SUMMARY

• Senior Business, Systems, Technical Analyst and Project Manager with 25 years of experience achieving optimum levels of competitive advantage and profitability for an organization with high emphasis on quality
• Specialist in the effective use of business process engineering to leverage information for the business purpose and the secure sharing of information inside and outside the organization in a Global Delivery Model
• Technical Expert in the software life cycle: planning (as - is to future state/commercial off-the-shelf deployment)analysis, design, development, testing, implementation & maintenance in Agile methodology
• A Subject Matter Expert with inpatient, outpatient and ancillary (LAB, RAD, PHARM, etc.) core functions: claims, billing, financial forecasting, legal, quality, compliance, access to care/pt. population
• Business Requirement Elicitation & Documentation (BABOK) - User Requirement Specification
• Software Development Life Cycle (Waterfall & Agile: Scrum/Sprints)
• Data Integration/Mapping (Unidirectional & Bidirectional) - ISA-95 Standard Integration Exchange
• Part 11 of Title 21 of the Code of Federal Regulations; Electronic Records; Electronic Signatures (21 CFR Part 11)
• Project Management of ICD-10/5010/HEDIS on both the Provider and Payor sides
• Good Manufacturing Practice (CGMP)/Good X Practice (GxP) initiatives for Human and Animal Drugs and Biologics
• Delivery of Data Analytics (HIPAA transaction: 837, 999, 824, 277), HL7, SNOMED, CPT4, HCPCS, UB92
• Medicare Health Plans (Part A, B & D) and Part C - Medicare Advantage (PPO, HMO, PFFS and SNP)
• Medicaid Plans for most U.S. States and Marketplace Exchanges
• Children's Health Insurance Plan (CHIP), Behavioral Health and Long-term Care Programs
• Database Design/Development, T-SQL Query, Stored Procedures, Functions and VBA Scripting
• Electronic Medical Record Analysis/Development/Implementation/Maintenance
• Systems and Quality Processes Review (Modification to Organizational Workflow)
• Use Case Diagraming/User Stories to include End User Go-Live Support
• Lean Six Sigma (uncertified Green Belt)
• Pharmaceutical Analytics - Medicare Part D (PDP) via Prescription Drug Plans and Advantage Plans (MA-PD)
• Joint Application Development (JAD) & Root Cause and Impact Analysis with Process Mapping
• Data Extraction, Transfer and Load (ETL) - XML, XL7, Flat Files
• Demonstrated understanding of statistical concepts (regression, correlation, analysis of variance, etc.)

TECHNICAL SKILLS

• MS Windows (10/7) and x32/64-bit
• MS SharePoint 2014 & Team Foundation Server
• Zoom
• Waterfall (SDLC) method, Agile w/Scrum (Stand-ups/Sprints), Joint Application Dev (JAD), Lean Six Sigma
• Word/Excel (VBA)/PowerPoint/OneNote/Publisher/Outlook/SharePoint/Skype/OneDrive/Office365
• MS Access (VBA)/MS SQL Server 2005-2017/Teradata/SalesForce/Fieldglass
• SQL 05-18/SAS/Bus. Objects/Cognos 10/Crystal Reports/SSIS/SSAS/SSRS/Tableau 9.1/Power BI
• Smartsheets/JIRA/HP Quality Center 9.2/HP ALM
• EPIC/QNXT 4.7/AHLTA/PowerMHS/IKA/Cerner/Allscripts/Meditech/Clarity/NexGen/RxClaim/RxNav
• Adobe Acrobat Pro/HTML/Corel Draw 9.0//Uberflip/CAD/Photoshop 5.5/PageMaker/Illustrator

PROFESSIONAL EXPERIENCE

Confidential

IT Project Manager

Responsibilities:

• IT project management using Agile methodology (Scrum, Stand-ups and Sprints) and JAD sessions includes overseeing projects (launched 2 drugs for Pfizer) for software development, hardware installations, network upgrades, cloud computing and virtualization rollouts, business analytics and data management projects and implementing IT services.
• Assisted primary Business Analyst with requirement for the Provider, Patient and Reimbursement Portals.
• Held daily stand-ups and coordinated 2-week sprints. Assured QA testing was achieved for incremental releases in accordance with the project schedule and as stipulated by the client deliverable requirements.
• Modeled use cases for wire frames to support testing

Confidential

Senior Business Analyst

Responsibilities:

• Initiated, planned and executed specifications using MS SharePoint per project/service agreements such that Key Performance Indicators were met per the process improvement plan.
• Used Agile software development w/JIRA technology to write use stories and use cases.
• Analyzed large datasets to Geomap service station throughout Arizona. Which included a compliment of reporting capabilities for the end client that were developed via complex queries in a SQL Server environment.
• These files were delivered in Extensible Markup Language (XML) data file format with custom tags to define objects and the data within each object such that custom reporting could be accomplished.
• Built the infrastructure (data warehouse) to hold business metrics. This led to successful management of county and state adherence and tracking throughout the life of the project with emphasis on 21 CFR Part 11 compliance
• With my proprietary tool, led conference calls to gather requirements for the project completion (high level business, business, functional, non-functional and user requirements) which led to considerable data mapping for both clients.

Confidential

Senior Analytic Advisor

Responsibilities:

• Pharmacy Benefits Management, analytics and outcomes for 12 Health Plans across 7 states via EXCEL (VBA), SQL and SSRS Provider Payor reporting working with CCO assuring compliance with Federal and State contractual requirements
• Reviewed and provided documentation for maintenance and distributed of Medicare Part D claims detail file (XML & flat files for integration into enterprise wide database and through Agile Sprints and SharePoint 365 or distribution.
• Modeled data using MS Excel (VBA), Access (VBA), SQL, XML/HTML, flat files (from Argus) and/or other data warehouse analytical tools applying Part 11 (records in electronic form that where created, modified, maintained, archived, retrieved or transmitted under any records requirements set forth in Agency regulations
• Assisted with training and mentoring other Data Analysts
• Assisted with determining workload and related activities for other Data Analysts

Confidential

Business Analyst

Responsibilities:

• In an Agile environment independently and in cooperation with the Project Management Officer used MS Project Professional 2010 and MS SharePoint for the effective management of this important and highly visible project
• Delivered effective presentations that offered immediate insight and recommended task planning, resource allocation, expenditures and impact assumptions for the project to include Provider and Vendor education
• Used Excel (VBA)/Gantt/bar/milestone charts for reporting dependencies and/or constraints among activities and network/production schedules that where united to show an overall integrated Master program schedule
• Maintained and advanced the ICD-10 project to include support of physician training, joint ventures, Pharmacy Benefit Management and benefit management as paired with new code set and business vendor readiness programs