SUMMARY:

• Experience with BPO, EMR, Salesforce technical design/ implementation, financial, sales, cloud, testing, HICN, MBI, MCO updates, project schedule, and deliverables with remote and off - shore teams.
• Experience with migration, implementation, design controls, device specs, DHF, DMF, DHR, quality controls and risk.
• Experience with project planning, Oracle, CRM/ updating milestones, progress, remote teams, tasks, project plan, scope, change management, support, documentation, testing, security, issue resolution, allocations, rules, audit, legal, Ad hoc support, and security.
• Experience with 837, 820, 835, 270, 271, 276, 277, 278, test plans, cases, new Medicare CMS card change, HICN, MBI, replacing Medicare ID format, experience with UAT, development (DEV), and various internal/ external test environments within healthcare.
• Experience with VA, DALC, DMPs, telehealth, DRGs, determining risks, IT, requirements, vendor partnership, VA schedules .
• Experience creating project plans, schedules, WBS, establishing goals, expectations, tracking tasks, and managing escalations.
• Experience managing managers, IAM, salesforce implementations, project managers, meeting and building relationships with decisions makers, communication with all levels, enterprise applications, security, Oracle products, SQL, MS Analyzer, SAP, reporting, assigning task, project expenses, timesheet/ travel approvals, resource training plans, and manage project portfolio.
• Experience quickly obtaining knowledge of the business, partnering with peer executive management on issues, business, change management, resource allocations, business models, cost reporting, budget, products, services, expansion, and growth opportunities.
• Experience with federal, state, gates reviews, governess, government documentation, IAM, government funding, regulations, VA, presenting business value, application licenses analysis, healthcare purchasing, pharmacy, claims, IAM, design, and implementations.
• Experience with project charter, kickoff meetings, weekly project agenda/ goals/ objectives, and SP documentation management.
• Experience with encounters, Oracle, CRM/ updating milestones, lessons learned, meeting minutes, testing, creation of test plans, test cases, mainframe testing, documentation of test results, steps to re-create system issues, experience with UAT, and development.
• Experience with FDA design controls, requirements for design controls, device specs, DHF, DMF, DHR, quality controls and risk.
• Experience with HRIS, workers compensation, legal, Taleo, onboarding, configurations, support, documentation, testing, security, service request, Oracle Cloud, capital management, talent management, requisition, issue resolution, Ad hoc support, and security.
• Business Analyst professional with CRM, healthcare, HIPAA, auditing, finance, salesforce implementations, business intelligence, IT, management, reporting, analysis, change management, requirements, security, financial analysis, tracking, leadership updates, and issue resolution.
• Experienced project manager with project scope, planning, estimations, prioritize Agile/sprint planning, monitor team activity, project reports, manage task dispositioning, defining requirements, collaboration, reporting, and business analysis.
• SME for workers compensation, rules, policies/ procedures, eligibility, enrollment, Medicare, Medicaid, MITA, MMIS, pharmacy, EDI, billing, transaction 270/271, enrollment/ response 276/277, 820 payment/ tracking, 834, benefits/ maintenance, 835 ERA/ tracking, requirements, reporting, testing, test/ use cases, implementation, and support experience.
• Great hands-on healthcare IT aptitude, HEDIS, Medi-Cal, MITA, analysis management, knowledge, claims, IT, SDLC, dental, Coding, project planning, quality, leadership updates, pharmacy, testing, enhancements, implementation, and capturing requirements.
• Experienced project management expert with remote team, work break down, burn down, project funding, metrics, and accounting.
• Experienced in healthcare payee/payor, EDI, EHR, EMR, TOC, coding, finance, change process, compliance, testing and validation.
• Experienced SME for project funding, milestones, financial and system analysis, support of Remedy/ Salesforce implementations force ticketing system.
