Summary

• Energetic, detail-oriented professional with more than 15 years experience designing, developing, implementing, and testing complex applications in the healthcare industry.
• Determined and resourceful, quick to grasp new ideas, and stimulated by challenges.
• Able to comprehend and organize complex materials according to requirements and draw on experience and judgment to plan, accomplish goals, and meet demanding deadlines.
• Excellent written and oral communication skills with the ability to communicate appropriately in business and technical situations at all levels.
• Strong organizational skills with superb analytical skills.
• Resourceful thinking and problem solving skills.
• Experienced in all levels of testing including document preparation, test case execution, and problem diagnosis and resolution.
• Self-motivated, hardworking team player with proven experience as a team leader and mentor.

Technical Skills

• COBOL
• DYL-280
• Easytrieve
• Assembler
• CICS
• MVS JCL
• UNIX
• IMS DB
• DB2
• SQL
• VSAM
• TSO/ISPF
• Abend-Aid
• MS Office
• IDX
• QNXT
• RFP Machine
• Healthcare
• HIPAA Privacy and Transactions
• Medicaid and Medicare
• SQL Server Management Studio
• Requests for Proposals
• SDLC Waterfall and Agile Methodology
• Requirements Gathering
• Gap and Risk Analysis
• Business Requirements
• Traceability Matrix
• Functional Specifications
• System Requirements
• Use Case Diagrams
• Project Estimates
• Testing Plans, Cases and Scenarios
• Training and User Manuals
• Medicaid Encounters

Professional Experience

Information Technology Specialist III,

Confidential

• Design, test and implement new and enhanced encounter applications as a Business Analyst on the Division of Developmental Disabilities DDD encounter team
• Rescued a new User Interface UI for resolving Medicaid encounter pends. Corrected and enhanced business requirements and functional specifications.
• Prepared, documented, and executed test scenarios based on project documentation and developer interviews.
• Tested the AHCCCS Medicaid Encounter submission process due to a SQL and server upgrade.
• Thoroughly documented steps taken, data used, and test results for over 25 system enhancements. Confirmed resolution of all identified defects. Issue free production installation on 100 of tested items.
• Solely responsible for all testing and documentation for the 5010 implementation, which had no production issues. Prepared test documents Used: word, SQL, scripts, and files in the following formats:
• Prepared Business Requirements BRS , Functional Specifications FS , testing documents, and conducted all testing for the adjudication portion of the Acute encounter load to FOCUS. Thorough testing identified multiple major load issues that were not identified by the load testers.
• Gathered requirements through user meetings and data analysis to prepare a BRS to utilize Behavioral Health Data received from the Arizona Department of Health Services ADHS / Division of Behavioral Health Services DBHS .
• Prevented encounter pend sanctions by identifying cause and resolution of encounter pends.

Environment: Vista, Microsoft Office 2010, and SQL Server 2008.

File Formats: 837I, 837P, 824, 999, U277, U277 Supplemental, XML and AHCCCS proprietary CL Pend.

Senior Business Analyst

Confidential

• Implemented new business and managed IT Request for Proposal RFP response content for Medicaid, Medicare, and commercial plans.
• Worked directly with business stakeholders, developers, and customers to drive the translation of business needs into technical and design specifications for new and existing Medicaid business.
• Developed and maintained project documentation for new plan implementations including charter , scope, business and system requirements, as-is and to-be flows, traceability matrix, SAM, BAM, and functional specifications.
• Analyzed requirements to formulate potential solutions to meet state requirement of generating Explanation of Benefits EOBs for 5 of select claims for Missouri's Medicaid population.
• Selected to attend and review a new business analyst course through PmCenters USA.
• Wrote test plans and created test cases based on project documentation.
• Acquired and sustained understanding of company information in order to construct RFP responses that accurately represented capabilities. Built key relationships with geographically dispersed Subject Matter Experts SMEs .
• Composed specific customer-focused, technically accurate RFP responses as the only IT resource supporting over 15 sales and marketing teams. Wrote quality responses in a compact, intensive timeframe. Successfully met or exceeded 100 of deadlines. Received high score for contribution to RFPs that won Medicaid business in four states.

Environment: IBM mainframe, IDX, Mumps, Cache, RFP Machine, SDLC Waterfall approach, Remedy, and MS Office.

