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Principal Consultant Resume

Windsor, CT

SUMMARY

  • 15 years of senior level experience, providing project management, reporting, systems and business analysis to various healthcare and government environments. An in depth understanding of PPACA related policy and experience with system strategy and operational planning for Health Information Exchange (HIE), Patient - Centered Medical Home (PCMH), Home-Medical Health (H-MH), Accountable Care Organization (ACO) and healthcare mandate initiatives.
  • Worked on many enterprise-wide projects and has in depth knowledge of application implementations and reporting notwithstanding of OLAP cubes, data modeling and mapping.
  • Aligns architecture with the business to meet key deliverables.
  • Highly self-motivated and goal oriented, analytical as well as precise.
  • Excellent planning, organizational and time management skills.
  • Works well independently with or without staff under pressure and completes tasks within allotted time period.
  • A strong communicator with exemplary listening and interpersonal skills.
  • Demonstrates professionalism, constancy, flexibility, and dependability.
  • Specializes in clinical data, information exchange, enterprise resource planning systems, systems implementation, systems upgrades, reporting methodology, relational databases, quantitative data, user-acceptance testing, systems development life cycle, quality assurance initiatives, and an in depth understanding of various data systems.
  • Also specializes in business intelligence (BI), business process improvement, developing IT audit processes particularly change management and ensuring that the controls put into place for business related processes are adhered to in accordance with corporate policy.
  • Built alliances and relationships with other departments in order to enhance reporting and data system for end-users and in turn reduce the organizations operational costs.
  • Proficient in Six Sigma, Waterfall, Agile (iterative & SCRUM) UML, and BABOK methodologies.
  • Acted as the liaison to IT and upper management in order to provide feedback and recommendations on data architecture, security permissions, application development, and enhancements.

SKILL SUMMARY
  • Hands - on experience with and passion for providing IT and analysis guidance, project management, and support to government, IT, health, insurance, and business related environments.
  • Specialize in enterprise-wide data architecture, system upgrades, implementation, reporting methodology, relational databases, testing, systems development life cycle, quality assurance initiatives, and an in-depth understanding of various data systems.
  • Highly self-motivated and goal oriented, analytical as well as precise.
  • Excellent planning, organizational and time management skills.
  • Works well independently with or without staff under pressure and completes tasks within allotted time period.
  • Strong communicator with exemplary listening and interpersonal skills.
  • Demonstrates professionalism, constancy, flexibility, and dependability.
  • Also specialize in business process improvement, developing IT audit processes and ensuring that the controls put into place for business related processes are adhered to in accordance with corporate policy.
  • Built alliances and relationships with other departments and agencies in order to enhance data systems for end-users and in turn reduce the organizations operational costs.
  • Experience using six sigma, waterfall, agile methodologies.
  • Acted as the liaison to IT and upper management in order to provide feedback and recommendations on software flaws and necessary enhancements.
TECHNICAL SKILLS

Business Intelligence S/W: Business Objects, Cognos, IBM Fraud and Abuse Management System, Oracle BI Discoverer, SAS

Databases: SQL Server 2008, DB2, MS Access, Oracle, Paradox

EMR: Epic, HealthPro, QuadraMed

Methodologies: Agile, Six Sigma, Waterfall, Scrum, BABOK

Operating Systems: MS-DOS, Windows - 98, 2000, NT, XP, Vista, 7

Payroll: ADP PC Payroll for Windows, ADP CSS HRizon(Auto link Tables), ADP EV4, ADP, Report Smith., ADP Pay expert

Programming: HTML, SQR, Visual Basic

QA Tools: Test Director, Quality Center

Spreadsheets: Excel, Lotus

Text Editor: KEDIT 5.0

Word Processing: Word, WordPerfect

Statistical Software: SPSS 8.0, SYSTAT 9.0

Others: AQT, Audit stage, AutoCAD, Aventail, Citrix, Crystal, Desktop Streaming, E-time, ERP (Munis), Live Meeting, MS Project, HP Service Desk, Issue Tracker, Outlook, OpenEMR, PC Anywhere, PowerPoint, Query Analyzer, QMF, Report Writer, Right Fax, RFFlow, SAP, SAS, Scanning, SharePoint, Snagit, SQL Developer, SRSS, Toad, Visio, WebEx