• Solid workforce management experience, data analysis, mapping, configurations, leading remote resources, and financial background.
• SME for ICD 9-10, CPT’s, DRG, HCPCS, business analysis, web tools, MMIS subsystems MARS/SARS, and healthcare.
• SME and lead for feasibility analysis, clinical support, MU I/II, CPOE, policy/ procedure, requirements, finance, and project funding.
• Experience with Confidential, Cerner, Epic, Clarity, report writing, clinical applications, mobile application, patient portal, patient portal, claims, coding, provide support, define changes, review and define deliverables, testing, and acquire approvals.
• Great diverse skill-set professional with 18+ years’ healthcare, IT, hospital scheduling, HEDIS, finance, project charter, funding, estimations, work effort, design, analytics, TRIRIGA, project metric tracking, audit, and quality experience.
• Experience with FDA design controls, requirements, design controls, device specs, DHF, DMF, DHR, quality controls and risk.
• Experience with test plans, test cases, mainframe testing, documentation of test results, steps to re-create system issues, experience with UAT, development (DEV), and various internal/ external test environments within healthcare.
• Seasoned PM/ BA with Oracle, enterprise manager, Inter/Intra targets, various OS, middleware, service packs, security, consistency management, great experience with applications: Cerner, Pulse, and Epic, Medhost, Meditech, Aetna, Athena, CMS, Medicaid, CRM, TFS, JIRA, interfaces, portals, mobile app development, Business Objects, SAP, Crystal, SharePoint, Analyzer, Salesforce implementations force, Query, DW, and related.
• Experience supporting management, salesforce implimentations, finance, information systems, reporting, new business development, RFP, EDI, enrollment, X12, QA, migration, operations, CMS, TFS, JIRA, testing and training.
• Professional with large projects, leadership experience, clinical and mobile applications, patient portal, requirements interviewing, meeting facilitation, project management, HEDIS, SOA, finance, HIE, and MUI/II.
• Experience with MMIS claims, billing, provider, healthcare, banking, IT, UI, planning, mapping, merging data from various sources, adhering to budget, determining critical paths, milestones, resource management, cross-functional team management, trend analysis, reporting project progress, issues, risk, and critical path.
• Experience with BI, enhancements, implementations, HRIS, Telco Enterprise / Business Recruiting, SQL, process analysis/ re-engineering, testing, change management, payor data analysis, and feasibility analysis.
• Managing scope, contract adherence, project initiation to successful delivery, mentor, validation of work, technical staff, vendors, on/off-site teams productively, removing barriers, training, and client expectations.
• Business analyst experience asking the right questions, envisioning ideas, creation of use cases, testing DIV, UAT, PROD, HEDIS reporting, quality, MMIS, MARS SURS, MITA, MECT, encounters, and work with quality.
• Over 18 years of experience in project management, business analysis, testing, requirements documents, artifact tracking, finance, budget, information systems, SOA, BI, revenue, SME, healthcare, analysis and implementations.
• Experienced with eligibility, claims, reporting, TPL, provider, management, coding, and full claim life cycle.
• Seasoned SME in healthcare, government regulations, claims, billing, change management, HIE, technical specifications, performance standards, salesforce implementations / marketing, manuals, data models, modeling, and reviews.
• Over 15 years’ experience that includes on/off-site teams, MMIS Systems, healthcare, programming, SQL, JavaScript, CSS, HTML, rules, dashboards, flow diagrams, BW, SFDA, SAP, Crystal reports, SP, and tableau.
• Seasoned professional managing testing process, Micro Strategy, HP Quality Center, insurance, technical teams, on-shore/ off-shore teams, web portals, test plans/ cases, working remote, and reporting.
• I have experience with enrollment EDI, HL7, X12, 270/271, 276/277, 820, 834, 835, 837, meaningful use, testing, data elements, data mining, 4010a1 to 5010, development, support, and analysis.

