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HIGHLIGHTS OF QUALIFICATIONS

• Senior level Business Analyst experienced in writing business, functional system, and non-functional requirement documents for complex applications applying Business Process Modeling Notation BPMN guidelines and Catalyst methodologies for process flow depictions
• Experienced facilitating business and functional requirements gathering meetings JAD sessions with up to 40 stakeholders internal/external from both local and remote locations
• Experienced in leading a team of business analysts to produce large scale enterprise wide requirement deliverables used Sharepoint for document sharing and distribution
• Expertise in Financial, Medical, and Commercial Healthcare Related Transactions and Business Processes
• Experienced in web online application, web services, and various platform interface designs
• Review, interpret, and revise business requirements, specifications, and business processes to form recommendations. Proposed functional and technical solutions using PowerPoint presentations.
• Creation and maintenance of business system designs, requirement traceability matrix, and business use case documents using MS Word 2003 and 2007
• Experienced creating VISIO 2003 and 2007 flow and swim lane diagrams of both business processes and application processes for process improvement and process re-engineering efforts
• Strong analytical skills applied to thoroughly understand and interpret client business requirements and business rules in order to translate them into system application and operations specifications
• Expertise in Black Box testing including Mainframe, Web, and Unix client server applications
• Advanced Expertise in Application White Box testing including Unit, Integration, Regression, User Acceptance, and Stress/High Volume level testing
• Experienced in writing test plans, test cases, performing test execution, and recording test defects
• Advanced Knowledge of Software Development Life Cycle processes
• Vendor contract management experience
• Received client satisfaction survey results averaging 95 out of a possible 100 for all project deliverables completed in 2011.

HARDWARE/SOFTWARE

• Operating Systems IBM MVS/OS Mainframe, UNIX, SQL Server, Windows 2000 XP and 2007
• Software Languages - COBOL II, SQL, HTML, XML, VBScript, Easytrieve, CICS, TSQL
• Software Packages MS Windows, Word, Excel, VISIO, PowerPoint, Ultra-Edit32,
• BeyondCompare2, Putty, SQL for Windows, Sybase ECMap, ViaSoft
• SmartTest, Princeton Softech tools, Endevor/PDM, Librarian, Power MHS,
• QNXT, MS SQL Server Management Studio 2005, Borland Caliber
• Testing Tools - HP Quality Center/Test Director, QuickTest Pro, Borland Silk Central
• Files/Databases DB2, Oracle, SQL Server, VSAM
• Email Systems Outlook, Lotus Notes, GroupWise
• Other Tools Sharepoint, QMF, SPUFI, FileAid, FileAid for DB2, AbendAid, BMC Utilities,
• BMS/GT screen generator, TSO/ISPF, OS/MVS JCL, Xpediter, SyncSort
• EDI - HIPAA EDI Healthcare Transaction Sets

EMPLOYMENT/RELEVANT EXPERIENCE

Confidential

• Organized and led business requirement gathering meetings with business stakeholders, external vendors, and subject matter experts local and remote for various bank projects including: the investment services platform conversion project, the introduction of a new investment checking product line impacting online and mobile banking, an RFP process for replacement of the Supply Chain Finance and Factoring systems, and most recently, a project to upgrade the bank's ATM software and processes.
• Produced business and functional requirement documents for each of the projects listed above.
• Identified non-functional requirements included the functional documentation for each project.
• Organized and led functional requirement discussions with business and technical subject matter experts based on information documented in the business requirement documents for each assigned project in order to develop functional requirement documents.
• Created VISIO swim lane and process flow diagrams to depict both as-is current and to-be future business process and system flows.
• Created use cases for all new online interfacing applications for the new investment services platform which included online capability for both the banking investment counselors, back office staff, and the external investment banking customers. Created use cases for bank client interfaces with the ATM machines for the new processes.
• Worked on various business analyst initiatives for applying process improvements to the current requirement gathering strategies and documentation templates.
• Received client satisfaction survey results averaging 95 out of a possible 100 for all project deliverables completed in 2011.

Confidential

• Organized and led business requirement gathering meetings with the business stakeholders for both water fall and iterative development projects.
• Produced business requirements and functional system requirements documentation and related use cases for maintenance and enhancement modifications to the RBC Bank Pegasystems online web client portfolio transfer application.
• Created VISIO flow diagrams of business processes and system flows of the existing Pegasystems client portfolio tracking CPT application including swim lane diagrams.
• Created application documentation using the Pega PRPC V5.4 DCO Application Profile and designed the online screens utilizing the Pega Application Accelerator tool.
• Developed and executed unit and integration test cases using HP Quality Center for testing the modifications to the CPT. Utilized QC Excel Export Add-in tool to upload requirements and test cases.
• Mentored less experienced business analyst in document preparation, use case creation, and how to use HP Quality Center for entering requirements, test cases, and defects.

