SUMMARY

• Insurance business and IT experience, health, dental, property and casualty and securities.
• Main frame full life cycle Medicaid and Commercial Management Information Systems.
• Business Intelligence.
• Insurance fraud and abuse, investigation, prosecution assistance, recovery .
• System Testing smoke, use case, parallel, regression and user acceptance testing .
• Reports, authoring, training and execution ,
• Requirement elicitation and documentation, policy, regulatory, compliance and user
• Internal audit.
• Quality Assurance Operations and Test Documentation .
• Business and clinical management.
• External vendor management.
• IT and project management.
• Employee Leadership and professional relations.
• Project Management.
• End User Training.
• Report Analytics.
• User and System Requirements.
• Customer Interface.
• Resource Reporting.
• Change Management.
• User Interface Design.
• Train Testing Resources.
• Data Mining
• Technical and operational writing.

SKILL SETS

PROJECT DETAILS

Confidential

PM Business Analyst

My role includes adding value as a Business Analyst t corporate projects assigned t the Project Management Office PM .

Responsibilities:

• Facilitate the build and maintenance of a well-functioning team in moderate t high complexity project environments.
• Establish the boundary between requirements and design/development t ensure alignment from business, IT, testing, and other receivers.
• Create effective stakeholder profiles identify gaps in SME engagement. Escalate potential SME gaps and works with business and project partners t secure SMEs t represent subject areas that may not have been included in the original resource plan.
• Use acquired domain knowledge t consult with the customer through identifying gaps, proposing alternate solutions, pointing out risks issues and escalating appropriately
• Proactively engage stakeholders t determine the appropriate deliverables t produce for various audiences.
• Establish and document a requirements approach for moderate t high complexity projects and gain early buy-in on plan from requirements suppliers, supporters and receivers.
• Decompose complex requirements efforts t properly scale approach.
• Adapt the deliverables package t the unique needs of the business and requirements receivers.
• Establish verification and validation processes that are appropriately scaled t the size and complexity of the project.
• Implement a requirements change control approach following PM guidelines.
• Use deep project knowledge t assess the impact of proposed changes and advises the business and other project stakeholders in processing or dispositioning the change.
• Implement and facilitate traceability tools and processes that accurately trace requirements t business needs, design development, and testing deliverables.
• Participate in testing t include develop, coordinate and monitor user acceptance testing UAT .
• Skills Used: Microsoft Office, SharePoint, BlueWorks, Outlook.

Confidential

Proposal Writer

My role includes converting MITA requirements t boilerplates utilized as template for future Medicaid RFP responses.

Responsibilities:

• Facilitate peer review sessions.
• Create Medicaid requirement and design documents t align with MITA requirements.
• Support all phases of proposal development.
• Support efforts t meet requirements for Requests for Proposals RFP's .
• Write proposal content, as direct.
• Maintain a consistent company image and brand through the creation and use of templates, presentation materials, graphics and supporting tools.
• Create Medicaid boilerplates.
• Skills used: ACS SharePoint, MS Project, MS Office, Outlook

Confidential

Position: Business Analyst/SME

Responsibilities:

• Identify and resolve risks and issues impacting the progress and outcome of the project.
• Research and provide recommendations on critical business decisions.
• Assist in leading the implementation and associated changes t the mainframe and interface applications.
• Assist with creating and managing work.
• Collaborate with other business areas t provide subject matter expertise on system functionality, business areas and regulatory compliance.
• Define and document customer business and processes requirements for both mainframe and interface applications.
• Liaison between executive stake holders and technical programming staff in the analysis, design, configuration, testing and maintenance of a care management system t ensure optimal operational performance.
• Facilitate JAD sessions for requirement elicitation and documentation.
• Track and document changes for functional and business specifications write detailed universally understood procedures for permanent records and for use in training and operational use.
• Lead and facilitate with client staff, Sr. executives, clinical staff and IT t develop the detailed scope statements, and high level technical system requirements for implementation.
• Read and interpret case management systems and functional technical literature and translates in terms understandable t the end-users.
• Develop an overall change management strategy t include prioritizing implementation changes as well as future releases, post implementation.
• Research of CMS, MITA, Medicaid and customer SOW guidelines t ensure compliance with corporate process and procedures.
• Load and test data int the care management system.
• Create and peer review documentation for Readiness/G Live audit walk through.
• Create strategic level business requirement deliverables, functional and design requirement documentation as well as system solution documents with associated workflows or diagrams.
• Manage and integrate business, functional and technical requirements and design, and provide oversight in the definition of system related work processes and changes in alignment with the client's business and IT needs.
• Write technical administrative spec manuals, and end user manuals for mainframe.
• Creation of Gap analysis, data mapping and develop Data Conversion specifications of mainframe t interfaces applications.
• Create workflow and swim lane documents.
• Develop Software Development Lifecycle SDLC documents including as-is and to-be business processes, screen mock-ups, and use cases.
• Key business process analyst and technology solution specialist between the client and technical staff.
• Skills Used: Excelicare, SharePoint and MS Visio, Word, Excel and Excelicare portal.

