Business Analyst Senior
Resume:
Donnetta S. Mathis
Austin, Texas *****
Qualification Summary:
Extensive experience in consulting with large-scale government system implementations. Including integrated eligibility projects, MMIS, and intensive history in other healthcare systems within areas of claims operations, prior authorization, third party recovery operations, eligibility, managed care, contract monitoring, documentation, Total Quality Assurance/Management, Provider Management and EDI.
Knowledge in Software Development Life Cycle (SDLC), Business Process Improvement (BPI), Business Requirement Process (BRP),BRD Business Requirement Documentation, phases of Project Management Life Cycle
Good understanding of MMIS Multi-Payer Systems, Joint Application Development-focusing on business requirements issues.
Experienced with Functional requirements, traceability matrix, and business requirements documents.
Experienced and knowledgeable of Independent Verification & Validation (IV & V) Assessments and Analysis; Assessment of business, technical, and enterprise architecture artifacts, tools, and environments, in accordance with Institute of Electrical and Electronic Engineers (IEEE) Standards [IEEE-STD-610 & IEEE–STD-1012]; Conducting risk and issue list reviews; Performing System Requirements Evaluation; Conducting System Test Assessments and Verification; Developing IV&V monthly activity and task reports; and Performing traceability matrix analysis and Organizational Change Management.
NACHA Operating Rules, ACH EFT Standards and CAQH CORE Operating Rules and DDI (design, development and integration/migration and implementation)
Heavy involvement in various states participate of Medicaid Management Information Systems Lifecycle implementations, planning and analysis, gathering as-is/to-be business requirements, documenting functional specifications and user acceptance testing activities.
Defined and document business process flows, business process mapping source to target, and business requirements analysis. Medicaid Business Analysis, MMIS ICD-10 assessment, HIPAA X12 EDI analysis and solutions.
Managed approach and strategy in testing, acceptance testing, UAT and implementation of information systems, modules Excellent experience working with business users to define and document various business rules, identifying required information fields, participating in systems development efforts
and subsystems
Extensive regulation knowledge of both HIPAA 5010 transaction sets and ICD-10 initiatives
Knowledgeable and Experienced in State Medicaid MMIS (Medicaid Management Information System and implementing Medicaid enhancement projects.
Supported the vision of the Louisiana Department of Health and Hospitals (DHH), Bureau of Health Services Financing (BHSF) in providing Independent Verification & Validation (IV&V) services for the State of Louisiana.
Provided expert services for the entire scope of the Louisiana’s Medicaid Enterprise, including its Medicaid Management Information System, Eligibility & Enrollment System, Enterprise Architecture, and Enterprise Governance.
Team effort in providing the State and CMS regular Certification Reports and Gate Review Crosswalks to include progress against system and programmatic critical success factors, risk, recommendations, MITA updates, and all other elements as required by CMS.
Participate in project deliverable reviews and checklist walkthroughs
Checklist Review: Milestone reviews, System Review Criteria, and Comments on Operational Milestone Evidence
Written Entry/Exit - Go/No Go Startup document for the State of Louisiana DHH Medicaid Enterprise Modernization Project
Provided support in the successful launch of Louisiana Medicaid’s new Eligibility
and Enrollment System
Participated in migrating Medicaid Business software to new platforms.
Inventory tracking and fulfillment
Key Artifacts to capture Business/Functional/Solution Requirements:
Business Requirements Document/Specification
Requirement Traceability Matrix
System Requirements Specifications
Request for Proposal Project Kick off Plan
Business Process Flows
Project Charter/Statement of Work/Scope
Functional Requirements Document/Specification
Business User Cases Narratives
Test Plan
Test Scenarios/Cases/Steps
User Stories
AS-IS and TO-BE Process Flows
Use Case etc.
