Reference: Senior Business Analyst with Agile Experience

Attention: Hiring Manager

I have over fifteen years of experience in software development, with ten years’ experience in business and technical analysis and five years’ experience in Agile as Business Analyst and Product Owner.

As part of my role in most of my positions, I intermediate between external and internal stakeholders and developers to clarify business requirements for software development. I am a highly motivated, take-charge person who has participated in most aspects of software development, from requirements gathering, current state analysis, use case scenario definition, test plan development, to end-user documentation used by training and marketing groups.

I am used to working with large amounts of transactional data and can parse out the pertinent data in reports by writing complex SQL queries to extract this data as well as using Excel macros to generate reports that are submitted to Management.

In my current position, I lead a team of developers for a company that produces software for student management for schools across Arizona and California. Schools are required to submit student data to the State as part of funding. Although the industry is different, the struggles to remain in compliance and identify the data elements required for compliance are the same and I use my analysis and technical skills from health care every day.

I have experience working remotely and am comfortable collaborating with both colleagues and customers in different time zones.

I look forward to discussing this position soon. Please contact me at ac4bep@r.postjobfree.com or call me at 480-***-**** at your earliest convenience.

Sincerely,

Michele Colacino

AREAS OF EXPERTISE/CORE COMPETENCIES

User Stories

Business Requirements Gathering/Analysis

UI Prototyping

Validation Test Planning and Execution

Claims Adjudication and Pricing

EDI/HIPAA Transactions (837 P/I/D, 834, 835 270/271)

Agile Scrum

Jira

Microsoft SQL Server 2012

SQL queries, Excel macros

Visio, Powerpoint

PROFESSIONAL EXPERIENCE

PRODUCT OWNER, AZEDS DATA COMPLIANCE

StrongMind, Inc. (formerly known as Flipswitch), Chandler, AZ 05/2016 - Present

Accomplishment: Improved existing student data submission process to qualify data for submission against the State's business rules. Decreased the number of errors from 20% to 0.3%, saving the school money, time, and resources required to address and manually correct these errors.

Product Owner for the Data Submission Compliance team for the company’s Student Information System (SIS). Lead Agile Scrum team using Jira and Confluence to manage the project; define sprint content and timelines; define data mapping and data submission and response processes. Gather and clarify requirements with both external school administrator stakeholders and the Arizona Department of Education, which uses the Ed-Fi Standard, an open-source data standard developed by the educational community and used by several states across the country.

HEALTH INSURANCE CONTRACT CONFIGURATION CONSULTANT

Cognizant, Inc., Phoenix, AZ 02/2016 – 05/2016

As subject matter expert for a major claims adjudication enterprise application, provided contract configuration analysis for a large health insurance carrier. Evaluated State Medicaid coverage requirements and generated configuration plans for implementation.

EDI BUSINESS ANALYST

Health Choice, Inc., Phoenix, AZ 10/2015 – 02/2016

Accomplishment: Designed an Encounter Data Processing System (EDPS) for Medicare Advantage risk adjustments. This process compares supplemental diagnosis codes gleaned by third-party clinical analysis vendors to identify high utilization patients and generates supplemental encounters for submission to CMS. This process helped Health Choice realize millions of dollars in unrecognized revenue.

Defined EDI processes in response to CMS, AHCCCS, and vendor requirements for a healthcare company that has lines of business for Medicare Advantage, Medicaid, Integrated Care, and HealthCare Exchanges in the States of Arizona and Utah.

Analyzed COB issues that were occurring with the MED MC claims application on both 837 P/I/D and 835 transactions for Medicaid and Medicare Advantage lines of business.

BUSINESS ANALYST/SOLUTION DESIGN

Invidasys, Inc., Mesa, AZ 07/2012 – 09/2015

Developed Encounter validation product to ensure compliant encounter submission in accordance with State and CMS guidelines for HIPAA 837 P/I/D and NCPDP Post Adjudication History transactions.

Developed Medicare Advantage eligibility processing product, including BEQ Request and Response process; MARx submissions and DTRR response process. Developed software for 834 eligibility processing. Customized processing rules by line of business and State.

Used Jira and Agile for project management. Recommended sprint content and timelines. Wrote design documentation, which included user interface, schema, and logic. Developed test plans for QA and documentation for the end user.

PRODUCT MANAGER

The TriZetto Group, Phoenix, AZ 02/2010 – 06/2012

Managed third-party partner relationships and coordinated compatibility with their applications and the QNXT claims adjudication product. Facilitated user group conference calls and online conferences to discuss impact of CMS regulations on product functionality for Medicaid, Medicare Advantage, and the Affordable Care Act. Led the group to define business requirements and identify business scenarios to develop business enhancement requests.

Initiated the SDLC process for an enhancement request with the designer. Assisted in the production of a high-level design document and actively participated in the development process, acting as the voice of the customer to ensure that the finalized product addressed the business requirements.

PRODUCT DESIGNER

Quality Care Solutions, Inc. (QCSI) / The TriZetto Grouphttp://www.consolidatedmessenger.com/, Phoenix, AZ 07/2005 – 01/2010

Worked with health insurance customers to define business requirements and produced workflow diagrams, process models, and use cases to identify the business problem and proposed solution. Assisted Product Managers with the high-level design document, which would include these elements. Upon customer acceptance of the high-level design document, produced design documents that included UI, database, and logic enhancements required to meet the customer's requirements. Developed test plans for QA as well as documentation for technical writers. Also triaged issues from customers to determine whether the issue was a defect, represented a gap in existing functionality, or was an education or configuration issue.

Projects included 5010 HIPAA conversion; QNXT Case Management product; QNXT COB calculation method enhancements.

EDUCATION

Blue Cross/Blue Shield Association Training

Project Manager’s Toolkit, Mindavision

Business Analysis with UML, Watermark Learning

Chubb Computer Services Top-Gun Program, Client/Server Programming.

BA Linguistics, SUNY Stony Brook

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