Business Analyst/Product Owner

CAREER SUMMARY:

Innovative and experienced Management and Information Technology business professional with over a 25-year background in healthcare, leadership, business analysis, project management, and customer service. Possess exemplary skills in project leadership, quality testing, written and verbal communication, critical thinking, and client relations. I am devoted to building strong and effective relationships with stakeholders, teams and employees, while taking initiative to achieve exceptional customer satisfaction and business results.

PROFESSIONAL EXPERIENCE

TEKsystems- American Express- Phoenix, AZ Sept 2019- Feb 2020

Consultant and Information Security/Cyber Security Product Owner

Product Owner of Cyber Security Bot under Information Security (Slack and Intranet) working alongside Product Management and UI/UX to create strategic Marketing Plan throughout Technology and Enterprise.

Know and execute SAFe Agile and Kanban standard methodologies for collaboration in a dynamic product development environment

Maintain all product plan documents to ensure all features and user stories are on target to completion, to include defining acceptance criteria, detailed requirements, and business values.

Maintain the product backlog and ensure user stories are aligned to underlying product outcomes

Support in identifying technical problems and devise solutions to the current and future business environment

Facilitate cross-functional collaboration with design, analytics, engagement, project management, and engineering

Assists with communications to facilitate resolution of risks, issues, or changes tied to initiatives

Develop Product Release Training materials for the end users

Use analytical and strategic abilities to identify trends and make recommendations that will help improve the user experience

Maintain critical metrics and reporting tools to analyze success

Reviewing and performing sign off prior to production release of all end to end testing, to include writing and performing testing when needed

Infosys Limited, Inc – Aetna - Phoenix, Arizona Nov 2016 – Sept 2018

Senior Consultant/Business Analyst

Lead RPA Business Analyst for Aetna Medicaid IT. Took lead on team projects for their National Health Plans.

Lead meetings to guide Business Owners/Stakeholders through SDLC Lifecycle as IT liaison to identify, plan, and design automation needs by analyzing data and processes. Continue through development, integration/UAT, and implementation.

Work closely with QA Analysts to develop test scripts, testing scenarios, and review testing outputs - STLC

IT Governance Committee Member to present ROI as Project Lead seeking approval on behalf of the business

Gather and write functional/technical Business Requirements for customer efficiency on AI/RPA for claims processing, LTSS timeliness, customer service improvements with WFM reporting, HIPPA and encounter and file downloads, standardizing provider credentialing, HEDIS/case management, pharmacy, utilization management, financial reporting, and ERP. Define and monitor SQL outputs. SaaS interface (Salesforce, Google)

Utilize SharePoint and Microsoft Project to update all PM Project documents through the SDLC Lifecycle and hold regular stakeholder meetings. Share any delays or risks

Gained a comfort level and trust with the Business Owners and provided input for new Projects by analyzing data for efficiencies. Increased processing standards and decreased penalty payouts. Created post implementation standardized documentation and train business users on their finalized projects.

Train Development Team/ IT Project Management Teams on the Healthcare Domain – Running Infosys RPA AssistEdge

Software Development Life Cycle functionality with Waterfall and Agile knowledge – Client is going to DevOps.

Axiom Systems Inc. – Frederick, Maryland Aug 2015 – Jan 29, 2016

Senior Healthcare Consultant/Project Manager/Acting Claims Director

As Claims Director and Project Manager, provided leadership and created effective relationships by training and developing the staff on improved business processes. This was a Medicare Advantage/Medicare Supplement Plan

Developed a business model based on analyzing claims data to significantly decrease adjustment and refund backlogs. A decrease of 80% in 120 days

Through complex analysis developed new claim production reports, which increased analyst productivity by 20%

Identified and implemented system enhancements through configuration and RPA solutions to eliminate manual processes.

Developed and trained Claims Edit Documentation to increase staff production and increase accuracy

Analyzed claim and correspondence data to create new Standard Operating Procedures and update those outdated

As a Project Manager, held cross functional team meetings to develop standardized processes, I.E. COB and Medical Management.

Through Workforce Management Planning and analyzing performance reports, developed a workload structure to meet/exceed all claims entry and processing standards to meet CMS audit standards and increase STR ratings. 99.5% of claims processed within 30 days.

Developed and presented PM Microsoft Project documents and results in weekly meetings with Senior Level Executive and CEO of the Plan (Stakeholders). Presented to Executive Team at Axiom.

CVS Health Inc. Dec 2014 – Mar 2015

Client Implementation Benefit Manager – Testing Team

Managed a Health Plan Testing Team for the Pharmacy Benefit Management side of CVS Health. Responsible for the operations and oversight of New Plan implementations and maintenance of business for national health plans covering millions of lives.

Knowledge with the PBM includes: Medicaid, Medicare D, Exchange, and Commercial Plans.

Maintaining Customer Satisfaction and Customer Retention by meeting all Client Commitment Dates, Quality Standards, and CMS Star Rating. Testing statistics maintained at 99-100%.