Confidential

Position: Offsite Coordinator/Team Lead and Testing Specialist

Responsibilities:

• Train both onshore and offshore testing resources.
• Create and execute test scripts for
• Sprint, Regression, Functional and System Integration Testing across all functional areas.
• Create and remediate defect and change orders.
• Data base mapping verification/create and execute SQL data queries.
• SME for Claims EDI/Manual , 5010 and ICD-10, Claim Finance and Remittance Advice.
• Define, document and validate requirements.
• QA of Regression Test Results for IV and V submission.

Design testing templates.

• Lead sprint test sessions.
• Ensure delivery of services within the controls of the project/team on the obligations defined within the Statement of Work SOW contract signed between the client and corporate management.
• Develop project teams work plan with milestone schedules.
• Identify possible areas of improvement of business and project/team processes.
• Communicate problem issues t management.
• Provide direction for team member training and exercise working supervision over corporate project/team personnel with the assistance of Human Resources.
• Provide performance feedback t assigned team members.
• Provide monitoring, coaching and knowledge transfer/sharing t less experienced employees.
• Prepare and coordinate the Project/Team's work and monitors.
• Ensure technical accuracy and adequacy of team results prepare reports for client and corporate management review.
• Review project/team schedule and determine necessary changes t complete the project or assignment on time, maintaining corporate's quality standards.
• Gather, review approve and send timesheets t Corporate Office Manager.
• Provide leadership t all team members.
• Conduct team meetings as necessary and interact regularly with staff t fully engage staff in ownership of the project and its success.
• Assist new employees joining the project.
• Facilitate employee recognition.
• Assess Client/customer satisfaction on a regular minimum of quarterly basis and provide input t Account Manager or Client Relations Director.
• Skills Used: Medicaid Management Information System Enterprise , Clear Quest, Rational Manual Tester, SharePoint, Project Web Access, Microsoft Office, SQL Developer. Rational Manual Tester, Project Web Access, Golden and Control M., IBM Rational Tool Suite, MS Project, Consultrak

Confidential

Position: Offsite Coordinator/Team Lead and Testing Specialist

Responsibilities:

• Participate in release meetings t aid in the scheduling of new code releases.
• Develop project teams work plan with milestone schedules. Participate in the client/customer dashboard meetings t report project status.
• Resource and Cost Allocation.
• Create and maintain the client's test team weekly project status report.
• Create SIT test plan.
• Create End-to-End test plan.
• Approve both client and contractor timesheets.
• Create and publish resource reports t client management.
• Lead and drive defect triage meetings with onshore and offshore business and technical staff.
• Create and execute data queries using Clear Quest BI tool.
• Design testing templates.
• QA of Regression Test Results for IV and V submission.
• Define, document and validate requirements.
• Data base mapping verification/create and execute SQL data queries.
• Create and remediate defect and change orders across all functional areas.
• Create and execute test scripts for Performance, Operational Readiness, Sprint, Regression, Functional and System Integration testing across all functional areas.
• SME for Claims EDI/Manual , 5010 and ICD-10, Administrative Reporting, Introduction and Architecture Provider Enrollment and Architecture.
• Train both on and offshore testing resources.
• Lead sprint test sessions.
• Ensure delivery of services within the controls of the project/team on the obligations defined within the Statement of Work SOW contract signed between the customer and corporate management.
• Identify possible areas of improvement of business and project/team processes.
• Communicate problem issues t management
• Provide direction for team member training and exercise working supervision over project/team personnel with the assistance of Human Resources.
• Provide performance feedback t assigned team members.
• Provide monitoring, coaching and knowledge transfer/sharing t less experienced employees.
• Prepare and coordinate Project/Team's work and monitors performance t ensure satisfactory progress and project time management.
• Ensure technical accuracy and adequacy of team results prepare reports for client and Management review upon request.
• Review project/team schedule and determine necessary changes t complete the project or assignment on time, maintaining corporate quality standards.
• Approve client and employee payroll submissions.
• Provide leadership t all team members.
• Conduct meetings as necessary and interact regularly with staff t fully engage staff in ownership of the project and its success.
• Assist new employees joining the project.
• Facilitate employee recognition.
• Assess Client/customer satisfaction on a regular minimum of quarterly basis and provide input t Account Manager or Client Relations Director.
• Skills Used: Medicaid Management Information System Enterprise , Clear Quest, Rational Manual Tester, SharePoint, Project Web Access, Microsoft Office, SQL Developer. Rational Manual Tester, Project Web Access, Golden and Control M., IBM Rational Tool Suite, MS Project, Consultrak