SUMMARY:

• A highly motivated, dynamic, dedicated leader, with expertise in areas such as: project management, health care services/ administration, business analysis, program administration, policy administration/analysis, account management, research development/analysis (quantitative/qualitative), electronic health records, HL7,surveying, abstracting data, extensive data collection, evaluation, educational administration, operational management, legal administration, human resources, management, contract administration, training & development, marketing & account management, budgeting, FAR/DFAR, grant writing, marketing, court administration, customer service Health Services/, non - profits, and other outstanding skills.
• An individual with over 15 years of professional experience (in healthcare and other areas) working with clients and coworkers in varies environments with a BA in Communications, Master’s in Public Administration and expected PhD in Public Policy/Administration by Winter 2017 online, which would not interfere with job duties .

TECHNICAL SKILLS:

Computer Skills: MS Word, Excel, Access, PowerPoint, RNA (Testing, Scripting), Visio, Troux, IBM Rational, FACETS, SXC, Xcelys, MARX, PEGA, FILENet, IFX, QuickFind, SPSS, SAS, Epic Resolute, ASAP, Visio, SharePoint, MMIS; Data warehousing and more

APPLICABLE WORK EXPERIENCE:

Regional Director

Confidential

Responsibilities:

• Worked with stakeholders continuously to support to maintain products, architecture and design, process modeling, and rapid prototyping approach to defining FEP Benefits Administration product requirements along with other FEP product and services
• Served as a primary liaison
• Managed the day to day operations
• Manage all billing aspects to ensure efficient cash flow; created extensive reports related to billing as needed
• Managed all budgeting requirements
• Consulted with external customers a nd managed customer relationships and expectations
• Managed critical projects, in all business analysis phases of the SDLC
• Managed healthcare /IT and business analysts team members maintained systems development life cycle.
• Contract administration and development
• BPO claims processing training and development
• Extensive documentation of varies documents
• Hire and manage staff members as needed
• Developed and maintained organization policies and best practices
• Established and maintained business relations and accounts

Regional Director of Business Analyst

Confidential

Responsibilities:

• Analyzes the business objectives of the stakeholder and develops solutions to their business issues,
• Analyzes and defines processes of business both “To Be” and “As Is”,
• Analyzes the entire business (such as Centers for Medicare & Medicaid), including data, goals, process, and organization,.
• Interviewing, analyzing documents, draw out requirements like workshops, surveys, visiting sites, developing business processes using task flow analysis and work-flow analysis,
• Simultaneous engagement in various initiatives,
• Document system interface documents (system development document; functional specifications, technical specifications and more)
• Collect, evaluate and compress data and information from multiple sources, resolve conflicts and differentiate between actual and required user needs,
• Document system integration documentation (System development, Technical Specifications, Functional Specifications and others) as required for system upgrades & implementation
• Deliver results after thorough research of functional needs by collaborating and communication between various users,
• Using strong analytical reasoning to understand end user's requirements and transforming them into operational application,
• Acquire deep knowledge of working systems and bringing efficient and effective changes for better performance,
• Use Understanding business process management and business requirements of the customers and translating them to specific software requirements,
• Understanding the technical designs as well as the specifications,
• Effectively communicating with internal teams and external clients to deliver functional requirements like GUI, screen and interface designs,
• Worked extensively with SOWs and acquisition management
• Supports the Centers for Medicare & Medicaid Services (including Child Welfare Programs) for the Patient Protection and Affordable Care Act as a Marketplace Advisor for technical integration of all Marketplace systems, end-to-end business processing, program management services, and analyze requirements and Use Cases to ensure the requirements across the Marketplace are in alignment,
• Very strong technical skills, coupled with business intelligence and a deep understanding of the customer's needs so that they can be transformed into application and operational requirements,
• Prepared and edited several XLC documentation and adhered to CMS 508 standards as required
• Knowledge and understanding of the SDLC,
• Worked on MPL Tools consisting of three parallel work streams - 1. App 2.0, 2. Scalable Login System (SLS), and PMO Support,
• Core Responsibilities: Be the Technical Advisor for the MPL Tools implementation,
• Participate in high level planning, sprint planning meetings,
• Identify system interfaces and coordinate interface design discussions with stakeholders,
• Participate in Architecture and Design discussions; provide technical oversight and recommendations,
• Ensure alignment with the CMS Technical Review Board, participate in TRB meetings and follow up on TRB findings and recommendations,
• Performed Change Management Tasks for CCB/CMS
• Worked extensively with the PMO for CMS Marketplace
• Worked within the Change Control Process based on CMS Marketplace
• Supported all data warehousing efforts (design & Implementation)
• Implementation of business rules with stored procedures, various technologies & middleware
• Performed several testing scenarios based on heathcare.gov (App 2.0 & PET 2.0 environments) and trained additional team members on the testing procedures and environment accordingly
• Documented testing result and defects in JIRA as needed
• BPO claims processing training and development
• Performed re-testing of any know defects identified related to the App 2.0 and OET 2.0 environments for healthcare.gov
• Coordinate and manage documentation tasks (1. Create Requirements documents, 2. Facilitate meetings, and 3. Create and manage document trackers, action trackers, open items, and clarification requests),
• Provide PMO support - representation at PMO meetings, create and distribute weekly development status reports, and create and distribute meeting minutes,
• Liaise with Consumer Tools Tower, Performance Testing, and Release Management teams,
• Lead & manage BA and IT Team day to day operations;
• Construct BA Team discussions/trainings as needed,
• Administer Weekly BA Status Reports and Marketplace Reports
• Acted as the IT Programs Director as needed including any necessary operational duties,
• Administer the overall BA and IT team day to day operations

