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Business Systems Analyst Project Manager/Lead Contractor/Consultant

Palm Harbor, Florida, United States
April 21, 2017

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Samuel Einstein

Palm Harbor, Florida *****

SUMMARY: A results-oriented professional with diverse contracting, consulting, and corporate employee career experience that enables solid contributions in a variety of roles, Business-IT environments, and organization cultures that is seeking new opportunities after a brief early retirement. Among others, strong interpersonal, analytical, problem-solving, facilitation, consensus building, decision-making, risk management, and conflict/issue resolution skills coupled with a seasoned ability to manage expectations through effective communication provides the qualities necessary to achieve success in a wide range of initiatives even under the most challenging conditions. In addition to the value gained from a hands-on multi-platform systems background, capabilities to work collaboratively with all resource levels in corporate environments have been progressively enhanced by assisting organizations to successfully translate Business strategy into IT solutions while working on contracts through staffing and consulting firms at their end-clients outlined below.


Florida Blue (BlueCross BlueShield of Florida) – Jacksonville, FL 6/11 – 12/14

Business Project Management Analyst: Telecommute 4/14 –12/14: Returned by request of senior management to the Clinical Enablement team/Care Management organization to take over critical Operations management reporting responsibilities including: daily/weekly/monthly Operations metrics for areas such as Pre/Post Service, Utilization Management, Concurrent Review, and Grievance/Appeals; Call Center/Workforce statistics; Authorizations status; Medical Director reviews; current/future state reports analysis; and Audits data for regulatory and CMS compliance.

The role allowed high-visibility reporting responsibilities to be handled seamlessly so that core employee focus and efforts could be directed to successful phase implementation of the new ZOmega JIVA integrated Care Management platform.

Business Project Management Analyst: Telecommute 6/13 – 12/13: Position held on the Clinical Enablement team with responsibility to acquire, extract, and ensure quality/accuracy of data for compiling a wide variety of scheduled production as well as ad-hoc management reports providing mission-critical information obtained from multiple sources/corporate systems on metrics for the many aspects of the Clinical Operations organization and its Care Management programs.

Project Manager/Business Analyst: On-site 6/11 – 5/12: A multi-faceted lead role with the Provider Connectivity Solutions group on a special project that provided an innovative and industry-leading migration program for 837/27X submitters to move into HIPAA 5010 version processing in advance of the government mandated deadlines.

The Production Validation Process (PVP) project was designed to engage 250 selected organizations nationwide such as high-volume clearinghouses, billing services, and other direct submitters in working on a collaborative effort with BCBSF and its strategic partner Availity to minimize the business/revenue disruption inherent in migration to 5010 processing.

Responsibilities included, but were not limited to: Outreach communications tailored to each of the targeted organizations mentioned above as well as Practice Management Systems vendors and a variety of Providers to assist in their 5010 and ICD-10 readiness; Inter-organization coordination, monitoring, problem resolution, and follow-up for 5010 processing with Business/IT/EDI management at healthcare entities subscribing to the PVP program; Daily tracking/status reporting on all aspects of the project; and ongoing/daily adjustments to accommodate the changing needs of the organizations involved. This initiative resulted in the company not only achieving its 5010-related compliance goals, but gaining industry-wide recognition for the proactive efforts benefitting all parties involved in the claims processing scenarios.

Shared Health – Chattanooga, TN 7/10 – 9/10

Held a Business Systems Analyst role with responsibilities that focused on eliciting requirements from various business units within the organization for a new web-portal/n-tier product with multiple functional modules targeted to replace the current core Health Information Exchange (HIE) systems capabilities as well as marketing the product across multiple levels in the healthcare industry. Major focus was to bring project deliverables up to published schedule quickly due to the lack of BA resources for several months on an aggressive fixed-price timeline the prime vendor was having problems with.

The project used Agile-based methodology that was new to the organization and included rapid development of all business-related artifacts such as Requirements, Process/Work flows, Wireframes, User Stories, Conditions of Acceptance, and Error Handling to support Sprint planning with development scheduled to be done by offshore resources.

Affiliated Computer Services (ACS - Xerox) – Atlanta, GA 8/08 – 11/08

Assigned to telecommuting work with Atlanta and DC-based Proposals Centers as an EDI Subject Matter Expert (SME), Business Analyst, and Proposal Writer on responses to the State of Virginia’s separate RFPs for takeover of Medicaid Management Information System (MMIS) Fiscal Agent, Provider Enrollment, and Drug Rebate services. This included desired systems enhancements, replacements, and quality control measures on areas of compliance for audit purposes.

