SUMMARY

• Member of the HIPAA team that put in place current federal HIPAA guidelines for the Wellpoint Blue Cross and Blue Shield Plan.
• Provided business requirements for the HIPAA Privacy Project and configured into Anthem/Wellpoint systems.
• Accounts Delinquency Project - entailed the system maintenance of delinquent accounts.
• HIPAA Security Project - This project consisted of codes used to protect customer’s sensitive information and configuring these codes into the system.
• Worked on various EDI Transactions 837, 834, 835, 276, 270 and 271 During Anthems/Wellpoint HIPAA guideline configurations
• Account Implementations Project - This project consisted of implementing new accounts ensuring that their business needs is configured into Anthem/Wellpoint systems and consolidated as one.
• Benefit Verification Project - This project consisted of loading and testing codes and configurations to ensure benefits are processed on claims correctly.
• Obtained certification in maximizing team effectiveness.
• Received awards for perfect attendance 2 years in a row 2001 and 2002.
• Member of the MetaVance migration, conversion and testing team for NASCO and Carefirst Blue Cross and Blue Shield.
• Lead the Medicare data cleanup team that put together ideas on loading Medicare information onto the NASCO system before conversion and configuration.
• ITS Inventory reduction project; this was a project I lead, where we had to reduce the ITS correspondence (mail) that came in from out of state providers.
• Team member and Lead in the Operation Excellence Program Project for Horizon Blue Cross and Blue Shield.
• Team Lead in ICM Crisis Management when all Oncology applications are down.
• Provided Server and Network Support for the Oncology department, and provided analytical support for the application Engineers.
• Studied HL7 (Health Level 7) Specifications for EDI and messaging exchange between health Applications for healthcare information companies.
• Performed Medical Billing and Analysis with NASCO Claims systems.
• Leading the SharePoint Migration for the MetaVance team; responsible for performing conversions of MetaVance documents and NASCO Documents to the new MetaVance webpage.
• Responsible for maintenance of all documents on the MetaVance SharePoint site for all our MetaVance team members.

TECHNICAL SKILLS

• Fundamentals of Networking, Internet Protocol Systems Network Architecture, Lotus Notes, IBM Mainframe Systems A/S 400, Windows NT 2000, Windows XP, Test Director.
• Rational ClearQuest, Rational Test Manager, Reqpro, and RUP, Mercury Quality Center, Test Director. SAP applications Maintenance and support. Oracle Database testing and support
• Health Care Systems (NASCO) MetaVance Systems, ICM systems (Integrated Care Management Systems), QO Administration (Quality Oncology Administration)
• Microsoft Project and Visio.
• Microsoft SharePoint, Windows 7, MetaVance (Members Edge Systems). Webclient. SQL Basics.

PROFESSIONAL EXPERIENCE

Confidential

Sr Business Systems Analyst (mentor)

Responsibilities:

• Responsible for leading initiatives and providing consultation to the internal and/or external customer.
• Provided expertise in the customer area and provided support with technical understanding of the business unit’s systems, capabilities, and respective technologies.
• Analyze customer processes and requirements.
• Prepare specified project documentations.
• Assist in business process redesign as needed.
• Maintain communication with customer and team members and promote a team environment.
• Essential Responsibilities*:
• Gather, develop, coordinate, and maintain business requirements for various projects and/or systems from initial phase to final implementation, assuring requirements meet standards.
• Interact with users, other portfolios, and vendors for full life cycle of project.
• Troubleshoot, coordinate, and maintain production systems/programs/applications, as needed.
• Produce scheduled and ad hoc reports as necessary.
• Assist in maintenance and communication of project status reports and tracking.
• Provide user support and coordinate resolution of issues to include change management, root cause analysis, and appropriate escalation as needed.
• Develop use cases and functional specifications and coordinate the capture of process models and functional testing, ensuring system is functionally appropriate, technically sound, and well integrated.
• Develop and manage user acceptance criteria.
• Coordinate the process to analyze, evaluate, implement, and maintain systems developed internally and/or externally with an outside vendor.
• Assist in the development of project definitions, cost/benefit and risk analysis, work plans, progress reports, and presentations.
• Transition product support to systems operations.
• Assist in establishing end user training.
• Wrote requirements for the SAP application migration project, conducted requirement gathering sessions, performed analysis on current state and future state of the SAP applications.
• May perform other duties as assigned.