Program Director

Confidential

Responsibilities:

• Program support and development for clients
• Research analysis
• Data analysis
• Supported all data warehousing efforts (design & Implementation)
• Implementation of business rules with stored procedures, various technologies & middleware
• Program Development/Management
• Project Management
• Client Training & Development
• Technology support, tracking, reporting
• Evaluated & developed Policy
• Utilized SDLC (System/Software Development Lifecycle) regularly; Performed work requirements if needed in JAVA Script, Develop/Gather requirements using UML and/or use case approaches to requirements and more.

Director - Business Analyst

Confidential

Responsibilities:

• Work effectively with business and IT partners to define requirements and provide estimated level of effort as needed for assigned task.
• Lead team in reviewing policies and other documentations in terms of third party liability ( Confidential ) procedures to ensure compliance
• Translate business requirements into specific systems, applications, or process designs.
• Market and sale medical systems/technology
• Conduct design review sessions (or Joint Application Development sessions) and data mapping sessions with various IT, vendor, and business teams.
• Initiate, identify and coordinate the analysis of complex client systems and requests.
• Lead cross-functional and/or cross divisional task forces to identify and document the current and future states of functional requirements, user workflow and system specifications.
• Work closely with business partners, business consultants, project managers, vendors, and IT teams that will be involved in the project.
• Responsible for producing work products or deliverables as needed by the project defined Use of strong writing, speaking, interpersonal and organizational skills.
• Document system integration documentation (System development, Technical Specifications, Functional Specifications and others) as required for system upgrades & implementation
• Work projects related to claims, billing & ICD10
• Worked extensively with SOWs and acquisition management
• Gather requirements using the SDLC methodology's of waterfall, spiral, RUP, and Agile on several projects including but not limited to: ASAP Implementation/Clinical; Government Improvement Process; Billing Enhancements; Membership ID Cards and more.
• Experience with presenting issues / solutions and influencing the decisions of project sponsors and executive leadership.
• Analyzed & Created test cases and completed tests thru the CMS/HITECH Registration and Attestation System,
• Budgeting, administered Electronic Health Records through systematic processes, worked with HL7 interfaces
• Performed software development testing in exclusive testing environments,
• Develop/Gather requirements using UML and/or use case approaches to requirements.
• Adhered to CMS, HIX and the Affordable Care Act 2010 policies. Worked extensively with the PMO for CMS Marketplace
• Worked within the Change Control Process based on CMS Marketplace (Including Child Welfare Programs)
• Supported all data warehousing efforts (design & Implementation)
• Implementation of business rules with stored procedures, various technologies & middleware
• Perform health care payor duties including membership & billing administration, benefits administration, claims processing, CRM, analytical skills, financial management and utilization management. Health care delivery experience using, upgrading and implementing all EpicCare Suites Medicare Part A & C D (enrollment and claims, reporting) and Medicaid claims enrollment.
• Worked on several healthcare related projects
• Performed work requirements if needed in JAVA Script
• Requirement management with product similar to HP Quality Center

