Project Manager Analyst

Helen Simon

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Home : 973-***-**** - Cell: 973-***-**** E mail: ********@*****.***

Professional Summary

A Senior Information Technology Professional with experience working within the Healthcare and Retail / Electronics and

Brokerage Industries. Experience includes working as a business/systems/application analyst and project manager.

Responsible for requirements gathering, data/process modeling, business strategy, policy/procedures, mapping of

business rules to technical requirements and mentoring junior staff. Extensive work with both Mainframe and Client

Server EDI transactions-based projects. Fluent in English and Russian with a strong working knowledge of French.

Strong SDLC lifecycle experience and AGILE/SCRUM Project Methodologies.

Areas of Expertise / Core Competencies

• Solid development background

• Proven track record of project planning, development and timely completion

• Understan d the business needs and tie them into th e technica l requirements

• Able t o interfac e wit h and make p resentation s to en d users, managers, and technica l team

members

• Negotiat e & build consensu s around requirements

• Model data & processe s around specifi c project

• Facilitat e & develop business strategy

• Understan d & manag e o rganizational change/polic y as i t applie s t o t h e p roject

• Ability to assess problems and solv e them with a strong sense of urgency

• Work closely account managers and i mplementatio n t eam

• Fluent in English and Russian

• Working knowledge of French

Skill Highlights

• Abilit y t o gathe r requirements

• Pla n & manag e activitie s a roun d requirements g athering

• Understan d the business needs and tie them into th e technica l requirements

• Able t o interfac e wit h and make p resentation s to en d users, managers, and technica l team

members

• Negotiat e & build consensu s around requirements

• Model data & processe s around specifi c project

• Facilitat e & develop business strategy

• Understan d & manag e o rganizational change/polic y as i t applie s t o t h e p roject

• Ability to assess problems and solv e them with a strong sense of urgency

• Work closely account managers and i mplementatio n t eam

• Fluent in English and Russian

• Working knowledge of French

Technical Skills and Competencies:

IBM 3090, MVS, DB2, SQL, QMF, SPUFI, File/Aid, TSO/ISPF, Windows XP, Microsoft Office Suite

(Word, Excel, PowerPoint, Access), Project Leadership, EDI 834 transaction and File Structure,

Information Engineering Methodology using IEF Case Tool, PowerPoint, REMEDY, AGILE Project

Development

Professiona l Experience

Sr. Business Analyst / Project Manager Septembe r 2007 to March 2013

Express-Scripts Holdings – Franklin Lakes, NJ

Primary responsibilities:

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I n t his client -facin g role responsibl e fo r identifyin g clien t requirements, implementatio n o f n e w c lien t a ccounts

f ro m i nitia l concep t t o f ina l implementatio n, supported clien t vendo r change s an d on -goin g c lien t m aintenance .

S pecific r esponsibilitie s i nclud e d efinitio n o f c lient account structure on ESI systems, mapping of proprietar y

client/vendo r layouts to the standard company layout; mappin g of E DI 834 X 12 501 0 eligibilit y t ransactions ;

analysi s of c lient files, suc h as claims, ope n refills, p rior a uthorizations, h andlin g of a nnua l e nrollmen t p roces s

a nd p rovidin g sign -of f t o t h e d evelopmen t a rea.

In the Project Manager capacity responsibl e fo r identifyin g p roject scope and project objectives, chang e

needs, assessin g the impact of th e change, capturin g and documenting requirement s, preparing and reviewing

test cases and ensurin g that the requirement s are delivere d by IT whils t supportin g the business throug h th e

implementatio n p rocess. In addition responsible for timely project implementation by following established

g uidelines and project schedule and leveraging existing processes. Conducted weekly staff meetings to ensure

p rojects deliverables are on time. Reported the project status to senior management on a weekly basis.

P artnered with other project managers to ensure SOP conformity. Conducted one-to-one meetings with junior

staff to clarity requirements and coordinated recruitment of qualified personnel.

Responsibl e for identificatio n of client transmissio n preference s and ensurin g that FT P connectio n is set up

p roperly; coordinated FTP setup with the Information Exchange team. Attended internal technical reviews, reviewed

and confirmed FRD, prepared test cases, obtained client sign-off and signed off on requirements.

Accomplishments:

• SME on EDI 834 file structur e as it relates to client business models and requirements

• SME on the Book of Business eligibilit y processes

• Functioned as Project Manager o n E DI 8 34 4 01 0 t o 501 0 conversio n of a ll commercia l a ccount s

a s part of company -wide HIPAA conversio n effort ; handle d conversio n fo r a ll commercia l accounts ;

p rovide d guidanc e t o team members ; attende d interna l technica l reviews ; schedule d a nd coordinate d

t imel y d eliver y acros s multiple groups; provided sign-off on requirement s and test results

• Coordinate d a n d b rough t t o completio n clien t year -end activities, such as Open Enrollmen t files as

well as current year files

• Authore d S O P o n t h e S ingle -Sign On process which allows clients to access ESI Client

Website from a centralize d l ocation.

• Participate d in th e conversio n of commercia l account s t o EGWP; worked closel y wit h th e Medicar e

tea m to ensur e that both commercia l and EGWP f iles are in sync; advised clients and vendors on the file

changes required for conversion.

