SUMMARY:

• Software Development System Design Process Improvements Dynamic, detail - oriented, bilingual Software Engineer with a proven track record for requirements gathering, designing, and developing applications. Excels at learning new technologies and applying them to develop clean and well-structured code.
• Experienced at working on projects at all stages of the Software Development Life Cycle (SDLC) from idea to development to delivering the completed product.
• Promoted to positions of increasing responsibility by exceeding overall performance expectations, outstanding leadership ability, and customer service attitude. valuated purchases from suppliers for quality, pricing and delivery timeliness.
• This function required I functioned as vendor manager to initiate and handle relationships with vendors and their company’s operational department.
• Such relationships provided a platform to negotiate on behalf of the client company for the best value of purchases that support its operations and business objectives.
• Performed a number of duties in the role as Project Manager for several organization.

CORE COMPETENCIES:

• Application Programming
• Disaster Recovery Implementation
• SCRUM
• Change Management Specialist
• Client Relations Manager
• Master Data Management
• Business Intelligence
• Credit Card Processing: Confidential
• Software Analysis and Design
• Agile Professional
• Earned Value Management Analyst
• Workgroup Facilitator
• EXIT & Remedy Identity Management
• PMP Course work completed, Exam for Certification scheduled within 6 months
• Application & Unit Testing
• JAVA: Affordable Care Act, Confidential, Stanley Morgan Financials)
• Access Management
• Pega7 and Cloud

PROFESSIONAL EXPERIENCE:

Confidential

Project Manager, Baltimore, MD

Responsibilities:

• Development of Remediation Plan
• Gather requirements in perform gap analysis. Illustrate current and existenting workflows
• Develop Organizational Network Management Plan
• MDM Utilize the most recent warehouse file to stay up to date and reload using ETL to populate software for as needed data analysis
• Incorporated the use of Cloud and Pegs 7 to distribute data in the Disaster Recovery workflow
• Utilized tools for sprint planning. Sprint planning meetings determine what the team should complete in the coming sprint from the backlog, or list of work to be done
• Track and manage sprints
• Led Daily scrums or stand ups
• Preformed Data Modeling featured for Kanban, Waterfall and Agile methodologies

Confidential

Consultant/ Business Analyst

Responsibilities:

• List
• Change directory
• Move files
• Manual of inputted data
• Remove directory
• Make files
• Equate text files
• Remove files
• Locate/ find files
• Clear files

Confidential

Sr. Business Analyst, Birmingham, AL

Responsibilities:

• Tools for sprint planning. Sprint planning meetings determine what the team should complete in the coming sprint from the backlog, or list of work to be done. ...
• Track and manage your sprints. ...
• Daily scrums or stand ups. ...
• Features for kanban.
• Confirmed clients were current on Mandates, Banners, and Bulletins for Confidential and Medicaid by using test scenarios that followed the full Claims Processing lifecycle. gap analysis for coded, loaded, and tested claims processing on current and future platforms then applied this data to guide the transformation of the systems using agile methodologies.
• Processed claims in compliance with policies and procedures as defined by the Centers for Medicare and Medicaid’s (CMS) Regulatory Affairs.
• Used SCRUM Responsibilities and Agile Methodology as needed perform checks and balances as understood according to priority set by the product owner. Scrum Master was executed to handle backlog as the Project Manager, making sure that deliverables are on time with production quality
• Conduct sprint and reconciliation ceremonies
• Update changes for IT development and product enhancements< -- -->
• Planning and Defining Scope.
• Activity Planning and Sequencing.
• Resource Planning.
• Developing Schedules.
• Time Estimating.
• Cost Estimating.
• Developing a Budget
• Documentation: Creating artifacts and supporting documentation

Sr. Project Manager

Confidential, Owing Mills, MD

Responsibilities:

• Provide Requirements as stated by client so that Departments can apply quality to deliverables provided via training and on-boarding of new hires
• Have experience with Confidential . Built group structures identifying Confidential members via Enrollment, Billing and Eligibility as well as contracting and compliance benefits
• Identity Management/ Cloud
• Worked as part of a cross-functional Change Control Board to evaluate using either Agile or Waterfall methodologies.
• Administered contracts, including on-boarding, off-boarding, resolving issues, and coordinating periodic reviews with management and other stakeholders.
• Managed risk by identifying issues and then allocating appropriate resources.
• Initiated project milestones then scheduled, executed, monitored and controlled the program through to completion.
• Trained providers on payment services and options provided by the health care plan.
• Streamlined Remedy ticket processes, writing guidelines for completing a ticket analysis.
• Performed a gap analysis for call center deliverables.