LEADERSHIP SKILLS
  • WCS: Customer driven and provides world class service to external/internal clients.
  • Coaching and Mentoring/Team Leader: provides guidance and motivation for team members to achieve personal and professional aspirations.
  • Communication: a strong communicator with exemplary listening/interpersonal skills, writes clearly and concisely; effectively communicates customer needs to technical staff and can intercommunicate throughout organizations hierarchy.
  • Organization/Planning: compile and analyze metrics reporting for achieving service levels and projecting staffing capacity.
  • Results Orientation: meets and exceeds timelines for business deliverables.
  • Consensus Building/ Negotiating: demonstrates ability to persuade others and build positive alliances and relationships.
  • Crisis Management: can guide others to refocus on goals and objectives while working well under pressure to complete tasks.
  • Strategic Thinking: streamlines processes to help reduce cost and resources while increasing productivity.
  • Creativity: championed the setup of standard reporting templates made available to external customers via web portal, which has been used company - wide.
  • Innovation: developed, implemented and promoted a SOX audit process by which the Operations and Development departments follow to-date.
  • Risk Management/Risk Taking: identifying risks and gaps, developing contingency plans of action, and maintaining communicating with key stake holders.
PROFESSIONAL EXPERIENCE

Confidential, WINDSOR, CT

Principal Consultant

  • Leading efforts to reverse engineer pharmacy data for the purposes of data modeling and future cost and benefit plan configurations.

Confidential, MANHATTAN, NY

PM/ Sr. Clinical BI Reporting & Business Analytics Consultant

  • Leading grant analytics and reporting initiatives to support NCQA/CMS- HEDIS, UDS, and QARR clinical measures.
  • Conduct detailed requirements gathering sessions for projects and authoring use cases, designing mock ups, and writing Business Requirements Documents (BRD).
  • Consults with key stake-holders to gain buy in and sign-offs on requirements.
  • Creates functional/non-functional requirements documents as wells as Requirements Traceability Matrix (RTM).
  • Assists in translating BRDs to Systems Requirement Specifications (SRS).
  • Provide expertise to requirements projects on business processes, products, and/or supporting systems.
  • Partner with BI leads to identify BI IT needs and consult on Business Intelligence solutions to complex business problems.
  • Perform assessments / gap analyses to identify opportunities for new projects.
  • Lead testing and implementation of new and existing systems capabilities.
  • Create and implement, test plans which include test cases, test scenarios, tests identities, and test data for User Acceptance Testing (UAT).
  • Build and implement processes and procedures to support SDLC and new EMR and BI platform.
  • Analyze, evaluate and deliver special reporting for Hospital-Medical Home Demonstration /PCMH/ACO program.
  • Create dashboards, metrics and reports for upper management.
  • Assist in creation of metrics and data dictionary and do cross analysis for enterprise-wide usage.
  • Perform clinical data analytics on large multi-variant data sets and metadata.
  • Advanced knowledge of SQL to extract data from a data warehouse.
  • Mapping source to target data where necessary for complex reporting.
  • Utilize BI Discoverer, TOAD, SQL Server, Crystal Reports, Cognos, Business Objects, OBIEE, IBM FAMS as BI tools
  • Assist in standardizing and data to be consistent across the business units