Project Plan/Status/Issues
Functional/Non-Functional Requirements Document
Change Logs/Risks/Action Items
Change Management Tracking
Pass/Fail/Defects
Data Flow Diagram
Issues Log
Technical Skills:
Documentation Tools: Microsoft Suite: Word, Excel, Power Point, OutLook, Microsoft 365, And Microsoft SharePoint JIRA, JAMA, Confluence and Freedcamp
Databases: MS, Oracle, SQL Server, Microsoft Team Function Server, Microsoft (SaaS), Microsoft products including Office Suite, SharePoint, Teams, Planner, Visio, and Azure DevOps
Project Management tools: MS Server, MS Project; Project Workbench; Business Objects and SQL;
Methodologies: SDLC, Waterfall, Agile, Scrum, Citrix, As-One
Testing Tools: Clear Quest, Silk Central, Mercury Test Director, SQL Work Soft, Test Track Pro, WinRunner EDMS; Info Image - (OCR) Optical Character Recognition;
Process Models: MS Visio, Snagit
Education Qualifications:
Business Administration – University of Alaska-Fairbanks
Professional Experience
State of New Mexico, Axxum Technologies February 2021 – September 2021
Change Management Consultant – Organizational Change Management/MMIS/SME
Assist in reducing the impact that change has on the organization, its culture, its people, and its ability to fulfill its vision and mission
Assist clients in solving complex challenges and supporting them through critical transformations
Encourage personal growth and development through various coaching and learning opportunities
Deliver change management, organization design and governance, culture and technology adoption solutions that enable the success of transformation goals for the clients.
Provide tools and resources that facilitate clearer and more consistent communication
Encourage leadership to value their employees and to not only engage them in the change process but to also promote a culture that is engaged
Support employees' development of their personal brand through learning opportunities, professional experiences, inclusion, collaboration and personal well-being.
Assist in providing the tools that individuals needed in order to implement change in the least disruptive, most efficient, and effective way
Utilize data-driven solutions to address the human factors affecting an organization's ability to reach its strategic objectives.
Manage the development of frameworks that support improved client future-state organizational design and alignment.
Manage the process for preparing job descriptions and profiles that were legally defensible that may include job responsibilities and tasks, accountabilities, and competency definitions and matrices.
Applied behavioral tools to assess the impact of change, using assessments of organizational culture, performance and readiness for change.
Prepare comprehensive change and workforce transition plans and programs, including strategies to support change and transition initiatives and leadership. •
Manage identification of required leadership/stakeholder attributes and articulate the importance of leadership in an effective change process. •
Lead and contribute to practice development initiatives including culture building, internal community involvement, eminence, recruiting, whitepapers, etc.
Responsible for business development efforts, including Statements of Work (SOW), proposal development, client presentations, etc.
Act in a mentoring capacity to support the career development of colleagues.
Organization Transformation, in transforming the organization (and the benefits providers that serve them) to support its business strategy.
Helping the client move from where they are today to where they need to be in the future.
Changing the organization's culture, modernizing specific functions, re-designing the organization structure, and a combination of change management actions to execute the transformation.
To enable success, it was critical to use data and insights to inform better ways of working together.
State of Arkansas, Mastech Technologies March 2020 – November 2020
Sr. IV & V Business Analyst - IT Integration Management/MMIS/SME
Supporting required reporting to federal funding partner agencies
Identifying of findings related to risks, issues, or concerns of unexpected gaps in the development of project plans, designs and deliverables
Provide recommendations for remediations
Review requirements and ensure mapped to system test conditions, test cases and scripts for coverage to RTM using JAMA test management tool
Instrumental in development of testing artifacts to support SIT test cases
Review story boards for production streamline and IV&V reporting
Reviews of critical project metrics and deliverables.
Providing actionable recommendations that can be used by the project team to resolve issues
Support data collection and analysis for monthly and quarterly reporting
Providing testing support during SIT phase where defects reported and followed through resolution via JIRA incident management tool
Attend and observe project meetings to collect project information and data, to get understanding of activities, and gain insight
Participate in the analysis of project information and data collected
Assist in the review of project deliverables to include weekly, and monthly quarterly reports
Participate in the definition of “To-Be” process flows and BPR requirements
Development of reports required by federal funding partners in compliance with IV & V contract requirements.
