Sr. Business Analyst/Product Manager

Brooklyn, NY 347-***-**** ***********@*****.***

Nicole H. Daniels

SUMMARY

Possess over 30 years as a Business Analyst and Senior/Lead Business Analyst or Project Lead, Product Manager or Project Manager with various organizations working on projects that is large to medium to small scale with the public sector and state agencies. Proven ability to increase client retention and increase product use through marketing, upsell, and education. Over 12 years targeted experience related to NYS programs with 23 years related to health insurance and quality regulatory experience

(QPMs, CMS, NCQA, Medicaid state programs).

SKILLS

● IBM Rational Administrator, IBM Rationale Requisite Pro, Business Process Modeling (BPM), SharePoint Workspace, Lync, HP ALM Quality Center, Quick Test Pro, Adobe Live Cycle Designer, NG911, MS Office Suite, TOAD for Oracle, TOAD Data Modeler, SQL Script development and ability to join, Pencil Project, BALSAMIQ, Wireframes, XML, XSLT, Java script, LoadRunner, Performance Center, Selenium, Splunk, NIEM v2.1, XSLT, MQ Series, AS400, COMTEC, Seibel, SOA design concept, DDI using metadata lifecycle, EDI Transactions, PEGA, Cacti, Carelink, Facets, MMIS, EMR, ePaces, FTP, Batch Claims, Raw data retrieval and interpretation, Claims Billing System, Enrollment and Client Management (ICIS), MAXDat, MAXe, FACETS, Edifecs Spec Builder, MHS, Thin Client, Total View IEX, Pipkins, Raw Data, POS Transactions, POS Terminals, VeriFone Premier, IVR, CRM, CCMA, Avaya, C3, HIPAA, JIRA, CERIDIAN, SCRUM/RAD, Waterfall, Agile, ServiceNow, MACES, Kronos, ADP Workforce Now, TelAthena Services, Zoom, Marketing, Planisware, CTMS, EDC, eTMF, Veeva Vault, SSO, ALM VERA Smartsheet, Yammer, RDS, SAGE 3X, Sustainability and Data Collection, SAP, WBS, RAVE, MARS, Power BI, CARAT, Clarifi, Epic EHR, Cerner, Azure, Power BI, Azure, Quality regulatory experience

(QPMs, CMS, NCQA, Medicaid state programs), SalesForce, Interactive Billing System, Indirect Sales Application, Direct Sales Application, Interactive Desktop Application, MAUI/OneAgent EXPERIENCE

Apex/Optimum Senior Business Systems Analyst 04/2024- 08/2024

• Support growth and development of Junior Analysts/Drive Project Completion/Support Organizational success/create stories for Functional and Business Success. Collaborate dependencies within the team for optimal delivery outcomes. Contribute to Vision, Roadmap and ROI.

• Utilize LEAN, ITIL and Six Sigma practices within Customer Journey Mapping. Identify automation opportunities to support process improvement. Create Kanban boards and utilize Scrum framework including embracing agile principles and SAFe/Lean and ITIL standards.

• Drive engagement between process owners, users and technical teams. Improve the user experience and drive efficiency by building a shared understanding of customer and business needs. Ensured the team risks and dependencies were identified and mitigated. Decision maker including functional and NFRs.

• Provided standard professional advice and created initial reports/analyses for review. Analyze metrics and create a dashboard reflecting the findings. Make on-site presentations to existing and prospective clients to educate and inform on products. Responsible for providing client support in the areas of service, maintenance and penetration. Cognisight, LLC (Lead Business Systems Analyst) 01/2023 – 02/2024

● Lead Team and drive requirements gathering sessions for new work and implementation questions. /Capture requirements for review and approval/Convert requirements documentation into actionable development tasks (“development stories”) with the assistance of lead and senior developers. Mentor and support Junior Analysts growth/development. Create workflow documentation, produce diagrams, and wire frames for multi-line claims management. Lead and actively support the initiation and implementation of multiple Agile projects which includes managing daily standup sessions and 2-week sprints for COTS and internal development solutions. Demonstrated continued success in interaction/support of all levels of management to include CIO, Chief Security Office, Directors, Managers, Utilize the CDH, IBM Business Process Modeling

& Business Animation Workflow, SharePoint, and SmartSheet for retention of information and analysis of data during project development and implementation.