Confidential, FARMINGTON, CT

Sr. IT Business Analyst Consultant

  • Lead as the Consultant for complex, multifaceted IT projects defining scope, tasks and timelines to meet deliverables.
  • Assisted in implementing readiness for corporate Private Exchange to support Health Insurance Exchange
  • Solid understanding of benefit summaries as it relates to health care mandates.
  • Conduct detailed requirements gathering sessions for projects.
  • Provide expertise to requirements projects on business processes, products, and/or supporting systems.
  • Partner with leads to identify IT needs and consult on solutions to complex business problems.
  • Perform assessments / gap analyses to identify opportunities for new projects.
  • Lead the testing and implementation of new and existing systems capabilities.
  • Provide input to project plans as they pertain to requirements.
  • Apply expert knowledge of systems capabilities, processes, and tools to business issues.
  • Lead the analysis of current state and future state capabilities for IT, including user interfaces and delivery options and the tools necessary to support them.
  • Partner with Information Architecture and Solution Architecture to create a well-rounded view of the IT capabilities and needs.
  • Provide expertise to others on the techniques and tools that the Delivery Methodology recommends for requirements modeling, review, documentation and management of IT initiatives.
  • Identify and exploit opportunities for enhanced systems that align with business architecture and roadmaps.

Confidential, HARTFORD, CT

Sr. IT Consultant

  • Lead as the Business Intelligence Consultant for complex, multifaceted BI IT projects.
  • Simultaneously manage 3 work stream engagements- Property Technical and Development, Claim Legal, and Investigative Services.
  • Utilize Cognos and SharePoint as web-based tools; use SharePoint as primary documenting and project tracking tool; and use SQL and Excel as querying, data mining, and analysis tools.
  • Conduct detailed requirements gathering sessions for projects and authoring use cases, designing mock ups, and writing Business Requirements Documents (BRD).
  • Consults with key stake-holders to gain buy in and sign-offs on requirements.
  • Creates functional/non-functional requirements documents as wells as Requirements Traceability Matrix (RTM).
  • Assists in translating BRDs to Systems Requirement Specifications (SRS).
  • Provide expertise to requirements projects on business processes, products, and/or supporting systems.
  • Partner with BI leads to identify BI IT needs and consult on Business Intelligence solutions to complex business problems.
  • Perform assessments / gap analyses to identify opportunities for new projects.
  • Lead testing and implementation of new and existing systems capabilities.
  • Create and implement, test plans which include test cases, test scenarios, tests identities, and test data for User Acceptance Testing (UAT).
  • Provide input to project plans as they pertain to requirements.
  • Apply expert knowledge of systems capabilities, processes, and tools to business issues.
  • Lead the analysis of current state and future state capabilities for BI IT, including user interfaces and delivery options and the tools necessary to support them.
  • Partner with Information Architecture and Solution Architecture to create a well-rounded view of the BI IT capabilities and needs.
  • Provide expertise to others on the techniques and tools that the Delivery Methodology recommends for requirements modeling, review, documentation and management of BI IT initiatives.
  • Identify and exploit opportunities for enhanced systems that align with business architecture and roadmaps.

Confidential, CHRISTIANSTED, VI

Health Information Exchange Project Manager/BA

  • Managed day-to-day operations of the development of the state HIE infrastructure.
  • Responsible for leading the design of the HIE architecture and aligning the architecture with the business to meet healthcare reform.
  • Created storyboard and documentation for DOH web site interface for the department’s clients and providers.
  • Assisted in writing the state-wide Strategic and Operational plans for the USVI.
  • Worked closely with governance body to define strategy and policy for HIE.
  • Managed the development of the strategic and operational statewide HIE strategic and operational plans.
  • Liaised with ONC, OGM, CMS, HHS, Deloitte, and REC concerning the project.
  • Assisted with the development of the strategic and operational statewide HIX strategic and operational plans.
  • Identified commonalities across architectural solutions.
  • Provide technical leadership on both development and proposal efforts.
  • Assist in RFP process and works with third party vendors for application solutions.
  • Capture complete and detailed project assessments and ensures efficient project implementation.
  • Establish and document project plans, clearly specifying deliverables, deliverable ownership and project’s critical path.
  • Communicate project progress, risks and issues to steering committee, governance, and key stakeholders.
  • Provide ARRA reporting and documentation.
  • Complete SF424As and narrative budget justification for project.
  • Awareness of PPACA provisions regarding HIT/HIEs.
  • Have an understanding NHIN Direct protocol, Medicaid Management Information System (MMIS) capability for CMS, and CIGNA Pharmacy Benefits Management (PBM).
  • Utilized and supported ERP Munis and SAP system for documenting financials.