Supported and facilitation of meetings and conference calls
Adhere to contract requirements and complied with all corporate policies and procedures
Interviewing stakeholders to identify their requirements and challenges
Report project status to director, project manager and application manager weekly
Baylor Scott White Health Plan, Austin, Texas November 2018 – May 2019
Sr. Business Analyst - IT Integration Management/Medicaid Consultant/SME
Migrate SWHP’s Medicaid business to the First Care platform
Implementing workstreams timelines and work plans for integration activities.
Creating action plans to improve integration expenses, document complex business processes and business requirements to solve business needs.
Manage one or more medium-scale, systems projects having cross-functional, global, and organizational implications.
Communicate directly and independently with customers, IT professionals, and developers in the analysis and resolution of development and production situations.
Analyze and solve complex problem areas and recommend comprehensive global, cross-organizational solutions.
Participated in the implementation strategies and plans for branding, materials, and documentation.
Serve as a liaison with stakeholders / internal customers of IT, for understanding and translating the business context, immediate needs, as well as their longer-term vision for the initiatives
Develop a good understanding of both, the business objectives/ outcomes and the detailed requirements of the stakeholder departments
Utilize industry standard tools and methodologies to elicit business and user requirements. These include interviews, workshops, questionnaires, surveys, site visits, workflow storyboards, use cases, scenarios, user stories, process modeling, analysis of existing systems and documentation, and other methods.
Develop and utilize standard templates for requirements gathering and communication
Understand and document business process(es) of current state and desired system state that would improve business process efficiency
Facilitate quality peer and stakeholder reviews of requirement artifacts to ensure requirements were complete, consistent, comprehensible, and signed-off/approved
Fast -paced work involving a system of team stand up meetings or scrums followed by sprints to allow for a more flexible system of taking on and completing work.
Maintained and reconciled forward and backward traceability of requirements.
Worked with stakeholders to assist in identifying the business problems to solve for business objectives
Deep dive on comprehensive understanding of the business objectives/ outcomes and the detailed requirements of the various departments
State of Louisiana – Public Consulting Group July 2016 – November 2018
Louisiana Department of Health & Hospitals – Baton Rouge, LA
Sr. IV & V Business Consultant/SME
Supporting Louisiana Department of Health (LDH) in conjunction with the Louisiana Department of Children & Family Services (DCFS) implementing Medicaid Eligibility & Enrollment (E&E), Integrated Eligibility (IE) System (SNAP & TANF) projects and the New MMIS Claims Modernization System and Provider Management System
Participant in process design sessions, software design reviews, and assess resulting work products and produced deliverables.
Clarifying observations and findings with DHH Modernization project manager(s)/team and other stakeholders
Reviewing and documenting standard operating procedures (SOP), and policies and procedures
Contributes to the planning and executes tasks that satisfy the IV&V objectives and contractual requirements associated with one or more of the Modernization components.
Assess the Systems Development Life Cycle (SDLC) processes to verify that they are consistent with best practices and standards.
Participate in Sprint Planning, daily standup meetings, and planning of user stories
Understand As-Is and To-Be business processes
Maintain current and future state documentation using Visio, Project, Excel, Word, JIRA, JAMA, Confluence, Oracle, SharePoint and other tools as needed.
Ensure technical procedures and processes were properly documented, are kept up-to-date, and followed established SDLC requirements
Understand existing Case Management System
Able to identify, draft, gather, perform gap analysis and validate requirements for New MMIS Claims Modernization System and Provider Management System using a COTS product.
Supporting and/or preparing Management Briefings related to the latest, respective (initial or periodic) IV&V Review Report’s results to the State and CMS
Provide consolidated analytics for informed decision making.
Assure the new systems conform to the enterprise architecture and meet business and technical requirements.
Assure compliant with the CMS Seven Conditions and Standards, MITA, the Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act (HIPAA).
Validate deliverables against best practices in system engineering, and verify that they meet the client’s requirements
Provide services across modules to include Eligibility, Enrollment, Enterprise Architecture and MMIS.