Senior Business Analyst Consultant

Confidential

Responsibilities:

• Served as a Senior Business Analyst that gathered requirements for complex systems, performed storyboarding, presentations and use cases,
• Market and sale medical systems/technology
• Collaborated with the development team, customer stakeholders and evaluated healthcare policies,
• Develop/ lead documentation and artifacts extensively,
• Evaluated and developed systems and procedures by documenting specifications, workflows, and user requirements,
• Utilized Client & timeline management,
• Verified documentation was CMMI (Process of Configuration Management) compliant,
• Perform extensive research analysis, evaluated data from studies, policies and procedures including third party liability information ( Confidential )
• Reviewed and analyzed Medicare/Medicaid financial/payment process on many Medicaid/Medicare and other projects,
• Working with federal clients, participated in JAD sessions,
• Excellent oral, analytical and written communication skill,
• Performed Agile/Waterfall development methodologies,
• Worked extensively with SOWs and acquisition management
• Knowledge of Section 508, analytical skills
• Document system integration documentation (System development, Technical Specifications, Functional Specifications and others) as required for system upgrades & implementation
• Created documentation by adhering to 508 compliances as required by CMS
• Analyzed & Created test cases and completed tests thru the CMS/HITECH Registration and Attestation System,
• Administered Electronic Health Records through systematic processes, worked with HL7 interfaces
• Constructed meeting minutes, business description documents and used to close out projects,
• Reviewed and analyzed Medicare/Medicaid financial/payment process on many Medicaid/Medicare and other projects,
• Created the System Development Design (SDD) document and performed peer reviews,
• Worked extensively with HITECH/ CMS/ Medicaid and Medicare Part C & D ( billing , reporting, payments) & Child Welfare Programs
• Performed extensive research analysis,
• Worked extensively with the PMO for CMS Marketplace
• Worked within the Change Control Process based on CMS Marketplace
• Supported all data warehousing efforts (design & Implementation)
• Implementation of business rules with stored procedures, various technologies & middleware
• Performed extensive testing in the RNA technology environments (and others) related to the end user’s experience
• Documented test case results and performed system related aggressive testing as needed
• Work projects related to claims, billing & ICD10
• Created Change Requests and loaded them in SharePoints’ Ensemble system
• Utilized SDLC (System/Software Development Lifecycle) regularly; Performed work requirements if needed in JAVA Script,
• Develop/Gather requirements using UML and/or use case approaches to requirements.
• Adhered to CMS, HIX and the Affordable Care Act 2010 policies
• Use of MS Word, Power Point, Excel, Access, Epic Suites, Visio, SharePoint’s and more programs,
• Use of NPPES, PECOS, I&A MMIS, and RNA technology systems and used XML, SOA and SOAP.
• Completed SDLC Engineering Organization Process (EOP) training qualifications,
• Completed CMS Security CBT training certification.

