SUMMARY

• Highly accomplished Healthcare professional with extensive experience providing business solutions that enhance productivity, improve quality, drive sustained business performance, and maximize revenue potential.
• Quality Assurance Information Technology Customer Service
• Strategic Planning Electronic Healthcare Claims Agile

PROFESSIONAL EXPERIENCE

Confidential

Business Systems Manager

• Responsible for managing employee development and training.
• Managed the Claims Management system that achieved 98 approval rate for Timeliness of Provider Payments within 30 days, 99 Claims Processing Accuracy, and 99 Financial Accuracy.
• Experience with HIPAA X12 Electronic Data Interchange EDI healthcare transactions.
• Managed an application support team that provided system support for 400 internal users and 1000 active providers in the Alliance catchment area.
• Responsible for ensuring that Medicaid claims process correctly between the Alliance claims management system and the new NCTracks Medicaid Management Information system. MMIS
• Responsible for managing the process that ensures enhancements and new system builds are propagated into production successfully.
• Responsible for ensuring that the ICD-10 and DSM-5 conversions are implemented and tested in the Claims Management system.
• Responsible for ensuring that Policy and Procedures are in place for Utilization Review Accreditation Commission URAC audits.

Confidential

Business and Technology Applications Analyst - Medicaid

• Liaison between the non-IT business users and technical development with regard to communicating technical concepts for business and system requirements.
• Ensure that Behavior Health Computer Service Requests CSRs enhancements are validated, tested and implemented in the Medicaid Management Information System MMIS per DMA requirements.
• Lead the development of the new DMA-IT Data Request system using the Agile methodology.
• Experience with HIPAA X12 Electronic Data Interchange EDI healthcare transactions.
• Experience with HIPAA 5010, ICD 10, and Medicaid policies/programs.
• Responsible for finding root cause for why provider electronic and paper Medicaid claims deny in the MMIS system.
• Member of the DMA readiness review team responsible for ensuring that Managed Care Organizations MCOs implement and pay claims for the Medicaid 1915 b c waiver for Behavior Health services according to DMA contract.
• Responsible for ensuring that the Critical Access Behavioral Health CABHA Agencies are following Medicaid policies as they pertain to claims processing.

Confidential

Senior System Service Support Analyst Incident Management

• Provided first-level internal customer system support for an Oracle based HR Access payroll system supporting 40,000 employees by triaging and resolving production incidents via the ServiceCenter6.2 tool.
• Trained in the Information Technology Infrastructure Library ITIL methodology.
• Liaison between the non-IT business users and technical development with regard to communicating technical concepts for business and system requirements.
• Responsible for planning, testing, and implementing software changes resulting from customer change requests and defects.
• Restored service for reported incidents based on business and financial impact and created problem management tickets to find root cause for system defects.

Confidential

Senior Systems Analyst Center for Medical Education

• Verified and worked with technical personnel to ensure accuracy of daily checks issued for payment of grants. Approximately 100M annually
• Liaison between the non-IT business users and technical development with regard to communicating technical concepts for business and system requirements.
• Gathered Business and System Requirement documentation for new enhancements for the Center of Medical Education Grants System.
• Ensured Grants for medical education were in compliance with regulatory guidelines by conduction audits.
• Responsible for ensuring that accurate data was maintained for the Diabetes, Oncology, Cardiovascular, and several other therapeutic areas.
• Developed and executed system and unit test cases for the Grant-Central system that resulted in the successful implementation of new system functionality.

Confidential

Quality Assurance Systems Analyst Customer Product Complaints

• Application Administrator for the validated Global Web/Oracle-based Product Complaint Management System CMS .
• Trained on cGMP, and GAMP practices and processes at the Zebulon GMS manufacturing site, I also have strong knowledge of 21 CFR Part 11.
• Ensured that the customer complaint system was compliant with the Health Insurance Portability and Accountability Act HIPAA regulatory guidelines.
• Developed and executed system and unit test cases for the CMS system that resulted in the successful implementation of new system functionality.
• Gathered Business and System Requirement documentation following the Integrated Quality Management System iQMS methodology for the Manufacturing Enterprise Resource Planning Solution MERPS project to develop the CMS/SAP R/3 QM Quality Management interface.
• Liaison between the non-IT business users and technical development with regard to communicating technical concepts for business and system requirements.
• Ensured that all enhancements to the system were designed, tested, and deployed to several GMS manufacturing sites per internal customer group requests while maintaining FDA regulatory system compliance.
• Tracked audit results and performed follow-up to insure that all Corrective Action and Preventive Action CAPA items were closed.

Confidential

Market Definition Analyst

• Validated and maintained Product and Market Definitions for the U.S. Pharmaceutical Commercial Division.
• Worked with internal Information Technology Support Staff and existing computer systems to validate and ensure Market Definitions were accurately integrated with internal and external data.
• Worked with External Data Vendors to ensure products and markets are aligned correctly for incoming data deliverables.

Confidential

Senior Verification Engineer

• One Night Process ONP Software Upgrade/Regression Test leader and System Administrator for XACORE and BRISC Switches.
• Managed Software Upgrade schedules to provide maximum utilization of lab time during Software Test Life cycle.
• Executed Test Cases for the Software Optionality Control SOC feature to ensure the load states and Call processing software transferred properly.
• Tested VoIP Call Processing features utilizing the Traffic Operator Position Systems Internet Protocols TOPS-IP and Operator Centralization Internet Protocols OCIP utilizing the DMS100 Switch.

Confidential

Senior Software Specialist

• Utilized the Product Library System PLS for weekly source code Configuration Management, which specifies the appropriate version of software modules for a given development stream.
• Configured and executed 30 software Loadbuilds per week to verify system functionality and business requirements. This test effort involved precise execution of source code propagation, download/application of patches, and backup/restore due to parallel testing of both the old and new dump-side images.
• Verified that the Software Designer's source code was packaged correctly.
• Managed and trained 6 contractors to achieve Compile and Loadbuild release objectives during second and third shift operations.
• Maintained Loadbuild and UNIX servers for the Software Integration Release SIR organization.