Review and provide documented feedback on all deliverables
Submit written weekly and monthly activity reports to client
Submit monthly assessment and status reports to client and CMS
Responsible to ensure that system functionality and business operations met the Medicaid Certification Checklist criteria from the MECT to achieve CMS certification.
Participate in developing and implementing a strategy and plan for proper documentation of system artifacts to support the certification process.
Assisted in providing oversight of the certification process and prepared for and lead the State participation in periodic certification reviews.
Worked closely with the State with its engagement and interaction with CMS for certification efforts.
Ability to effectively manage and maintain required project artifacts
Analyzed, evaluated and identified concerns, risk and issues via meetings.
Ensured all requirements were accurately reflected in test planning and execution, and that traceability to requirements were maintained
Coordinated the on-going maintenance of the Requirements Traceability Matrix with test related data
Performed desk check, and peer review of IV&V deliverables and work products prior to submission
Executing the archival of IV&V documents and artifacts
Leading/participating IV&V lessons learned and process improvement activities on a continuous basis
State of Illinois/ Cognosante/DSN July 2015 – February 2016
Department of Family and Health Services – Springfield, Ill.
IV&V Manager/Sr. IV & V Business Analyst/CORE MMIS Project
Senior IV & V Business Analyst for the State of Illinois Department of Family and Health Services. worked independently to perform IV&V oversight
Served as the primary point of contact for HFS management
Conduct assessment activities of subsystems
Provide independent verification, validation and quality assurance throughout the Projects
Attend project leadership team status meetings during the project
Participate in gap analysis and solution sessions for MMIS
Experienced in conducting Joint Application Development (JAD) sessions
Participate in gap analysis and solution sessions for MMIS
Conducts periodical project reviews to ensure satisfactory deliverable for project success
Participate in MMIS requirements and design sessions
Participation in Cloud migrations
Ensure that all Project Control Management plans were complete and consistent with the IV & V management plans and methodologies
Worked closely with Director and Senior Managers of the CORE MMIS to weekly discuss Project Status
Ensure that milestones and deliverables correspond with the development MMIS project schedule
Maintain IV & V methodology checklist
Assessment Report on the activities of the IV&V Analysis of the project to submit to CMS
Monthly meeting with Steering Committee to present, discuss and evaluate MMIS project status, Contractor deliverables and recommend corrective action when activities and/or deliverables fail to achieve the standards established in the RFP, and the Vendor’s proposal.
State of Illinois/ Cognosante/DSN July 2014 – June 2015
Department of Family and Health Services – Springfield, Ill
Sr. IV&V Business Analyst/MMIS Team Lead
Senior IV& Team Lead for the implementation of a new Medicaid system for the State of Illinois.
Project is a new 'model' of implementation, as Illinois targeted as a tenant in a cloud-enabled MMIS that is 'shared' with Michigan.
As the Independent Verification and Validation Project Analyst Team Lead was responsible for Preparation and presentations of status reports to HFS leadership
Reviewed and monitored all project activities to identify risks, issues, Action Items and quality assurance concerns through participation in meetings, interviews and formal assessment tools.
Contributed to written IV&V project status, assessment reports and other deliverable documents and reports.
Participation in Cloud migrations meetings and reviews
Reviewed deliverables during project SDLC to ensure satisfactory deliverable for project success
Reviewed requirements tracing with a traceability matrix to process links between the requirements and work products that were developed to implement and verify those requirements
Supported user acceptance testing
Maintained SQL scripts. Indexes, and complex queries for analysis and extraction for work products.
Assessed and documented and reported on implementation and operational readiness
Assisted the testing team in developing the test plan, test conditions, and test cases based on business requirements and technical specifications
Participated in the identification, understanding and documentation of business requirements, business rules, including the applications capable of supporting those requirements
Involved in meetings with Sr. business analyst. managers regarding various process plans, business processes, and functionality in detail
Participates in requirements and design sessions and document results
Participates in the UAT testing meetings and processes, as requested by HFS, and document results
Review and Validated requirements traceability matrix to test cases
Subject matter expertise and experience relevant to Medicaid and systems implementation
Completed IV&V DDI Development, Design and Implementation oversite
Written Entry/Exit - Go/No Go Startup document for the Illinois/Michigan Provider Enrollment Project
State of Alabama May 2013 – July 2014
IT PROJECT AND CONTRACT SYSTEMS MANAGEMENT- Montgomery, Ala.
