We provide IT Staff Augmentation Services!

Senior Manager Resume

Chester, VA

SUMMARY:

  • Experienced Analyst and Program Manager with a background in Healthcare operations and analytics
  • Experience in setting up new processes, operations, and Medicare programs
  • Experience working directly with senior level management in determining business needs.
  • Experience with Microsoft Excel, Word, Visio, SharePoint and T - SQL.

PROFESSIONAL EXPERIENCE:

Confidential

Senior Manager

Responsibilities:

  • Implemented D-SNP and two additional MAPD plans.
  • Responsible for managing relationships with external vendors for Medicare enrollment and OTC supplemental benefit.
  • Lead role in implementing upgraded enrollment system to handle, among other things, LEP for new commercial MAPD plans.
  • Lead role in implementing Mobile Sales app for use by call center sales agents and captive sales agents, allowing enrollment applications to be taken via URL site or via i-Pad.
  • Lead role in managing web app portal for use by prospective members looking to enroll in our MAPD plans.
  • Report development related to D-SNP and supplemental benefits using T-SQL.

Confidential

Business Analyst

Responsibilities:

  • Start-up team member with the Finance-Duals team, responsible for developing certain financial reports for use in monitoring and managing financial reporting for CMS and DMAS.
  • Responsible for managing relationship with external vendor PPL - including management of pre-payment bi-weekly invoices and monthly post-payment reconciliation. My analysis and subsequent recommendation led to ‘pullback’ of $645,000 in overpayments made to vendor
  • Lead role in Quality Withhold group - responsible for facilitating quarterly meetings with senior level staff to monitor and manage quality withhold metrics with the goal of ensuring VPHP meets quality goals
  • Designed and implemented member services and care manager member surveys that are administered to VPCC members on a monthly basis. Created surveys in SharePoint and manage survey results, creating monthly deck to share results with senior management and DMAS.
  • Developed and maintain monthly Plan to Plan (P2P) processes currently in place to reimburse other plans for prescription drug payments they have made for VPCC members and track reimbursements owed to VPHP for prescription payments made for people who are not our members.
  • Established processes and procedures for updates to ATBT and manual P2P reconciliation processes related to recent CMS Part D changes.
  • Established mentor relationship with other plans for guidance in setting up all P2P processes.
  • Identified $1.3 million in DMAS premium payment discrepancies from program inception through current date through careful analysis of DMAS premium dollars based on members’ plan, age, and region. This development ultimately alerted other duals plans in Virginia to their own DMAS premium discrepancies.
  • Developed SOPs and process flow diagrams for certain processes and financial reporting.
  • Responsible for mentoring and coaching junior level business analysts.
  • Responsible for certain monthly financial reporting using T-SQL to generate data for analysis.
  • Member of NCPDP FIR Task Group
  • Enrolled in Career Enhancement Program with VPHP.
  • Designated SME for Intro to SQL for VPHP.

Confidential

Business Analyst

Responsibilities:

  • Worked with laboratory staff to observe manual processes in order to develop data flow diagrams and create business requirement documents (BRD).
  • Developed BRD’s for graphical user interface enhancements to Renaissance, a laboratory information management system (LIMS).
  • Lead BSA on development work for the interfacing of laboratory instruments to Renaissance.
  • Created data flow diagrams for forensic, molecular and clinical genetics using Microsoft Visio.
  • Created wireframes for graphical user interface changes to Renaissance using Microsoft Visio.
  • Queried backend database and stored procedures using Microsoft T-SQL.
  • Managed defect tickets via Spice works.
  • Managed documents via TMS.

Confidential, Chester, VA

Business Systems Analyst

Responsibilities:

  • Initiated and implemented security code to track VISA and MC on-line secured codes, eliminating fraud losses of approximately $500,000 per month.
  • Worked with Fraud Authorization and IT Support Services Group, managing Intent Analysts and Operations Investigators providing transaction fraud defenses via TSYS CardGuard fraud-detection module, a rule based fraud detection system.
  • Worked closely with SME’s on and off shore to gather analytical data necessary to develop business requirements.
  • Facilitated JAD sessions via war room meetings to collect business requirements.
  • Responsible for creating and reviewing Business Requirements Document, Functional Specifications Document and documentation.
  • Responsible for implementing defenses in rule based CardGuard system.
  • Responsible for managing Chordiant fraud defense and message tables and updates in SQL for queue management.
  • Responsible for tracking implementations via Confidential ’s Service Manager.
  • Worked with off shore analysts to design fraud defenses ultimately used in implementations.
  • Gathered requirements for implementations, created specifications documentation.

Confidential

Business Systems Analyst

Responsibilities:

  • Support of E-Script, Dominion’s gas transmission accounting system
  • Responsible for monitoring defect tickets via Quality Center.
  • Use of Cognos to research data issues.
  • Gathering of business requirements for end user enhancement requests.

Confidential, Richmond, VA

Business Systems Analyst

Responsibilities:

  • Supported Testing Services Team working on the development of Shaw Spectrum, a web based Object Oriented financial accounting system using Agile Methodology. The application was designed to work with DB2, Oracle, and MS SQL.
  • Designed and executed daily smoke tests and iterative tests using Selenium, a shareware regression development and testing tool, to test the end to end (E2E) functionality of Spectrum.
  • Built test sets (batch files) to be run in Test Runner.
  • Utilized detailed Use Case diagrams, Data Flow diagrams, and user stories to analyze functionality of E2E processes.
  • Conducted User acceptance testing.
  • Utilized SQL database analysis to verify test results.

Confidential, Richmond, VA,

Bank Operations Analyst

Responsibilities:

  • Member of Strategic Reporting and Analytics group within Collection Call Center Management in the areas of early and late stage, ACD, segmentation, bankruptcy and foreclosures collections.
  • Forecasting, variance and trend analysis of collections data for financial reporting utilized by upper management.
  • Initiated testing of collection production documents for migration from Avaya database to Microsoft SQL server database.
  • Developed key drivers and performed statistical analysis to identify quantitative employee performance measurements for Strategic Development Reports (SDR’s) in the areas of Bankruptcy and Foreclosure.
  • Conducted interviews with employees to gather requirements for SDR reports.
  • Trained off shore partners on-site and via internet in preparation for takeover of Strategic Reporting and Analysis Group.

Hire Now