Carmen Bennett

Summary

Over ** plus years of Healthcare experience utilizing applications such as Facets, Amysis, Mainframe, Care Advance, and Membership.

** **** ***** ** ****** experience related to customer service, claims and configuration activities. Worked with Facets enrollment and billing team to review provider and facility contracts for payment reimbursement. Responsible for provider and facility reimbursement configuration of fee schedules and reimbursement.

20 plus years of project management and coordination experience with successfully executing project management methodologies, providing business analysis, advising clients, providing status reports and leading teams.

15 plus years CareAdvance clinical system configuration, training and user interface

15 plus years continuous improvement experience with knowledge of multiple methodologies (Lean, Six Sigma, Kaizen, process re-engineering)

Trained to work with all stakeholders: clients, users, senior management, contractors, and direct reports.

Excels with presenting in front of large groups as well as senior leadership

Excellence in building customer relationships.

Graduate level training in Healthcare Informatics and Data Analytics.

Skilled in executing SDLC techniques that include Waterfall and Agile requirements gathering; rapid business process design and workflow, system testing and user acceptance; formal change management practices. Familiar with the tools JIRA and Confluence.

Excellent communication, facilitation, negotiation, problem solving, decision-making and analytical skills.

Experienced in SQL, SAS, Access, Dreamweaver, FrontPage, Visio, and other Microsoft Office products

Experienced in the creation of WBS schedules for project related activities

Education

Master of Science, Professional Science/HealthCare Informatics, Middle Tennessee State University, Murfreesboro, TN May 2008

Bachelor of Science, Business Administration and Human Resource Management, University of Tennessee Chattanooga, Chattanooga, TN May 2002

Certifications

CareAdvance Clinical Care Management System Training Certification, Completed December 2010

Lean Six Sigma Certifications

Six Sigma Yellow Belt Completed December 2010

Six Sig Green Belt Completed November 2015

Professional Experience

Gainwell Technologies 01/2023 – Current

Senior Business Analyst

Responsibilities

Responsible for all client configuration related to reimplementation project for Essence Suite upgrade.

Serve as subject matter expert for Essette Suite clinical care management system; meet with business users regarding system enhancement requests, configuring requests and releasing them on sprint cycles, work as a liaison between the business and technical IT teams to translate technical needs. Worked extensively on Extraction, Transformation, and Loading (ETL) data from Oracle, SQL Server, Access, Excel, Flat Files and XML using SSIS Services.

Conducted extensive analysis on migration and conversion of Provider data, Group configurations, Benefit configuration, plan codes, benefit set-ups, fee schedules, provider pricing, capitation, and set-ups

Implementation of new software enhancements (review/creation of user stories, UAT and SQA testing).

Participate in client status calls for Essette Suite configuration review and question and answer sessions.

Configuration for all system users for Essette Suite clinical care management system clinical care management system upgrades.

Perform regression testing for system upgrades and verify system availability and issue identification.

Benefit coordination and configuration, updated, adjusted, and revised fee schedules, coding, rates, provider contracts, database, claims and information via Healthrules

Iqvia 04/2022 – 12/2022

Business Analyst V

Responsibilities

Create/modify business process and procedural documents.

Create current state process maps and work with business partners for review and validation.

Draft test plans for UM implementation.

Create requirements documents for planning purposes.

Align with engagement manager to lead and track efforts for UM project related activities.

Participate/Lead UM design and requirements gathering session.

Responsible for gathering requirements, documentation and communication with development and implementation teams will be daily tasks.

Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL

Serve as system matter expert of UM application management system for clinical and non- clinical users.

Cigna 8/2021 – 04/2022

Data Process Analyst/Project Coordinator

Responsibilities

Coordinate with organizational leads on development of all process and work with the scrum teams in coordination of the releases with the business users in determining user acceptance criteria.

Create internal team procedures.

Conduct weekly meetings with scrum teams to review current state process maps.

Meet with scrum teams to design future state process maps.

Create and coordinate process features in Jira.

Created ER Diagrams for RDMS using MS Visio and validated the same using SQL queries.

Conducted analysis on migration and conversion of provider and member data, group configurations, premium billing, benefit set-ups, fee schedules, provider pricing, capitation.

Coordinated a project for supplemental data including strategizing, planning, risk management and status reporting to members of management. Created system specifications and other lifecycle artifacts through the use of Agile and Waterfall methodologies.

Experience in Microsoft Business Intelligence technologies: SQL Server Integration Services (SSIS), SQL Server Reporting Services (SSRS) and SQL Server Analysis Services (SSAS).