Confidential, Atlanta, Georgia

Sr Business Systems Analyst

Responsibilities:

• Prepare detailed system requirements and specifications and participate in the development of system solution design for existing and new capabilities and design activities.
• Work closely with Product Managers, Development and QA teams to development requirements in preparation for enhancements or system updates.
• Facilitating JAR/JAD sessions.
• Working with other analysts to detail use cases and analysis models, Functional or conceptual designs.
• Working with technical design team to complete the detail technical design and testing of the application prior to full system integration testing, using CMMi methodologies.
• Performs requirements gathering and analysis, use cases, SDLC process analysis, MS Applications.
• Analyze Client Requests for Project/Work Initiation.
• Identify and document high level business requirements.
• Provide leadership/ direction/consultation to technical staff for system solutionssupport acquisition of project resources.
• Performs testing for new or upgraded pharmaceutical system solutions.
• Manage Project Implementations and leading multiple projects for product management.
• Act as a mentor, providing coaching and guidance to Stage I and Stage II SBAs on work related issues.
• Creating project plans and timelines for requirement gathering sessions.
• Proactively consult with client and other business and technical staff to resolve business/technical issues and needs.
• Perform system analysis on pharmaceutical products for preparation for JAD sessions, and requirement gathering.
• Performs requirement gathering planning sessions using metrics such as MLOE’s to develop timelines.
• Performs peer reviews with other analyst on the team to review completed requirements before final approval with stakeholders.
• Works with technical staff and others to determine and document the root cause, propose a design solution, test and implement the solution, with minimal guidance and no negative impacts to adjacent functionality.

Confidential, Jacksonville Florida

Sr Systems Analyst

Responsibilities:

• Prepare detailed system requirements and specifications and participate in the development of system solution design for existing and new capabilities. Primary accountabilities includes analysis and design activities, facilitating JAR/JAD sessions,
• Working with other analysts to detail use cases and analysis models, Functional or conceptual designs, working with technical design team to complete the detail technical design and testing of the application prior to full system integration testing.
• Requirements gathering and analysis, Use Case, UML, RUP, SDLC process, MS Applications, and SQL Basics
• Analyze Client Requests for Project/Work Initiation
• Identify and Document High Level Business Requirements
• Provide Leadership/ Direction/Consultation to Technical Staff for System Solutions
• Support Acquisition of Project Resources
• Performs Testing New or Upgraded System Solutions
• Manage Project Implementation
• Act as a mentor, providing coaching and guidance to Stage I and Stage II SAs on work related issues
• Creating project plans
• Proactively consult with client and other business and technical staff to resolve business/technical issues and needs
• Act as a SME regarding key business functions within BCBSFL product family
• Understanding interface points of core business/systems and processes
• Verify all/most testing at the systems level
• Review test results for any system modification
• Provide direction on key requirements for test plans
• Providing research analysis and gap analysis on potential issues for existing systems, work with technical staff to determine root cause, propose, document, implement a solution, conduct testing, with minimal support
• Performs research analysis and gap analysis on ICD 9 and ICD 10 migration.
• Works with technical staff and others to determine and document the root cause, propose a design solution, test and implement the solution, with minimal guidance and no negative impacts to adjacent functionality.

Confidential, Atlanta GA

Senior Business Systems Analyst

Responsibilities:

• Reviews all work deliverables with Senior Application Manager prior to submission to NASCO Project Manager for publication to Horizon Blue Cross and Blue Shield.
• Completes weekly status report, using the customer’s status report template, each week.
• Participates in Core Team Meetings and providing input to any possible changes or enhancements.
• Follows Customers Redesign Program Management Approach and prepares deliverables in accordance with NASCO Enhancements or changes.
• Performs development of test strategies, test plans, and test grids, and deploying of test cases to the automated testing system.
• Performs executions of test using appropriate applications once test cases return from testing application.
• Performed system maintenance and support using the NASCO system.
• Conduct post implementation once changes, updates are made or migrations are performed, e.g. quality check to ensure updates or corrections using
• Responsible for all project deliverables within contractually mandated timeframe.
• Skillfully identify and pursue testing objectives in a challenging environment under minimal supervision.
• Performed analysis with client to investigate any defects on claims that are processing benefits.
• Participated in the implementation of the changes once approved by senior level directors. I’m also the team lead in testing the changes in different testing environments, before it's deployed to production.
• I then performed a regression testing for the clients to ensure there is no in production problem and monitor the enhancements for 90 days.
• Created release notes to the clients or managers using PowerPoint and all Microsoft tools to explain the enhancements or changes that was done In addition to training the new and current users.
• Performs research analysis and gap analysis on ICD 9 and ICD 10 migration.

