Project Management Customer Service

Daniel Brian Payne, Jr.

Franklin, TN

m: 615-***-****

******.*.*****@*****.***

Professional Summary

Results-driven change agent with career-long record of operations, business analysis, and project management success for leading organizations

Proven talent for aligning business strategy and objectives with established solution architecture and operations management paradigms to achieve maximum operational impacts with minimum resource expenditures. Growth-focused thought leader with expertise spanning software development, business analysis, database design, team leadership, infrastructure development, portal monitoring, quality control, client relationship development, cross-functional team collaboration, operations optimization, customer service, system integration, technology solutions, and project management. Exceptionally dedicated professional with keen interpersonal, communication, and organizational skills.

Professional Experience

Centerstone, Nashville, TN, Nov. 2014 to Present

EHR SOLUTION ARCHITECT

Collaborate with the project team to establish a project plan that accelerates adoption and delivers both short and long-term benefits.

Garner experience working with myAvatar, CarePOV Clinician and various other modules; demonstrate knowledge of assigned areas of expertise including integrated software, including designing workflows in conjunction with permissions structure.

Create a strategy for data migration and federation while understanding the integration points of the solution, including data stewardship.

Interpret technical requirements and business needs into innovative solutions.

Identify and lead the mitigation of any technical gaps or risks.

Represent IT at client governance meetings to review technical aspects of projects and offer recommendations to boost the efficiency and progress of the solution.

Operate as the senior lead on assigned projects, tasked with directing and mentoring all team members and project resources.

Oversee and manage various concurrent customer requirements providing a balanced assignment to each project, working simultaneously in pre and post implementation situations.

Contribute to the development of best practices through the identification of reusable project-level assets.

Deliver feedback to vendor product groups and development teams on features and functionalities.

Foster and maintain strong relationships with peers in various teams and vendors.

Remain abreast of new developments in the industry to gain an understanding of how vendors are deploying new and emerging technologies. Utilize this knowledge to advance solutions and assist customers and stakeholders.

Provide technical governance to ensure the technical viability of any change control and monitor the technical progress of the project during implementation and deployment, support timescales, and financials.

Secure and handle confidential data, ensure against unauthorized access, improper transmission, or unapproved disclosure.

Integrated electronic data interchange (EDI) healthcare transactions, including 837 claims, 834 enrollments, 835 payments, 270/271 eligibility requests, 276/277 claim status requests, and 278 utilization reviews, with core healthcare administration platforms for claims adjudication and enrollment. Successfully mapped EDI data to internal formats to enable seamless processing of high-volume EDI transactions, ensuring timely and accurate claims payment and member enrollment. Configured platform to validate transactions, generate ACKs/errors, store data, and route to appropriate systems. Enhanced automation and efficiency of key financial and administrative processes.

8+ years of experience implementing and supporting SAP SD (Sales and Distribution) module across multiple healthcare clients. Led full lifecycle SAP SD implementation projects for 2 large hospital systems, including requirements gathering, system configuration, testing, training, and go-live support. Partnered with business users at healthcare providers to understand pain points and develop solutions leveraging SAP SD functionality. Strong understanding of healthcare sales and revenue cycle management processes and how to configure SAP SD to support those needs.

Led efforts to migrate and cleanse customer and material master data during client SAP implementations.

Cigna/HealthSpring, Nashville, TN, July. 2013 to Nov. 2014

BUSINESS ANALYST/QA ANALYST

Compiled all necessary business requirements for various projects while simultaneously producing technical documentation for IT Operations, training, workflow and analysis, and ensuring full HIPAA compliance.

Ensured all systems and clinical applications were operating at optimal performance levels. Oversaw various clinical application solutions and critical systems of the Healthcare Solutions Team.

Served as a key contributor in identifying and designing solutions and improvements for numerous clinical systems and applications, offering User Acceptance Testing (UAT) to ensure products were efficiently released.

Aligned objectives and bridged communications between internal partners, external clients, vendors, and clinics, serving as a communication liaison.

Generated documentation of all business processes corporate-wide, providing follow up to ensure all specifications were accurately implemented and on time, accelerated all technical issues to appropriate IT staff.

Created and documented business requirements and specifications for extracts and reports.

Delivered comprehensive application support to user requests, including dictionary configuration, functionality troubleshooting, custom reports, training, and workflow analysis serving as a liaison between IT and business units.

Spearheaded several successful deployments, including documentation of test plans, creation of test data, and evaluation of results functioning as the primary Business Analyst in MAS Support for the Compass Project.

Implement, update and maintain automated, direct connect and manual eligibility data.

Provided technical support for the electronic processing of eligibility for CCMS (McKesson), AppXtender and CPS (Centricity) and QNXT while working with client’s format and Internal Systems to resolve technical issues efficiently.

Evaluated both operational and organizational areas to identify areas for potential improvement, while also addressing workflows, processes, and data flow regarding customer systems/practices.

Demonstrated software, discussed workflows, and participated in site visits while attending marketing functions and opportunities.

Functioned as Business Analyst/Tester during the updating of Windows Server 2012 and QNXT Application from version 5.2 to 5.2.2 working in conjunction with a Developer.