MMIS - Sr. Team Lead/ MMIS Project Manager
Serve as an interface between PMO/IT, policy, and the fiscal agent in overseeing DDI MMIS Enterprise projects
Written and submittal of the Implementation Advance Planning Documents (IAPD’s) to CMS with a plan of action, budget and schedule request for federal funds
Written request to CMS for approval to implement Operating Rules Phase III EFT/ERA and Transformed Medicaid Statistical Information System (T-MSIS) services for the State of Alabama
Determine business rules and requirements for the enhancement and modification of the current MMIS Enterprise
Responsible for the oversite of DDI of Operating Rules Phase III for Eligibility and Enrollment (EFT and ERF) and T-MSIS
Monitoring, reporting and facilitating updates to the fiscal agent's project plan
Tracking and reporting on the project's budget and finances
Determining and tracking project metrics aimed at reporting the "status" of the project
Monitoring and tracking progress of project milestone for CMS
Tasked with participation in the implementation of the CAQH CORE 360 Uniform Use of CARCs and RARCs (835) Rule which is a part of the Affordable Care Act (ACA)-mandated EFT & ERA Operating Rules
Work with in and out of house managers, team leads, technical staff, and fiscal agent staff and business users to identify, track and manage project issues as they arise.
Validate deliverables task has been completed for approval for billing during the invoicing cycle
Meet with shareholders, partners and CORE team to review updates, resolve issues on project tasks.
State of North Carolina/DHHS/OMMI March 2009 – May 2013
Senior Business Analyst/SME – MMIS Consultant – Raleigh, NC
Participate in all aspects of development of a Multi-payer Medicaid Management Information System (MMIS) Replacement Project for the State of North Carolina.
Selected appropriate methods to elicit and document requirements as-is and to-be.
Business requirements analysis gathering to finalize requirements and design.
Ensured customer business and technical requirements were captured and validated, business benefits defined and measurable, requirements translated into project scope
Participate in JADs for detail design activities.
Identified process gaps, proposes alternatives and recommended implementation of new processes to improve management practices as they related to organizational goals.
Involved in 5010 Detail Designed Development with department’s business owners and the project fiscal agent.
Involved with EDI Team for review of HIPAA X12 transactions: 270, 271, 277, 278, 835, 837, 999 and 277CA, 4010A1 to 5010 with gap analysis, mapping analysis and solutions.
Gathered, analyzed, digested, and documented complex business rules, requirements and business processes.
Developed and maintained the requirement traceability matrix to capture all requirements and their traceability delivered at the conclusion of the life cycle
Liaison for state on Change Control Board (CCB) meetings to translate decisions made for business units
Participate in conducting the assessment and rating for MITA 3.0.
State of Georgia January 2008 – January 2009
Senior Business Analyst – MMIS Consultant – Atlanta, Ga
Modified MMIS and business processes to comply with federal mandates associated with the Georgia Manage Care and Waiver Program.
Reviewed, analyzed and evaluated business systems and user needs.
Documented requirements, defined scope and objectives, and formulated systems to parallel overall business strategies.
Interfaced with business users to prepare and update Business Users Requirements (BUR) and Software System Requirements (SSR).
Created test cases and test scripts.
Prepared business process models and used Visio to create use case diagrams.
Participated in JAD sessions to create a series of Detailed Document Design (DDD).
District of Columbia September 2007 - January 2008
Medical Assistance Administration - MMIS NPI Remediation Project – Raleigh, NC
Senior Business Analyst – MMIS Consultant
Assisted in the implementation/remediation of the DC MMIS Claims Processing Subsystem.
Reviewed, analyzed, and evaluated business requirements and user needs.
Documented requirements, defined scope and objectives, and formulated systems to parallel overall business strategies.
Participated in JADs for Detailed System Design (DSD) deliverables.
