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Business Analyst Resume Profile

OBJECTIVE

Healthcare project management or senior business analyst consulting opportunity. Specifically, the planning, design, development, testing, evaluation, implementation, or maintenance of healthcare delivery systems, focusing on liaison skills between the internal/external business community and the IT development team.

QUALIFICATIONS

PROFESSIONAL EXPERIENCE

Project Manager/ Senior Business Analyst, Confidential

Project Manager/Senior Business Analyst for the Medicare/Medicaid Data Matching Pilot project. This is a pilot project which loads and algorithmically matches Medicaid provider and beneficiary data against Medicare provider and beneficiary data in CMS' Integrated Data Repository IDR . Once matched, the beneficiary/provider data is matched against claims data in the IDR in an effort to identify fraud, waste, and abuse. Develops and maintains the project schedule using MS Project creates the CMS Requirements Document, the CMS System Design Document, Decision Analysis Resolution DAR and other CMS supporting artifacts.

Senior Medicaid Program Advisor, Confidential

  • Works directly with Maryland Medicaid Executive Staff to manage the Medicaid program related business and IT capabilities within Healthcare Reform from concept through to operational readiness
  • . Collaborate with stakeholders at the Maryland Health Benefit Exchange MHBE and the MD Department of Human Resources DHR to facilitate/resolve program issues. Ensures that all work included under the scope of the program is appropriately defined, tracked and managed and risks are identified and addressed.
  • Facilitate and drive decisions across groups of diverse stakeholders including directors and managers from multiple State agencies.
  • Responsible for drafting and finalizing FFY2014 and FFY2015 Medicaid Advanced Planning Documents APDs for additional funding for operation and development of the MD Health Benefit Exchange.

Senior Business Analyst/Medicaid Subject Matter Expert, Confidential

  • Responsible for writing technical specifications documentation, presenting technical solutions to CMS stakeholders, creating MDM test plans, test case scenarios, and performing testing prior to production deployment. The MDM Enterprise Data Services Contract EDSC includes a base year plus five option years with a total estimated value of 105 million.
  • Master Data Management MDM contract with the Centers for Medicare and Medicaid Services CMS to provide enterprise data services, identity resolution for Medicare and Medicaid beneficiaries and providers to support the agency's information systems.

Senior Consultant, Confidential

  • Senior Business Analyst on the DDI of the Colorado Health Benefit Exchange project. Conducted Requirements Validation sessions and JAD sessions to define and clarify the system specifications for the CO HIX.
  • CMS SME, keeping team apprised of CMS developments related to project activities, providing guidance and direction on CMS policies and procedures, and participates in preparation and execution of establishment/gate reviews.
  • Acted as Senior Consultant on procurement efforts for HIX and MMIS contracts throughout the United States. Assisted in the writing, development, review, and approval of HIX and MMIS proposals provides healthcare IT knowledge, expertise, and healthcare systems solutions for CGI's healthcare line of business as a whole served as MMIS Deputy Project Manager on procured MMIS contracts served as a healthcare systems consultant on assigned projects.

Medicaid Health IT Specialist, Confidential Performed reviews for CMS Baltimore Central Office on State Medicaid Health Information Technology Plans SMHP's and Implementation Advanced Planning Documents IAPD's from State Medicaid programs to approve/deny requests for CMS funding for Electronic Healthcare Provider Incentive Payment program. Wrote impact analysis for State Medicaid programs to implement T-MSIS reporting requirements to CMS. Delivered presentations at various HI-TECH and MMIS conferences. Responsible for the review/analysis of the MITA/HITECH crosswalk analysis of the MITA/HITECH business process alignment related to the EHR provider incentive payment program analysis and input into the proposed MITA 3.0 Framework.

