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Senior Healthcare Business Analyst

Apex, North Carolina, United States
August 15, 2018

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Over 15 years experience exceeding expectations in Healthcare software, managing complex IT projects. Practiced in obtaining/clarifying business requirements, gap analysis (goals vs. existing procedures/skill sets), and designing process/system improvements. Extensive expertise in Electronic Data Interchange (EDI), Electronic Media Claims (EMC) and American National Standard Institute (ANSI) X12 transaction sets, Medicare and State Medicaid Paper and Electronic billing requirements and Commercial Clearinghouses.

Core competencies include:

Certified Scrum Master

Diplomatic Negotiator

Project Management Skills

Functional and Data Requirements

HIPAA EDI Compliance

Subject Matter Expert: Medicare/Medicaid

Effective Communicator

Interpersonal Skills


TEKsystems at BCBS of NC 12/2017 – 7/2018

Business Analyst

Implemented Medicare Diabetes Prevention Program (MDPP) enterprise project within four months. Managed over fifty stakeholders internal/external from various areas of the company. Lead analysis to define, analyze, and develop enterprise solutions to resolve business impacts. Coordinated and identified Facet pain points with Cognizant staff. Obtained Change Request Approval for the Council for Affordable Health Care initiative.

Elicited, analyzed, documented and managed requirements for changes to business processes, policies, information, and information systems for larger and/or more complex business problems. Facilitate and influence construction of specific complex solutions. Analyzed and documented function requirement.

Developed requirements for departmental and corporate projects that are more complex in nature as requested by internal/external customers; prepare business and functional requirements. Communicate and validate requirements with stakeholders and identified SMEs.

Managed requirements and change request process throughout project lifecycle. Build and support strong business vendor relationships by documenting business issues, determining project needs, and supporting training as needed.

ACCENTURE 08/2015 – 06/2017

Consultant/ Business Analyst/Associate Manager/Functional Analyst

Created resolution document for the Provider Mass Change Report by working with both the Department of Health & Human Services (DHHS)/Department Medical Assistance (DMA) representatives to reduce the time spent during monthly meetings by fifty percent. Analyzed, defined and documented

Analyzed and resolved business related system issues while working across project teams, enhancing business and technical knowledge and informing leads of issues that may affect the schedule and/or quality of the product.

Partnered with the test team, ensuring functionality was adequately tested on a continual basis.

Resolved design issues as well as provided guidance for new designs and clarity to documentation. Named primary point of contact for new Child Care Provider Portal application for the NC Department of Health and Human Services. Resolved escalated Child Care Issues for Tier 3 team.

Coordinated activities of offshore Ab Initio developers at Blue Cross NC.

Created a comprehensive action plan for the Batch Optimization project, reviewing reports to identify and resolve those greater than three hours.

Facilitated meetings with Blue Cross Blue Shield clients and third-party vendors, remediating the ETL Batch Window issues.

Reviewed data and ran SQL scripts on Teradata tool.

Role as Design Analyst for Kansas Medicaid.

Researched system defects, implemented Change Requests and coordinated meetings with internal clients.

Defined and documented highly complex business requirements.

Facilitated meeting discussions between business users, business analysts and technical analysts.

Documented organizational policies and procedures in the context of system requirements.

Worked with technical staff and business users, problem-solving and identifying workable solutions.

Worked with team leads, technical staff and key users, identifying, tracking and managing project issues.

ALLSCRIPTS, Raleigh, NC 08/2005 – 05/ 2015

Senior Business Analyst

Subject Matter Expert for Commercial Clearinghouses, Medicaid, Medicare, Home Health and Hospice billing formats.

Assisted stakeholders in understanding regulatory requirements to implement mandated initiatives into detailed user stories for development team. Developed and created test plans for billing templates.

Product owner for state Medicaid Electronic Data Interchange (EDI) billing changes.

Conducted and participated in all regulatory Sprints and presented Concept Reviews to Homecare team.

Managed all Medicaid and Commercial Payers electronic billing formats and issues related to claims processing.

Implemented and tested ANSI 5010 835 and 837 Transaction Sets.

Trained provider and internal staff on complex Medicaid Regulations.

Liaison for Emdeon and Payerpath Clearinghouses including the creation of monthly vendor reports.

Ensured that the Home Health and Hospice software is compliant with Medicare and Medicaid guidelines.

Participated in both Agile and Waterfall methodologies.

Managed multiple initiatives and escalated effectively while maintaining implementation dates,

Translated complex ideas into clear user documentation and have the ability to present complex concepts in graphical and non-technical language.

Created test scenarios and performed testing on changes to the software.

Coordinated ICD-10 testing with Medicare.

Lead analyst to update Help Documentation.

Prioritized and resolved 41% case backlog for Regulatory team of 3; resolved 63 SFDC cases within 10-month period.

Trained new Business analysts on Home Health and Medicaid projects in addition to templates for electronic billing and other tools.

CAREFIRST, Columbia, MD 11/ 2001 – 01/ 2002

Medicare Applications Coordinator and Subject Matter Expert

Designated as Medicare SME for the Health Insurance Portability and Accountability Act (HIPAA).

Coordinated remediation package for the Medicare application and obtained all necessary signatures for project implementation, wrote the Medicare Scope and Assessment documents.

Coordinated activities with the HIPAA testing.

Provided the work plan for the Medicare application, assisted with HIPAA compliance of Medicare COB business.

Analyzed workflow of existing operations, including policies, procedures and informal/formal practices.

Trained in chain management as it relates to Medicare, interacted with and provided assistance to CareFirst, Inc.

BIRCH & DAVIS ASSOCIATES, INC., Frederick, MD 04/2000 – 11/2001

Software Tester, Department of Defense (Fort Detrick)

Provided software testing for the Defense Medical Logistics Standard Support (DMLSS) automated software for theater Level III hospitalization units.

Successfully tested a comprehensive range of medical material, equipment software for the Military Health system including Army combat support hospitals, Air Force expeditionary medical systems, Navy hospital ships and Navy medical force hospitals.

Developed technically adept test scenarios and quality assurance, and updated documentation after quickly learning software as only non-military personnel on project.

SETA CORPORATION, Baltimore, MD 12/1998 – 4/2000

Senior Staff Team Leader

Team Lead for the testing claims adjudicating systems of the MCS, VMS Part B /D and GTEMS systems.

Developed business requirements for Change Requests and Program Memorandums based on Medicare Part B claims processing.

Developed Test Scenarios, Test Plans and Test Cases for testing software changes and system modifications based on the quarterly releases.

Developed the specifications for a Microsoft (MS) Access database to develop test transactions systematically and a database to compile all change requests in a comprehensive file to be accessed by multiple users.

Assisted in the development of QA/CM plans for the specific requirements of independent release testing.

Senior Amisys Configuration Analyst, Kaiser Permanente 1998

Project Manager HBOC (Amisys Business Group) 1996 - 1998

Staff Analyst/Project Manager, PA Blue Shield 1992 - 1995


Master of Public Administration, Kutztown University, Kutztown, PA

Bachelor of Arts - Political Science, Hampton University, Hampton, VA

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