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Senior Project Manager/senior Business Systems Analyst Resume

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SUMMARY

  • I established three PMOs by creating cultures of Requirements and SDLC excellence. Managed project intake processes including scoring, prioritizing, creating project charters.
  • I delivered four complex enterprise products against critical deadlines and fiscal goals via customer synergy, empowerment, teamwork, partnering, and application of best practices, training, and meticulous monitoring/tracking in support of millions of dollars in revenue.
  • My topline results of supporting business requirements and testing services as well as bottom - line process-improvements thru SDLC training, coaching, tracking, and interaction models have delivered savings in the millions of dollars. Obtained CMMI rating of Level 3.
  • The programs which I coded, coordinated, managed, and deployed are performing over one million mission-critical financial transactions over billion dollars daily. Worked on infrastructure projects.
  • I supported contract negotiation, requirements gathering, and development to deployment processes as a software dev. program manager reducing costs by $7+MM annually.
  • I worked with over 20 businesses around the world delivering critical projects satisfying legal, regulatory, and market requirements enabling continued revenue growth.
  • I worked with Web Analytics to assess the effectiveness of news articles based on Google Analytics, Facebook, and Twitter metrics to measure effectiveness and to improve.

TECHNICAL SKILLS

  • Change Management
  • System Analysis
  • Contract Admin
  • Operations Oversight
  • Data Analytics
  • Certified Trainer
  • Healthcare
  • Program Management
  • Compliance
  • 6 Sigma
  • Fiscal Control
  • Requirements Analysis
  • CMM, ISO, SDLC
  • PM Methodology
  • Process Change
  • PMO Governance
  • Portfolio Management
  • Customer Skills
  • Executive Coaching
  • Status Gathering & Reporting

PROFESSIONAL EXPERIENCE

Senior Project Manager/Senior Business Systems Analyst

Confidential

Responsibilities:

  • Worked on ERP SAP finance, accounting, premium billing, and claims payment projects to build a scalable and interconnected foundation for effective enterprise execution and growths. Setting up general ledger chart-of-accounts and claims sub-ledger mapping as well as supporting actuarial functions. Supporting online payments via IVR, Payment portal, as well as call agents. Interfacing to existing Salesforce, QNXT, Data mart and other internal/external systems.
  • Worked on Health Services projects such as Clinical Data Warehouse, Potential Provider Quality of Care Issues, Health Information Exchanges (HIE) such as EDIE-Pre-manage and LANES which were used by CM and UM to monitor cohorts with pain, pediatric asthma, and triple-threats (i,e., Opioid, Benzodiazepine, muscle relaxant) being in the ED.
  • Managed mission critical Provider Network Operations (PNO) data sync from the Master Provider Database (MPD) to the claims processing and authorization systems (e.g., MHC, QNXT, CCA, Essette). Tested end-to-end business processes from plan partner data upload, manual provider data entry, MPD provider data extract, and provider data upload to claims systems, authorization systems, and claims payments. Executed Providers, Claims, Capitation, Credentialing (Sanctioned & Ineligible Providers), and Membership projects.
  • Managed mission critical Facility Site Review (FSR) projects per DHCS regulations on Physical Access Review Survey (PARS), Medical Records Review (MRR), FSR audits, and Scheduler for PCPs, Specialists, CBAS, and ANCL providers.
  • Authored BRDs, reviewing designs, and leading in SDLC activities for projects with LA County DHS, CMC, CMB, Provider Data Management (PDM), and other partners. Performing functional analyses using Toad, Oracle tables, Visual Studio, and PL-SQL to reduce wait time and cycle time.
  • Performed As-Is analyses and Should-Be solutions aligning processes, systems, and structures for Provider Relations, Contracting, Credentialing, Incentives, and Member Services as Visio swim-lane diagrams for the Provider Data Integrity (PDI) project.
  • Led 8 project teams including 4 vendor teams to remediate Encounters, claims, authorization, interfaces, and reporting on LA Care’s QNXT, CCA, and Surround Systems such as ADM, DDM, Hyperion, MPSS, HO&A, PNO, Provider Portal, and IVR systems for ICD-10 compliance.

IT Manager, Methods and Services

Confidential

Responsibilities:

  • Team members included Medicaid, Medicare, Dual, ICD10, and Health Plan PMs.
  • Provided training on processes, principles, requirements, and teamwork while defining the framework including project intake, approval, initiation, requirements, and, execution.
  • Led cross-functional teams of 100+ to define SDLC processes and standardize templates.
  • Delivered parts of Phase-I for Apps-Dev and Phase-II for infrastructure/security projects.

Senior Program Manager

Confidential

Responsibilities:

  • Creating Requirements document, project plans and project schedules utilizing MS Project.
  • Working with executives, architects, senior directors, and managers to enhance the products. Conducting process improvement training and SDLC expertise.
  • Providing leadership in business analysis, continuous process improvement, SDLC application, Project Management standards in a functional (i.e., weak matrix) environment, mentoring, and coaching.

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