Nathan Ladd Rigsby

**** ******** **** ******

Brookhaven, GA

850-***-****

acw83t@r.postjobfree.com

PROFESSIONAL OBJECTIVE:

Lead teams in the creation and support of new and existing innovative solutions for a cutting edge technology company as a Senior Business Analyst and Project Manager.

PROJECT MANAGEMENT METHODOLOGIES

Skill Set Experience (Yr) Skill Set Experience

Agile Development Methodology 3 Healthcare Claims Payment Systems 10

Supervisory or Team Leading Experience 5 HCFA & UB-92 Claims Analysis 10

Joint Application Design (JAD) Sessions 8 Full Life Cycle Development 12

Process & Data Modeling/Mapping 8 Presentations & Facilitation 12

Program, Project & Resource Management 9 Project Planning & Implementation 12

Medicaid Management Information Systems 9 Systems Development Implementation 12

Software Application Training & Development 10 CMM Concepts and Techniques 12

Change Control & Change Management 10 HIPAA Implementation & Compliance 12

UML & OO Methodologies 10 Business Analysis & Process Modeling 12

Use Case Analysis 10 Iterative/Waterfall Development Methodology 12

Risk Mitigation & Defect Tracking/Resolution 10 Process Improvement Initiatives and Analysis 12

TECHNICAL SUMMARY:

TFS – Team Foundation Server Microsoft Project

Mainframe Environments (CICS, TSO, JCL, etc) Microsoft Office Professional & Visio Professional

Report Storage/Retrieval (COLD/SIR) Structured Query Language (SQL)

HP Quality Center, Test Management Software Microsoft SharePoint Document Management

Corticon Business Rules Management Software Caliber RM – Requirements Management Software

SharePoint Software - Storage & Doc Mgmt Agile (Scrum) Software Development Life Cycle

.NET & JAVA Platforms ERD Data Modeling

EDUCATION:

Florida State University, School of Business Bachelor of Science – Marketing (2003)

EMPLOYMENT HISTORY:

Jackson Healthcare, Jackson & Coker

Senior Business Analyst - Alpharetta, GA 4/2015-Present

Senior BA for company-critical development of Physician Staffing tool to replace existing legacy system

oCompleted successful development of first generation on-time release of ZEUS application

Led requirements elicitation and application design sessions with 6 independent functional business units

Ongoing prioritization of 1,000+ user stories from sprint backlog into 3-week Agile development sprints

Coordination and assignment of tasks with local and offshore development teams during sprint planning sessions

oManaged and delegated workload for 3 onsite and 5 offshore developers

Facilitated daily Scrum/sprint stand up sessions to review and discuss development and potential roadblocks

Assisted with quality assurance testing when needed

Conducted sprint retrospective meetings with development team and leadership to review completed code, milestones, successes, failures, lessons learned and opportunities for improvement in subsequent sprints

Cypress Care Healthcare Solutions

Senior Business Analyst (Contractor) - Duluth, GA 4/2014-4/2015

Developed best of breed Business Requirement Documents (BRD) and templates requirements gathering and elicitation.

oDefined standards for 6 new templates to be used for documentation of currently undocumented processes

Developed requirements specifications that are comprehensive in coverage for business and technical audiences.

Worked directly with the developers to turn the business requirements into technical requirements.

Managed 4+ projects and project plans at any given time

Communication to impacted business areas after system changes or enhancements

Led Quality Assurance/Regression testing effort of all implemented requirements

Issue tracking and oversight to resolution

oIdentified and prioritized up to 20 unique defects per project

EDS, an HP Company (Electronic Data Systems, Hewlett-Packard)

Senior Business Analyst - Alpharetta, GA 8/2007-12/2013

Creation and documentation of scope and requirements for back-end agnostic portal product for Medicaid recipients, providers and eligibility brokers.

oSuccessfully delivered requirements for 4 sub-portals for 4 distinctly different user experiences

Window/screen design for ease of navigation, enhancements to the user portal experience while complying with ADA standards and Section 508 guidelines.

Review, perform cost analysis and provide procurement recommendations for 3rd party/COTS products for integration into existing portal framework to enhance consumer-driven healthcare initiatives.

oSuccessfully vetted and integrated new products with 3 different vendors

Researched and created CMS 5010 Impact Analysis for Electronic Data Interchange (EDI) team.

