SUMMARY:

• Sr. Business Analyst, Sr. Systems Analyst, Project Manager, Architect, Designer, Developer, QA Testing, Programmer, Team Lead. Configuration for Health Ins software.
• Expert proficiency: SDLC methodology
• SQL & Data - mining (Advanced joins)
• Business process analysis and modeling / Requirements / Use Cases / Matrix.
• Business Analysis. Project Management, Data Analysis
• (Waterfall/Agile/combination development methodologies)
• Process Improvemen
• SAP Business Objects and Crystal Reports (7 yrs) HealthIns Claims: PowerMHS (15 yrs), PowerSTEPP (5 yrs), AMISYS (2 yrs) IBM i - series AS400 SQL SQL400 RPG COBOL QUERY (20+ yrs) SHAREPOINT development, QUICKBASE Intuit development. (2 yrs) MOBIUS Web Page HTML with medium proficiency of VisualBasic (2 yrs). MS-OFFICE: Excel, Word, PowerPoint, MS PROJECT, VISIO, ACCESS. UML Unified Modeling Language, Workflow modeling, Medium proficiency: Control-M Scheduler, ALDON / HP Quality Center /Service Center, Informatica, ETLs, Rational, Clarity AGILE / Scrum, Six Sigma, Lean. SDLC documentation: Business Requirements, Functional Specifications, Technical Specifications, Use Cases, Test Requirements Matrix, Design Specifications, Test Plan, Unit Testing, Integration Testing Healthcare and Health Insurance Apps: (20+ yrs) Develop, Analysis and Support of Finance (including Billing, A/R, A/P, Reporting, Payments, Batch Posting, State Reporting), Claims Processing, Adjudication, Enrollment /, Benefits, Configuration, Provider, Pharmacy Rx, Authorizations, Medicare, Medicaid, EDI HIPAA 4010 and EDI HIPAA 5010, ICD-9 to ICD-10 conversion, EDI 5 / 837, Security, Communications and interfaces. PowerMHS (15 yrs), AMISYS (18 mos), PowerSTEPP (5 yrs) software, and custom in-house.

TECHNICAL SKILLS:

Banking/Financial: Support all apps (20 yrs) specifically Mortgage and Banking processes. (2 + yrs)Manufacturing: Production, BOM, Purchasing, BPCS, ERP (5 + yrs)

Data Migration: Transformation between systems/platforms when employer merged companies.

Methodologies: SDLC, PMLC, Agile Scrum ( 1 + yr at BCBS of NC), Six Sigma, Lean.

PROFESSIONAL EXPERIENCE:

Confidential, Raleigh NC & Amherst NY

Principal Owner / Senior Business Analyst / Senior Systems Analyst

Responsibilities:

• PowerMHS primary claims processing software.
• Role: 50% Sr Business Analyst, 50% Designer/Developer, also Project Manager, Data Analyst and Senior Team Lead managing team of 3.
• / Benefits / Claim / Finance support projects, and Enterprise projects with BusinessIntelligence, Business Rules&Automation, EDI and Finance teams. dept included 22 communication portals including web portals.
• Write Business Process Requirements / User stories / Functional Specifications / As-is process and Future process modeling
• Data mining / Development - Technical Specifications Design / QA Test Plans / Test Scripts
• SAP Business Objects report development (WEBI, WEBI Rich Client, DESKI, Crystal) for both DB2 database (i-series) and Data Warehouse databases (2 + yrs)
• SHAREPOINT design and List design & maintenance. (2 + yrs)
• Web Page HTML development with some VB VisualBasic
• Quickbase (Intuit) development and maintenance for multiple databases.
• MS-Project, SQL, HP Quality Center, VISIO, PowerMHS, Excel, Sharepoint
• Lead PowerMHS 7x claims software upgrade
• Control-M Scheduler research/analysis.
• Quarterly PowerMHS Release Coordination and Testing.
• SDLC, Agile Scrum, SixSigma Lean methodologies
• QA Test Plans and Test Scripts development\

Confidential

Sr. Implementation Consultant Analyst, Sr. Business Analyst and Project Manager.

