SUMMARY:

• Results - oriented professional with more than 15 years of experience in many vertical or horizontal areas: healthcare, insurance (Property, Casualty, Health, Life and Dental), banking and securities, financial services, government, Medicare, Medicaid, data/information management and legal.
• Broad working knowledge of SDLC (from feasibility studies through maintenance), CMMI structured methodologies, Six Sigma, HIPAA, SOX and other IT/Data controls.
• Demonstrated proficiency to communicate precisely and clearly with both business and technical at all levels of an organization.
• Education and training in Information Management, Technology Management, Data Management and Product Management
• Possess excellent human interaction skills with the ability to build consensus while remaining diplomatic.

SKILLS AND EXPERIENCE:

• Agile, Waterfall, Scrum
• Data Architecture
• ICD9/10, HCPCS, CPTs
• Project Management
• Application Development
• Training Materials
• Java, TLC
• Quality & Change Mgmt.
• Business Intelligence
• DMbok/PMbok/BAbok
• Medicare/Medicaid
• Relational Database Design
• Business, System &Data Analyst
• EDI - 4010/5010, 837I/P
• Multi-Tier Architecture
• Sarbanes Oxley (SOX)
• Client/Server Technology
• Health Informatics
• Object-Oriented
• SharePoint Administration
• Data Management
• HIPAA, NIST
• Policy & Procedure Design
• SQL, PL/SQL, T-SQL
• Data Modeling
• Information Mgmt.
• Process Improvement
• System Architecture
• Data Warehousing/MDM
• ISO, CMMI, Six Sigma
• Process Reengineering
• Training and User Support
• Product Management
• Use Cases, UML, UI Design

PROFESSIONAL EXPERIENCE:

Confidential, MD

Data Quality Analyst/Architect

Responsibilities:

• Developed and Maintained Data Quality Plan.
• Facilitated interface discussions, developed and designed Interface control documentation and conversion plans between the Heath Exchange and State systems.
• Liaison between other project areas to ensure consistent data quality from data entry through storage and reporting.

Environment: DB2, Informatica, Enterprise Architect, Cognos, ER Studio, BPM, Teiid, Tivoli, Quality Center, EDI, JIRA

Data Quality Architect

Confidential, MD

Responsibilities:

• Implement process for analysis and testing of the pharmacy and laboratory data.
• Facilitated data discussion, analyzed data, created test cases, developed test scripts and managed testing.

Environment: Oracle, Informatica, Data Flux, SQL Server, Confidential 9 & Confidential 10 Codes

Lead Consultant

Confidential, PA/MN

Responsibilities:

• Liaison between customer & technical organization.
• Lead and performed technical analysis activities, drive quality and process improvements.
• Identified, mitigated and provided solutions to project issues and risks.

Environment: Oracle, SQL Server, Trizetto Facets, MCKesson Claim Check, TriZetto Networx, TriZetto Networx Pricer, OptumInsight PPS, Confidential 9 & Confidential 10 Codes

Product Manager

Confidential, MD

Responsibilities:

• Managed Encounter Data 5010 Transition for Medicare Risk Adjustment bridging the business needs with the technical implementation.
• Directed external and internal cross-functional teams for all client/customer new implementations and ongoing data integration.
• Managed & reengineered, automated, enhanced data quality and profiling process increasing efficiencies and savings millions that would have been owed due to contractual liability based on data quality.
• Initiated Confidential 9 to Confidential 10 Project, setting up preliminary discovery team, attending and representing company at meetings.
• Managed internal Confidential 9 to Confidential 10 crosswalk activities, including impact and assessment on data quality upstream and downstream.
• Managed directly and in directly 25 resources; including Analysts, Data Architects, Engineers.

Project Manager

Confidential, Baltimore, MD

Responsibilities:

• Managed Facilitation of business requirements gathering, design review & data mapping sessions with IT, key stakeholders (internal and external).
• Work with Systems Engineers/IT Infrastructure team to design server topology.
• Managed Plan Data Management standalone implementation of E*ENRL, E*LOG, E*DATA, E*Data, E*PRO, E*HCC /E*RX HCC, E*RXEVENT.
• Managed the business intelligence/ decision support tool selection project. Tools reviewed Ingenix Impact Intelligence, Thomson Reuters Advantage Suit and Milliman MedInsight
• Managed contract negotiation for the Thompson Reuters Advantage Suite Business Intelligence Suite.
• Managed Custom Development (Data interfaces), hosting, testing, reports & letters projects for the TriZetto Facets Implementation.
• Managed full life cycle of the data warehouse & SSRS Report Conversion implementations from initial design, deployment and maintenance.
• Managed relationship with the offshore IT reporting and Data Team.
• Developed and manage Quality Assurance /testing processes for the Report team.
• Managed the testing project plan for the TriZetto implementation.

