Biographical Summary

Information systems professional with over 25 years of experience encompassing software development life cycle (21 years), Project Management supervisory experience (16 years) in addition to 20 years of Database Design and normalization. System Administrator (20 years) in systems development for clinical imaging, business unit workflow, call center backend systems, and member/ provider portal(s). Exceptional work ethic with proven on target high performance results in the areas of software development, software interfacing, software conversion, data mining, data storage, and customer service. Data Conversion preparation for database inputting EDI integration layer supported system design, data mapping, and testing activities to enable Health Rules to process 834 enrollment, 837I/P claim, 270/271 eligibility, 276/277 claim status, and accumulator data cleansing. Lead in CMS data collection coordination and collaboration for QRS (NCQA, HEDIS and PQA) measures analysis using SQL and SAS to evaluate elemental data set requirements. Testing of statistical output of data concerning claim systems.

EDUCATION

University Of Phoenix

Bachelor Of Science in Information Technology – Cum Laude - 3.51

Associate Of Arts with A Concentration in Information Technology – Honors - 3.46

Phoenix, AZ

July 2016 – November 2019

July 2016 – March 2018

City University Of New York – BMCC Campus

New York, NY

Major: computer science minor in mathematics

September 1988 - June 1993

Professional Experience

Capgemini (Sogeti) USA

Dayton, OH

Product Manager

October 2022 – February 2023

●Responsible for defining & communicating the overall vision, objectives, and goals of the business with the development and quality assurance team in relation to the minimum viable product in the Commercial & DHP data synchronization of Claims domain. Manage the link between development, QA, and business clients by ensuring the technical solution developed satisfies the requirement value.

●Provide managerial oversight and final review of all product backlog user stories, unit testing, QA testing, and production readiness release of the product vision. Provided reports regarding the aforementioned reviews.

●Contribute to defining, prototypes, MVPs, KPIs, features, and pilots with all stakeholders.

●Responsible for the product backlog management, prioritizing user defined stories, and prioritizing. the business requirements.

●Document functional specifications as well as vetted contingency plans in case of risks or roadblock occurrences.

●Cultivate partnerships with cross-functional teams to ensure each integration is fully supported.

●Data Modelling for current business workflows on all levels conceptually, logically and implementing those structures physically using AEM (Adobe Experience Manager). This tool was used to manage multiple website content for user experience.

●Capturing member EHR from practitioners and practitioner groups for HEDIS measurements for STARS which involve (effectiveness, access and availability, and experience of Care as well as Utilization, Risk and health plan description).

●I have successfully implemented clinical data interfaces utilizing Application Protocol Interface (API) for internal and external value-based care partners.

●Prepared data structures for sending and receiving information to be translated for both internal databases and external database systems in formats such as JSON, XML and UML to complete member clinical business processing.

●Successfully provided product structure for market release through the following collaboration team channels of research and discovery, finance, public relations, legal, business operations, business development, executives (stakeholders) and users (customers) to ensure product viability value.

Tata Consulting Services

Island, NJ

Product Owner/Product Manager

July 2021 – October 2022

●Responsible for defining & communicating the overall vision, objectives, and goals of the business with the development and quality assurance team in relation to the minimum viable product.

●Manage the link between development, QA, and business clients by ensuring the technical solution developed satisfies the requirement value per the future Oncology/Non-Oncology inventory items within an application.

●Provide managerial oversight and final review of all product backlog user stories, unit testing, QA testing, and production readiness release of the product vision. Contribute to defining wireframes, prototypes, MVPs, KPIs, features, and pilots with all stakeholders.

●Responsible for the product backlog management, prioritizing user defined stories, and prioritizing the business requirements.

●Document functional specifications as well as vetted contingency plans in case of risks or roadblock occurrences.

●Ensure high-level design is included with the project management requirements by creating an excel matrix that accurately accounts for approved data and user requirements. Utilize AEM (Adobe Experience Manager). This tool was used to manage multiple website content for user experience

●Cultivate partnerships with cross-functional teams to ensure each integration is fully supported.

HCL Technologies

Cary, NC

Product Owner/Product Manager

February 2020 – May 2021

●Manage the link between our development teams and business clients by ensuring that the technical solutions being developed satisfy their needs in terms of value per CMS guidelines for Medicare, Medicaid, ACA, Government & Commercial claims.

●Provide managerial oversight and final review of all product backlog user stories, unit testing, QA testing, and production readiness release. Contribute to defining wireframes, prototypes, MVPs, features, and pilots with all stakeholders.

●Make available clarity of Commercial, ACA, Medicare, Medicaid Claims adjudication and billing, as it pertains to coverage of each member in a clinical setting.