Confidential, HARTFORD, CT

Sr. Business Analyst / Special Investigation Unit

  • Analyzed business workflows and system needs for conversions and migrations within a BI /IT clinical teradata repository environment.
  • Utilized skills to analyze and data mine potentially fraudulent providers and members.
  • Queried and analyzed provider and membership data in order to further scrutinize outliers using SAS, SQL, Business Objectives, Excel as querying, data mining, and analysis tools.
  • Operated business intelligence IBM Fraud and Abuse Management System and used CPT codes in order to setup and run through models.
  • Prepared various internal managerial reports, presentations, and analyses to support monthly operating processes and management strategic decision-making.
  • Performed analyses to uncover potential fraudulent trends and patterns within disparate datasets.
  • Participated in analyzing and reporting on economic-driven fraud forecasts.
  • Assisted with special projects for upper management.

Confidential, BLOOMFIELD, CT

Sr. Business Systems Analyst

  • Analyzed IT workflows and system needs for conversions and migrations within a clinical teradata repository/IT environment.
  • Read use cases and wrote detailed system specifications while documenting the business needs and unit test plans.
  • Utilized SharePoint as primary documenting and project tracking tool; and used SAS, SQL and MS Access Excel as querying, data mining, and analysis tools.
  • Developed and tested data mapping, and performed QA at several stages of ETL process including running SQL queries on Oracle tables.
  • Extensive knowledge of medical terminology and related procedures and diagnostic coding (CPT-4, ICD-9, HCPCS.)
  • Analyzed business requirements and define information systems solutions to address business needs.
  • Specialized in evaluating and analyzing membership data as it related to PHI and HIPAA.
  • Liaised with third party vendor- Thomson Reuters to ensure data was properly cleansed and that all membership records were accounted for.
  • Working knowledge of the following CIGNA systems; TDS, P-MHS, Proclaim, CED, CPF, CDB, Pharmacy, HCE DM, IM Finance Marts, UM DM, Clinical Lab Database.
  • Experience with EDI (Electronic Data Interchange) processes .
  • Presented options for problem resolution using agile methodology.
  • Worked with business units, development, operations, and technical support groups in the testing and implementation of recommendations.

Confidential, WINDSOR, CT

Sr. Business Systems Analyst

  • Primary responsibility was to co-lead the upgrade of reporting databases and software to be compatible with ADP EV4 enterprise-wide platform for UTCs payroll operational use.
  • Worked within a SAP environment with all business units under Shared Business Services.
  • Additional responsibilities included writing use cases, creating mock ups, documenting requirements, leading user acceptance testing (new, regression, unit test), writing test scripts, documenting desk top procedures, and scheduling releases to test, development and production environments.
  • Utilized object oriented tools to help with analysis and process design.
  • Provided technical support and analysis services to the Governance Team to Payroll, Acquisitions, Implementation and Operations teams.
  • Secondary responsibility was to provide guidance to CSS HRizon payroll production support with HRizon Auto link tables and error resolution to multiple business units.
  • Tertiary responsibility was to document processes, create technical documentation, and provide training to end users.
  • Duties included support for UTCs payroll operations including troubleshooting and error resolution to payroll processing.
  • Provided support for business unit Acquisitions upgrades, and migration to third party payroll system.
  • Liaised with multiple departments including HRIS, IT, Labor Relations, Benefits and ADP.
  • Additional activities also included Access queries/set-up/maintenance of HRizon Auto link tables.
  • Set up and maintenance of HRizon Auto link tables.
  • SQR/SQL reporting and utilization of other relational databases.
  • Assisted is standardization of playgroups/company codes across UTCs business units.
  • Compiled and analyzed metrics reporting.

