SUMMARY:

• Versatile and technically sophisticated IT project professional with strong background in all phases of project realization
• Successful C - level communicator in the gathering of enterprise-wide requirements, creation of stable architectural blueprints and devising of operational and clinical solutions to establish standards and best practices that align technology services to meet business objectives
• Experienced achiever in leading local, national and international cross-functional teams, driving project milestones and coordinating team activities to achieve short-and long-term goals and deliverables

TECHNICAL PROFICIENCIES:

Platforms : Windows, UNIX, Linux, Rackspace and AWS Cloud Accounts, VLANS, Confidential AS/400 Security Officer/System Admin

End-User Tools : All MS Office Applications, Mercury Quality Center/ALM, WebEx, Skype, Reporting tools such as Business Objects (SAP), Telnet Applications, SFTP, Eclipse, Confidential MQ, SOAP UI, XML Spy

Databases: Oracle, Microsoft Access, MS SQL Server, DB2, MySQL, ERWIN, Mastery in SQL

Languages: Oracle PL/SQL, Java, VB, .Net, SQL, C++/C#, HTML, JavaScript, CSS, PHP, AJAX, XML, HTML, SOAP, Linux shell scripting, DOS Batch scripting, Perl, UML (Uniform Modeling Language), QTP (Quick Test Pro), XBASE, AWK

OTHER PROFICIENCIES:

• Operations Analysis and Requirements Gathering
• Project Management, Budgeting and Strategic Planning
• Master Data Management (MDM) and Business Intelligence (BI)
• Database Design and Application Development
• Quality Assurance Planning, Testing and Automation
• Teaching/Mentoring and Team Building

PROFESSIONAL EXPERIENCE:

Confidential

Project Manager

Responsibilities:

• Client-facing project manager of over 8 highly integrated multi-vendor health plan implementations of Aerial Care Management (Population Health - Case Management, Disease Management and Utilization Management) from project kickoff through post production support with combined project budgets over 1 million dollars at a time while also serving as primary technical resource (Systems Analyst) using technologies such as XML, Oracle, X12, SQL, HTML and Java.
• Development of project plans in MS Project for SaaS and Non-SaaS implementations, scheduling team meetings, agendas, minutes and accountability to action items (internal and client-facing meetings), approving team hours (Change Point and Service Desk), tracking project budgets and managing daily issue log.
• Educated clients (technical and non-technical personnel) in the implementation of 3 rd party integration points (SFTP, ActiveMQ or Webshpere message injection & SOAP) such as:
• Membership and Provider batch feeds (both proprietary and X12 (834 and 274)) or custom real-time on-line bridges (OLI) depending on client choice. Used tools such as Mirth, XMLSpy, SOAPUI, Microsoft Access and Linux utilities such as xmllint, awk, grep, sed, etc;
• Population Health, Business Intelligence and Analytic feeds;
• Single-Signon solutions (OpenDS, Active Directory, Tivoli, Kerberos etc), setting up users, roles, functional permissions and other security configurations;
• Correspondence Management (Top Down - Client Letter, Cincom - Eloguence, HP - Exstream);
• Custom developed endpoints (Authorization and Outcome Numbers, Custom Provider Network Searches, etc).
• Mentored Business Analysts in requirements gathering and other Systems Analysts in XML, XSD, WSDL’s and XPATH expressions using tools such as SOAP UI, XML Spy and Eclipse.
• Built tools in Microsoft Access to assemble transactions and call web services for volume testing of custom endpoints.
• Developed department standard Project Plans in Microsoft Project for SaaS and Non-Saas implementations.
• Developed product configuration tool to better assist Business and Systems Analysts in the understanding of the overall product configuration and automate the creation of new environments.
• Contributed to company knowledge base on internal Wiki and SharePoint.
• Developed custom endpoints and other custom utilities in Java using test driven development and Mirth for automated builds. Source code saved to SVN using trunk, branch, tag conventions.
• Maintained internally developed configuration tools written in JavaScript using HTML executables (hta).
• Assisted marketing activities with SOW review and answering technical and implementation questions for potential clients.
• Trained clients in Business Objects Reporting (SAP).

