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Pbm Payer Resume

SUMMARY:

  • Experienced and certified and product owner. I have a proven record of success applying leading methodologies (Structured Analysis, Object Oriented Analysis, Agile, Scrum, Lean, Waterfall, ITIL, ADKAR) to a variety of change initiatives (change management, ERP, SaaS, legacy, and integration projects) on Java/Oracle or .Net/SQL technology stacks. My motto is to lead teams to collaboratively deliver the greatest value efficiently and effectively to meet or exceed the organization’s mission.
  • Comfortable interfacing with key stakeholders and apply technical proficiency across different stages of the Software Development Life Cycle including Requirements Elicitation/Analysis, Application Architecture definition design, testing, deployment and post implementation warranty. Experienced liaison between the business units, technology teams and support teams.
  • Experienced project manager on all aspects of individual projects (e.g., solution analysis, user experience design, information architecture and content strategy, front and back - end development, technical implementation, testing and quality assurance), and have served as primary point-of-contact to stakeholders for related work.
  • Establish and maintain stakeholder relationships to determine project requirements, create proposals that reconcile stakeholder requirements with service scope and ensure proper setting and managing of expectations (e.g., project goals, scope, participant responsibilities, delivery dates, and governance).
  • Develop detailed project work plans, timelines and budget (if applicable). Maintain project assignments, monitor workloads, and resources to meet project requirements. Frequently reassess project scope to ensure projects are carried out according to established plan and budget.
  • Strong influencing skills to align with stakeholders’ practices (project management, risk management, etc.), strategies (metrics, goals, outcomes, strategic priorities), and utilizing tactics (negotiation skills, triple constraint, business relationship management principles).
  • Strong technical aptitude with system design, data extracts/analysis, report and dashboard design. Critically evaluate information gathered from multiple sources as in eliciting and verifying requirements and solution design; reconcile conflicts; decompose high-level information into details; abstract up from low-level information to a general understanding; and distinguish user requests from underlying true needs.
  • Excellent customer service, interpersonal and organizational skills; ability to analyze situations, respond independently, prioritize to meet deadlines, work under pressure, and be a team player while maintaining a positive attitude.
  • Strong written/verbal communication and interpersonal skills: effective communicator with ability to leverage technical, business and financial acumen to communicate with client executives and their respective teams.
  • Experienced with Microsoft, cloud and open source tools: MS application suite ( Confidential, Excel, Visio, PowerPoint, Outlook, SharePoint, and Project), Salesforce, HP ALM, Jira, Rally, Balsamiq and Snagit/Camtasia (prototyping tools), database query tools (SQL Server Management Studio, Toad) and report design tool MS SSRS.

PROFESSIONAL EXPERIENCE:

PBM Payer

Confidential

Responsibilities:

  • Improved organizational maturity around system development lifecycle (SDLC) and developed then implemented, trained and coached staff on change management processes and tools for SOC2 and HIPAA compliance.
  • Integrated MS Outlook Change Requests (CRs) scheduled CAB (Change Approval Board) meetings as part of SDLC/project lifecycle release planning/pre-deployment, applying ITIL framework to CRs.
  • Work within IT security policies, technology standards, network infrastructure, and organizational structure.

Confidential, Santa Ana, CA

Senior Systems Analyst and Project Lead

Responsibilities:

  • Lead systems analyst of custom developed pharmacy pricing tool Magenta for Confidential Pharmacy Benefit Management Payer, Provider business unit of Confidential 100 organization.
  • I was hired to help transition project from traditional waterfall to agile project approach, however based PMO funding at project/program level, the organizational culture and high risk level mandated we keep waterfall project approach. Documentation approaches are UML and structured analysis.
  • Rescued struggling multimillion dollar custom software development project Magenta by expertly facilitating four weeks of JAD sessions, prioritizing requirements, modeling then tracing specifications to requirements and test case outcomes for Confidential 100 healthcare organization.
  • Received thanks and appreciation for leadership in successfully completed JAD sessions by IT management, and received Diamond Level recognition for leadership and team contributions by Program Manager - PMO.

