SUMMARY:

• Senior - level Business Analyst and database analyst with over 14 years of professional experience in the analysis, design, development, execution, and delivery of highly complex, customized technology solutions.
• Expertise in diverse development platforms accompanied with multifaceted programming capabilities with a strong emphasis on Microsoft-based technologies - including SQL Server.
• Firm hands-on experience in Software Development Lifecycle with an experienced approach in SCRUM and AGILE.
• Solid analytical and project management background in formulating technology solutions for healthcare industries - including a strong knowledge of Facets Software (version ), HIPAA 834,835 & 0/271,276, 277, X12) compliance file formats, 5010 formats, ICD-10 and Medicare/Medicaid environments, Health Edge 4.31-4.6.
• Expertise in eliciting stakeholders to help them understand their requirements within the scope of a project including eliciting requirements, brainstorming options, analyzing documents, running focus groups, analyzing system interfaces, interviewing stakeholders and subject matter experts, observing real-time activities and work environment, facilitating requirements workshops, reverse engineering existing systems, and collecting input via surveys and questionnaires.
• Requirements Analysis: Working with the whole project team towards defining a solution that will meet the agreed requirements including documenting and analyzing business inputs, modeling the business domain using process diagrams, flowcharts, data models, exploring behavior models (use case, user experience design, storyboards, wireframes, user profiles and user stories), assessing business architecture, performing gap analysis, conducting feasibility studies,, and verifying and confirming requirements.
• Solution Assessment and Validation: Assessing proposed solutions to help the stakeholders select the solution which best fits their requirements including developing mechanisms to assess how well solution meet system requirements, evaluating alternate solutions, determining quality assurance mechanisms, crafting and assessing Requests for Proposal, supporting implementation through periodic check ins of requirements clarity and scope definition.
• Skilled team leader; adept in training, coaching, and motivating members to support broad ranging development, functional, and operational needs.
• Smart working and focused with exceptional analytical, organizational, and interpersonal skills.

TECHNICAL SKILLS:

Languages: MS SQL Server 2000, MS SQL Server 2005 (test environment), Sybase 12.0, Oracle 9i, Access, Informix, FoxPro, TSQL, PL/SQL, DTS, SSIS (test environment), Visual Studio.NET, ASP, Visual Basic, Visual Interdev, C, C#, Visual C++, XML, Windows/UNIX Socket programming, Delphi, Pascal, Perl, Assembler.

Software: FACETS (versions 2.96, 4.11, 4.21, 4.31, 4.51,4.7,5.01), Health Edge (Health Rules Payor),DataStage 7.5, Microsoft Office, dBase, Excel, Rapid SQL, TOAD, Crystal Reports XI, CPS, Qiclink

Platforms: Windows NT, Windows 2000, DOS, AT&T/Unix, Sun/Unix, HP/Unix, Linux

PROFESSIONAL EXPERIENCE:

Lead Technical Data Analyst

Confidential

Responsibilities:

• Develop clinical reports based on clinical, utilization and demographic data feeds from source vendors.
• Develop SQL triggers and stored procedures to identify key Facets clinical data elements in file transfers and translate data into homegrown data warehouse.
• Mentor Data Analyst staff in understanding Facets Membership/Claims/UM Data model to facilitate report development.

Facets Configuration Consultant

Confidential, Roch, NY

Responsibilities:

• Analyze current products and configuration for changes necessary to meet HCR regulations.
• Configure benefit products within Facets 5.01 to meet new sales requirements and promulgate changes throughout development environments.
• Elements of Facets Benefit configuration include but not limited to: (Product DEDE, LTLT, SERL, SEPY, BSBS, BSDL,PDBL)
• Recommend business processes to make configuration of benefit packages more efficient throughout development lifecycle.
• Liaison with Technical and System testers to ensure correct understanding of system coding and aide with testing scenario development necessary to effectively test configuration.
• Troubleshoot Facets 5.01 to locate any inefficient configuration (Product/Membership build) and make necessary recommendation toward solution in system configuration.

Facets Technical Consultant

Confidential

Responsibilities:

• Assess Facets configuration for Confidential of New York
• Interview key resources to determine actual Benefits and Product configuration Facets 4.71 and develop recommendations on more efficient configuration for Facets5.01.
• Recommendations given to Upper management on more effective Business process and communication opportunities to effect overall configuration strategies within the company.
• Developed an assessment package which could be followed to achieve HCR product changes within the new Facets environment.