Associate Director

Confidential

Responsibilities:

• Analyzed complex administrative problems to be solved with automated technology systems. Prepare business process models and artifacts and provides technical expertise in analyzing and evaluating systems and procedures that meet user requirements.
• Responsible for multiple phases of the project life cycle and provides outstanding client service and contributes to the organization's mission of utilizing information technology to improve patient care.
• Met with stakeholders to evaluate, assess (on site and off site) and document the "As Is" and "To Be" work environment,
• Market and sale medical systems/technologyIdentify stakeholders, analyze administrative processes and workflows, and met with users to identify needs and requests for the system.
• Analyzed complex problems to be solved with automated systems with an in depth understanding of the health systems and potential functionality, made suggestions for process improvements and modifications to existing systems based on the findings and criteria of the users.
• Lead team in analyzing system processes. and policies and procedures including third party liability information ( Confidential ) to ensure accurate policies are implemented
• Worked closely with team members to identify technical needs, technical constraints, JAD ( Joint Application Development) session efforts, and the potential to meet user needs.
• Identified the source of a problem or issues, planned and organized meetings regularly, provided technical expertise in identifying, conducting extensive research on Health Care Reform and other health related topics.
• Evaluated and developed systems and procedures by documenting specifications, workflows, and user requirements.
• Client & timeline management.
• Work projects related to claims, billing & ICD10
• Worked extensively with the PMO for CMS Marketplace
• Worked within the Change Control Process based on CMS Marketplace
• Developed/implemented/supported PMO processes and tools and PMO execution
• Supported all data warehousing efforts (design & Implementation)
• Implementation of business rules with stored procedures, various technologies & middleware
• Extensive research analysis, evaluating data from studies and more.
• Maintained specifications, revising as changes and enhancements developed.
• Estimate and reports own effort s and adhere to project schedule as defined in Work Breakdown. In the process of requirements gathering and learning the client’s workflow, re-engineer their current workflow to take advantage of the new system capabilities.
• Extensive data collection & outstanding power point presentation/ developed use cases.
• Document system integration documentation (System development, Technical Specifications, Functional Specifications and others) as required for system upgrades & implementation
• Constructed meeting minutes, business description documents and used to close out projects.
• Created governmental business plans and other extensive reports.
• Review and analyze Medicare/Medicaid financial/payment process on many Medicaid/Medicare (Parts A & & D including billing , reporting, claims) and other projects including Child Welfare Programs
• Provided and created system related documentation on the 508 compliance as required by CMS
• Facilitate workflows, meetings (in person and over the phone) and communication planning with the Center for Medicaid/Medicare, Dept. of Health and Human Services, with focus on the Health Care Reform including Medicare/Medicaid and CHIP Programs, analyzed health related public polices regularly, knowledge of HIPPA, extensive data analysis, and worked consistently with other Federal and LTC health related agencies. Subject Matter Expert (SME) on several sections of the Patient Protection and Affordable Care Act and HITECH Act, Financial Management projects and more.
• Use of MS Word, Power Point, Excel, Access, Troux, MMIS, Epic Suites, Visio, XMLSharePoint’s SOA, SOAP, and JAVA Script

Director for Technology Systems Program

Confidential

Responsibilities:

• Served as a Director for Technology Programs GWU by overseeing technology programs day to day operations.
• Supervised a diverse staff regularly (managed 80 plus people).
• Responsible for training
• & development, health promotions, client & timeline management, outreach on special projects, marketing, participants activities, met with high level stakeholders regularly, policy development, organize and manage conferences, facilitate workshops & meetings over the phone and in person, leadership, creating and documenting business plans, technical assistance, staffing, budgeting, resolving issues as they arise,
• Sale/Tested software as needed
• Responsible for contract administration, teaching, attending meetings, preparing extensive reports and more.
• Use of MS Word, XML, MAC, Excel and other software usage.

