Business Analyst Quality Assurance
Resume:
Barbara Schwartz
Senior-level Consultant
A strategic and resourceful leader with more than 25 years of experience in the public health insurance industry. Expert knowledge in Medicare & Medicaid IT MES MMIS Managed Care Operations EDI as well as multiple State and Local Government programs including, State Automated Welfare Systems (SAWS) program operations, Benefits Analysis, Eligibility, and Enrollment determination, including, Health Benefit Exchange (HBE), Covered California State-Based Exchange (SBE) / Health Insurance Exchange (HIX) / Affordable Care Act (ACA) Medicaid, Medi-Cal, CalFresh, TANF/cash aid, refugee assistance, and other social services programs.
End-to-end procurement and operational process expertise, managing large and complex Health and Human Services Implementation projects for multiple states. A wide range of experience as a results-oriented Project Manager, Business Analyst, and Quality Management Lead with extensive knowledge of large program development including procurement, RFPs, vendor evaluation methodologies, and analytical tools.
Software Development Life Cycle (SDLC), Contract Management Services and SLAs, and development of quality assurance processes.
SUMMARY OF SKILLS
Strong oral and written communication skills Facilitation skills
Interpersonal and consultative skills Detail-oriented
Analytical, problem solver Stakeholder analysis
Organizational skills Contract Management
Quality Assurance Program Integrity
Project Management Program Management
Process Improvement Eligibility Determination
Data Analysis Benefit Analysis
Procurement Specialist RFP development
Requirements: Management, Gathering, Writing, Traceability
Testing: Independent testing, Regression testing, and User Acceptance testing
APPLICATION AND TOOLS EXPERTISE
Advanced user of Microsoft Office Products Adobe
JIRA HPQC/ALM
AWS Meriant Tracker
ServiceNow
CERTIFICATIONS
Lean Six Sigma Certification
Behavioral Interviewing
Certified Project Management Essentials
EXPERIENCE
EthosWest. November 2020 – August 2024
Senior Analyst
California State Automated Welfare Systems (CalSAWS) Project
Key role supporting the implementation of the California Statewide Automated Welfare System (CalSAWS) Project and Consortium automating welfare business processes in California serving all 58 California counties. The implementation of CalSAWS will merge California’s three county-level consortia welfare systems, supporting six core programs: California Work Opportunity and Responsibility to Kids (CalWORKs), Supplemental Nutritional
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Assistance Program (SNAP) known as CalFresh in California, Medi-Cal, Foster Care, Refugee Assistance, and County Medical Services. Responsibilities encompass the following functions:
●Eligibility determination
●Benefit computation
●Benefit delivery
●Case management
●Information management
Conduct independent test activities in parallel with the DD&I Vendor System Test. Including planning, preparing, and executing independent test activities and associated deliverables and work products for the CalSAWS QA Project. Monitor UAT Testing activities for adherence to stringent project schedules and reporting to Project Stakeholders as follows:
●Multi-channel applications
●Test management
●Communication and test reporting
●Test planning, defect, and data management
●Collaborating with multiple counterparts in each technical area to ensure effective end-to-end testing is performed and managed
First Data Government Solutions, LP November 2012 – June 2020
Installation Manager July 2019-June 2020
CA DMV Electronic Payment Processing Services Project (CA DMV EPAY)
Installation Manager providing oversight, management, and scheduling of installation of Clover POS devices to CA DMV Field Offices. Maintained overall responsibility for activities performed as follows:
●Deliverable development
●Worked with the DMV and Project Stakeholders to coordinate the scheduling of installation to CA DMV field offices
●Scheduled implementation resources
●Conducted Requirements Gathering, systems analysis, and design using agile methodologies, performing evaluation of the requirements, plans, and results continuously taking place
●Created Data Modeling to demonstrate, define, and analyze data requirements needed to support the business processes
●Provided Quality management oversight ensuring installation was completed in accordance with the requirements, producing weekly installation status reports
●Produced Field Office Statewide Rollout Schedule and Logistics, Issue, and Risk Management as well as Asset Management
●Developed Site Survey and Checklist, Pre-Installation Checklist, Installation Checklist, Installation Report, Lessons Learned
Quality Assurance Manager October 2014-July 2019
LEADER Replacement Systems (LRS) Project
Quality Assurance Manager supporting the replacement of LA County’s Eligibility and Foster Care systems with the new LRS system. Maintained overall responsibility for activities performed, including the following:
