Objective
To obtain a challenging opportunity utilizing fifteen years of healthcare experience in conjunction with attained skills from past educational and work experiences.

Work History

Confidential, July 2011 to October 2011

Project Manager

• Lead teams in the delivery of high-quality programs and solutions that meet business needs
• Create detailed project design documents and task-level project plans to organize cross-functional teams
• Partner closely with other members of functional project teams to define business requirements
• Prepare and present cost-benefit analyses

Confidential, February 2011 to July 2011

Senior Consultant

• Resource for State of Indiana ICD-10 Assessment and Implementation
• Resource for the Northern Arizona Regional Behavioral Health Authority (NARBHA) information technology redevelopment, stabilization and system enhancements.
• Elicit, analyze and document Business Requirements for Behavioral Health, and Medicaid benefits
• Develop Use Cases based on business requirements
• Process Flow Diagram creation for system enhancement.

Confidential, August 2010 to February 2011

Senior Project Business Analyst
Lead Business Analyst on the EEi4 Remediation Project

• Validate Project Charter
• Coordination of Success Metrics
• Generate “Current State” Business Operations documentation: Schedule & conduct Process/Organizational Interviews, Develop Current State Process Documents, Process flowcharts showing steps, systems and roles, Validate and Obtain Consensus, Known metrics (volumes, duration, cost)
• Conduct Stakeholder Analysis
• Generate “Future State” Business Operations documentation: Conduct Functional Group Interviews or Focus Groups, Develop SIPOC, Draft Future State Workflow/Swimlane, Process flowcharts showing steps, systems and roles with associated metrics (volumes, duration, cost), Process-related operating procedures
• Elicit, analyze and document Business Requirements
• Ensure Business Requirements are met
• Draft Operations Support Plan
• Develop User Acceptance Testing Plan
• Document and manage success metrics and required measures
• Develop Use Cases based on business requirements
• Build Acceptance Test Cases and trace to BRD
• Conduct User Acceptance Testing, document and report results, report defects, and sign off on results
• Develop/Finalize Operation and Support Plan
• Assist and verify transition to Business Operations
• Assist in developing Communications and Training Materials
• Refine Training Plan and Develop Training Materials
• Finalize Future State Process Documentation
• Assist in transition to operations
• Coordinate Training activities
• Transition Future State Process to Current State
• Close the project and transfer responsibility from the Project Manager to the System Owner
• Provide the System Owner with all the necessary documentation for the system, the acceptance tests and the analysis models
• Communicate that the project is formally closed
• Capture lessons learned to feed continuous improvement
• Lead a team with two direct reports

Confidential,IL July 2009 to August 2010

IG&S (Information Governance and Stewardship) Senior Analyst
Enterprise Information Strategy and Management Division

• Participate in the development of consistent terminology, definitions, business rules, and metrics by following a consensus drivien approach that promotes the combines strengths of diverse, cross-functional, and cross-departmental enterprise groups
• Work with Information Analyst to develop appropriate content and ‘straw man’ definitions
• Lead discussions of Stewards and SMEs (Subject Matter Experts) to get a single enterprise set of terms and definitions to be implemented in the product platform
• Manage internal client relationships
• Business Process and Procedure development
• Business liaison for the Stewardship program
• Implemented and leveraged IG&S program information
• Issue identification and resolution activities in Strategy and Management disciplines; Meta Data, Data Integration, Data Modeling and Content Management
• Creation of Enterprise IVCs (Information Value Chains/Data Flow)
• Team room administration

Confidential,IL December 2007 to July 2009

Subscriber Services Tech Business Specialist V
Business Analyst on the ME CCSP Project
Claims Customer Service Project (CCSP)/Member Enhancements