Confidential, El Segundo, CA

Consultant and Senior Business Analyst

Responsibilities:

  • Rescued failing multi-million dollar ACES SaaS software project through analytical and systematic requirements verification, traceability, and prioritization.
  • Derived analytical traceability approach combined with leading facilitated Joint Application Design (JAD) sessions to meet extensive reporting requirements, and confirmed business rules around required documents that were ingested and produced for more than 200 civil enforcement types of service.
  • Evangelized business analysis standards of practice as a leader of Sierra's BA Center of Influence.
  • Applied proven business analysis through the application of established frameworks, methodologies and processes.
  • Facilitated JAD sessions or other formal information gathering activities.
  • Lead the development of use cases, state diagrams and system requirements specifications techniques.

Confidential, Long Beach, CA

Senior Technical Business Analyst and Configuration Admin

Responsibilities:

  • Help coordinate acquisition of equipment through established purchasing and leasing processes.
  • Develop, maintain and manage relationships with third-party software vendors and consultants to ensure service levels are met and maintained.
  • Reduced process overhead while managing enterprise wide initiatives, minimizing time and budget dollars needed for successful implementations.
  • Advised and recommended streamlined IT processes to standardize support and system implementations improving system reliability, reducing system downtime and technical support response time.
  • Cross-trained infrastructure and legacy development teams on establishing and appropriately supporting Windows platform alongside third party interfaces and Mainframe legacy systems.
  • Provided business analysis and project management expertise implementing IT process and system changes to support streamlined project management and business analysis practices, work products and deliverables.
  • Perfected system integration modeling from concept through implementation.
  • Selected to participate in the intensive and exclusive 11-month leadership program - Confidential Leadership Academy.

Confidential, Long Beach, CA

Consultant

Responsibilities:

  • Incorporated brand management by conforming graphical user interface "look and feel" to follow Corporate Style Guide on all custom designed web and Windows based applications internally constructed.
  • Evaluated multimillion dollar RFPs then wrote and presented business cases to executive IT project committee.
  • Designed change management processes and documented procedures for custom developed maintenance and support system.
  • Developed, tracked, and managed project plans including goals, strategy, resource scheduling and detailed implementation timelines for IT department.

Confidential, Long Beach, CA

Senior Business Analyst

Responsibilities:

  • Conducted preliminary investigation for all project requests, including identifying requirements, specifications, testing plans, support and training plans to ensure conformity with business objectives.
  • Maintain HIPAA, SOX, CMS compliance.
  • Created then conducted training of IT staff on change controls for SOX, HIPAA and CMS procedures and processes.

Confidential, Orange, CA

Marketing Manager

Responsibilities:

  • Managed half million dollar marketing department budget for all advertising and creative materials and led artistic direction into overall advertising campaigns for several new product/brand launches.
  • Managed team of 5 graphic designers and copywriters for in-house and vendor content created for multiple company lines of business encompassing a wide variety of health and life insurance administrator’s marketing and sales and marketing communication for print, radio and electronic media.
  • Planned and managed $1.5 M annual department budget and conducted financial analysis such as ROI measures on variety of projects under consideration.
  • Created innovative, successful process and system redesign of automated (Coordination of Benefits Retirement Administration) COBRA program tools from existing static product.

Confidential, Long Beach, CA

Marketing Designer (Business Analyst, Product Management)

Responsibilities:

  • Benchmarked database performance through custom SQL queries and recommended specific data input standards and validation techniques to reduce bad data in database due to free form user input, reducing related data entry errors to no more than 5% error rate.
  • Automated system increased member satisfaction and was extensible as data tier for web site portal www.scanhealthplan.com.
  • Created end user training, installation support/documentation and contributed to system output and system design in controlling the brand image consistency and representation throughout system deliverables and documentation.
  • Copywriter and creative designer for enterprise-wide marketing and sales communications.
  • Worked with print vendors to produce marketing materials.
  • Planned and scheduled multiple advertising channel (radio, tv, print).

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