●Document functional specifications as well as vetted contingency plans in case of risks or roadblock occurrences.

●Ensure high-level design is included with requirements by creating a requirements matrix that accurately accounts for approved requirements.

●Cultivate partnerships with cross-functional teams to ensure each integration is fully supported.

eReceivables

Secaucus, NJ

Product Owner (Programmer Analyst)

February 2019 – December 2019

●I designed a new ETL platform to replace the existing outdated Sun-settled FoxPro DB and programs with SQL and XML as the primary transfer code.

●I independently built and integrated the older database with both a new Document distributed database (Mongo) and a MySQL database that handle the bulk of these data processes.

●I managed the reviewing of all SDLC processes from unit testing to QA testing and production release.

●Responsible for Modifying all current ETL customers to the newly designed Platform with SQL. This includes writing SQL scripts and XML scripts to load into the billing system, and billing returns to all clients.

●Work with current 837i/p and 835 billing processes to evaluate the data for input into our source claims billing system.

●Provide oversight and final review of all unit testing, QA testing, and production release of design specifications, as well as vetted contingency plans in case of risks or roadblock occurrences.

●Managed Commercial, ACA, Medicare, and Medicaid Claims billing pertains to the benefit plans covering each member in a clinical setting.

Anthem

Atlanta, GA

Product Owner/Product Manager

June 2017 – February 2019

●Define functional, usability, reliability, performance, and support of current state documented requirements of the WGS & Facets claims systems for Medicaid, Medicare, ACA, and commercial business books.

●Configure benefits and entity group contracts and other claims elements to meet adjudication criteria for Medicaid, Medicare, ACA, and Commercial Claims processing within the Facets claims system and WGS claims system.

●Manage quality assurance for integrated functionality, usability, reliability system performance in support requirements. All QA test case data are built and reviewed and performed on an Oracle database platform with SQL as the main code for process analysis.

●Create feature use cases & strategies in Confluence/Jira for the WGS claims environment regarding all business books for internal and external client relationships.

●I provide a link between our development team and business users of the system by ensuring that the technical solutions developed to satisfy the needs of Medicaid as per CMS guidelines, Medicare, ACA, and Commercial claims.

●Ensures high-level designs, including architecture requirements, are accurately documented and map to approved requirements.

GalaxE Solutions

Somerset, NJ

Product Owner

February 2016 – June 2017

●I configured key data migration elements for client entities such as Argus Pharmaceuticals, AHA Pharmaceutical Corporation & IBC Pharmaceuticals, Inc. regarding pharmacy benefits management system conversions and new benefits plans.

●Collaborate with a team of developers and quality assurance analysts to map specific business retail rules and conditions to be configured within the SQL (GxCare) application benefit management system to be migrated to the RxClaim mainframe system.

●I worked on the Coach retail account where I provide application support, working in the data warehouse monitoring customer utilization options for product replenishment. We also analyzed seasonal trends for product changes based on statistical analysis.

●Answer questions regarding GxCare coded elements configured for the plan benefit. I would review request approvals for the release of coded element configuration.

●Document functional & technical specifications for drug formulary application enhancements. Advise and collaborate with IT team members and business customers to ensure business requirements and technical and functional documentation are synchronized and compliant.

VALENCE HEALTH (CONTRACTED POSITION)

Chicago, IL

Senior Quality Assurance Analyst

July 2015 – November 2015

●Wrote ad-hoc queries for dataset conversions queries and stored procedures with MS SQL for data analysis drilldowns. Research, assemble, examine, and cleanse data. I provided reports to senior management and project-related entities created in MS SQL SSRS.

●Tested, analyzed, and presented data to confirm Facets application configuration during the initial implementation of the new ICD10 codes compared to ICD09 codes in system inclusive of the claim financial, clinical, and benefits configuration for all business books to include Medicaid.

●Configure new Pay Classes, Service Qualifiers, Keywords, Remark codes, Fee Schedules, etc.

●Maintained test database in MS Access. Provide technical lead assistance to staff members in Test Rails testing application.

●Develop, configure and maintain current workflows and Benefit Pricing service qualifiers for claims adjudication.

●Develop and execute test matrices for SIT/UAT, test plan, and test cases based on functional requirements.

●Ensuring the QA, testing teams are following the Solution Delivery processes on all projects and applications. Perform VB scripting for Access test planning data entities.

●Develop Excel macros for conditional QA test case data.

Blue Cross Blue Shield North Carolina Medicare Advantage (Contracted Position)

Winston Salem, NC

Senior Business Systems Analyst

July 2014 – November 2014

●Product Manager for the Macess imaging system. Assisted in building a provider portal to be utilized by internal medical staff for case management work.