Create requirements documents for planning purposes.

Responsible for coordinating aspects of various projects and/or project phases as assigned (initiate, plan, execute, control, close).

Must be familiar with system scope and project objectives to effectively coordinate the assigned tasks. Confers with project team to outline work plan and to assign duties, responsibilities and scope of authority.

Assist with creating and maintaining project documentation (i.e. status reports, issue logs, development of project schedules and plans) related to projects and/or project phases assigned by a higher level Project Manager.

Ascension 2/2021 - 8/2021

Technical Analyst/Project Coordinator

Responsibilities

Work with IT technical leads on development of supplemental data files; work with technical managers and mayors in coordination of the releases with the business users in determining user acceptance criteria.

Created SSIS Packages to perform filtering operations and import the data on daily basis from the OLTP system to the SQL server

Conduct weekly meetings with technical teams to review new and current payor requests for supplemental data files

Coordinated a project for supplemental data including strategizing, planning, risk management and status reporting to members of management. Created system specifications and other lifecycle artifacts through the use of Agile and Waterfall methodologies.

Create requirements documents for planning purposes

Work as project manager to lead and track efforts for supplemental data project

Responsible for coordinating aspects of various projects and/or project phases as assigned (initiate, plan, execute, control, close).

Must be familiar with system scope and project objectives to effectively coordinate the assigned tasks. Confers with project team to outline work plan and to assign duties, responsibilities and scope of authority.

Assist with creating and maintaining project documentation (i.e. status reports, issue logs, development of project schedules and plans) related to projects and/or project phases assigned by a higher level Project Manager.

Performs configuration activities, which included the following institutional, and Provider Contracts, Benefits, Authorizations, and Fee Schedules updates.

Directs preparation of records such as agendas, notices, minutes and resource utilization reports for multiple project meetings and standing PMO meetings

Cognizant 7/2020 – 12/2020

Clinical Data Consultant

Responsibilities

Provided business and systems analysis for high-profile healthcare initiatives such as; Population Health Management, Behavioral Health insourcing and McKesson Disease Management insourcing.

Served as project leader and CareAdvance clinical subject matter expert with planning, managing and executing daily activities for key systems integration to support business for Medicare and Medicaid Services (CMS) and Commercial lines of business.

Coordinated projects including strategizing, planning, risk management and status reporting to members of management for new and existing programs. Created system specifications and other lifecycle artifacts using Agile and Waterfall methodologies.

Implementation of new software enhancements (documented through use of user stories, UAT, SQA testing). Create test scenarios and test plans and work with business to provide UAT test instruction.

Work in collaboration with the director, in selection of new software replacement for current corporate communication system; while severing as subject matter expert to create gap analysis, creation of workflows and conduct system training.

Serve as subject matter expert for CareAdvance clinical care management system; meet with business users regarding system enhancement requests, configuring requests and releasing them on sprint cycles, work as a liaison between the business and technical IT teams to translate technical needs.

Lead large workgroups of all system users for CareAdvance clinical care management system upgrades; assist in establishing test scenarios, document workflow processes, training and process enhancements.

Work with IT technical leads on prioritization of system enhancements to be placed in sprint cycles; along with coordination of the releases with the business users in determining user acceptance criteria.

Conduct bi-weekly meetings with the CareAdvance clinical care management teams to review new programs/mandates forthcoming and develop roadmaps for changes and implementations.

Anthem 08/2017 – 07/2020

Systems Analyst

Responsibilities

Responsible for implementing Scrum practices in software and product development in an agile environment as well as demonstrating Scrum practices on projects.

Work as the liaison between the scrum team members and those who work outside of the Scrum Team such as business owners, etc.

Guide those outside the scrum team understand how to effectively communicate with the Scrum Team members. Scrum team consist of both on-shore and off-shore team members.

Responsible for bridging the gap between obtaining requirements, coordinating meetings and assisting in the effective flow of communication.

Responsible for working with internal clients to identify enhancements and changes needed in their internal systems.

Responsible for gathering requirements, documentation, project coordination, and communication with development teams will be daily tasks.

Performs configuration activities, which included the following institutional, and Provider Contracts, Benefits, Authorizations, and Fee Schedules updates

Work with key stakeholders, and the ability to understand enterprise environments are necessities for

Responsible for working with internal clients to define the functional, usability, reliability, performance and support requirements of a system serves as a business subject matter expert, and act as a liaison between the business and IT.

Applies use of tools to define requirements and documentation.

