SUMMARY:

• Driven technical professional with leadership, management, organizational, communication, analytical, and problem resolution skills.
• Ability to effectively plan, coordinate, and meet deadlines within the organization.
• Capability to bridge technology and business goals to provide productive solutions.
• Demonstrated success in streamlining existing operations and upgrading applications.
• Proven success leading and mentoring co - workers to achieve a common goal. Able to work well with others as well as independently.

TECHNICAL SKILLS:

Operating Systems: Microsoft Windows OS, UNIX, MAC OS

Applications: Analytics Administrator, Agile, Waterfall, Crystal Reporting, IDQ, IDX, Oracle, MS Office Tools,, SQL*Plus,, FTP, Visible Analyst Case Tools, QNXT/Trizetto,, GAMUT, Selecta, Vistar, PharmScreen, Macess, Pivotal, Praire Frye, SharePoint 2010, Cognos Impromptu Medical Intelligence, DBMSBIDS, Report Builder, AccuRoute, McKesson Applications (CCMS, Interqual, DM, CRMS,VITAL, Eloquence), Track-It 8, Minitab14, Salesforce.com, IDX, Navinet

Languages: SSIS, SSRS, SQL Server, TSQL

WORK EXPERIENCE:

Confidential

File Transfer Technical Analyst

Responsibilities:

• Specializes in guiding applications that use the file transfer connector to connect to the Oracle-based IAM solution through the on-boarding process.
• Review the File Transfer Field Mapping Template with the Application SME and recommend changes as necessary
• Review target application export process and Asset Integration Design document with the Application SME
• Analyze current state organizational access to entitlements and make future state recommendations
• Assist LOB Liaison in the construction of process groups that will administer access request approvals, fulfillment
• Assist LOB Liaison in populating upload templates & tools that will be used to load entitlement and related meta-data
• Rapid On-boarding Path Maintenance
• Maintain Rapid On-Boarding Process documentation for the File Transfer Path
• Participate in requirements gathering exercises for IAM Solution feature releases

Business Configuration Analyst

Responsibilities:

• Developed SQL queries for quality and assurance of file transfers and data integrity
• Daily use of Excel and MS Access to dump the data and analyze based on business needs
• Developing environments to be used for testing and a range of functionalities per technical specifications.
• Configured Qnxt for the member benefits and claims teams.
• Reduced Qnxt ticket backlog by 50% to help the company meet goals
• Configure healthcare insurance payer systems
• Analysis of benefit plans and configuration of benefit plans/rules
• Analyze and create data workflows

Clinical Applications Business Analyst/Manager

Responsibilities:

• Report writing according to the business requirement in SSRS.
• Enhanced/deployed SSIS Packages from development server to production server.
• Developed automated queries to write deliverables for the state agency which have received 100% accuracy
• Worked on claims, provider, member data extracting and importing data from various sources such as flat files, Oracle and Mainframes
• Data mapping determining what data will be extracted from an internal data warehouse, transformed and sent to an external party.
• Performed large data mining efforts on Claims and member health HIPPA data using complex SQL queries
• Analyzed business requirements, system requirements, data mapping requirement specifications
• Responsible for documenting functional and secondary system requirements
• Developed error subscriptions which in turn increased annual authorization issue detection by 90%.
• Slashed clinical staff overhead by implementing an automated mailing process that showed 10% daily time reduction
• Successfully Implemented new lines of business which increased company’s membership by 10,000 members
• Ignited a team of business analysts for numerous Software and Claims system implementations
• Created sql based business logic to ensure compliance with all mailings based on membership
• Lead team of business analysts for QNXT systems conversion with thousands of data points

Business Analyst II Clinical Applications

Responsibilities:

• Transfer member and provider HIPPA data and demographics through secure nightly FTP process
• Performed large data mining efforts on Claims and member health HIPPA data using complex SQL queries
• Responsible for analyzing various data sources such as flat files, ASCII Data, Relational Data (Oracle, MS SQL Server) from various data sources.
• Delivered files in various formats (ex. Excel file, Tab delimited text, Coma separated text, Pipe delimited text etc.)
• Daily FTP process analysis identifying and correcting errors and fallout
• Creation of analysis reports using SQL to identify data discrepancies caused by FTP failures and errors
• Assistance with design, development and implementation of the Clinical Application Software servicing 200k members
• Systems expert team lead for QNXT claims configuration implementation
• Team Lead for ICD 10 system configuration
• Implemented software for launch of Inova Health Care
• Monitor daily flat file transfers of provider payments and demographics

Business Analyst I Provider Networking

Responsibilities:

• Created regulatory reports for departmental business analysis using SQL
• Implemented Provider Data reconciliation reporting that saw a 25% decrease in provider discrepancies
• Slashed overpayments to vendors with estimated savings of 500k, lead on individual consideration rate project
• Developed and enhanced existing corporate metrics for the department president and Directors
• Monitor daily flat file transfers of provider and hospital payments and demographics
• Daily use of Excel and MS Access to dump and analyze data based on business needs