PROFESSIONAL SUMMARY

• Seasoned Information Systems professional with 15 years in project management and delivery with extensive
• experience in the HealthCare industry. A strategic planner and facilitator, experienced in organizing and directing
• the product and process development, motivating people toward achieving the goals of the corporation through the
• use of Project Management, Resource Planning, Staff Development, interpersonal and communication skills. A professional dedicated to quality, effectiveness and customer service excellence.

SKILLS

PROFESSIONAL EXPERIENCE

Confidential

Systems Analyst

• Work remotely with minimal supervision in a matrix management environment.
• Play a key role in the strategic implementation and integration of Client Plan's business onto the PlanConnexion ITS platform.
• Review assessment documents and conduct gap analysis between Client Plan's existing and PlanConnexion's ITS platforms.
• Gather and develop complex business requirements creating a BRD. Translate the BRD into technical specifications.
• Ensure the proposed technical solution fully meets the customer's objectives and all integration points for file and report transfers have been addressed.
• Responsible for oversight and coordination for all implementation activities.
• Facilitate knowledge exchange with Client Plan with regard to process and procedures.
• Coach and develop new team members in support of project activities.
• Develop Concept and Content Diagrams utilizing Visio to depict at a high level, the system and its interfaces, particular functionality, and overall system flow.
• Triage and resolve Help Desk tickets as needed.
• Development of all custom components utilizing COBOL, MVS JCL.
• Wrote SQL queries as necessary.

Confidential

Information Technology Technical Manager

• Responsible for the strategic implementation and integration of Client Plan's business onto CIMRone, BlueLink and Blue , ITS and AMMS Claims Adjudication Systems.
• Worked extensively with external clients to include BCBSWI, SunStar, Florida Combine Life, BCBSNE, BCBSM, and HealthNow New York.
• Provide input into the contract process documenting product and services to be delivered. Participate in contract discussions to review content with external clients.
• Cultivate productive relationships with both internal and external customers to understand their business, develop business requirements, and efficiently communicate these requirements to the technical team for product development and delivery.
• Participate in discussions with perspective clients to solicit information and provide feedback during initial planning phases.
• Manage scope and design in accordance with contract. Conduct gap analysis and determine requirements which fall outside the scope of the project. Negotiate these items as change control with the Client Plans.
• Monitor and manage relationship between external clients and the project team with a strong focus on customer satisfaction.
• Directed large corporate development efforts such as HIPAA 270/271, HIPAA 276/277, Claims Display Screen rewrite, BlueExchange, Benefits Eligibility Systems BELG/DELG as well as smaller systems enhancements.
• Managed a contingency of Design Architects and Business Analysts. The team was responsible for overall systems architecture and design for both new development and system enhancements for the Commercial Division claims adjudication systems.
• Responsible for coordinating multiple departments in responding to RFP's. Responses consisted of definition of scope of work, concept diagrams, as well as high level estimates for defined objectives and approaches.
• Staff skills assessments and Performance Appraisals. Responsible for staff performance appraisals on an annual basis. In addition, a mid-year assessment was conducted to outlined development goals and training opportunities to achieve set goals.
• Developed and coordinated Noodle Soup an educational lunch and learn for direct reports.
• Resource planning, budget management, managing multiple projects, as well as project prioritization and scheduling.

Confidential

• Led the Wisconsin transition team to implement BCBSWI onto the Automated Major Medical Claims Adjudication System and interface with the ITS system.
• Worked extensively with the Wisconsin customers, Business Analysts and Project Team to define business requirements, and deliver a quality product for all 6 phases of their implementation.
• Participated in and contributed to the creation of the Scope, Design, Implementation, and Post-Implementation documents required in keeping with SDLC standards.
• Monitored and tracked project tasks, provided estimates, assigned resources, met with the customers on a daily basis to review defects and resolution.
• Responsible for system enhancements as well as new development to the Automated Major Medical Claims Adjudication System to include claims entry screens, pre-authorization and referral processing, as well as calculating patient liability, coinsurance, copays, and provider payment based on benefits.
• Completed analysis, design, and programming modifications utilizing COBOL, APS, SQL, VSAM,
• Responsible for system enhancements as well as new development to the Automated Major Medical Claims Adjudication System to include claims entry screens, pre-authorization and referral processing, as well as calculating patient liability, coinsurance, copays, and provider payment based on benefits.
• Contract Programmer-
• Provided staffing updates and reporting to senior level management on a weekly and monthly basis.
• Negotiated with vendors on hourly rates for contract employees, as well as volume discounts.
• I/S Recruiter Interviewed outside vendors for acceptance to approved vendor list.
• Provided input into each team members review.
• Mentored and trained both ELTP's and new hires.
• Conducted testing for all new development and /or enhanced components.
• Completed analysis, design, and programming modifications utilizing COBOL, APS, SQL, VSAM,
• Conducted testing for all new development and /or enhanced components.

Project Leader

• Project Leader for the Assigned Risk Workers Compensation System.
• Worked extensively with Clients to identify business requirements in order to streamline workflow and increase efficiency.
• Reverse engineered and rewrote old system, updating to meet new requirements and platform using SQL and Teradata.
• Analysis and design of system solutions to business problems.
• Completed analysis, design, and programming modifications utilizing COBOL, SQL, VSAM,
• Wrote SQL to extract data from Teradata to be used in processing for Assigned Risk Pool or ad-hoc reports.
• Conducted testing for all new development and /or enhanced components.
• Responsible for the training, development and evaluation of project staff.
• Received the RISE Recognizing Information Systems Excellence Award for the WC Pools Project.

Senior Programmer/Analyst

• New application development and system enhancements using Structured COBOL on the Accounts Payable, National Inquiry, and Sales Reporting Systems.
• Provided on-call support for all application systems.
• Network Support which included the ordering, setup, installation and troubleshooting of both hardware and software.
• Provided one-on-one training and support for end users on new PS/2's and standard software
• Responsible for PC to AS/400 connectivity using LAN Support program and 5250 emulation.

Programmer/PROFS Administrator

• Installed and maintained the Payroll/Benefits Genesis System and in-house programming interfaces.
• Applied and tested new releases as they were received.
• Created and provided training on the PROFS system.

ELTP to Senior Programmer

• Developer for the Bank Account Reconciliation and Reinsurance systems.
• New applications programming, enhancements and maintenance to existing programs using.
• Worked jointly with customers to gather and analyze business requirements.
• Documented required system modifications.
• Coded, tested and implemented necessary system changes