Senior Business Analyst

Confidential

• Project Manager for a critical project with a 200 seat implementation for a new appeals application used by Medicare Advantage, Medicare Plan D, and Medicaid plans.
• Designed and prepared detailed business documents based on user observation and interviews, developer input, government compliance manuals, and existing system functionality.
• Verified system operations met businesses needs through development and use of UAT testing strategies.
• Developed training materials and instructed users on new application, processes, and procedures.
• Defined and documented data conversions needs. Oversaw and participated in data conversion tasks.
• Appeals project implemented on-time, error-free, and within budget.
• Appeals system used companywide even though it was designed for only one plan.

Environment: QCSI QNXT/QMACS, MS Word, Excel, Visio, MS Access, and SQL Server.

Independent Consultant

Confidential

• Offer consulting services for both the business and private sector including Abrazo Healthcare, DHL and NDC Health.
• Migrated a vendor claim application handling more than 210 million monthly transactions from an IBM mainframe to Sun UNIX using COBOL, MicroFocus Cobol, MVS JCL, and Korn Shells.
• Gathered requirements and prepared specifications for a new online Medicaid provider system for Abrazo Healthcare.
• Executed and monitored a large production claims history process using COBOL, DB2, JCL, and CA-7.
• Administered unit and system testing for a new claims projection history application using COBOL, DYL-280, MVS JCL, SDSF, TSO/ISPF, and DB2. Included creation of test strategies and scripts and result documentation.
• Traveled to Seattle to assist the computer operation team with the DHL/Airborne IBM mainframe integration.

Senior System Analyst

Confidential

• Supplied migration analysis and implementation services for UniKix re-hosting software, Mainframe Transaction Processing MTP and Mainframe Batch Manager MBM . MTP and MBM are used as an aid when migrating applications from an IBM mainframe to the UNIX environment. Delivered product based consulting for customers.
• Improved Sun software accuracy as project manager for a new COBOL/CICS application designed to determine VSAM file performance within re-hosting products. Included requirements gathering, writing business, functional and technical specifications, test documents, and coding. Exceeded stakeholders' expectations due to detailed technical and user documentation, error free turnover, and early completion.
• Transitioned large IBM mainframe health care application to UNIX, which included preparation of workflow and program risk area documentation, program specifications, and test scripts. Worked closely with customer to identify and resolve migration problems and inefficiencies.
• Provided project leadership for migration audits. Analyzed existing customer systems and determined valuable application reuse. Prepared professional proposals using audit results. Met or exceeded all deadlines.

Environment: MicroFocus Cobol, COBOL, CICS, DB2, IMS, JCL, Assembler, CA-Easytrieve Plus, DYL-280, IBM Utilities, Perl, Java, MVS, Korn Shell, Sun UNIX, IBM mainframe, OS/390, Vi Editor, File-Aid, and MS Office.

Senior System Analyst

Confidential

• Designed, developed, documented, and delivered online and batch enhancements to government and commercial healthcare applications. Mentored 7 junior programmers.
• Invited to perform as a business analyst on over 83 projects when the company experienced a shortage of resources.
• Wrote business and technical specifications for 10 different government clients to ensure HCFA 1500 and Universal Drug Form compliance. Examined and documented existing Medicaid and Medicare applications.
• Project lead for the successful implementation of more than 122 system changes.
• Facilitated sessions with stakeholders to identify and document high-level tasks associated with becoming HIPAA compliant. Identified needs, provided recommendations and best practices. Developed a work plan detailing the individual tasks, effort required for each, and approximate budget needs to achieve HIPAA compliance.
• Streamlined daily and monthly batch processing reducing execution time by 33 .
• Investigated and modified online modules and maps reducing customer response time 40 and errors by 55 .
• Completed regularly changing Medicaid claim reporting requirements on or prior to due dates.

Environment: IBM mainframe, OS/390, MVS, TSO/ISPF, JCL, COBOL, CICS, CA-7, CA-11, IAM VSAM, DYL-280, BMS, DFSORT, File-Aid, MicroFocus Cobol, and MS Office Suite.

Consultant

Confidential

Recruited to convert processing of Canadian Corporate Accounts Receivable CAR to the American CAR application using COBOL, IMS DB/DC, DB2, MVS JCL, Easytrieve, IBM utilities, Syncsort, TSO/ISPF, and File-Aid.

Programmer Analyst

Confidential

• Developed, analyzed, and maintained enrollment application. Mentored junior programmers and new employees.
• Exceeded user expectations as project lead for an automated retrieval system for archived eligibility records.
• Successfully implemented an enhanced enrollment/eligibility application supporting more than 50 million members.

Environment: IBM mainframe, TSO/ISPF, SDSF, CICS, COBOL, VSAM, MVS JCL, IMS DB, DB2, and Easytrieve.