Confidential, HARTFORD, CT

IT Business Analyst II

  • Primary responsibility for data systems was to review and test each step of projects systems development life cycle from inception to completion, i.e. reviewed programming logic, test scripts, authorizations, data quality/ data integrity, etc. using Six Sigma methodology.
  • Analyzed business workflows and system needs for conversions and migrations within a clinical data repository/IT environment.
  • Gathered and documented audit findings, then reported these results to Directors and the Vice-President of Operations.
  • Compiled and analyzed metrics reporting for staffing capacity.
  • Provided guidance and recommendations for best practices as it related to being SOX compliance.
  • Assisted in guiding auditors through understanding the business processes and the controls that were set Experience with EDI (Electronic Data Interchange) processes.
  • Provided project management guidance and was liaison to 5 project managers to make sure that any outstanding artifacts/issues were remedied.
  • Extensive knowledge of medical terminology and related procedures and diagnostic coding (CPT-4, ICD-9, HCPCS.)
  • Acted as the Internal SOX Auditor for the Operations and Development teams.
  • Developed, implemented and promoted SOX audit process by which the Operations and Development departments follow.
  • Archived audit data on as needed basis.
  • Ensured that the controls put into place for business related processes were adhered to.
  • Well read on the Sarbanes-Oxley laws and MCCRs
  • Helped to set the policy and procedures for the department as it relates to SOX.
  • Audited and tested various business related projects as it related to healthcare data to ensure Sarbanes-Oxley compliance.

Confidential, WINDSOR, CT

Sr. Business and Reporting Analyst

  • Acted as liaison between IT, upper management, sales, implementations, customer service, training and reporting departments to provide feedback and recommendations on data management, software deficiencies and possible enhancements.
  • Reproduced and documented flaws and weaknesses with reporting software tools and web-based applications.
  • Tests new enhancements and provides recommendations to IT and upper management prior to roll-out.
  • Provided daily reporting tasks via phone support for accounting, payroll, and human resources ADP clients.
  • Gathered requirements, wrote specs, created mock ups, solicited sign- offs, and produced reports.
  • Assisted payroll clientele in retrieving financial data via use of SQL or ORACLE functions and relational databases.
  • Troubleshot windows/hardware issues including SAP, Oracle and PeopleSoft former clients via phone support.
  • Provided help desk phone support for ADP software to end users.
  • Created and maintains reference/technical documentation for internal clients to provide feedback and thus assist them in providing better reporting system outcomes.
  • Trained ADP clients on how to use payroll/reporting software.
  • Built and customizes financial reports for accounting, payroll, and human resources clientele.
  • Derived special calculations for financial reporting via visual basic coding.
  • Accustomed to federal, state, and institution/company’s financial reporting needs (i.e. taxes, section 125, 403b/401k, census, W2 wages, direct deposits, etc.).

Confidential, HARTFORD, CT

Health and Data Resources Coordinator

  • Setup data tracking systems for Hartford, Tolland, and Middlesex counties.
  • Uploaded monthly healthcare tracking data to statewide data repository.
  • Tracked clinical triage team and audit clinical files.
  • Assisted in preparing and generating grant statistic for program.
  • Established database on all available HIV/AIDS healthcare sources.

Confidential, HARTFORD, CT

Information Systems Technician

  • Completed daily help desk tasks which included, but was not limited to phone support.
  • Tested programming changes for daily workers usability.
  • Uploaded census files using KEDIT, a text editor for DOS and OS/2.
  • Provided software support to systems and end users.
  • Uploaded service requests using Excel for Business Analysts
  • Ran random test reports via MS Access and Crystal.
  • Created intermediate interfaces to databases.
  • Modified existing Visual Basic code in order to format census.
  • Created databases, tables, forms, and reports using MS Access.

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