Responsibilities:

• One year dedicated to client: Independence Blue Cross (IBC), Philadelphia, as Sr. Business Analyst and Project Manager, QA planning.
• PowerMHS Finance and departments support on IBM midrange i-series / Mainframe / Networks /, and special projects for VP.
• For each release PowerMHS upgrade, research both new functionality and changes compared to current release level, to determine new or lost features. PMHS Release testing and business support.
• ROI Assessments.
• Work as liaison between Lines of Business, Support Partners, and Enterprise levels.
• Facilitate client meetings and conduct detailed interviews to solicit User Requirements.
• Senior management high priority project to document critical Enrollment including web portals process by interviews and research, with final deliverable of a Visio design (Current and Future process).
• SQL for data-mining, data-mapping and research. Also HP Quality Center.
• Coordinate support for production issues and service tickets, between DST and IBC.
• QA Test Plans written for regression testing.
• Senior project team member for HIPAA 5010 EDI Assessments and conversions (all segments), ICD-9 to ICD-10 conversion, for in-house and multiple clients with PowerMHS (IBM i-series) and PowerSTEPP applications. Research and Review PMHS and PowerSTEPP new release functionality for newest release.
• Various Project Management assignments for national clients, utilizing MS Project, Visio.
• Humana of Puerto Rico Implementation Project Lead on Benefits Configuration multiple LOBs.
• Multiple PMHS clients nationwide - Instructor for classes for all PMHS systems (Finance, Benefits, Claims,, Configuration, Security, EDI, Provider, Pharmacy, etc.)
• Health Partners of Philadelphia - 2 projects on Provider Configuration and EDI Configuration
• BCBS of Vermont Migration/Conversion effort. Analyst for PowerMHS5.0 installation. Additionally, designed Access database for QA Release Mgmt team to manage defects during implementation.
• Enterprise-wide systems, and large-scale systems experience.
• SDLC PMLC methodologies

Confidential, Raleigh NC

Senior Designer / Systems Analyst

Responsibilities:

• PowerMHS / PMHS Health Insurance software, QUERY, SQL, MS Project, Visio, Aldon.
• Provide Analysis and Design of PowerMHS software
• Responsible for analysis, application design, quality code reviews, and coordination/support f critical production issues.
• Write Functional Specifications Design and Technical Specifications Design.
• Facilitate client meetings and conduct detailed interviews to write User Requirements, Use Cases.
• Review User Acceptance and User Testing. Write QA Test Plans and Matrixes
• ROI Assessments.
• Enterprise-level project for Provider Network Pricing with Trizetto vendor - act as Designer and Analyst to implement real-time Claim pricing which eliminated need to maintain Fee Schedules in-house.
• Deadline oriented environment requiring prioritizing and accomplishing multiple demands.
• SDLC System life cycle methodologies.
• Project Management with Offshore and Onshore contracted software development personnel.
• Environment: IBM iSeries / AS400, RPGLE, RPG IV, COBOL, SQL, DB2, EDI.

Confidential, Amherst, New York

Senior Systems Analyst,

Responsibilities:

• Roles: Team Lead, Systems Analysis, Application Design, Development, User Requirements, Use Cases, Test Plans, Testing
• PowerMHS primary claims software on IBM i-series RPG COBOL SQL CL and BI Data Warehouse
• Crystal Reports, Informatica, MS Project, Visio, Rational Rose (UML), Aldon, Linoma Software.
• Project Manager of 2 to 14 developers for new subsystems development and maintenance.
• Perform Quality Reviews for my team’s proposed work.
• Facilitate client meetings and conduct detailed interviews to solicit User Requirements, Use Cases.
• SDLC System life cycle methodologies environment with Business Analysts, QA Dept, EDI Analysts.
• For each upgrade release of PowerMHS, I researched both new functionality and changes compared to current release level, to determine new or lost features. Then work with my dept for PowerMHS Release testing and business support.
• Support PowerMHS Releases, by researching new functionality and changes compared to current release level, including File Layout Changes.
• Facilitate client meetings and conduct detailed interviews to solicit User Requirements, Use Cases.
• PowerMHS 5.0 Release Upgrade Sr Analyst/Manager. Managed 20 month project conversion upgrade.
• Financial and Billing specialty.
• BI Data Warehouse design and development.
• SUPPORT: Configuration Finance EDI Provider Enrollment BenefitsConfiguration
• Claims Medicare Medicaid Commercial Medical-Billing Pharmacy FeeSchedules Pricing
• HIPAA, as well as other outside and inside . s for Team of Month Nov 2003 and Team Performance Plus Oct 2003.

Environment: IBM iSeries / AS400, CL, RPGLE, RPG IV, COBOL, SQL, XML files.

Confidential

Principal Owner, Manager and Senior Systems Analyst

Responsibilities:

• Design and Requirements Analysis / Project analysis, Supervise IT projects, Custom software development.

Environment: IBM AS400 RPG III RPG IV ILE, SAP (3 mos) Duration: 12 mos.