Senior Business Analyst, Confidential

Drafted, developed, and delivered of the State of Illinois' Medicaid Health Information Technology Plan SMHP . Drafted and developed business processes related to the IL Electronic Health Record EHR Medicaid Provider Incentive Program PIP develop a healthcare provider environmental scan survey to assess IL healthcare provider Electronic Healthcare Record EHR awareness and participation provide outreach and education to the Medicaid providers of IL about EHR and PIP analyze data collected in the provider surveys to determine compliance with Federal meaningful use definition.

Medicaid Subject Matter Expert, Confidential

  • Functional Team Lead for the Provider Management and Prior Authorization teams consisting of business analysts, technical developers, and testers associated with the analysis, design, testing and
  • implementation of the transfer from the legacy MMIS to the new web-based South Dakota MMIS.
  • Provided leadership as liaison between internal/external business community and the IT team to provide technical solutions for requested user needs. Translated business requirements into functional requirements and specifications, manage changes, and direct the IT team on current business direction.
  • MITA Experience 1 Analyze and complete an assessment of the As-Is and To-Be capabilities of South Dakota's MITA Business Objectives for the Provider Management.
  • Authorization functional areas, 2 Map the MITA process areas to Use Cases for the Provider Management and Prior Authorization functional areas, 3 Analyze and define the quality
  • measures for MITA levels 1-5 for each Business Process within Provider Management and Prior Authorization, 4 determine the As-Is and To-Be MITA Maturity Levels for the business process areas within Provider Management and Prior Authorization.
  • Successfully conduct Requirements Validation sessions and JAD sessions with the State staff of South Dakota and effectively meet all requirements requested for the new South Dakota MMIS.
  • Assist with the final mapping of the to-be processes insuring that these processes are aligned with the MITA maturity model and the CMS certification checklist.
  • Accountable for writing, overseeing, and delivering the formal Requirements Validation Documents and Requirements Traceability Matrices for Provider Management and Prior Authorization for the new SDMMIS received sign-off from the State on these Requirements Validation Document deliverables.
  • Lead and create solutions in the Iteration Design and Development sessions and demo sessions associated with the agile approach to design and development of the SDMMIS confirm As-Is processes and develop the To-Be processes and flows of the new SDMMIS.

Team Lead/Senior Business Analyst, Confidential

  • Project Lead for Enterprise and divisional projects dealing with AR Blue Cross/Blue Shield's claims processing system private business side of BCBS defined at the corporate level manage projects from initial specifications through implementation insuring accuracy, timeliness, and budgetary responsiveness.
  • Develop, design, test and document necessary system modifications on an ongoing basis develop test plans, test case scenarios, and test scripts to insure functionality of the modification.
  • Demonstrate, present and communicate solutions to basic problems to appropriate individuals
  • involved in various divisions of BCBS.
  • Maintain an ongoing assessment of the Group Claims Processing System GCPS assure efficiency and effectiveness of the claims processing system.

Project Manager, Confidential

  • Successfully managed numerous IT projects related to Medicare and Medicaid billing and collections for
  • Beverly's 400 nursing facilities using RUP methodology and Microsoft Project software supervised technical/operations staff.
  • Effectively streamlined Beverly's Therapy Interface Project billing and collection process of therapy services, which resulted in enhancing company bottom line by 15 million.
  • Provided advanced desktop and network support configuring new user's workstations, MS Outlook support, and trouble-shooting network problems for Beverly's Home Care subsidiary.
  • Served as overall Y2K project manager for Beverly's Home Care division. Involved inventory, assessment, risk, and remediation of all hardware and software products for Beverly Home Care's 62 agencies - 03/1998-01/2000.

Operations Development Consultant/Provider Relations Manager, Confidential

  • Manage and conduct provider outreach and statewide provider training sessions shortly before the new NM MMIS was implemented.
  • Instrumental in winning MMIS proposal for the MS Medicaid RFP participated in requirements analysis with the State, developed sections of the GSD and DSD.
  • Hire and train the MS MMIS Provider Relations Department staff of 37 prior to go live of the new MS MMIS. Responsible for all contract requirements of provider training, provider communications, provider manuals, and provider publications.

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