Project Realization Lead

Confidential

Responsibilities:

• Worked with CFO and department directors to document requirements and design of a new internally developed company-wide billing system that could accommodate all lines of business for the largest Workers Compensation payer in the US.
• Worked with CFO to sell the solution to other C-level executives .
• Extended beyond 8 week consulting assignment to mentor Business Analysts and Project Managers in the Project Management Office (PMO) and communicate solution with internal team of .NET and ETL developers.

Project Manager/Business Analyst

Confidential

Responsibilities:

• Coordinated resources of client, internal Confidential staff and multiple vendors (FICO, Radiant, MetricStream) and conducted meetings necessary to maintain accountability, communicate project status and overcome project challenges of the implementation of Confidential 's Fraud Waste and Abuse solution involving FICO Analytics (InvestiClaim) for a client with over 30 million covered lives.
• Asked to assume Project Manager after working on the project for a few months as the Business Analyst.
• Worked with Extract Transform and Load (ETL) team to make necessary process and configuration changes needed to accommodate such a large volume of data.
• Wrote designs of MetricStream conversion (client’s previous solution).
• Contributed to internal documentation library on SharePoint.

User Acceptance Test Lead

Confidential

Responsibilities:

• Recruited by former coworkers to implement Confidential ’s Confidential Medical Award project under extremely tight deadlines.
• Partnered with Project Manager and coordinated with IT on overall testing plans to ensure testable requirements, manage traceability matrices, train users in the development of test cases and determine where automated testing could be utilized.
• Developed comprehensive test plan for project that became standard template used for future projects.
• Coordinated integration of new inbound and outbound files that would be needed to support new line of business: Pharmacy Claims (CVS Caremark, Medco and Optum), Banking transactions (Fidelity) and eligibility files (834 - Confidential ) and the testing to ensure schedules and load processes were working correctly.
• Assisted testing teams in development of automated SQL queries validating load routines & test case execution of 3 rd party accumulators & benefit configuration changes to FACETS (claims-processing system) and check cycles.
• Primary liaison for external auditors hired by Confidential to certify go-live requirements were complete (Mercer).
• Planned refresh schedule of multiple testing instances to ensure testing timelines and prerequisites were met.
• Managed Quick Test Pro (QTP) developers in development of automated test cases.
• Managed testing of changes to HEDIS and NCQA reporting needed to accommodate new line of business.
• Managed testing of new telecom and voice response call center workflow designs needed to accommodate new line of business.

Confidential

Senior Solutions Consultant/Project Manager

Responsibilities:

• Coordinated the development of project requirements, technical solution designs and implementation details for claim-intake, HL7 Interfaces, X12 transactions (837I & P, 274, 834 and 278), HSS Grouping and Pricing, Claim Review, 3rd party Accumulators, Authorizations, Provider Contracting and Claim Imaging processes.
• Led all automated testing activity of this platform throughout each implementation and upgrade utilizing Agile project management methodologies.
• Successful implementation of several key components of the common claims processing platform across 4 separate Confidential divisions using Uniform Modeling Language (UML) and Waterfall project management methodologies and coordination with multiple product vendors.
• Designed, documented and implemented scores of automated testing tools and processes using Agile project management methodologies and tools such as: Mercury/HP Quality Center, Quick Test Pro (QTP) using both data driven and keyword driven testing frameworks, ITKO Lisa, Oracle PL/SQL, Microsoft Access, Unix shell scripts, Perl Scripts, Windows batch files, Excel Macros, SOAP UI, Terminal Emulation (Reflection WRQ) Scripting, JavaScript and JQuery.
• Eliminated over 5000 manual testing hours per quarter across four separate Confidential Divisions and standardized their use.
• Solved complex PHI de identification issues with test data using Oracle PL/SQL
• Automated the building of test data specific to a test case and the execution, validation and documentation of results
• Trained staff in SQL Reporting, Business Objects Reporting (SAP), Microsoft Access automation and Excel Macro’s