Environment: TriZetto Facets 4.2.1, TriZetto Facets 4.5.1, MS Project, MS VSS, MS SQL Server, MS Visual Studio, RedGate, TriZetto NetworX, Ingenix HSS EASYGroup, Onbase, MS SharePoint, SalesForce, PDM EAM

PMO Project Manager

Confidential, Owings Mills, MD

Responsibilities:

• Managed full Life Cycle Project Management in a CMMI Level 3 Project Management Environment.
• Coordinating requirements development and system changes to Multiply Legacy Systems.
• Collaborated with other Project Managers with dependencies, risks, issues and interdependencies on other project, Corporate Initiatives and Model Office.
• Facilitated design sessions and documented requirements, use cases, and work flows.
• Procured the Ingenix HSS EASYGroup Software and other vendor management in my area.
• Provided leadership to a Core Solution Team and Project Team of over 30.
• Held weekly status reports completed for executives and biweekly stakeholder status meetings.
• Coordinated with data and reporting teams and documented data sources and data mapping inputs and output based on the system architecture.

Environment: Serena Dimensions CM, Mercury Quality Center (MQC), FLEXX, NASCO IBM, TriZetto NetworX, Ingenix HSS EASYGroup, TIBCO, ACS, Microsoft Project, Clarity, Primavera Project Manager, Beeline, CMMI Level 3

IT Project Manager

Confidential, Baltimore, MD

Responsibilities:

• Directed software development lifecycle projects by supporting multiple project activities.
• Facilitated communication between business stakeholders and technical teams to ensure proper translation of Business Requirements to System Requirements.
• Facilitated business and data requirements gathering sessions with internal clients including data mapping and crosswalks from legacy system to new system.
• Provided leadership to a new Medical Management Department, Quality Assurance, System Analyst, developers and various other members of the Organization.
• Evaluated system architecture and made recommendations to improve system configurations.
• Supported other projects, including Cisco Call Center report development.
• Created Data flows for diagrams for the Call Center and Medical Management departments,
• Translated business requirements into technical specifications.
• Created workflows for the Medical Management Migration.
• Monitored and managed project scope and risk.

Environment: Gemini, TriZetto QNXT, MS SQL Server, MS Visual Studio Suite, MS Project

Senior Consultant

Confidential, Owings Mills, MD

Responsibilities:

• Work with the BSS department to gather business requirements for issues, maintenance and enhancements to enterprise applications.
• Scheduling and facilitating meetings with Business and end users.
• Manage Developers and Mentor Junior Analyst.
• Developed Data workflows and other diagrams as need to assist in the development of technical requirements.
• Data analysis and field mapping documents that are clear and concise that allow for proper integration of enterprise wide systems into the new SOA.
• Maintain accurate reporting and documentation on all trackers.
• Work with my manager in the creation of standardizes Software Requirement Documents.
• Complete and update Software Technical Requirements documents.
• Preparing agendas, meeting minutes and other documents as needed.
• Create Visio and other documents as needed to assist in obtaining requirements.
• Documented system upgrade process for the migration from TLM 1.0.2 to TLM 2.0.1.

Confidential

Technical Analyst/System Analyst, Columbia, Maryland

Responsibilities:

• Translated UAM Service Contract into business requirements for the Ameritrade Call Track (ACT) application/system.
• Managed project scope and gathering of business requirements.
• Facilitated agile SOA meetings and documented system and process designs.
• Managed change request to service contract.
• Facilitated UAT and create user cases and test plans as needed on all trackers.
• Documented thoroughly Data analysis and field mapping documents that are clear for all trackers.
• Maintained accurate reporting and documentation on the intranet.
• Develop documentation for service contracts as well as technical documentation.
• Preparing agendas, meeting minutes and other documents as needed.
• Creating UML diagrams of process flows and use cases.
• Creating Business requirement document for the ACT.