● Actively participate in Scrum Agile Meetings Follow Agile and Waterfall SDLC processes based on project, security protocols, and best practices to deliver software solutions. Support client retention with marketing new products and enhancement opportunities to promote higher ROI and maximize growth, stability, and longevity of customer relationship. Nicole H. Daniels Page 2 of 7 ***********@*****.***

● Liaison with current business operation leadership and product development team to ensure solutions are understood and implemented. Quality regulatory experience (QPMs, CMS, NCQA, Medicaid state programs). Demonstrated use of PDSA/PDCA. Support IVA, PACE, MA programs and SOC audits. Work with third party vendors for processing claims.

● Utilize LEAN and Six Sigma protocol within lifecycle of projects. Utilize WBS structure for management of tasks. Utilize multi-line claims management processes and systems. Utilize Power BI, Azure, SQL, SQL Server, Visio, and Microsoft SharePoint, AWS and APIs.

● Collect and assess maintenance, support, bug fixes, and issue resolution efforts. Translate those observations into actionable requirements for product platform improvement. Utilize automated test scripts and various testing (performance, regression/functional etc.)

● Adhere to CMS guidelines. Support capturing metrics, producing dashboards, and training/instructional material for internal and external users. Support the Health and Human Services (HHS) for mandated review of Health Insurance and Oversight System (HIOS) audit of identified provider records for the IVA, MA, Health Status, RxC, D&E, and PACE work paper audit processes. Work cross-functionally to maximize customer experience, address SDOH, and improve HEDIS scores and population Health outcomes. Utilize Epic HER.

Freelance Product Owner City Liquor/Murray Construction Sr. Business Analyst 12/2020 – 12/2022

● Strong communication and collaboration with stakeholders to outline implications of modifications and necessary development. Provide insights for business opportunities, capture metrics/analyze and identify trends, and opportunities for improvements. Manage implementation of updated user interface and support maximizing the user experience. Utilize online and in person marketing strategies to promote increased utilization of products/services. Support client’s revenue stability and enhance products through marketing internally and externally. Support business objectives by working with third party vendors. Utilize Power BI, Azure, SQL, SQL Server, IBM Business Process Modeling & Business Animation Workflow Visio, and Microsoft SharePoint, AWS and APIs. Translate business requirements into relevant documentation for developers/architects, and quality management. Support End-to-End Data Mapping, Validating and Comparing the Product attributes Development of report reconciliation/validation, data element validation/ quality reviews. Navigate large volumes of data for analysis, creating dashboards, automations, user manuals, guides, training and tip sheets.

● Develop, support and initiate testing to include mapping of tables/columns/rows etc. stored in the data warehouse, UAT, Functional Testing and Systems Testing. Identify defects, gaps, and software enhancements. Utilize SQL tools to replicate defects/bugs and to support data analysis. Support transition from PEGA platform version 8.5.1 to 8.7. Utilize guided claims and batch processing on PEGA platform improving claims management/auto adjudication and reductions in claim adjustments. Utilize the Customer Decision Hub to enhance the overall experience of the end users, stakeholders, and to support real time analysis. Provide leadership to entry level support to include training, mentoring, and development. Lead and actively support the initiation and implementation of both Waterfall and Agile projects partnering with the project team and leading daily stand-up during Sprints as needed. Develop the Risk Assessment and implement quality improvement. Utilize quality management tools to produce, manage and monitor reports and submissions. Engage SmartSheet and SharePoint for retention of information and analysis of data during project development and implementation. Vera Institute of Justice (Brooklyn, NY and Remote) IT Project Manager/Product Manager 12/2019 – 10/2020

● Ensure all projects are delivered on time within the stipulated scope and budget. Lead the initiation and planning of a project and ensure technical feasibility. Ensure resource availability and allocation. Support alignment of requirements to meet functional and business needs. Meet governance and strategic goals by partnering with the business, and development/architecture/operations. Develop a detailed plan to monitor and track the progress of the project. Coordinate with internal and external parties for the flawless execution of projects. Manage relationships between clients and stakeholders. Measure project performance using appropriate project management tools.

