Project Customer Service
Resume:
C LIVE RAPHAEL
Winston-Salem, NC 27127
************@*****.***
+
BIOGRAPHICAL SUMMARY
Information systems professional with 24 years experience, accompanied by 21 years in software development life cycle, and 15
years supervisory experience in Project Management, 16 years experience in Practitioner and Facility Medical Billing (837, 835). I
possess an exceptional work ethic with my best work performances in the areas of software development, software interfacing, data
mining and customer service. I have experience in EDI data cleansing analysis and data conversion preparation for database input
and statistical output use. Developed and maintained proprietary business software for clinical imaging and automating paper
workflow processes. Automated over 150 workflow processes for Claims, Accounting, and Marketing, Sales, Clinical Performance,
Medical Management, Appeals & Grievances and Member Services departments in current and previous employment. Ability to
handle a large number of client accounts to negotiate standardization of input and output data file formats. I have 16 years’
experience as a System Administrator on more than eight different systems to include a clinical imaging, workflow, call center
backend systems and service and data portal systems.
PROFESSIONAL EXPERIENCE
Winston-Salem NC
BLUE CROSS BLUE SHIELD NORTH CAROLINA
Senior Business Systems Analyst /System Tester July 2014 – October 2014
Prepare and present graphical drill down reports to senior management, and project related entities using MS SQL
SSRS for Macess 3.7. Installing, trouble and monitoring Macess.
Write ad-hoc queries for data conversions queries and stored procedures with SQL and PL/SQL for data analysis drill
downs for Macess 3.7. Setup new Macess environments, upgrading and migration.
Provide technical lead assistance to Senior Medicare Advantage staff members for the clinical imaging/workflow
system. Provided analytical and processing support of all systems software applications.
Develop configure and maintain current workflows and Benefit Pricing service qualifiers for claims adjudication.
Responsible for creating and managing data conversions, test plans and project schedules for all systems.
Ensuring the development teams are following the Solution Delivery processes on all projects and applications.
Foster communication within IS around activities relating to projects. Provide a single point of contact for the Project
Manager and the business units.
New York, NY
HEALTH FIRST MANAGEMENT SERVICES LLC
Senior Business Systems Analyst / Systems Administrator May 2008 – July 2014
Prepare and present graphical drill down reports to senior management, and project related entities using MS SQL
SSRS for Macess 3.7. Installing, trouble and monitoring Macess.
Write ad-hoc queries for data conversions queries and stored procedures with SQL and PL/SQL for data analysis drill
downs for Macess 3.7 and other Oracle backend application. Setup new application environments, upgrading and
migration tools.
Responsible for creating and managing data conversions, test plans and project schedules for all systems.
Prepared and review functional program specifications and requirement for all business units.
Technical owner for the Macess clinical imaging/workflow system, interactive voice response systems (Strata &
Interactive) and the Digital Asset Management Marketing.
Develop and execute test matrices for SIT/UAT, test plan and test cases based on functional requirements.
Provided analytical and processing support of all systems software applications to include EDI file processing of the
following file formats 837, 835, 270/271 and 276/277.
Ensuring the development teams are following the Solution Delivery processes on all projects and applications.
Foster communication within IS around activities relating to projects.
Page 1 of 3
C LIVE RAPHAEL
4097 Leak Creek Court
Winston-Salem, NC 27127
************@*****.***
Troy, MI
SIRCO ASSOCIATES – CONTRACTOR FOR BCBS (BLUE CROSS BLUE SHIELD)
Senior Systems Analyst / Lead Developer May 2006 – May 2007
Responsible for leading project design from current state to implementation release.
Maintained system support files and provided analytical and processing support of all in-house system files software
applications for the NASCO Processing System (NPS).
Performed analysis of multiple areas within the NASCO Processing System (NPS) for aforementioned system file areas.
Prepare reports too senior management, and project related entities using MS SQL SSRS, Chrystal reports, MS Excel, Visio
and Word.
Write ad-hoc queries for data conversions and data analysis drill downs, Cognos Impromptu 7, MS Excel.