Confidentia, Detroit, MI

Senior Business Systems Consultant

Responsibilities:

• Performs work as assigned by MetaVance Senior Business Analyst/Lead
• Reports progress of work to Senior Program Manager.
• Reviews all work deliverables with Senior Application Manager prior to submission to NASCO Project Manager for publication to Blue Cross Blue Shield of Michigan
• Completes weekly status report, using the customer’s status report template, each week.
• Participates in Core Team Meetings and providing input to any possible changes or enhancements.
• Follows Customers Redesign Program Management Approach and prepares deliverables in accordance with MetaVance Enhancements or changes.
• Performs Development and review of business requirements and documents in addition to leading project initiatives for MetaVance changes or enhancements.
• Utilize clients Project Methodologies to write business cases and requirements.
• Performs development of test strategies, test plans, and test grids.
• Perform research and analysis on EDI transactions 835, 834, 820, 276 and 277.
• Performs executions of test using appropriate applications related to the client in addition to performing different test in multiple testing environments for MetaVance applications such as webclient and NASCO mainframe systems.
• Conduct post implementation once changes, updates are made or migrations are performed, e.g. quality check to ensure updates or corrections using Webclient, NASCO and IBM Clearquest to log any Issues or defects.
• Responsible for all project deliverables within contractually mandated timeframe.
• Skillfully identify and pursue testing objectives in a challenging environment under minimal supervision.
• Performed analysis with client to investigate any defects on MetaVance
• After analysis and research, I provided recommendations on how to get these issues fixed, this was done by having meetings with the MetaVance leadership team. .
• Participated in the implementation of the changes once approved by senior level directors. I’m also the team lead in testing the changes in different testing environments, before it's deployed to production.
• I then performed a regression testing for the clients to ensure there is no in production problem and monitor the enhancements for 90 days.
• Leading the SharePoint Migration for the MetaVance team; I was responsible for performing conversions of MetaVance documents and NASCO Documents to the new MetaVance webpage.
• Responsible for maintenance of all documents on the Metavance SharePoint site for all our MetaVance team members.

Confidential, Atlanta, GA

Senior Business Systems Analyst

Responsibilities:

• Gathering of Business Requirements and writing requirements for the developers
• Perform Liaison duties between offshore developers and clients within the Oncology department.
• Performs SDLC duties from Implementation to completion for projects initiated by the business unit or operations management.
• Performs analysis on web based applications with the Oncology department.
• Reviews all requirements written in preparation for signoff with the clients.
• Performs testing on requirements once developers complete development in preparation for deployment to production by creating test cases or use cases from the scratch.
• Provided analysis and support for portal development and application development.
• Log defects during testing using Test Director and testing defects once fixed in model office.
• Provide web application support to offshore developers and oncology nurses that work the ICM (Integrated Care Management Systems) application.
• Provided Server and Network Support for the Oncology department, and provided analytical support for the application Engineers.
• Trained new developers on how to use the web based application in the Oncology department.
• Complete weekly status reports and submitting to application development Director.
• Attend Meetings with clients and developer and perform interpretation when necessary.
• Perform presentations to clients and train clients once enhancements and changes are complete.
• Performs redesign activities on the QO (Quality Oncology) systems, and providing recommendations on possible enhancements and changes.
• Utilizing Clients methodologies in writing business requirements for developers.
• Reports progress to Client Manager and Application Director.
• Writing of both High Level and detail level requirements for new clients that want system customization.
• Performs Conversion of Helpdesk tickets to Test Director using Mercury Quality Center.
• Performing System Administration duties and supporting over 300 hundred nurses across the 4 time zones in addition to performing IT analysis for the users when they have application issues.
• Performed and assisted deployments of updates to all Oncology applications and websites in the Oncology Department.
• Team lead on Crisis management when Oncology applications are down, and providing solutions to the ICM business team when issues are resolved.