TECHNICAL SKILLS:

• EDI, HL7, X12, ANSI
• SQL/ Databases
• TFS / JIRA / SP
• PowerPoint/PeopleSoft
• Salesforce/ Cloud
• Agile / Waterfall
• SFDA, SAP, BW
• HRIS
• Telco Recruit/ Onboarding

BUSINESS SKILLS:

• Project Management Program Management Client Engagement Management Risk Management
• Project Planning Business Analysis Testing Technical Writing Program Management IT Planning
• & Management QA RFPs Data Integration Data Mapping Data Modeling Salesforce
• Medicaid, Medicare, Pharmacy, 4010/5010, Certified, Oracle CRM, Athena, Analyzer SharePoint, Cerner, MedHost, Pulse, Meditech, Salesforce, JIRA, TFS, SFDA, SAP, BW, Tableau
• Blueworks, CA-MMIS System Replacement, TN/ FL MMIS, Claims, TPL, Provider, Recipient, Reference, Encounter, Managed Care, AVRS, Medical Need, Auth. Subsystem, MARS, (Eligibility, Reporting), Policy and Procedure, IAM
• CMS, Department of Veterans Affairs ( VA), SDLC/ IT
• Agile, Scrum (master), Waterfall
• Requirements gathering, meeting facilitation, scope, definition, managing stakeholder relationships, documentation, testing, modeling, design, presentations, policy & procedure, research information
• MS Office, CFS, Adobe InDesign, HP Quality Center, TSO/Fidelity, IEX, Invision

PROFESSIONAL EXPERIENCE:

Confidential

Project Manager

Responsibilities:

• Creating project plans, risk plans, RAID logs, edits for state of Tennessee, Backlog grooming, requirements, updating milestones, review of testing schedules, IT planning, sprint planning, scrum master, identify risks, and solutions.
• Experience with project management practices via JIRA/ TFS, creation/ updating reports, CRM, maintain project plan, scope, changes, support, PMO Metrics, supporting methodologies utilizing portfolio project management practices.
• Responsible for business analysis, claims, data analysis, testing, implementations and test cases.
• Served as the lead Program solution delivery and management resource on the programs; managing cross-functional & cross-organizational project teams as well as working in a hands-on strategic technical advisory role.

Confidential

Project Manager

Responsibilities:

• Work with HP, KPMG, Tech Democracy, State and vendors on tracking status, progress, requirements, and updates.
• Work with state and vendors on all agency “single sign-on project, meetings, progress, requirements, and related.
• Work on Active Directory (AD), and Identity & Access Management (IAM) Initiate assessment of Program create a Phase approach for implementation, strategy, organize priorities, create a resource plan, determine course is to avoid huge changes to the processes/ organization, inventory related applications/platforms/agencies/end users, create training for migration, and post-production support
• Liaison between partnering vendors, recruiting, HR, training, DALC, marketing, IT, salesforce implementations, operations, and stakeholders.
• Managed IT project schedules, testing, timelines, leadership meetings, ATO, issue resolution, purchasing, DMPs, and resources.
• Maintained vendor relationships, tracking development progress, training, prioritize objectives, tasks, deliverables, and escalations
• SME for technical requirements, support, business requirements, change management, planning, and project quality.

Confidential

Business Analyst / Project Manager

Responsibilities:

• Experience with Salesforce technical design/ implementation controls, requirements for design controls, device specs, DHF, DMF, DHR, quality controls and risk.
• Experience with WC claims, legal, reviews, rules adherence, project planning, creation/ updating reports, maintain project plan, scope, changes, Oracle, CRM/ updating milestones, support, documentation, testing, issue resolution, Ad hoc support, and security.
• Experience with the creation and management of test plans, test cases, mainframe testing, documentation of test results, steps to re-create system issues, experience with UAT, development (DEV), and various internal/ external test environments within healthcare.
• Experience creating project plans, schedules, WBS, establishing goals, expectations, tracking tasks, and managing escalations.
• Experience with Experience with, legal, workers compensation, rules, policies/ procedures, eligibility, reviews, meetings, liaison with providers. executives, communication with all levels, enterprise applications, IAM, Oracle, SQL, MS Analyzer, business objects, SAP, reporting, assigning task, project expenses, timesheet/ travel approvals, resource training plans, and manage project portfolio.
• Experience with federal, state, gates reviews, governess, government documentation, IAM, government funding, regulations, creating presenting business value, application licenses analysis, healthcare purchasing, pharmacy, claims, IAM, design, and implementations.
• Experience with project charter, kickoff meetings, weekly project agenda/ goals/ objectives, and SP documentation management.
• Facilitation of scheduled reports, support of salesforce implementations, issue resolution, business analysis, financial analysis, query, incentive calculations, change management, performance reporting, creation of growth opportunities, and business reporting.
• Facilitation of meetings, leadership updates with all levels, accounting, and mentoring, training, investigative reporting. Issues tracking, financial reporting, problem identification, escalation, and resolution management.