●Provided oversight of independent testing, Regression testing, and Non-Regression Testing of key portions of the LRS system ensuring specific functionality is met and recommending Quality Improvements
●Produced weekly and monthly project status reports for all Project Stakeholders
●Performed Project and Test Management activities assisting with the planning, preparation, and coordination of test activities
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●Coordinated and facilitated County Work Groups to ensure project readiness, information gathering and analysis efforts (including JAD sessions) on a project, documenting, and publishing minutes for all sessions
●Monitored completion of Project Schedule tasks
●Performed extensive business systems analysis and design
●Developed Process Guides documenting procedures and workflows for use by staff; "As is and To Be" processes
●Created Project Schedule and Plan including roles, responsibilities, activity, and task duration
●Requirements gathering, systems analysis, and design using agile/scrum methodologies, evaluating requirements, plans, and results continuously taking place
●Developed use cases, scenarios, and workflow analysis
●Created Data Modeling to demonstrate, define and analyze data requirements needed to support the business processes
●Conducted independent testing, developing use cases, scenarios, and workflow analysis to help create and validate business requirements, using JIRA, HPQC/ALM, ServiceNow
Business System Analyst November 2012-October 2014
C-IV Maintenance & Operations (M&O) Project
Operation Verification and Validation (OV&V) Project
●Supported multiple projects, including C-IV M&O Project where responsibilities included analyzing System Change Requests (SCRs) and System Investigation Requests (SIRs) on the C-IV and C4Yourself web application
●Requirements Lead - Gathered, organized, and designed the implementation of e-Notifications to notify recipients of possible discontinuance of benefits
●Conducted testing, developed use cases, scenarios, and workflow analysis to help create and validate business requirements using multiple test tools using JIRA, HPQC/ALM, and Meriant Tracker
CGI Technologies and Solutions, Inc. August 2010-August 2012
Quality Management Lead
California Department of Health Services Medicaid Management Information Systems (MMIS) Project
Quality Management Lead supporting California Department of Health Services (CDHS) and the established Quality Management Unit for the MMIS Contract with responsibilities as follows:
●Performed independent Quality Assurance (QA) assessments of the State’s fiscal agent, evaluating information gathered, reconciling conflicts, and decomposing high-level information into details
●Ensured CDHS project implementation complied with all Federal Standards, Centers for Medicare & Medicaid Services (CMS)
●Designed, developed, and implemented a Contract Management tool to monitor Service Level Agreements
●Performed systems analysis and design
●Established processes to ensure contract compliance and program compliance
●Ensured all QM activities are completed in accordance with documented processes and procedures
●Managed the Quality Management Compliance Team and reporting on their activities and status to Project Stakeholders
●Defined and developed quality processes to establish quality and standards management requirements are met
●Interviewed, hired, trained, and mentored quality and standards staff
●Developed the Quality Management Plan (QMP) and the Quality Assurance Procedures and Standards Manual (QAPSM)
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EDS/HP August 1993 – August 2010
Operations Liaison Quality Assurance Specialist
California Department of Health Services MMIS Project
●Operations Liaison supporting the California Department of Health Care Services on multiple projects with the primary area of focus being Program Integrity to reduce and eliminate fraud, waste, and abuse in the Medicaid/Medicare Programs. Including prevention, investigation, education, audit, and recovery. Project manager coordinating and organizing auditing of the state of California Medi-Cal Program for multiple audits.
●Project Manager working with the Department of Vital Statistics- Conducting audits of Medi-Cal Claims to ensure Federal compliance with administration of CMS programs including Medicare/Medicaid, Children's Health Insurance Program (CHIP), and Health Insurance Portability, Supplemental Nutrition Assistance Program (SNAP) standards.
●Special Claims Review (SCR) overseeing the handling and processing of fraudulent providers
●Provider Enrollment - Analyzed Medi-Cal physician applications to determine provider eligibility for enrollment into the Medi-Cal program and to detect possible fraudulent providers
●Program Eligibility Determination
●Performed benefits system analysis
●Quality Management - Provided measurement and reporting performance to DHCS, performed trend analysis, and resolution, acted as a liaison between DHS and EDS
************@*********.***
Folsom, CA 95630
linkedin.com/in/barbara-schwartz
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