Confidential, Atlanta, GA

Senior Systems Consultant

Responsibilities:

• Performs work as assigned by NASCO Senior Business Analyst/Lead or Kaizen Project Manager.
• Reports progress of work to Senior Program Manager.
• Reviews all work deliverables with Senior Program Manager prior to submission to Kaizen Project Manager for publication to Horizon (and prior to any scheduled tasks marked completed)
• Completes weekly status report, using the customer’s status report template, each week.
• Provide weekly updates to changes in vacation requests and on-site schedule
• Participates in Core Team Meetings
• Follows Customers Redesign Program Management Approach and prepares deliverables in accordance with Horizon process templates unless otherwise directed by Project Manager
• Performs Development of Business requirements and documents in addition to leading project initiatives.
• Utilize clients Project Methodologies to write business cases and requirements.
• Performs development of test strategies, test plans, and test grids.
• Performs executions of test using appropriate applications related to the client.
• Conduct post implementation once changes, updates are made or migrations are performed, e.g. quality check to ensure updates or corrections.
• Responsible for all project deliverables within contractually mandated timeframe.
• Skillfully identify and pursue testing objectives in a challenging environment under minimal supervision.
• Performed analysis with client to investigate why the NASCO system was not processing claims correctly.
• Performed research with claims analyst, and customer service reps on how the claims were processing for provider and how errors codes were stopping claims from making payments to the providers.
• After analysis and research, I provided recommendations on how to get these issues fixed, this was done by having meetings with the NASCO leadership team.
• Recommend system enhancements to suppress the suspends that happens on the claims.
• Participated in the implementation of the changes once approved by senior level directors. I also was the team lead in testing the changes in different testing environments, before it's deployed to production.
• I then performed a regression testing for the clients to ensure there is no in production problem and monitor the enhancements for 90 days.
• Created release notes to the clients or managers using PowerPoint and all Microsoft tools to explain the enhancements or changes that were done.
• Gathering of reports for different edits in the NASCO system and documentation of project updates.
• Prepared Technical Documents or modified existing documents for the development team.

Confidential, Atlanta, GA

Senior Consultant, Quality Management

Responsibilities:

• Responsible for all project deliverables within contractually mandated timeframe.
• Skillfully identify and pursue testing objectives in a challenging environment under minimal supervision.
• Interpret and understand system requirements for new and existing applications for both production and model office environments.
• Execute test using predefined business cases against a test environment.
• Participate in UVT, Migration, Regression, and parallel testing via manual and automated tests.
• Identify, manage and document defects to closure using IBM clearquest and RUP.
• Trained and lead new testers on new procedures and existing applications and testing tools.
• Performed Installations of the MetaVance Software on desktops for operations and performed technical support when issues and defects occur in addition to troubleshooting escalations.
• Performed EDI analysis on 835, 834, 837, 276 and 277.
• Trained other Analyst on the NPS (NASCO Processing System) and provided technical support for the operations department.
• Performed liaison issues between operations and the technical unit when production and testing issues occur.
• Performed functional expertise in regard to product, application and services.
• Maintained project management documentation for assigned projects.
• Performed testing on web based conversions in addition to software application products.
• Created test scripts for Manual and Automated testing.
• Performed whitebox testing in a web based environment (MetaVance Systems), testing were performed in model office, production staging, and production.

Confidential, Worthington, OH

Business Systems Analyst

Responsibilities:

• Research and provide analysis on health claims such as UB92 and HCFA claims.
• Provide technical support for operations by creating work flow processes, flow charts and developing ideas on enhancing current and future workflows for the operations department.
• Troubleshoot and provide data analysis to operations, such as detecting defects, and creating automated reports for the operations team and researching of specs to identify possible defects from either membership or claims department.
• Coding of benefits into the system and testing the benefits to ensure efficiency.
• Worked on HIPAA projects and implementation of policies
• Implementation of groups, conversion of business requirements into systems and testing of applications.
• Configuration of codes and testing of applications
• Creating test scenarios for new groups once implemented into the system
• Train new and current analyst on the NPS System and developing training documents to enhance the efficiency of the team.
• Performed claim adjudications, account implementations, claim analysis and provided technical support for Anthem’s operation department using NASCO mainframe system.
• Document and reviewed current process flows for business and vendor requirements.
• Verified environmental readiness for testing for multiple vendors between the NPS modules.
• Performed testing in various environments, model office, production staging, production, and .NET environments.