Worked as a collaborative team member regarding the configuration of Benefits, Enrollment, Utilization Management, Authorizations, Provider Contracts, Claim Test Pro (CTP), and Medical Claim Processing.

Performed data mapping of interfaces for dental, pharmacy, vision benefits, nurse triage, and electronic membership files while monitoring configuration of QNXT relating to provider demographics.

Outlined and reviewed contract terms, Term Restriction Groups (TRGs), and ensured services groups were configured correctly to assure proper scoring of claims for reimbursement to the provider in the contract module.

Offered support for ongoing project maintenance, facilitated documentation of corporate policies in support of new enterprise systems environment, and developed a business process repository.

Executed test activities as needed under the direction of Test Team Lead, QA, and validation of Membership Conversion. Validation that all required data elements were converted successfully

Coordinated and assisted in the creation of end user training materials for the QNXT (tm) system, including tip sheets, quick reference guides, and verified the appropriate PCP was converted and assigned to the correct enrollment span.

Authenticated all required CMS tracked data elements, LIS/Copay combinations, LEP Flag and uncovered months, Medicaid indicator and level, ESRD, Dialysis indicator, and Transplant indicator.

Verified rate code setup and payment method within QNXT AR Module and verified various payment methods and confirmed the appropriate submission to CMS form while authorizing the Service Area Reductions (SARs) and Service Area Expansions (SAEs), as well as the non-renewal plans for 2014 and 2015.

Completed routine preventative maintenance and upgrades to ensure network, system, and data availability optimization.

Assisted help desk staff with first-level troubleshooting of various processes, provided documentation relating to start-up, and shutdown.

Preserved the integrity and security of data, reports, and access with the implementation of company policies, technical procedures, and standards.

Achieved all deadlines and requirements consistently for all production work orders.

Maximized inter-department communication and data sharing, facilitating efficient operations.

Ingenix/OptumInSight, Franklin, TN, September 2008 to July 2013

COB BUSINESS ANALYST

Conducted routine research and updated information needed to verify Medicare eligibility utilizing Web based applications, client systems, and/or internal systems applying Rules of Coordination of Benefits (COB) for Commercial and Medicare policies and updating Client Systems with the correct order of benefits.

Partnered with business units to streamline the process of identifying, reviewing, and analyzing claims and overpayments

Reviewed and verified overpayment, which included Duplicate Payments, Contract Compliance, Authorizations, Eligibility, Coordination of Benefits, and Medical Reviews.

Prioritized, assigned, and managed queries and action plans while reviewing members on the VDSSA/MIR files.

Interfaced directly with external clients and customers, serving as a liaison between management.

Delivered exceptional customer service via outbound calls to members, Medicare providers, employer groups, or others deemed necessary by management.

Mentored and educated new COB Analyst/Validation Analysts on understanding the complete process for multiple clients while providing all necessary documentation for projects on hand.

Designed and deployed modified queries that enabled increased growth and revenue by an additional 15% to 20% each quarter.

Willis North America, Nashville, TN, March 1994 to September 2008

BUSINESS ANALYST

Communicated with clients to effectively analyze initiatives, build business cases, provide cost/benefit analysis, devise project measurement objectives, and identify business-staffing requirements for IT projects and user training.

Utilized project management methodologies, such as SCRUM and Waterfall, to coordinate all involved parties and techniques while initiating change requests from the business to ensure timely and accurate depositions and coordinated user acceptance testing and signoff regarding various projects such as the WCP policy management system.

Oversaw the entire project lifecycle, including investigation, design, testing, and implementation, to ensure business requirements were successfully implemented. Served as a liaison between end users.

Managed the daily operational activities of the Oracle and SQL Server Database Administrator resources.

Played an integral role in writing, testing, and implementing improved company databases designed to enhance the ability to provide superior customer service.

Communicated with business/user group representatives to garner an understanding of business needs and requirements.

Documented process automation needs translating all necessities formal, documented business requirements (BRD’s) following internal established methodologies and processes.

Drove continuous efforts to streamline business operations and improve efficiency through collaborations with various departments and all levels of management.

Served as a subject matter expert in understanding new and updated applications that had been streamlined for the company to run more efficiently.

Ran regular reports from the knowledge base and initiated communication with other BSAs, PMs, and department supervisors to develop new content or update existing content/requirements documentation.

Traveled extensively throughout the US and other international locations as a company representative.

Education and Credentials

Bachelor of Science (B.Sc.) in Business Administration, 1993

Middle Tennessee State University, Murfreesboro, TN

Certs School – AWS Solutions Architect Certification Training – In progress

Volunteerism

Special Olympics, Boys and Girls Club Nashville, American Cancer Society, Habitat for Humanity and TNacheives.

Additional Information

Technical Proficiencies: MySQL, Oracle, SQL Server Tools, MS Office, Project, Visio, SharePoint, VPN, Citrix, CCMS(McKesson), AppXtender and CPS (Centricity), QNXT, myAvatar, Windows, Servers, Routers, LAN, wireless LAN, Microsoft Exchange, Active Directory, Microsoft Project, Access, Crystal Reports, Notepad++, EDMS/Documentum, Visual Basic

Interests: Scuba Diving, Skiing, Flying, Photography, Culture, History, Travel, Hiking

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