Performed 5010 compliance and awareness surveys with 15 State Medicaid accounts to determine overall account preparation level.

Initiated and mediated monthly conference calls between State Medicaid accounts and EDI team to address concerns, questions, timelines, regulatory compliance initiatives and 4010 to 5010 transaction mapping.

Updated existing HIPAA 4010A transaction loops and code set documentation with 5010 rules.

Performed regression testing and defect tracking for Commercial Claims Payment Processing system (MetaVance).

Performed documentation of scope and requirements for Medicaid recipient Asset Verification System (AVS) required under Section 1940 of the Social Security Act.

Lead Business Analyst for a Medicaid Healthcare Eligibility Solution tool providing real-time self-assessment and application services.

Lead Business Analyst for revenue-generating Healthcare Quality Measures (HCQM) solutions to provide accurate analytics reporting to support multi-organization measures such as NCQA, HEDIS, and National Quality Forum (NQF).

oAnticipated go-live revenue of $5,000,000+ for HCQM tool

Claims Processing Subject Matter Expert (SME) for Georgia’s Medicaid Management System with an emphasis on payment reconciliation, transaction adjustment processing and HIPAA 5010 claims transaction processing.

Benefits Management Subject Matter Expert (SME) for Georgia’s Medicaid Management System with an emphasis on ICD-9/ICD-10 Benefit Hierarchy Tables for covered/non-covered services

ACS (Affiliated Computer Services) 8/2002-8/2007

Client Services Manager/Business Analyst for Maryland Medicaid– Position held: 2/2006-8/2007

Development of use cases using UML and identification of potential existing solutions, recommendations for system development and strategies for implementation.

Provided day-to-day oversight of the project from planning through implementation phases.

Translated business requirements into functional and technical specifications.

Ensured good system-engineering practices are maintained throughout the duration of the project.

Developed and executed system test scripts and scenarios and provided defect tracking and resolution updates.

Provided recommendations for approval of all deliverables and software releases and possible solutions for code integration issues.

Implemented project management best practices and ensured all system requirements were consistently met.

Worked with system architects to provide enterprise network solutions and information security.

Created step-by-step manuals that included policies and procedures for proper utilization of software applications and MMIS systems.

Participated in HIPAA implementation and compliance training.

oLean and Six Sigma preparation training

Experience in “project office” duties that includes planning, scheduling, tracking project deliverables and risk mitigation.

Applied standard project management methodologies, including: creation and maintenance of detailed project plans, schedules, scope definition, change management, risk and issue management, and budget monitoring.

Worked with PM Office to become CMM compliant and followed PMI (PMBOK) project methodology.

Business Analyst – Federal Department of Labor – Position held: 7/2004-2/2006

Created and maintained status reports for corporate sponsors/customers, coordinated efforts of technical staff and assisted in maintaining project scope.

Documented high-level business requirements for new and existing projects.

Translated business requirements into functional and technical specifications.

Significant communication with clients, software development staff, technical staff and senior management.

Participation in an SQA Team (Software Quality Assurance) that evaluated existing processes for accuracy and efficiency.

Created and delivered PowerPoint presentations to senior management and staff to create vision and understanding of existing and future project goals.

Worked with QA (Quality Assurance) teams to develop test plans by providing concise functional specifications and any outstanding documentation updates.

Monitored application design and reviewed specification documents to ensure adherence to defined client requirements.

Provided maintenance support and defect-tracking for client systems.

Computer Systems Consultant – Federal Department of Labor – Position held: 8/2002 – 7/2004

Provided claims payment and adjudication information to both providers and recipients under the Department of Labor’s Healthcare Management Contract with ACS.

Performed resolution of suspended claims in an efficient, accurate and timely manner to ensure prompt payment.

Provided technical assistance in a call-center environment for a web-based prior authorization-processing portal.

Developed training materials for Team Leads to use when training new call-center employees.

Responsible for thoroughly understanding the business processes associated with the current account and assisting in identifying potential methods for cost saving.

oRecommended changes resulted in company cost-savings of $50,000 per year

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