Confidential

• Researched the business processes, requirements, and business rules for the Medicaid claim adjudication process for the State of North Carolina in order to create the Business System Design document for healthcare claims adjudication.
• Managed Business Analysts team of three in the process of document and VISIO flow creation.
• Organized and led business process review meetings with the client which included subject matter experts from various healthcare divisions from the State.
• Created Business Processing Modeling Notation VISIO flow diagrams of business processes associated with claims adjudication.
• Developed Requirements Traceability Matrix document to map the business requirements to the business processes defined in the design document.
• Developed business use cases/flows for Pega Provider Intake system to control and track inbound correspondence from both provider and state entities.
• Delivered completed Business System Design document of over 500 pages and RTM document in excess of 400 pages which were approved by the State for a 1.1 million payment to the vendor for the claims adjudication combined deliverable.

Confidential

• Held meetings with Maine Medicaid State client representatives to gather outstanding claims processing system conversion requirements for creation of system business conversion rules.
• Creation and validation of claim conversion business rules to map existing Medicaid of Maine application data elements to the new Unisys QNXT application.
• Used VISIO to create conversion process flows depicting data movement from the old system to the new platform.
• Researched and developed claim outbound interface technical design documents for the QNXT system.
• Provided support to less technical business analysts in writing TSQL validation queries.

Confidential

• Creation and validation of Healthcare claim status response requirements based on HIPAA guide rules 276/277 and internal Blue Cross and Blue Shield of North Carolina agreements with enrolled health care providers.
• Developed detailed test plans and test cases for modifications to Healthcare claim status and Healthcare eligibility EDI 276/277, 270/271 , batch, and online web application functions.
• Responsible for reviewing test cases of junior level analysts to ensure compliance to both HIPAA regulation and BCBS of North Carolina business requirements.

Confidential

• Interpreted high level business requirements to produce detailed test plan documentation
• Developed and executed regression, functional, integration and release test scripts using Mercury Quality Center / Test Director for a Healthcare claims financial data repository application.
• Executed test cases to validate MQ service calls from AS400 and mainframe claim processing applications to the healthcare claims repository.
• Developed detailed test plans for an ETL interface between a WebMD web application and a healthcare medical and pharmacy claims repository application stored in DB2 on the mainframe.
• Documented defects on failed test cases using the Test Director tool.
• Provided critical expert knowledge in the area of healthcare claim transaction processing to make the claim extract web interface project a success. Received an award for these efforts.

Confidential

12 month contract assignment

• Interpreted information from the Health Insurance HIPAA X12N EDI guides to

define requirements for applying changes to the Sybase EDI Unix based mapping software.

• Created data mapping crosswalks between the HIPAA healthcare EDI X12 data elements, the MMIS DB2 legacy COBOL fields, and the XML schema elements used in the Unix MMIS C programs.
• Created test scripts in Excel for validation of the XML produced by the Sybase interface and the MMIS C UNIX based client server application programs.
• Validated MMIS transaction XML data results for map promotion to model office and user acceptance test regions on Unix system.
• HIPAA EDI transaction validations included the 837 healthcare claim transactions, 270/271 inquiries and responses, 834 eligibility transactions, 276/277 claim status inquiries and responses, and 835 remittance advices.

Confidential

• Interpreted high level business requirements to produce detailed system development specification documents.
• Developed a mainframe based interface application between the State of Alaska's MMIS

Recipient subsystem and First Health's Recipient Subsystem.

• The interface application included extensive edits, data conversions, cross-referencing of recipient transaction data, and a DB2 subroutine to handle all DB2 inserts, updates, and deletions to the Recipient Subsystem tables.
• Updated system process flows to reflect how the recipient information interfaced with the rest of the MMIS using VISIO software.

Confidential

• Converted existing Lowe's Purchase Order system from VSAM file processing

to DB2 data bases.

• Made enhancements to online screens using BMS/GT screen generation tool.
• Designed, coded, and tested programs to provide interfaces between DB2 batch

applications and PeopleSoft DB2 tables used in the Purchase Order online system.

• Wrote test cases and validated all test results at the unit and integration testing levels.
• Modified existing JCL and Procs and created JCL and Procs for the new interface processes.
• Utilized BMC utilities for DB2 Functions Xpediter and Princeton Softech tools for testing.

Confidential

• Provided project management support of the MMIS DMH/DD/SAS healthcare payment processing and reporting claim billing system. This was a COBOL/DB2/CICS application which utilized HIPAA EDI healthcare transaction sets: 834 Eligibility, 837 Claim, 835 Remittance Advice and Unsolicited 277. This application was part of the State of NC MMIS system.
• Acted as DHHS DMH/DD/SAS representative to the vendor, EDS, who held the State contract.
• Produced requirement documents from client specifications for enhancements and corrections that included definition of benefit packages, valid procedure and diagnosis codes, payment hierarchies, budget allocations for services, and payment allocations for the area programs that provided the healthcare services.
• Reviewed and approved vendor detail design documents, test plans, and test results from claim adjudication processes prior to production implementation.
• Reviewed and approved all contract updates and vendor invoices received from EDS for the State of North Carolina IPRS contract.
• Committee member on the 2004 MMIS RFP selection committee for the State of North Carolina.
• Committee Lead of a DMH user group on the production of a DMH section of the RFP document.