Principal Consultant

Confidential

Responsibilities:

• Manage activities of the Configuration Competency center.
• Lead team of configuration analyst developing Healthedge product in Provider Contract pricing configuration for Fortune 500 client.
• Developed mentorship programs of the configuration team including pricing and processing rules configuration of the HR system. Develop system architecture to achieve client goals surrounding provider contract pricing goals.
• Report activities directly to PMO and align development strategy with corporate implementation planning.
• Manage budget constraints and report resource efforts to manage overall project efficiency.
• Document and review findings with customer to facilitate solution design for the business configuration of Health Rules product.
• Configure the system that will include information like benefit plans and provider payment provisions.
• Work with customers to define and build complete test cases.
• Act as a customer advocate; work closely with all stakeholders, articulate customer's business.
• Lead and manage a team of customer resources while configuring Health Rules product.
• Participated in delivery of commercial software, either externally procured or internally developed, including participation in a SDLC, within the healthcare payer space.
• Developed business processes between configuration teams and QAT to ensure timely transfer of test environment data to QA environment for additional quality measures on client configuration.
• Initiated standards such as second level peer review of Provider Contract configuration and Unit Test result review of the same contract configuration. This enabled Quality Assurance teams to have more effective lead times in preparing test cases.

Confidential

Benefits Configuration Analyst

Responsibilities:

• Develop benefit product configuration for multiple Motorola Client countries
• Document requirements and troubleshooting techniques for Employee Benefit Election system.
• Develop Benefit Rules Calculation based on a countryon country requirements basis (Israel/India/China)
• Managed development of 834 transaction set for Benefit Election System.
• Develop Web Portal visualization and calculations from host (Motorola)database.
• Document and report status of configuration efforts and relay to Senior Management
• Lead team of configuration analyst during troubleshooting and requirements gathering sessions
• Communicated system requirementsto country representatives in India/Israel and China in their respective time zones.
• Project management of tasks necessary to develop in-house Motorola benefits system and relay development needs to IS team.

Confidential, Rhode Island

Trizetto Facets Benefit Configuration Analyst

Responsibilities:

• Analyze exiting client healthcare products and advise on methods to configure products in Facets environment 4.71.
• Develop Facets Trizetto Benefit configuration for client healthcare products (Commercial, Medicare, Medicaid) in version 4.71
• Develop tools in MS Access/Sybase to help client quickly access information from Facets databases.
• Data then used to ascertain the validity of claims payment and membership ad-hoc reporting.
• Lead project QA Analysis team in validating current configuration while training client staff on current Industry testing methods.
• Lead team of client associates in building Benefit configuration in:
• Developed processes to account for thorough documentation of all configuration developed utilizing Worksite and SharePoint applications

Confidential

Sr. Project Manager

Responsibilities:

• Contributed to the successful achievement of the Affordability team goal to improve medical costs
• Successfully deployed projects in accordance with rollout schedule with minimal disruption using established Road to Deployment, UHC Operations and Medical Cost Management Team processes
• Utilized business analysis, project management and Six Sigma techniques to drive root cause identification and solution implementation
• Use project management tools (i.e., project charters, task lists, risk management plans, communication plans, benefit models, change management plans), and software (Microsoft Suite) necessary to be successful
• Coordinate and complete projects across various functional areas.
• Presented and communicated project progress to core team, work team, senior leaders in a fashion that makes it easy for the audience to understand, using the most effective way (right graph, right content, right formatting) to display work.
• Trained essential resources on newly implemented Enterprise software using Procedure and Policy techniques.
• Provided subject matter expertise in areas including project management, project scope definition, cost/benefit analyses, data mining, risk identification, project methodology, resource allocation, facilitation, and other areas of expertise based on professional knowledge and background.
• Generated status reports and metrics as required. Ensuring projects are completed on time and in control.
• Engaged other key matrix partners / subject matter experts to define project scope, perform levels of analysis, strategy development, and project implementation.
• Managed Systems analysts/IT Analyst in the development of HIPPA compliant EDI Gateway.
• Managed development timetable for enhancing EDI format file deployment of 837 (claims), 834 (Enrollment/Membership), 835 (Claims Payment Advice), 276/277 (Claims Acknowledgement), 270/271 (Eligibility) and X12 EDI file format (837) transaction set.
• Managed development of EDI transaction file formats from four different healthcare platforms (QuickLink, Facets, QNXT, CPS)
• Engaged IT and Systems analysts in developments sessions on best practice techniques to mine source data from healthcare platforms in HIPPA compliant format.
• Developed dependency matrix to facilitate EDI file development and project development timetable.

Confidential, Moline, IL

Facets Technical Consultant

Responsibilities:

• Facets Provider Implementation technical consultant
• Advised Business/IT staff on best practices for Facets Implementation
• Advised Business/IT staff on best practices for Provider Matching logic implementation and coding
• Advised Business/IT staff on areas of Provider data cleanup and data mapping principles

Confidential, Baltimore, MD

Quality Reporting Analyst/Facets Configuration and Report Development Consultant

Responsibilities:

• Developed and Implemented quality reports to determine differences between client Datawarehouse environment and Facets 4.51.
• Documented data integrity issues and coached client through Facets data mapping to Datawarehouse environment.
• Instructed client on Facets 4.51 mapping to Data Warehouse environment in following Facets modules:
• Enrollment/Membership
• Provider
• Claims
• Billing
• GL/Financials