• Installed and maintained over 30 client accounts and assisted junior staff

• Converted multiple manual file processes to automated file submission. This resulted in 97% accuracy

of client eligibility information; allowed for streamlined audits; facilitated client inquiries.

Project Manager February 2005 to August 2007

Health Management Systems – New York City, NY

As Project Manager was responsible for analysis and implementatio n of highly customize d processe s of evaluatin g

third party claim s fo r th e purpos e of recoupin g mone y f o r Medicar e a nd Medicaid . Worked d irectl y wit h client s t o

maximize recover y percentag e and to ensure compliance wit h policies and guidelines.

Consultant August 2004 to February 2005

Health Insurance Plan of New York – New York City, NY

Analysis, desig n a nd developmen t o f E DI 82 0 a nd 83 5 X 1 2 claim s t ransactions, as well as mapping o f inbound and

outbound E DI data t o company standards.

Participate d i n d esig n an d f unctiona l requirement s developmen t o f th e enhancement s of t h e curren t Claims

A djudicatio n an d B illin g systems.

Designed and developed E -pricing system to p rovid e p ricing informatio n for outsid e providers.

Senior Application Analyst November 1995 to January 2003

Merck-Medco Managed Care – Franklin Lakes, NJ

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Functioned as a senio r membe r of the Data Server Developmen t team whos e primar y rol e were design, developmen t

a nd suppor t o f high -complexit y back-end DB2 Inquir y and Update shareable CICS and Batch modules for

enterprise-wide usage.

Key contribution and accomplishments:

I n th e role o f a Technica l S pecialist, a nalyze d a nd f unctional p repare d b usiness and functional requirements

f o r e nhancement s f or Patient Eligibility, Physicia n Communicatio n Preferences, Pharmacy Networ k

Management, and Doctor Information, Prescriber Communication Preferences systems.

Hel d a l eadin g r ol e i n company -wid e V SAM -to -DB2 conversion . The system wen t liv e on schedule in November

2 002. The system allowed for Book of Business expanded functionality.

D esigne d a n d implemente d t h e Cash Back portion of the YourRX system. The goal of the system was to extend

p rescriptio n benefits to non-member s via a cash back incentiv e and t o provide monthl y reimbursement s base d on

t h e tota l a moun t spen t on medications.

Participate d i n t h e Pharmacy Super Chain developmen t effor t to expan d pharmac y networkin g capabilitie s and

functionality . Identified DB2 modules requiring conversion and coordinated development effort of client applications.

Initiate d and lea d the effor t t o propagate dat a serve r coding standard s to MIS g roups and communicate d server

e nhancement s t o developmen t t eams

Prepare d a nd periodicall y u pdate d serve r d ocumentatio n an d p resente d serve r functionalit y t o t echnica l a nd

business groups; responsible for creating UAT plans, supervision of user acceptance testing and user sign-off;

investigate d and resolve d QA testing issues.

Worked with third-party vendors (CODE 1 Plus;VALITY) to ensure completeness of enterprise address data.

Senior Systems Analyst May 1988 to October 1995

SONY Electronics – Woodcliff Lake, NJ

A s a membe r o f th e E mergin g Technologie s Team, participate d in variou s p roject s d evelope d usin g th e IE F Case

Too l t ha t i mplement s t h e I nformatio n E ngineerin g M ethodology.

Key contributions and accomplishments:

Designed, d evelope d a nd implemente d Receivin g an d Inventor y Contro l p ortion s o f t h e Stock Locator

Warehouse Management System for the Logistics Control Group. Entir e s yste m developmen t wa s a utomated,

from plannin g stag e t hroug h code generation, i ncluding maintenanc e operations . The database and code

developmen t stages ar e PC-base d and wer e develope d using t h e Informatio n engineerin g Facilit y tool w it h t h e

M ainframe -based generate d COBOL code and the DB2 Data M odel.

Develope d a n d i mplemente d t h e Employee Skills System t o e valuat e e mploye e p erformanc e a n d p rovid e well -

balance d project assignmen t based on e mploye e skills an d availabilit y fo r futur e assignments

Designe d a n d i mplemente d Preferre d Distributio n Channel sub-system of the Procuremen t Managemen t System

S upporte d a ll P roductio n I EF -writte n systems, modifie d a nd enhance d logica l a nd p hysica l d at a models,

developmen t coordination, t oolse t versio n contro l a t serve r an d clien t level, p roductio n suppor t of t h e mainframe

e ncyclopedias, g eneratio n a nd installatio n o f p roductio n code.

Prepared training cours e in the IEF Toolset for new hires

Applications Analyst February 1987 to May 1988

Prudential-Bache Securities – New York City, NY

Supported application development of Loans and Borrows department.

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P articipated i n t h e d evelopmen t o f t h e M ainfram e D ual -Host transmission of CCF deliveries to DTC. Upon

completio n th e transaction s were bein g accepte d and p rocesse d within t wo minute s of th e cut -of f t im e t hat

equate d t o a 45% processin g improvement.

Develope d a nd implemente d Averag e Weighte d Rat e syste m t ha t combine d custome r p ortfoli o information,

b roke r information, curren t marke r rates and reporte d on p rofitable and unprofitabl e customer loans in batc h and

o n -lin e f orm.

Education

Bachelor Degree

Marymount Manhattan College

New York, NY, USA

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