Senior Data Analyst

Confidential

Responsibilities:

• Served as the Senior Data Analyst (qualitative/quantitative) with extensive data collection needed to fulfill the 10 year census requirements.
• Evaluated information related to the community and other sources consistently.
• Examined and abided by all Census regulations

Director/Professional Educational Instructor

Confidential

Responsibilities:

• Stand up Trainer/Facilitator for many audiences on various subjects’ related to academic advancement and job related skills needed.
• Worked as a Professional Instructor to individuals ranging from elementary age to adults on various subjects such as TOEFL, SAT Critical Writing, Research, Public Speaking, TESOL, English, Reading and more.
• Extensive Curriculum Development
• Managed the classroom effectively through proper preparations for courses, provided tutoring as needed, provided a conducive learning environment, administered rules consistently and fairly, performed student evaluations and student action reports.
• Created classroom presentations regularly.
• Performed extensive computer usage of several Microsoft programs

Asst. Programs Director

Confidential

Responsibilities:

• Worked as the Assistant Program Director for the Social Services Dept. for Confidential SOS, which is a social service organization dedicated to providing self-efficient services to families
• Responsible for supporting, overseeing, and monitoring family/health services programs (that dealt with Medicaid, Alzheimer’s/Dementia etc.), which included health/mental services of youth and seniors, family oriented programs and projects in the department, as well as developing existing or new social service programs.
• Evaluated overall performance of the department and program; organized and managed events and conferences, tracking department budget; extensive research analysis, client management, evaluation, marketing & account management, overseeing program implementation and reviewing staff work-plans locally and nationwide;
• Maintained corporate documents for department; attending regular meetings/conferences of department programs; ensuring proper training of all department staff;
• Worked extensively with SOWs and acquisition management
• Extensive outreach efforts to sale program services
• Provided technical support and training, extensive project management, proposal/grant writing and initiating, collaborated with agencies such as the Center for Children and Families,
• Contract administration, coordinating media outreach and marketing activities across department programs; maintained relationship with partners, facilitate workshops, funders and sponsors;
• Wrote articles and initiated submission; media/ communication development; hiring, firing and monitoring work schedules of department’s employees;
• Processed Medicaid & Medicare enrollment claims and produced reports;
• Supervised 15 employees which include local and nationwide staff members; reviewing and submitting all reports.
• Used several Microsoft Office and Epic Resolute and more.

Senior Project Manager

Confidential

Responsibilities:

• Manager of Government Programs offered by CSC, which is a company dedicated to providing a range of valuable services to the government and commercial clients nationwide.
• Managed the day to day operations (managed 50 plus employees) of the Medicare Part D/Medicaid Program through the process of planning strategically and more.
• Performed duties such as monitoring technology teams performance levels, in order to achieve excellent quality assurance, coaching and training employees to ensure a complete understanding of applications used to assist clients.
• Extensive operations management evaluated and led processing of payment, Long Term Care evaluations, marketing & account management, client management, budgeting, extensive research pertaining to state and federal health related programs, reviewed and analyzed medical records through technology efforts.
• Extensive research/policy analysis, preparing business process description document, contract administration, schedule modifications, meeting conduction’s, and FAR regulations, determine a need for changes and made recommendations, knowledge of HIPPA, analysis of beneficiaries’ contracts to determine changes for cost related issues and more.
• Developed extensive business plan, power point presentations, meeting minutes, data collections, documentations and business requirements.
• Work projects related to claims, billing & ICD10
• Worked extensively with SOWs and acquisition management
• Analyzed policies and procedures including third party liability information ( Confidential )
• Analyzed policies and procedures including third party liability information ( Confidential ) with team efforts.
• Offered extensive account management and service to the clients through the use of FACETS, SXC, XML, MARX, MMIS, MS Excel, MS Word, Power Point, PEGA, SOA and SOAP, FILENet, Epic Resolute, IFX, JAVA Script, Greenhopper & VersionOne. and QuickFind computer programs.
• Extensive writing and analysis of data entered into the programs designed for the project.