Contributions included: serving as lead for the EDI technical and management portions of all three responses on 83X/27X HIPAA-compliant transactions processing; current-state vs. RFP gap analysis and planning; ensuring EDI platform processes/procedures complied with numerous contractual mandates in areas such as receipt of change requests as well as that software release updates and all related subsequent testing/implementation/support contained quality audit measures.

Also worked as a Proposal Writer for Software, Platform Management, and other solutions approach entries of the proposals ensuring compliance with CMS MITA architecture/processes/maturity models and that ITIL frameworks were included in all offerings as mandated for the contract proposals. These efforts contributed to the successful bids for Fiscal Agent, Provider Enrollment, and Drug Rebate with contracts for each awarded to ACS in March 2009.

CareFirst BlueCross BlueShield – Owings Mills, MD 11/07 – 12/07

Contracted as a Project Manager for the LWO (Large Workforce Outage) project that involved pandemic-related remote workforce scenarios as well as a DRG (Diagnostic Related Grouping) project scheduled to provide enhancements to the healthcare claims processing systems that adhered to the organization’s PMO quality and compliance standards.

Received orientation to the PMO's CMMi Level 3 methodology and training on SharePoint document management system.

Hawaii BCBS/ Hawaii Medical Assistance Services – Honolulu, HI 8/07 – 9/07

Provided assistance as a Project Manager to the Vice President and subordinate staff with statistical as well as quality analysis of the organization’s claims processing for IT and Business production planning with focus on Membership- oriented issues, resource allocations, risk management, and other related areas.

Participated with Vice President/Director levels in high-level project planning and forecasting for 2008 initiatives.

CareFirst BCBS/ Federal Employee Plan Operations Center (FEP) – Washington, D.C. 9/05 – 8/07

Recommended to client senior management for a high-impact role as Project Manager, Business/Systems Analyst, and as a Consultant/Trusted Advisor for establishing an IT Asset Management (ITAM) program solution within the Federal Employee Plan Operations Center (FEPOC) organization that provides healthcare enrollment, claims processing, and decision support services under contract from the US Office of Personnel Management and the BCBS Association.

In addition to direct management of all portions of the project from inception to implementation, areas of responsibility included, but were not limited to: common Project Management and Business/Systems Analyst functions; future-state design and gap/fit analysis; Requirements Management; environment and architecture; Business Process Management along with establishing Contracts, Asset Management, and Desktop Support quality control processes/procedures for internal as well as government audit purposes; Client business/technical resource management and training; System Administration; PMO-compliant testing and QA scenarios; Risk/Issues Management; Business Continuity (DR); Budget Management/cost analysis; and management of the FAR-governed procurement process from initial RFP though final award to MRO/IBM for the MAXIMO Asset Management product suite software, implementation, and support.

Private Health Care Systems – Waltham, MA 8/05 – 9/05

Dual role as Project Manager/Business Systems Analyst on Care Management/Eligibility Inquiry projects responsible for taking Business Solutions and Functional Requirements that were in various states of development and solidifying their direction/content with Business Sponsor’s approval to establish application development efforts in compliance with PMO methodology and quality assurance standards.

PharMerica – Tampa, FL 4/05 – 5/05

Interim Project Manager providing assistance with keeping the pharmaceutical services organization’s major finance-related BI projects on-track and documented in compliance with the organization’s quality standards until they could be transitioned from a resigned manager’s responsibilities into client management’s workload.

First Health Services Corp. (Coventry) - VA Dept. of Medical Assistance Services – Richmond, VA 3/03 - 9/04

Senior Project Manager/Business Analyst role on multiple Medicaid Management Information System (MMIS) claims processing contracts for HIPAA-related EDI and Legacy system enhancements/replacements. Responsibilities included developing project SOUs/SOWs; common PM functions guided by client PMO processes/procedures; project time/status reporting, other ad hoc/required reports, and budget maintenance; management of local/remote project teams; risk/issues management; collaborate with Executives through end-users at the State level, Provider community, and internal client staff; RFPs and vendor response evaluation/cost analysis; requirements definition, analysis, and coordination of various State/Provider/client internal/vendor/audit entities; testing strategies/plans/execution, QA, and multi-platform support; data analysis/gap analysis; and testing/production support for enrollment/conversion of Trading Partners/ Providers from proprietary formats to appropriate 83x and 27x X12N formats including Companion Guides, EDI environment guides, and other documents relative to doing business with State healthcare departments for Virginia, Alaska, and Nevada.