Testing went through the Software Testing Life Cycle (STLC) Phases

Blue Cross Blue Shield of Arizona, Phoenix, Arizona July 1988 - Oct 2014

Senior Manager Claims and Customer Service

Managed cross functional teams of claims and customer associates, claim leads and supervisors, QA Coordinators and WFM Analysts in multiple state locations. Managed 70 FTEs

Spearheaded the development. implementation, and then management of the Member Concierge/ACA Department – sales, enrollment, renewals, and full customer service for the IU65 Market and Over 65. ACA sales with direct interaction to the Federal Marketplace. All staff State licensed. Incoming calls, outgoing calls, and walk ins.

Vendor Management – Hired and recruited vendor and their employees for open enrollment. Held weekly meetings with vendor management.

Manager for the Coordination of Benefit Unit – Full customer service and claims processing, to include CMS primary and secondary Rules and Regulations. Coordination for Medicare Supplement, Workers Compensation, Disability, and Commercial. Continue data analysis for continued COB savings.

Manager for the Provider Assistance Department, to include claims, benefit inquiries, and utilization management for provider community. Knowledge of the Federal Employee Program, TPAs, large and small groups, and all Individual Markets. HMO/PPO/POS/EPO Medical, Dental, Vision, and RX claims and customer service.

Manager of the Claims Quality Coordinators. SME involved in developing Claim Quality Incentive Program, to include Witness call audits, Team and Individual Monthly bonuses for customer service and claim/correspondence processing. Departments maintained 99.5%. Incentives at 100%.

Workforce Management – Planning, scheduling, and forecasting multi-functional customer service and claims departments. Exceeded Association requirements for service and productivity level expectations – Calls routed through IVR for self-service and first call resolutions (FCR). 80% Service Level within 30 seconds. Maintain low abandon and busy ratios.

Plan, design, write and review requirements, write and run test scripts, and implement as a joint project effort with IT the HIPPA transaction sets. Utilized the Plan Internet service. Continued to monitor and analyze post implementation.

Local Project Lead to analyze IVR and Internet usage and data – Held regular team meetings for member and provider input. Worked closely with Sales and Marketing.

Subject Matter Expert representing Local Claims Division on the Medical Appeals Committee.

Project Manager and/or Subject Matter Expert on Project Teams analyzing data to design and implement new Claims, Customer Service, and PBM Third Payor Systems (RX)

Key Management Participant in URAC Accreditation for Utilization Management and Member Relations

Handled escalated service issues and customer complaints. Maintained and monitored URAC monthly complaints.

International Coordinator directing the claims processing and coordinating the precertification and medical records.

Coordinated and/or provided ongoing training and employee development. Ensuring all claim department SOPs were updated annually and company policy changes communicated timely to team members

Presented training on all upcoming Plan, Association, CMS, or regulatory changes to hospitals, outpatient facilities, specialists, and PCP offices

Managed the Claims Financial Accounting functions, to include claims adjustments, recoupments, and rework/reprocessing claim projects for large groups or provider groups

Large Group Presentations and Sales. Quarterly interaction with the Veteran’s Administration Department of Defense, Indian Health Service, Military Bases and other Federal Facilities.

Work closely with Sales through RFP and new group onboarding. Knowledgeable in underwriting.

Highly knowledgeable in Organization Development and Change Management - Includes recruiting, hiring, staffing, HR policies, and budgeting.

Highly knowledgeable in medical terminology, medical billing, and medical coding.

EDUCATION

Arizona State University, Tempe, Arizona

Bachelor of Science Degree in Communication, Organizational and Management

Phoenix College, Phoenix, Arizona

Associates of Arts Degree in Broadcast Journalism

PROFESSIONAL DEVELOPMENT

Project Management and Business Analyst Training

DevOps Training

Agile and SAFE Agile, Kanban and Waterfall Project Development Training – Includes Jira, Confluence, and Rally Training

Presentation Skills/Toastmasters

Continuing HR Education - Employment Law/Employee Diversity

Situational Leadership II

Impact 360 Quality Monitoring System Monitoring

Customer Service Solutions Implementation and Development Team

URAC Accreditation Team Utilization Review and Member Relations

Professional Academy for Healthcare Management

White Belt Training

Leasing Arrangements Training

CERTIFICATIONS /ACHIEVEMENTS

State of Arizona Health and Disability Producers License, 2013-2017

CMS Medicare Parts C and D Fraud, Waste, and Abuse Training – Compliance Training

Professional, Academy for Healthcare Management –AHIP – AHM250

Excellence Through Quality Team Leader and Facilitator

United Way Leadership Giver/United Way Women’s Council Phoenix

COMPUTER SKILLS

Microsoft Office (Outlook, Word, Excel, Visio, Project, and PowerPoint)

Genesys Workforce Management/CC Pulse/ Customer Service Solution

Witness Quality Monitoring System/Verint/Aspect

Operating Claims Systems –QNXT, Metavance, Telnet (TPS)

Pharmacy Management/RX Claim

Claims Manager

SharePoint

PeopleSoft and ADP

Microsoft Dynamics 365 (CRM)

SaaS Applications (Salesforce, Google, DropBox, Slack)

Jira/Confluence/Rally Project Management

RRC – Business Requirements Database - Lucidchart

Quick Base, CAQH and other Credentialing Applications

Availity

SQL Definition and Translation

Crystal and Solr Reports

Business Objects

RPA Assist Edge

Blue Prism

API Knowledge and Understanding

Botpress

Dynamo Software Application

American Express Iris/Abacus

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