mainframe Environments (CICS, TSO, JCL, etc) Microsoft Office Professional & Visio Professional
• Report Storage/Retrieval (COLD/SIR) Structured Query Language (SQL)
• HP Quality Center, Test Management Software Microsoft SharePoint Document Management
• Corticon Business Rules Management Software Caliber RM - Requirements Management Software

PROFESSIONAL EXPERIENCE:

Confidential, Alpharetta, GA

Senior Business Analyst/Agile Product Owner

Responsibilities:

• Senior BA for company-critical development of Physician Staffing tool to replace existing legacy system
• Completed successful development of first generation on-time release of ZEUS application
• Led requirements elicitation and application design sessions with 6 independent functional business units
• Ongoing prioritization of 1,000+ user stories from sprint backlog into 3-week Agile development sprints
• Coordination and assignment of tasks with local and offshore development teams during sprint planning sessions
• Managed and delegated workload for 3 onsite and 5 offshore developers
• Facilitated daily Scrum/sprint stand up sessions to review and discuss development and potential roadblocks
• Assisted with quality assurance testing when needed
• Conducted sprint retrospective meetings with development team and leadership to review completed code, milestones, successes, failures, lessons learned and opportunities for improvement in subsequent sprints

Senior Business Analyst

Responsibilities:

• Developed best of breed Business Requirement Documents (BRD) and templates requirements gathering and elicitation.
• Defined standards for 6 new templates to be used for documentation of currently undocumented processes
• Developed requirements specifications that are comprehensive in coverage for business and technical audiences.
• Worked directly with the developers to turn the business requirements into technical requirements.
• Managed 4+ Agile projects and project plans at any given time
• Served as the Agile Product Owner for our Claims Payment system
• Managed and prioritized the product backlog of 500+ user stories into 3 week sprints
• Led daily sprint standup sessions with development team
• Created burn-down charts for development task progress and tracking
• Communication to impacted business areas after system changes or enhancements
• Led Quality Assurance/Regression testing effort of all implemented requirements
• Issue tracking and oversight to resolution
• Identified and prioritized fixes for 20 unique defects per month

Senior Business Analyst/Agile Product Owner

Responsibilities:

• Creation and documentation of scope and requirements for back-end agnostic portal product for Medicaid recipients, providers and eligibility brokers.
• Successfully delivered requirements for 4 sub-portals for 4 distinctly different user experiences
• Window/screen design for ease of navigation, enhancements to the user portal experience while complying with ADA standards and Section 508 guidelines.
• Review, perform cost analysis and provide procurement recommendations for 3rd party/COTS products for integration into existing portal framework to enhance consumer-driven healthcare initiatives.
• Successfully vetted and integrated new products with 3 different vendors
• Researched and created CMS 5010 Impact Analysis for Electronic Data Interchange (EDI) team.
• Performed 5010 compliance and awareness surveys with 15 State Medicaid accounts to determine overall account preparation level.
• Initiated and mediated monthly conference calls between State Medicaid accounts and EDI team to address concerns, questions, timelines, regulatory compliance initiatives and 4010 to 5010 transaction mapping.
• Updated existing HIPAA 4010A transaction loops and code set documentation with 5010 rules.
• Performed regression testing and defect tracking for Commercial Claims Payment Processing system (MetaVance).
• Performed documentation of scope and requirements for Medicaid recipient Asset Verification System (AVS) required under Section 1940 of the Social Security Act.
• Lead Agile Business Analyst and Product Owner for a Medicaid Healthcare Eligibility Solution tool providing real-time self-assessment and application services.
• Documented epics, features and user stories for development efforts
• Modified and prioritized existing user stories into 2 week sprints
• Participated in daily stand up sessions with developers to monitor progress and mitigate issues
• Reviewed burn-down charts to track development progress
• Created test cases for all user stories included in sprints
• Lead Agile Business Analyst and Product Owner for revenue-generating Healthcare Quality Measures (HCQM) solutions to provide accurate analytics reporting to support multi-organization measures such as NCQA, HEDIS, and National Quality Forum (NQF).
• Anticipated go-live revenue of $5,000,000+ for HCQM tool
• Documented epics, features and user stories for development efforts
• Modified and prioritized existing user stories into 2 week sprints
• Participated in daily stand up sessions with developers to monitor progress and mitigate issues
• Reviewed burn-down charts to track development progress
• Created test cases for all user stories included in sprints
• Claims Processing Subject Matter Expert (SME) for Georgia’s Medicaid Management System with an emphasis on payment reconciliation, transaction adjustment processing and HIPAA 5010 claims transaction processing.
• Benefits Management Subject Matter Expert (SME) for Georgia’s Medicaid Management System with an emphasis on ICD-9/ICD-10 Benefit Hierarchy Tables for covered/non-covered services

Services Manager/Business Analyst

Responsibilities:

• Development of use cases using UML and identification of potential existing solutions, recommendations for system development and strategies for implementation.
• Provided day-to-day oversight of the project from planning through implementation phases.
• Translated business requirements into functional and technical specifications.
• Ensured good system-engineering practices are maintained throughout the duration of the project.
• Developed and executed system test scripts and scenarios and provided defect tracking and resolution updates.
• Provided recommendations for approval of all deliverables and software releases and possible solutions for code integration issues.
• Implemented project management best practices and ensured all system requirements were consistently met.
• Worked with system architects to provide enterprise network solutions and information security.
• Created step-by-step manuals that included policies and procedures for proper utilization of software applications and MMIS systems.
• Participated in HIPAA implementation and compliance training.
• Lean and Six Sigma preparation training
• Experience in “project office” duties that includes planning, scheduling, tracking project deliverables and risk mitigation.
• Applied standard project management methodologies, including: creation and maintenance of detailed project plans, schedules, scope definition, change management, risk and issue management, and budget monitoring.
• Worked with PM Office to become CMM compliant and followed PMI (PMBOK) project methodology.

Business Analyst

Responsibilities:

• Created and maintained status reports for corporate sponsors/customers, coordinated efforts of technical staff and assisted in maintaining project scope.
• Documented high-level business requirements for new and existing projects.
• Translated business requirements into functional and technical specifications.
• Significant communication with clients, software development staff, technical staff and senior management.
• Participation in an SQA Team (Software Quality Assurance) that evaluated existing processes for accuracy and efficiency.
• Created and delivered PowerPoint presentations to senior management and staff to create vision and understanding of existing and future project goals.
• Worked with QA (Quality Assurance) teams to develop test plans by providing concise functional specifications and any outstanding documentation updates.
• Monitored application design and reviewed specification documents to ensure adherence to defined client requirements.
• Provided maintenance support and defect-tracking for client systems.

Computer Systems Consultant

Responsibilities:

• Provided claims payment and adjudication information to both providers and recipients under the Department of Labor’s Healthcare Management Contract with ACS.
• Performed resolution of suspended claims in an efficient, accurate and timely manner to ensure prompt payment.
• Provided technical assistance in a call-center environment for a web-based prior authorization-processing portal.
• Developed training materials for Team Leads to use when training new call-center employees.
• Responsible for thoroughly understanding the business processes associated with the current account and assisting in identifying potential methods for cost saving.
• Recommended changes resulted in company cost-savings of $50,000 per year