Responsible for creating and managing test plans, environments and project schedules for all project in my care to include
time management and project resources.
Atlanta, GA
KAISER PERMANENTE
Business Systems Analyst /Macess Imaging Systems Administrator November 2001 – July 2005
Responsible for maintaining system support files and providing analytical and processing support to the end users of all in -
house application software such as MHC and Macess Imaging system.
Performed system administrator functions for MHC and Macess imaging system.
Accountable for assisting management in determining appropriate reporting requirements and enhancing the overall
utilization of all in-house software applications.
Prepared and presented reports for senior management using SQL, Corel Paradox and Cognos Impromptu 7.
Prepared vendor data specifications for data conversions and requirements for Claims auto adjudication processing.
Responsible for creating and managing test plans, environments and project schedules.
New York, NY
MULTIPLAN INC. (PPO)
Software Engineer December 1998 - February 2001
Accountable for full software development life cycle planning using Microsoft Project.
Responsible for gathering application data requirements for internal and external clients with regard to Facilitie s and
Practitioners networks.
Responsible for processing both facilities (UB92) and practitioner (HCFA1500) medical claims into Multiplan’s accounting
and claim billing systems.
Data conversion from client into our current systems for data archiving.
Performed cost analysis (feasibility study) with MS Excel and Access to ensure all projects are cost effective for the
organization. Developed data models, and maintained design schemas for databases using Erwin.
Prepared file layouts in Excel, and system configurations within PowerPoint for all production interface applications.
Designed flow-charts and diagrams using Microsoft Visio (v6.0).
Montvale, NJ
DATABASE AMERICA COMPANIES (INFO USA)
Systems Analyst September 1997 - November 1998
Assisted in the development and implementation of the General Motors OnStar system database input files.
Lead analyst for Database America on the General Motors client account.
Lead analyst for the Department of Immigration Naturalization Service (INS) LYNX system. This system designed for the
Department of Justice by DBA. Established an NT server with and Microsoft SQL 6.5 server database for the INS.
Performed various Ad-hoc queries, statistical analysis as well as demographic analysis for both GM and INS per the c lient’s
request. Database Administrator for the INS corporate investigations Microsoft SQL Database.
Page 2 of 3
C LIVE RAPHAEL
4097 Leak Creek Court
Winston-Salem, NC 27127
************@*****.***
Somerset, NJ
BELL ATLANTIC
Applications Developer / Systems Analyst April 1992 - September 1997
Developed proprietary database applications, maintained existing codes in PowerBuilder, Ingres report writer, Excel, GQL,
SQL, C, and embedded C.
Created prototype software that communicated and assisted in application deployment and implementations.
Responsible for software development that complies with c urrent or future environment issues, and meets coding
guidelines.
MILITARY EXPERIENCE
UNITED STATES ARMY RESERVES Fort Hamilton, NY
Staff Sergeant (Warrant Officer Candidate) May 1986 – 2001
Personnel Record Specialist, Training Instructor
Responsible for the assignment of sponsors to new unit members, and their assimilation into the unit mission essential tasks.
Accountable for team member’s development and training so members can meet each task assigned technically and tactically
proficient. Manage the maintenance and updating of all personnel files in the database. Supervise the installation, and development
of software applications in support of Company Battery and Troop Detachment or other organizations under Unit command.
SYSTEM TECHNICAL SKILLS
Software Development Tools: Microsoft Visual Studio Team System 2008/2010, Microsoft SQL Management Studio
2008R2/2010, SSRS, Crystal Reports, MS Project, Visio, MS Excel, MS Word, MS Power
Point, Visual Basic, XML.
Databases: Oracle, PL/SQL, MS SQL 12, Sybase, Ingres, MS Access
Operating Systems: Windows 7, Windows XP, UNIX.
Network Environment: TCP/IP, NetBEUI, Wins, INET
EDUCATION
City University of New York - Manhattan College Campus New York, NY
Major: Computer Science & Mathematics September 1988 - June 1992
Page 3 of 3
Contact this candidate