Financial Systems Manager

Confidential

Responsibilities:

• Payroll administrator during Confidential conversion project and divestiture of Northeast division and manager of 3rd party reporting tools such as new Business Objects (SAP) Universes and existing Impromptu catalogs for 20+ configuration and reporting analysts.
• AS400 Security Officer and Administrator of dedicated server room and private secure network responsible to ensure security of divisional payroll and HR data.
• Converted to national payroll department with no disruptions to paychecks or retirement benefits for 3500+ employees.
• Reduce time required to load 280 fee schedules from 40 people - 8 months to 2 people - 2 weeks.
• Automated retrieval of claims requiring re-processing because the fee schedules were loaded late in the year.
• Increased claims re-processing efficiency by 75% through the use of terminal emulation scripting (WRQ Reflection) against IDX (claims-processing system).

Provider Information Manager

Confidential

Responsibilities:

• Managed team of five reporting analysts responsible for all divisional regulatory reporting, customized interfaces for Division’s Voice Response Unit (telecom), Web based applications (ASP), Provider Directories, Confidential mapping systems and information security.
• Coordinated divisional regulatory compliance fulfillment with internal/external vendors.
• Eliminated redundant Credentialing department and successfully converted 2 regional FoxPro Credentialing applications (Cactus and MLS) into one new Oracle application
• Collaboratively managed RFP and vendor selection process
• Diagnosed and resolved regional Provider Directory inaccuracies (Oracle, Microsoft Access and Confidential )
• Developed and implemented the Master Data Management Strategy (MDM) using Oracle for data and MACESS for workflow management delivering divisional single-source-of-truth for provider contracting
• First in the state to achieve perfect submission status of compliance reports for NYS Medicaid
• Improved accuracy of regulatory compliance reports for Medicare, HEDIS, NCQA and other agencies
• Managed the design, development and implementation of an ASP (web based) customer service application, utilized by 100+ representatives reducing customer call time and providing better quality information to members.

Programmer Analyst/Senior Data Analyst

Confidential

Responsibilities:

• Recruited to improve data gathering and reporting processes for division’s provider relations department and resolved technical issues.
• Increased Claims processing and Member Services customer response time 15% through development of terminal emulation scripting (WRQ Reflection) against IDX (claims-processing system).
• Automated production of monthly provider capitation and fee-for-service reports out of IDX using C++ and Excel Macros.
• Developed application to allow customization and re-calculation and analysis of provider bonuses based on medical practice quality and performance profiling measures using Microsoft Access.

UR/QA Technician

Confidential

Responsibilities:

• Implemented and administered clinical QA computer system (45 users), developed applications in DBASE IV, FoxPro, DB2 and REXX.
• Established procedures for hospital-wide clinical and financial data collection and security and all IPRO audits and correspondence
• 2 years in Confidential (Registrar) and as a Patient Advocate.

Confidential

Production Specialist/Lead Operator

Responsibilities:

• Reported production results and forecasted production plans to management of a large microchip capacitor manufacturing facility.
• Trained in most aspects of microchip capacitor production and quality control.

Confidential

Quality Control Liaison

Responsibilities:

• Performed chemistry analysis and developed course of action to restore product chemistry to within specification.
• Utilized testing methods such as Statistical Process Control (S.P.C) and Design of Experiments (D.O.E).
• Communicated with production staff in Spanish.

Confidential

Bookkeeper/Front End Supervisor

Responsibilities:

• Supervised front-end staff of 7-10 cashiers and resolved customer complaints.
• Balanced cash tills, kept records of accounts receivable and accounts payable, answered telephones