Primary manager responsible for EDI production requirements, infrastructure, change management, and audits; Business Continuity (DR); EDI liaison to Virginia DMAS, the NY City Department of Mental Health EIP Program, EDI translator vendors, and various other IT/business teams; ensured systems provided required functionality and security measures under aggressive HIPAA compliance schedules for all Medicaid/Medicare claims processing with these organizations.

CSC Healthcare Systems - New York State Dept. of Health -- Albany, NY 10/02 - 3/03

Served as a Project Manager with duties related to MMIS systems integration testing (SIT) for Legacy and EDI platform enhancements/replacements including development of overall SIT testing approach, data analysis, gap analysis, templates/ checklists, transaction test plans/scripts; common project management processes/procedures/reporting using CSC project methodology and quality assurance standards on Web/Mid-tier/Legacy/EDI platforms; risk/issues management; coordination of local/remote testing phases and staff; liaison to Architecture, Development, Trading Partners/Providers, NYS DOH, Vendors, Claredi, and various other project groups to ensure new systems/enhancements provided desired functionality for the mandatory HIPAA compliance of all Medicaid Management Information Systems claims processing. Performed Business Systems Analyst and Tester roles when necessary to meet aggressive implementation schedules.

State Farm -- Bloomington, IL 3/02 - 10/02

A consulting Project Manager role for a heavily matrixed organization with evolving project teams responsibilities for systems performance, availability, quality assurance, and user experience scenarios across all lines of business.

Managed primary IT infrastructure impact assessment, performance testing, and risk/issues management for up to fifteen (15) concurrent projects on Web/Mid-tier/Mainframe platforms as well as provided infrastructure capacity planning and performance consulting services to business partners/IT groups in compliance with Summit-D project methodology in such areas as iBank, Wireless, Finance, Electronic Claims Filing, Call Center, Workflow, and vendor proofs-of-concept.

Empire Blue Cross Blue Shield -- Syracuse, NY 8/01 - 12/01

Performed in Testing Analyst, Business Systems Analyst, and Quality Assurance roles to assist the Electronic Commerce Services staff in various scenarios related to compliance with the mandated HIPAA 4010 systems conversions.

Duties included business requirements analysis; data/gap analysis; customer/provider communications; multiple claims transactions/versions data mapping; test criteria preparation; test data configuration; test scenario execution; verification/ validation of testing results; worked with developers to provide subject matter/change management guidance; composed conversion guides for customer, BCBS, and Help Desk training on 837/835 for corporate/private lines of business.

Motorola -- Austin, TX 9/00 - 1/01

Project Manager/Test Coordinator on the SAP APO global Legacy System Replacement manufacturing/ERP projects.

Partnered with Senior Management and project teams to create detailed action plans, introduce Quality Assurance processes/procedures, and enforce methodology compliance in accordance with PMO/CMMi Level 3 standards using Method 1 project methodology; identify, document, and follow-up on project issues/risks/changes and resolution; continually met formally/informally with business/IT project teams, PMO, and Quality/Process/Test management to guide efforts, manage scope, and monitor status of all phases of the project; advised client Managers, Engineers, IT staff, and Team Leads on testing strategies, quality-based practices/methods, and multi-tier implementations.

Keane, Inc. – Tampa, FL (Employee of this Consulting Services company with assignments below) 7/98 - 11/99

The Halifax Bank -- Halifax, UK: Project Manager: 9/99 - 11/99: Responsible for coordinating the corporate delivery/ installation of environment/infrastructure components consisting of multi-tier software, client/server test rigs, mainframe production mirror, and e-commerce interfaces for testing of new government-compliant mortgage applications. Keane’s Frameworks project methodology was used to manage the system testing process including test-bed install, conformance to organization’s quality standards, and maintenance of the Mercury suite of automated tools (WinRunner, LoadRunner, and Test Director). Customer groups were assisted with deliverables analysis and interdepartmental facilitation was provided along with issues/risks/change management to ensure adherence to negotiated project timelines. Presented a method to their executives for doubling testing capacity that was quickly adopted thereby allowing the mortgage applications along with other financial systems that had negatively impacted schedules to be successfully implemented.