• Lead Business Analyst on the Member ID project
• Provide data analysis on current state systems
• Report on current stat functionality in order to create and implement the future state
• Define project scope
• Communicate the business needs
• Identify, define, recommend, and coordinate business requirements
• Serve as a liaison between SSD Tech and Business Architects to interpret and document all functional and non-functional requirements
• Conduct requirements gathering workshops
• Input and manage requirements in Requisite Web application
• Translate Business Requirements into Use Cases
• Create process flows and diagrams
• Perform business research to identify gaps between current state and future vision
• Conduct interviews with customers and enterprise experts to provide insight based on business research and analysis
• Maintain documentation on the business project
• Solely responsible for the design of the Member Enhancements Graphial User Interface screens (GUI): Create page specifications for the GUI screens, Create GUI prototype in iRise application
• Create human and navigational workflows along with requirements and use cases for GUI screens
• Point of contact in Manager’s absence
• Participated in organization and leadership project meetings and workgroups
• Facilitate team and project meetings
• Document and discuss issues

Confidential, October 2006 to October 2007

Chicago/Florida Market System Migration Project Analyst
Project Manager for Chicago/Florida Market Sales Office
System migrations / Benefit Management

• Supervised a team of five people one of who worked out of a satellite office
• Manage system migration project for the Chicago and Florida Markets
• Develops strategy and implements approach for creation of deliverables and all supporting documentation for the concept and definition phases of the project
• Serves as the liaison between Large Group Sales and operations
• Train Account Executives on new benefit administration platform.
• Transfers knowledge and builds relationships with local brokers/agents. Educate Large Group clients on the corporation’s system migration project and how it affects their benefit selection.
• Acts as the first point of contact for the Large Group Markets regarding ASO and Custom migration activities. Possess overall ownership of group during they system migration process
• Understand platform functionality (CAS vs. MTV), differences and product features and be able to communicate impacts that may occur to the client and/or project.
• The benefit contracts are reviewed against the benefits the system pays and a variance discussion is scheduled. Review and provide feedback on the summary of differences and action items identified in the benefit variance meetings
• Keep Sales informed of new or changed processes and procedures. Assist AE to determine and request underwriting quotes to include new initiatives
• Guide Sales Team in implementing standard benefits, administrative processes and timelines for deliverables when possible
• Clarifies and sets expectations with the Sales team, broker/agent and/group
• Point of contact if the AE is unavailable.

• Confidential, November 2005 to October 2006

Pharmaceutical Services Marketing Manager
Marketing/Trend Analysis/Communications

• Blue Cross Blue Shield of IL October 2002 to November 2005

National Accounts Lead Support Analyst
Implementer/Project Manager of new and existing business
Benefit Management/Operations Management

• Confidential,IL February 2001 to October 2002

Credentialing Service Rep/ Assist Credentialing Analyst for provider affairs

• Confidential,IL May 1995 to December 1999

Seasonal Intern/Customer Service Representative for provider affairs

Education

• Bachelor’s Degree of Science, area of concentration Communications, Minor in Journalism,
• Illinois Life and Health Insurance License
• ASO Certification
• Microsoft Certified Technology Professional
• Member of (WEDI) Workgroup for Electronic Data Interchange

Skills

• Advanced computer skills, proficient in Microsoft Word, Excel, Access, Power Point, Project, Visio, Windows XP, Requisite Pro, iRise, Billing systems, SQL, SharePoint, HP Quality Center, Blue Chip, BlueStar LGTT (Large Group Tracking Tool which is mirrored from AMA.), CICS, PFIN (Provider File Inquiry), PREMIER (Provider Reimbursement Information Management Engine), PCPA (Primary Care Physician Associates), ISIS II, and Blue Key
• A solid understanding of the insurance industry, its products, practices and operations (EDI, COB and Claims adjudication), extremely knowledgeable POS,CDHP, HMO, Medicare, Medicaid, Medicare Part A - D and PPO products offered in the industry
• Vendor Relations NEBO, Ingenix, Real Med, and others
• Organizational, analytical, strategic planning and advisement, project management, managerial skills with creation of training manuals, guidelines, workflows, process improvements flowcharts and procedures.
• Integration of multiple programs both computer and special projects to avoid overlapping and encourage efficiency and productivity
• Advanced analytical and problem solving skills with ability to manage and prioritize multiple projects
• Excellent client and interpersonal skills and ability to work effectively with internal and external business partners
• Ability to lead teams, coach and mentor staff at all levels as well as a team player
• Excellent verbal and written communication skills ability to convey business
  requirements and technical needs in clear, concise, and effective manner
• Experience developing and implementing projects at a high-level
• Deadline driven