●Tested, analyzed, and presented data to confirm Facets application configuration during the initial implementation of the new ICD10 codes compared to ICD09 codes in system inclusive of the claim financial, clinical, and benefits configuration for all business books to include Medicaid.

●Configure new Pay Classes, Service Qualifiers, Keywords, Remark codes, Fee Schedules, etc.

●Provide technical lead assistance to staff members in Test Rails testing application.

●Develop, configure and maintain current workflows and Benefit Pricing service qualifiers for claims adjudication.

●Develop Excel macros for conditional QA test case data.

Health First Management Services LLC

New York, NY

Senior Business Systems Analyst (Product Owner)

May 2008 – July 2014

●Prepare and present graphical drill-down reports to senior management and project-related entities using MS SQL SSRS for call center IVR system regarding representative SLA matrix.

●Developed and executed QA test matrices in MS Access for Medical Management UAT test plan and QA test cases based on functional requirements.

●Wrote ad-hoc queries for data conversions queries and stored procedures with SQL and PL/SQL for data analysis drilldowns for Marketing campaign designation regarding IVR incoming calls to customer service.

●Advised and collaborated with IT team members and business customers to create business requirements, technical and functional documentation for all data conversion of Facets 4.2.

●Perform project coordination to ensure that the technical development team follows the Solution Delivery processes on all projects and applications.

●Assist with the data collection coordination and collaboration for QRS (NCQA, HEDIS, and PQA) measures analysis using SQL to evaluate essential set requirements.

Blue Cross Blue Shield Michigan (Contracted Position)

Southfield, MI

(Project Manager) Senior Business Systems Analyst

March 2007 – March 2008

●Delegating tasks on the project to employees best positioned to complete them

●Making effective decisions when presented with multiple options for how to progress with the project

●Serving as a point of contact for teams when multiple units are assigned to the same project to ensure team actions remain in synergy

●Communicating with executives or the board to keep the project aligned with their goals

●Performing quality control on the project throughout development to maintain the standards expected

●Adjusting schedules and targets on the project as needs or financing for the project change.

Kaiser Permanente

Atlanta, GA

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.

●Perform system administrator functions for MHC and Macess imaging systems.

●Accountable for determining the appropriate reporting requirement enhancements to the overall utilization of all in-house software applications.

●Prepare and present reports for senior management using SQL, Corel Paradox, and Cognos Impromptu 7.

●Prepare vendor data specifications for data conversions and requirements for Claims auto adjudication processing.

●Responsible for creating and managing QA test plans, environments, and project schedules.

Multiplan Inc. (PPO)

New York, NY

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 concerning Facilities and Practitioners networks.

●Responsible for processing both facilities (UB92) and practitioner (HCFA1500) medical claims into Multiplan’s accounting and Amisys claims billing systems.

●Data conversion from the client into our current systems for data archiving. Designed flow charts and diagrams using Microsoft Visio (v6.0).

●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.

Military Experience

UNITED STATES ARMY RESERVES

Fort Hamilton, NY

Staff Sergeant (Warrant Officer Candidate)

Personnel Record Specialist, Training Instructor

May 1986 – March 2000

●Responsible for managing the assignment of sponsors to new unit members and their assimilation into the unit mission essential tasks.

●Accountable for all team members' development and training to meet each task assigned technically and tactically proficient.

●Managed the maintenance and updating of all personnel files in the database for all national units assigned by or to unit command.

●Oversaw and manage the installation and development of software applications supporting all Company Battery and Troop Detachment or other organizations under and outside of Unit command.

●I supervised 30-45 team members during updates of Personal Records for all stateside and foreign shore Army Units.

●I managed a staff of 25 plus to accomplish updates of personnel files within all Units in the region.

System Technical Skills

Certifications

SCRUM MASTER AD# 154***********, SAFe 4.5 PM/PO ID: 592*****-****,

EPIC Certification with Piedmont Hospital in Atlanta GA 2019,

ITIL Management cert.

Software Development Tools:

Tableau, MS SharePoint, MS Visual Studio, SSRS, SSIS, MS SQL Management Studio, Crystal Reports, SaaS, MS Project, Visio, Excel, Word, Access, PowerPoint, Visual Basic/.NET, XML, JSON, HTTP, SSH, SSL, and DNS, HTML/CSS/JavaScript, Java, AEM (Adobe Experience Manager), Adobe Digital suite, Python, AHA, Jira, Rally & Confluence Expr. API Interfacing

Databases:

Oracle, PL/SQL, MySQL 12, Sybase, Ingres, MS Access, Mongo on AWS

Contact this candidate