Project Manager/Tier 3 Support Supervisor

Confidential, Falls Church, VA

Responsibilities:

• Produced a Statement of Work, supported project development and planning, and developed a communications plan.
• Maintained a website with WordPress to communicate the latest SOP changes required by CMS.
• Provided Tier3 support for edge server used to provide assistance with Confidential Reinsurance and Risk Adjustment.
• Supported the HHS-operated risk adjustment methodology determined each
• Triaged customer support issues regarding member enrollment from Agent Brokers, Issuers, and Submitters.

Sr. Project Manager

Confidential

Responsibilities:

• Supported the cross-functional development efforts for a mobile version of their web site.
• Supported Business Analysts with access to existing, impacted work flows.
• Establish workflows across business membership and accounts including those with ASO and Fully Funded arrangements incorporating Flexx/ Facets/ Medicare D incorporating CMS Mandates with HIPPA Compliances.
• Use Market Data Management principles to establish marginal requirements.

Sr. Project Manager

Confidential, Boston, MA

Responsibilities:

• Managed a cross-functional team to develop a charter and technical/functional project plans in MS Project, including assessing risks for Healthcare Reform products and processes such as enrolment, reinsurance, and providing rates.
• Analyzed risks for performing proposed system enhancements and developed contingency plans.
• Maintained a documentation library on SharePoint for charters and project plans.
• Scheduled kick-off meetings to present final deliverables and processes, identifying milestones and testing criteria.
• Implemented SOP’S for all systems based on CMS requirements.
• Consumer Driven Healthcare

Project Manager Coordinator/Consultant

Confidential, Baltimore, MD

Responsibilities:

• Facilitated status meetings to provide updates on the system conversions projects incorporating ICD10 compliance with CMS Mandates as well as EDI requirements for providers and carriers.
• Employed Pega Systems Software to run test claims processes during ICD10 training, incorporating Ruby tools to validate that the correct, updated ICD codes were used.
• Coached staff according to CMS Guidelines on the ICD10 Implementation Phases.
• Worked in a cross-functional team to scope the project, assess risk, and assign resources in a work breakdown structure.
• Monitored project progress, coordinating and documenting changes to the scope, schedule, and costs.
• Performed a systems analysis to convert Care of Service products from ASO to fully-insured enrolment.
• Conducted, on behalf of payer organizations, gap analysis, requirements analysis, and risk analysis - saving millions of dollars in streamlined oversight procedures.

Project Manager/Coordinator

Confidential, Tampa, FL

Responsibilities:

• Managed technical and functional personnel in support of the Automated Billing Integration process, enhancing the Credit and Returns IT capabilities using both Agile and Waterfall.
• Documented changes for beta testing.
• Developed requirement specs for scope, quality, and software development requirements to determine cost for review by Underwriting.
• Coordinated with IT to establish the ETL timeline.

Senior Retail Vision Provider Relations and Business Development Specialist

Confidential, Columbia, MD

Responsibilities:

• Documented the SOP’s for contract technicians.
• Coordinated the signing and processing of a wide range of previously unaccounted for legal contracts from numerous CEO’s of large corporations regarding rate and reimbursement adjustments required for the brand name change from Spectera to Confidential .
• Identified retail chains needing performance monitoring and reporting systems then acted as a liaison between Providers and Operations for UAT and Model Office Evaluations.
• Managed projects, using MS Project to communicate to the cross-functional work group and management.
• Analyzed data for rate variances based on region, creating reports illustrating utilization from both providers and members.
• Implemented the use of EDI to process retail claims for Provider reimbursements.

Implementation Project Manager

Confidential, Owings Mills

Responsibilities:

• Explain how end user would use what you created
• Explain testing you completed
• Any non-requirements taken into consideration
• Lessons learned and take-away
• Alternative analysis/ Could it have been done?
• Any dependencies
• Provide constructive feedback
• Retrospective- Core engine of continuous improvement efforts
• Control and Monitor User Acceptance Testing
• Risk adjustment experience evaluated risk adjustment as it relates to the Affordable Care Act BCBC Boston, Massachusetts. Final deliberation haulted pending Congress approval 2013. Risk Adjustment now under re-evaluation. Funding and support required from current Administration to adjust current risk.
• Claims adjustment 7 years experience. Adjusted denied or retro-activity claims according to either or account request or as mandated via Regulatory Affairs.
• Lead and Manage Technical and Functional Personnel
• Verify that the test cases provide comprehensive and effective coverage of all aspects of functionality of the application team’s role in documenting problems and working with the project team to resolve problems identified during testing
• UAT to team agree upon and understand the range of severity levels discussed with the project team and project stakeholders make understand that it must sign off on all test cases by signing the completed test worksheets
• Ensured that teams could recognize changes necessary to existing processes and take a lead role in ensuring that the changes are made and communicated to other users
• Taught and provided its role in verifying performance on business critical functions
• Integrated an understand its role in confirming the integrity of data
• Demonstrated roles in assessing system final production readiness?
• Showed resources its responsibility in executing the test cases and ensuring that the final outcomes of the tests are satisfactory