Summary

• Seasoned professional with 20 years of Health Care claims processing experience leading technical staff in development and implementation of high quality product solutions. Possesses extensive experience in all facets of product development, following the Systems Development Life Cycle SDLC methodology. Familiar with both Water Fall and Agile Methodologies. Detail-oriented, effective communication skills and proven ability to lead projects, and exceed customer satisfaction. Exemplifies integrity, admirable interpersonal relationships, strong organizations skills, and excellent analytical abilities.
• Large Scale Implementation Lead / Senior Application Developer Consultant/Senior Business Analyst: Experienced in developing Management and Administrative Reporting EMAR and Data Warehouse solutions, using the SDLC, for state Medicaid programs. Incorporated experience and knowledge of Medicaid into the EMAR product through a combination of leadership, business knowledge, and technical competency. Managed development and testing, including coordination and monitoring of testing, defect tracking, and results. Anticipated delays and initiated plans and alternative solutions. Managed project with specific focus on deliverables, tasks and due dates. Performed independently with minimal supervision and worked with others to develop trusting relationships. Participated in planning, preparation, and certification for District of Columbia CMS certification, utilizing the Medicaid Enterprise Certification Toolkit MECT for Program Management. Strong organizational and problem solving skills with excellent written and verbal communication skills. Ability to multi-task. CMS Knowledge. Heavy customer interaction experience.
• EDI Developer: Experienced in mapping CMS standardized HealthCare formats using Microsoft Biztalk and VB Scripting. Quick to learn new concepts, detailed oriented, assertive and willing to assume responsibility.
• Account Manager/Project Manager: Experienced in overall account management and project management, which includes: developing Project Charters, Work Breakdown Structures, Project Plans, and Test Plans estimating task efforts and durations managing project work plans ensuring compliance with project standards and methodologies working through approval process leading meetings reporting project status and mediating priorities between business units. Account Manager and technical escalation point for major Health Care Insurance Carriers: Cigna, Oxford, Aetna, United Healthcare, Tufts, Fallon, Harvard Pilgrim, Employers Health, HealthNet / PHS, and USAA. Implementation Project Manager for Year 2000 Y2K Payer Testing and Due Diligence for 200 Health Care Insurance Carriers. Respected for interpersonal skills, integrity, leadership, and team building.

PROFESSIONAL EXPERIENCE

Confidential

Management and Administrative Reporting EMAR

Implementation Lead - Senior Application Developer Consultant Senior Business Analyst

• Developed large-scale Medicaid solutions for Alaska, District of Columbia, Missouri, Montana, North
• Dakota and New Hampshire Managed Care using Informatica and Cognos for reporting:
• Assessment of contracts and creation of Change Request CR through project lifecycle
• Identifying data and business requirements
• Facilitating Requirement and Design Joint Application Development JAD Sessions
• Leading project team in the transformation of system requirements into a design
• Verifying data validity of source system prior to population into Ad Hoc / EMAR tables
• Developing Source-to-target Mapping documents outlining data elements from legacy system to database model tables
• Developing ETL Extract, Transformation and Load Business Rule document, along with control end-user lookup tables that can be easily updated and maintained
• Developing system test scripts, use cases, and scenarios
• Overseeing Testing Team
• Tracking and managing issues
• Providing clear, concise and timely communication and support to clients throughout the software development lifecycle
• Assisting in development of user documentation and online help
• Developing and facilitating end-user training
• Ensuring both departmental and CMS standards were followed
• Mentoring all team members
• Developing, reviewing, overseeing, creation of all project deliverables reflective of the system development lifecycle
• Developing, reviewing, and overseeing the creation of all project documentation

Confidential

Sr. Business Analyst

• Served as Lead Business Analyst in developing Enterprise MMIS reports for Member, Provider,
• Claims, TPL and Estate Recovery, Reference using Cognos
• Performed analysis of all State Medicaid Operational Reports
• Facilitated Design sessions with Enterprise team
• Read and Interrupted Cobol Mainframe Legacy Code to transfer into new Cognos Code
• Developed Enterprise reports in Cognos for ORR
• Responsible for Quality Assurance of all ORR reports
• Identified areas for improvement for end user i.e., Prompt Page Notes, Selection Criteria Page, Hover Overs, No Data Found, etc.
• Responsible for Cognos report standards and procedures
• Tracked and managed issues and progress
• Mentored/coached Associate Business Analyst and Business Analyst team members

Confidential

Sr. Business Analyst

• Served as Lead Business Analyst in developing large-scale Medicaid Data Warehouse Decision
• Support Solutions for Colorado, Florida, and North Carolina which included:
• Assessed contracts
• Identified business flows, business requirements, data and metadata requirements
• Facilitated Requirement and Design Joint Application Development JAD Sessions
• Lead project team in the transformation of system requirements into a design
• Verified data warehouse data validity
• Developed system test scripts, use cases, and scenarios
• Tracked and managed issues
• Provided clear, concise and timely communication and support to clients throughout the development lifecycle
• Developed user documentation and online help
• Developed and facilitated end-user training
• Ensured both departmental and CMS standards were followed
• Mentored/coached Associate Business Analyst and Business Analyst team members
• Developed project deliverables reflective of the system development lifecycle, specifically: Requirements Analysis Document RAD , Detailed System Design DSD Document, Source-to-target Mapping Documents outlining data elements from legacy system to database model, Transformation Business Rule Document, Requirements Traceability Matrix, Unit Data Validation Test Plan/Results, System Test Plan/Results, User Acceptance Test Plan/Results, System Documentation, Data Dictionary

Confidential

EDI Transformation Developer / Sr. Business Analyst

Led and developed payer implementation projects for the new Batch File System which included: reviewing contracts, writing Project Plans, reviewing and analyzing technical specifications, developing user and system documentation, developing complex mapping routines using Microsoft Biztalk translator and VB Scripting, unit testing, system testing with payers, code releases to production, and both internal and external notification of new implementation.

Confidential

EDI Implementation Supervisor Technical Lead

• Led 200 complex payer projects for both new implementations and maintenances for real-time eligibility and batch claims.
• Led high volume submitter implementation projects which included: reviewing contracts, writing Project Charters, Project Plans, Requirements Document, Design Document, and Test Plans technical liaison during testing, led meetings, mediated priorities between business units, reported overall customer status and satisfaction to management, and insured revenue quotas were being met
• Provided day-to-day production support to both internal and external customers
• Technically trained internal staff on real-time eligibility

Confidential

National Payer Account Manager

• Served as a technical escalation point, both internal and external, for major HealthCare Insurance Carriers, such as: Cigna, Oxford, Aetna, United Healthcare, Tufts, Fallon, Harvard Pilgrim, Employers Health, HealthNet / PHS, and USAA.
• Reported to the Vice President of Operations.
• Produced monthly report volumes for Senior Management.

Confidential

• Developed Project Charters, Work Breakdown Structures, Project Plans, and Test Plans.
• Mediated priorities between business units.
• Technical liaison for 200 Healthcare EDI Insurance Medicaid, Medicare, Commercial carriers.

Confidential

• Led payer projects for both new implementations and maintenances for real-time eligibility and batch claims.
• First line of support for all payer related questions both internal and external.
• Provided technical support to new vendors and trading partners as needed.

Confidential

Production Control Coordinator

• Scheduled Orkin Exterminating Cobol production jobs using JCL.
• Responsible for all production jobs finishing successfully and reports being produced successfully.
• Responsible for monthly client invoices being printed on time.
• Responsible for end-user requests.

EDUCATIONAL SKILL SET