Confidential

Project Manager / Business Analyst

Responsibilities:

• Experience with HRIS, Oracle Taleo Recruit, CRM/ updating milestones onboarding, configurations, support, documentation, testing, security, service request, Oracle Cloud, capital management, talent management, requisition, issue resolution, support, and security.
• Experience with analysis, claims, billing, revenue cycle, EMR, TOC, HL7, X12 ANSI, claims 270/271, enrollment/ response 276/277, 820 payment/ tracking, 834, benefits/ maintenance, 835 ERA/ tracking and billing.
• Responsible for forecasting, project funding/ deployment, financial analysis, audit, quality, project tracking metrics, leadership updates, issue resolution, regulations, accounting, business systems design/ analysis, and data analysis.
• Responsible for requirements, mapping, documentation with EDI/ data sets, training materials, implementation, manuals, meetings, data analyses, manage testing, use cases, test cases, testing, and project documents.
• Responsible for business documentation, planning, leadership updates, current state/ future state concept meetings, meeting facilitation, diagrams, analysis of business systems, user needs, and specifications.
• Responsible for forecasting, project funding/ deployment, financial analysis, audit, quality, project tracking metrics, leadership updates, issue resolution, regulations, accounting, business systems design/ analysis, and data analysis.
• Responsible for management of business processes, training materials, facilitation of implementation, manuals, meetings, data analyses, manage testing, use case and project specifications documents.

Confidential

Project Manager

Responsibilities:

• Managed Salesforce technical; design/ implementations, marketing, sales, financial, legal, policies/ procedures, eligibility, meetings, testing, implementations security, HIPAA, claims 270/271, enrollment/ response 276/277, 820 payment/ tracking, 834, benefits/ maintenance, 835 ERA/ tracking, system enhancements, tracking, testing, test cases, implementation, IAM, auditing, and support.
• Experience Oracle, CRM/ updating milestones, test plans, test cases, mainframe testing, documentation of test results, steps to re-create system issues, experience with UAT, development (DEV), and various internal/ external test environments within healthcare.
• Experience with FDA design controls, requirements for design controls, device specs, DHF, DMF, DHR, quality controls and risk.
• Experience creating project plans, schedules, WBS, establishing goals, expectations, tracking tasks, and managing escalations.
• Experienced building relationships, communication with all levels, enterprise applications, RDBMS, Oracle, SQL, MS Analyzer, business objects, SAP, reporting, assigning tasks, project expenses, and managing project portfolio.
• Experience with federal, state, gates reviews, governess, government documentation, IAM, government funding, regulations, creating presenting business value, application licenses analysis, healthcare purchasing, pharmacy, claims, IAM, design, and implementations.
• Experience with project charter, kickoff meetings, weekly project agenda/ goals/ objectives, and SP documentation management.
• Managed and monitored program quality control, resolved vendor issues and process defects, reviewed project ongoing reports for delivery of products/applications and delivery abnormalities, and recognized/ mitigated program risks/issues in their early states
• Responsible for management of business processes, training materials, facilitation of implementation, manuals, meetings, analyses, manage testing, current state/ future state concept meetings, diagrams, project recommendations and specifications.
• Responsible for management of business processes, training materials, facilitation of implementation, manuals, meetings, data analyses, manage testing, use case and project specifications documents.