Senior Consultant

Confidential, Dulles, VA

Responsibilities:

• Maintain the progress and productive mutual interaction of various parties in such a way that overall risk of failure is reduced.
• Provide guidance to stakeholders on devising effective and efficient approaches to achieve the project objectives.
• Work with the end users (stockholders), gathering requirements, which are translated into business and functional requirements creating detailed design documents.
• Lead/ Facilitate RAD/JAD sessions with technical and business stakeholders (SME’s) and document “As Is” and “To Be” Use Cases.
• Review the Test cases created by the testers to make sure they cover all functional requirements. Facilitate testing working with QA and Testing staff, including leading the UAT testing with stakeholders.
• Successfully complete training needs assessment for migration of a Maryland legacy system to a DC legacy system. This impacted not only the primary stakeholders for the USS project impacts all departs across the Confidential organization.
• Assist training and logistics department in developing training materials.
• Complete data analyst and field mapping documents that are clear and concise that allow the developers to develop application with proper mapping.
• Provide weekly status reports to the Project Management Office that show a clear picture of milestone and achievements as well as clearing displaying all.

Client Services Manager/Senior Data Analyst

Confidential, Bethesda, MD

Responsibilities:

• Consulted with Client on product functionality, business needs, system configuration.
• Coordinated schedules to insure that Client and Company milestones are met.
• Tracked, documented, and resolved all issues identified during the implementation process.
• Managed project resources, including internal staff, sales, software development, and medical management. Control and report project issues.
• Worked with Sales & Marketing, to coordinate product and service expansion.
• Facilitated design requirements gathering and review sessions.
• Meet with different external data sources to discuss and document data mapping.
• Conducted user training sessions for assigned clients, preparing customer staff to use the CKM system effectively. Coordinate issues related to ongoing support, education, documentation, etc.
• Provided direct support to client users who may require assistance in developing views, templates and analytic models within the CKM system.
• Analyzed health care data submitted in various formats.
• Manipulated, cleanse and map data; and validate importation of client data.
• Developed internal specifications and customer configuration documentation.
• Developed client configuration and analysis documentation.
• Developed functional and technical application specifications.

Manager, Product Analysis/Project Leader

Confidential, Rockville, MD

Responsibilities:

• Worked with internal and external peers and leadership with to development of rates, rating plans, pricing strategies, reserve programs, and financial forecasts.
• Worked with the end users (stockholders) to gather requirements, which are translated into business and functional requirements. Worked with IT Staff to create system and application technical specifications.
• Managed projects from the initial stage through development and testing to assure project success.
• Maintained Divisions Disaster Recovery Planning (DRP) documentation - documented all systems and applications required in case of disaster.
• Developed and updated Standard Operating Procedures (SOP) for all functional areas in the
• Divisions Sarbanes-Oxley (SOX) compliance representative for companywide SOX and HIPAA compliance projects - gathered and documented requirements for all systems used in my department/division.
• Evaluated system architecture and recommended improvements to system creating better workflows for business units.
• Created test cases and test plans for all application changes submitted to information systems department for main frame applications.
• Peer reviewed reports completed by departments’ actuary comparing to other data sources (main frame and data warehouse).
• Worked with Information technology department doing all User Acceptance Testing for all changes made to systems utilized b departments in my division.
• Also performed unit, integration and regression testing.
• Worked as a technical contact within the business group trouble shooting and working with IT to resolve end user issues.
• Trained and supported users during MS Office to IBM Lotus Notes conversion.
• Created online (intranet Web-based) Manuals for all department in my division utilizes Macromedia RoboHelp software applications.
• Provided Executive Management with the profitability of all health, dental and life products through use of the Profit and Loss Reports (P&Ls).
• Extracted and analyzed data from the Data Warehouse (Oracle 9i). Use SQL Navigator to extract data and create data sets in order to develop standard and ad hoc reports.
• Worked closely on projects in the Strategic Policy and Analysis and Data Warehouse Department to assist company’s initiative to analyze data to improve the quality and cost-effectiveness of health care services through regression and other advanced statistical analyses of claims and other data.
• Updated Profit and Loss (P & L) system monthly with current lag factors and created updated reports for distribution to senior leadership and department heads.