Kaleida Health -- Buffalo, NY: Project Manager: 5/99 - 9/99: Coordinated, facilitated, and moderated a variety of Y2K testing and verification/validation scenarios with client’s Director/Manager/Clinical staff support. Efforts included creating department activity schedules that tied into a corporate merger plan; analysis assistance for various mainframe, midrange, and client server system upgrades; guidance on business function identification/test plan design using Frameworks methodology; formal approval of corporate systems testing plans; identification/reporting of project issues from technical to CEO levels; managed multiple vendor, technical, contract compliance issues, and audit concerns for multiple healthcare facilities including Buffalo General/Millard Fillmore Hospitals and the VNA.

Tampa Electric Company (TECO) -- Tampa, FL: 4/99 - 5/99: Primarily involved in the final phase of Y2K efforts with focus on Payroll, HR, and Finance systems areas. Worked with client’s user/technical staff to define specific business functions/ systems for testing; provided test plan creation, data analysis, test script execution, system backup/archival, and project certification documentation in compliance with Frameworks methodology and client’s QA standards.

Publix Supermarkets -- Lakeland, FL: 7/98 - 4/99: Responsible for mainframe/DB2 test environment setup; JCL modification; manual/automated test execution and quality control; data aging; test plans, requirements, and schedules; review/analysis of test results; certification, documentation, and issues resolution using Keane’s methodology on Inventory/Payroll/Distribution/Accounting systems. Senior Team Lead supervising 10 Testers, mentored new Consultants, and provided statistics for project tracking on a $25 million contract for Y2K remediation/enhancements services.

Prudential Insurance -- Jacksonville, FL 5/98 - 7/98

Member of a Computer Horizon’s Y2K team providing compliance services including client server/mainframe test environment setup, test script/scenario execution, and results analysis; issue determination/resolution assistance to client staff; data aging; and production of project status reports/turnover documentation for audit/certification purposes.


GTE (Verizon) -- Temple Terrace, FL and Camillus, NY 7/88 - 11/97

Crisis Manager/Systems Engineer: 8/97-11/97: Duties involved national Help Desk management of time-line driven resolutions to system failures related to network, hardware/software, infrastructure, and all other scenarios impacting delivery of customer support and CRM services to local or national business groups/call centers.

SPOC Manager/Systems Engineer: 6/94-8/97: Single-Point-of-Contact Manager providing on-site and project management for determination/resolution of all operational problems/resource outages related to any component failures in a national customer support/CRM call center with 350 customer service reps and 40 management staff on a true 24/7 basis; change management/monitoring/quality control of all change-related activities involving applications, operating systems, environment, network, and hardware components in an n-tier and document imaging/workflow configuration; analyst/advocate role, risk/issues management, and project coordination for applications support, infrastructure, and business groups; gathered requirements for site systems upgrades, enhancements, performance, and stability.

Systems Analyst: 8/93 - 6/94: Produced management analysis and production reports that monitored various portions of regulations-driven changes in the Carrier line of business; worked with business-side resources in the investigation of all systems problem scenarios and provided liaison services between systems and business area.

Systems Analyst/Senior DBA: 4/89 - 8/93: Began as a Consultant and converted to employee after a year. Duties included project/product senior lead role and true 24/7/365 product support for BELLCORE's EXACT IMS-based software in 7 Data Centers with 17 national production, test, and training systems yielding $13+ billion in yearly revenue; lead corporate technical consultant for EXACT systems on a $108 million customer order/billing systems contract with Bell Canada.

Programmer/Analyst: 7/88 - 4/89: Programming duties and liaison to business functional areas for overall IT solution design, testing, performance/problem analysis, and system maintenance on Payroll, HR, Insurance, and ERP applications.

MONY (Mutual of New York) -- Syracuse, NY 7/86 - 7/88

Programmer: Primary contact for the definition and resolution of IMS transaction problems or enhancements on the Remittance/Commission Support team; lead Programmer/Analyst for online commissions change system; responsible for all processing related to policy dividends and held a consulting role on corporate check processing standardization efforts.

Special Metals Corp. -- New Hartford, NY 2/80 - 7/86

Computer Specialist: 11/84 - 7/86: Performed computer operations/systems support functions across all end-user departments for manufacturing production and ERP systems on a host IBM 4361 system.

Programmer: 11/83 - 11/84: Programmer/Analyst support to all departments of a super-alloys manufacturing company.

Computer Operator: 2/80 - 11/83: Responsible for all production processing/quality control RJE to an IBM 30xx host.

Oneida County Department of Central Services -- Utica, NY 1/79 - 2/80

Computer Operator: Provided data processing support functions for all departments of County government; RPG II and COBOL program maintenance, quality control, and ABEND resolution on a UNIVAC 9060 system.

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