Confidential

Project Manager/ Business Analysis

Responsibilities:

• Experience with project management practices via JIRA/ TFS, creation/ updating reports, CRM, maintain project plan, scope, changes, support, PMO Metrics, supporting methodologies utilizing portfolio project management practices.
• Responsible for business analysis, claims, data analysis, testing, implementations and test cases.
• Served as the lead Program solution delivery and management resource on the programs; managing cross-functional & cross-organizational project teams as well as working in a hands-on strategic technical advisory role.
• Ensure issues related to projects are documented, escalated and resolved in a timely fashion. Manage risks and maintain accountability to accomplish project goals. In all case an agile technique steps were taken to manage the project in hand
• Responsible for documentation hospital scheduling, support, and requirements, validations, managing project benchmarks and communication with client, project updates, bugs/ issues, gaps, scope, issue tracking, and portal.
• Responsible for business analysis, data analysis, testing, implementations and test cases.
• Responsible for documentation and requirements, validations, managing project benchmarks and communication with client, project updates, bugs/ issues, gaps, scope, issue tracking, and portal.

Confidential, Smyrna, TN

Project Manager/ Business Analysis

Responsibilities:

• Facilitate Salesforce design/ implementation requirements meetings with Jira/ TFS/ SP, CRM, mapping, encounter activity, Oracle, enterprise manager, middleware, service packs, security, mapping, claims, tracking, EMR, TOC, ERA requirements, messaging, for EDI, HL7, X12, send/ response for 270/271, 276/277, 820, 834, 835, and 837.
• Experience with management of test plans, test cases, mainframe testing, documentation of test results, steps to re-create system issues, experience with UAT, development (DEV), and various internal/ external test environments within healthcare.
• Experience with HRIS, Oracle Taleo Recruit, onboarding, configurations, support, documentation, testing, security, service request, Oracle Cloud, capital management, talent management, requisition, issue resolution, Ad hoc support, and security.
• Facilitate requirements meetings, coding, EDI, data analysis, define vision, payor eligibility, claims, and requirements.
• Work with claims, pharmacy, coding, artifacts, compliance, fraud, regulations, implementations, portals, and enhancements.
• Work with MMIS, CMS, claims, reporting, Medicaid, ICD-10, CPT’s, DRG, HCPCS, and healthcare rules.
• Responsible for forecasting, project funding/ deployment, financial analysis, audit, quality, project tracking metrics, leadership updates, issue resolution, regulations, accounting, business systems design/ analysis, and data analysis.
• Work with technical team/ developers on technical feasibility; clarify requirements, design, and understanding.
• Work with internal and external documentation, support, change managements, testing, and define deliverables.

Confidential, Chattanooga, TN

Project Manager/ Business Analyst

Responsibilities:

• Experience creating project plans, schedules, WBS, establishing goals, expectations, tracking tasks, and managing escalations.
• Experience with planning, scenarios, test plans, test cases, mainframe testing, documentation of test results, steps to re-create system issues, experience with UAT, development (DEV), and various internal/ external test environments within healthcare.
• Worked with federal, state, gates reviews, governess, government documentation, IAM, regulations, creating presenting business value, application licenses, analysis, healthcare purchasing, pharmacy, claims, IAM, design, and implementations.
• Experience with CRM, project charter, kickoff’s, weekly project agenda/ goals/ objectives, and SP documentation management.
• Facilitation of scheduled reports, support of salesforce implementations, issue resolution, business analysis, financial analysis, query, incentive calculations, change management, performance reporting, creation of growth opportunities, and business reporting.
• Lead communication for government agencies, EDI/ data sets, BRD/FRD work effort for mapping, requirements, messaging, for EDI, HL7, X12, send/ response for 270/271, 276/277, 820, 834, 835, and 837.
• Experience includes payor, claims, dental, gathering requirements, user stories, validation, mock-ups, payroll, ERP, SAP, HRIS, Oracle, HEDIS, requirements, quality, testing, Gaps and implementations.