Create system specifications and other lifecycle artifacts through the using Software Development Lifecycles (SDLC)

Atos 02/2017 – 07/2017

Project Management Office

Responsibilities

Responsible for coordinating aspects of various projects and/or project phases as assigned (initiate, plan, execute, control, close).

Must be familiar with system scope and project objectives to effectively coordinate the assigned tasks. Confers with project team to outline work plan and to assign duties, responsibilities, and scope of authority.

Assist with creating and maintaining project documentation (i.e., status reports, issue logs, development of project schedules and plans) related to projects and/or project phases assigned by a higher-level Project Manager.

Directs preparation of records such as agendas, notices, minutes, and resource utilization reports for multiple project meetings and standing PMO meetings

Anthem Blue Cross Blue Shield 07/2016 – 12/2016

Clinical Systems and Reporting Analyst (Medicaid Business)

Responsibilities

Configuration in Trizetto’s Clinical Care Advance Content Editor tool

Work with and review with Trizetto’s Clinical Care Advance front end application

Test script creation and text script execution and assist with developing use cases

Assisting in defining the project scope and managing the defined scope.

Defines the functional, usability, reliability, performance, and support requirements of a system serves as a business subject matter expert, and act as a liaison between the business and IT.

Provides the link between the technical and the business views of the system by ensuring that the technical solutions being developed will satisfy the needs of the business.

Leads system requirements definition, design, testing, training, and implementation support.

Applies use of tools to define requirements and documentation.

Provides analysis of efficiencies related to system enhancements/automation.

Works with IT learning organization to assist in the development of system training documentation and provides training to end users.

Blue Cross Blue Shield of TN 05/2016 – 07/2016

Project Manager – Project Management Office

Responsible for solving operations issues, building project pipeline, and executing rapid development for a weekly intake file with mission critical timeliness to ensure timely uninterrupted claims processing to prevent non-compliance and incurring of penalties.

Responsible for coordinating project tasks and directing resources; facilitate project meetings with stakeholders; managing client expectations; developing full-scale project plans and schedules, including WBS.

Managing project budgets and securing resources; reporting status to stakeholders and senior management via weekly meetings and executive status checks that define program progress, challenges and solutions

Business Engineering 04/2005 – 05/2016

Provided business and systems analysis for high-profile healthcare initiatives such as Population Health Management, Behavioral Health insourcing and McKesson Disease Management insourcing.

Served as project leader and CareAdvance clinical subject matter expert with planning, managing and executing daily activities for key systems integration to support business for Medicare and Medicaid Services (CMS) and Commercial lines of business.

Coordinated projects including strategizing, planning, risk management and status reporting to members of management for new and existing programs. Created system specifications and other lifecycle artifacts using Agile and Waterfall methodologies.

Manipulated data using SQL Joins, SQL queries for data retrieval, accessed for analysis and exported the data into CSV, Excel files for Data Profiling and Data Mapping.

Implementation of new software enhancements (documented through use of user stories, UAT, SQA testing). Create test scenarios and test plans and work with business to provide UAT test instruction.

Work in collaboration with the director, in selection of new software replacement for current corporate communication system; while severing as subject matter expert to create gap analysis, creation of workflows and conduct system training.

Serve as subject matter expert for CareAdvance clinical care management system; meet with business users regarding system enhancement requests, configuring requests and releasing them

On sprint cycles, work as a liaison between the business and technical IT teams to translate technical needs.

Lead large workgroups of all system users for CareAdvance clinical care management system upgrades; assist in establishing test scenarios, document workflow processes, training and process enhancements.

Work with IT technical leads on prioritization of system enhancements to be placed in sprint cycles; along with coordination of the releases with the business users in determining user acceptance criteria.

Conduct bi-weekly meetings with the CareAdvance clinical care management teams to review new programs/mandates forthcoming and develop roadmaps for changes and implementations.

System Configuration Specialist (Facets) Business Engineering 4/2003–4/2005

Responsibilities

Worked with IT to troubleshoot and resolve problems as they arise.

Provider contract review to determine system configuration needs.

Configure and maintain the Facets pricing schedules (fee schedules, per diems, and DRG’s) to enable accurate claims payment.

Prepares and runs access queries as requested by management to identify system/processing problems or to support Facets projects.

Assist in development of automation of processes and general process improvement efforts as identified by management.

Ensure all user workflow documentation is current by writing and distributing updates when needed.

Ensure that computer programming changes and modifications to the Facets and paperless system are correct by developing and documenting test conditions, expected results and testing prior to production and after placing in production.

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