Integrated test plans; system test cases, scripts and system test data; analyze results; documenting defects.
Utilized Microsoft Visio for process analysis to create use case diagrams.
State of North Carolina DHHS/OMMIS – Raleigh, NC March 2007 - September 2007
MMIS Subject Matter Expert - Senior Consultant
Responsible for assessment through the PMO
Gathered technical and general requirements.
Reviewed and maintained Statement of Objectives.
Participated in Joint Application Development (JAD) sessions.
Reviewed RFP Business requirements for the State of North Carolina.
Compiled information from each section of requirement documentation to present to PM
Edited language ensuring the release of the NCMMIS Replacement System RFP.
ACM Central - Omaha, NE December 2006 - March 2007
IT Project Manager – EDI Consultant
Responsible for directing multiple system activities, including Legacy EDI solutions.
Served as the principal point of contact for client issues.
Utilized MS Project for a variety of specific tasks that were to be completed within a specific timeframe, assigned resources to activities, created estimate of time and costs
Developed project plans, schedules and resources specified in the SOW.
Ensured that all deliverables were produced accurately and according to Trading Partners and Stake Holders specific format, media and frequency.
Led NPI IT core team efforts to plan and execute all (NPI) programs systems level.
Responsible for managing all project resources.
Texas Medicaid Health Partnership - Austin, TX June 2006 - December 2006
Senior Business Analyst/ Sr. Business Solutions Architect –Senior MMIS Consultant
Responsible for editing system changes relating to the implementation of the federally mandated National Provider Identifier.
Gathered and document requirements, for eligibility and claims.
PMO responsibilities for assigned modification, enhancement and/or project requests.
Reviewed functional specifications.
Participated in Joint Application Development (JAD) sessions.
Supported specific portions of MMIS or PCCM application areas.
Utilized MS Visio for process analysis.
Utilized Test Director to developed testing criteria, test plans, and test scripts.
North Carolina DHHS/OMMIS State of North Carolina -Raleigh, NC April 2004 - June 2006
Senior Business Analyst/Team Lead – Senior MMIS Consultant
Participated in a Multi-payer Medicaid Management Information System (MMIS) Replacement Project for the State of North Carolina.
Provided interpretation of business needs and objectives in design phases of System Development Life Cycle (SDLC).
Reviewed requirements for claims, eligibility, prior approval and managed care, document business rules gathering, analyzing, and documenting
Working with, business operations teams to ensure accurate implementation of all subsystems business rules.
Reviewed detailed desk procedures in preparation for replacement activities.
Documented and validated requirements and future process flows with the project team.
Analyzed and reviewed source-to-target mappings, business processes, process flows, business cases, and use cases.
Identified requirements for data warehouse and assisted with warehouse data model.
Involved in Joint Application Development (JAD) sessions with stakeholders throughout SDLC.
Participated in review of the functional requirements specifications and user interface design for the EDMS (Electronic Data Management System), to provide imaging, (OCR) Optical Character Recognition.
Worked with QA team to design test plan and test cases for User Acceptance Testing (UAT).
Fox Systems Inc. - Springfield, IL/Los Angeles, CA/Augusta, ME/Des Moines, IA/Tallahassee, FL/Nashville, TN, Scottsdale, Az. November 2000 - March 2004
Senior Business Consultant/ Senior-HIPAA/EDI Consultant
Performed requirement assessment and analysis of various MMIS (Medicaid Management Information Systems).
Maintained project plan for time constraints through MS Project
Identified current system configuration along with key interfaces and processes.
Analyzed and documented business requirements and processes.
Conducted Business Functions Analysis.
Performed EDI customer testing and conducted proactive EDI education to increase the volume of claims submitted electronically.
Designed workflow analysis.
Developed detail design specifications including service models and message schemas
Interviewed various business clients internal and external.
Participated in JAD Sessions for EDI/RFP requirements.
Mapped current EDI HIPAA data elements and code sets with required government guidelines.
Analyzed HIPAA impact methodology.
Standardized X12N transactions, developing unique identifiers for key functions.
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