● Manage Business Analysts and other subordinate staff coordinating and collaborating efficiencies are met. Develop the Risk Assessment and implement quality improvement. Utilize quality management tools to produce, manage and monitor reports and submissions. Utilize SQL tools to replicate defects/bugs and to support data analysis. Utilize Power BI, IBM Business Process Modeling & Business Animation Workflow SQL, Visio, OneDrive, SharePoint, Monday.com, SmartSheet and APIs. As Product Manager ensure existing applications are supporting business need, perform trainings and support the production of documentation. Determine additional products needed to support meeting or exceeding KPIs. Initiate contact with existing clients to detail new products and technology options including the benefits to their business. King TeleServices (Publishers Clearing House) (Brooklyn NY) Business Analyst IV 09/2019 – 11/2019

● Create Data Dictionary for TelAthena application. Develop documentation (BRD, FRD, Training Materials) related to High Activity Customer (HAC) and SCAM user interfaces. Translate high-level business needs into detailed requirements. Identify defects, gaps, and software enhancements. Utilize automated test scripts and various testing (performance, regression/functional etc.) Mentor and support Junior Analysts growth/development. Create workflow documentation, produce diagrams, and wire frames. Support alignment of requirements to meet functional and business needs. Meet Nicole H. Daniels Page 3 of 7 ***********@*****.*** governance and strategic goals by partnering with development/architecture/operations and the business. Develop and implement a training curriculum. Lead application testing, document defects, and coordinate business requirements with multiple stake holders. Support User Acceptance Testing. Develop the Risk Assessment and implement quality improvement. Utilize quality management tools to produce, manage and monitor reports and submissions. Monitor IVR and direct calls to agents if needed based on volume. Monitor queue status to ensure ASA and other KPI goals are met. Review agent and Call Center metrics.

Capital District Physicians Health Plan (CDPHP) Albany, NY Business Systems Analyst II 01/2019 – 03/2019

● to departmental standards and processes for documentation in Maces, ServiceNow, and JIRA. Create workflows, wireframes, the data dictionary and document the escalation path for pended claims. As the SME conducted internal departmental training for navigation of applications and process for versioning of documentation. Utilize Epic EHR. Utilize RACI Matrix and SWOT diagram to prioritize, monitor and track project tasks/efforts. Utilize ADP Workforce Now and Kronos software to manage timekeeping, project assignments and create dashboards reflective of the team. Create SQL queries and link tables when testing and searching the database using TOAD for Data Analysts and TOAD for Oracle. Utilize multi-line claims management processes and systems. Utilize SQL tools to replicate defects/bugs and to support data analysis. Utilize Power BI, SQL, Visio, OneDrive, SharePoint, SmartSheet and APIs.

● Use COTS applications Facets, JIRA, and others with contact to vendors if needed and developed documentation to support consistency and accuracy of agents’ actions. Ensured the COTS applications were clearly defined to support integration with existing applications. Quality regulatory experience (QPMs, CMS, NCQA, Medicaid state programs). Demonstrated use of PDSA/PDCA. Develop the Risk Assessment and implement quality improvement. Utilize quality management tools to produce, manage and monitor reports and submissions. Utilize PEGA SOI for communication, documentation and automation of processes. Utilize CDH to analyze data and enhance the overall customer experience using real time interactions/communications creating and managing segments and notifications. Support project from initiation to implementation ensuring mitigation of risks and issues.

● Utilize ETL/Informatica and SQL databases to manage the Data Warehouse. Support Facets jobs that included EDI transactions. Utilized TriZetto Facets Provider, Claims, Finance, Membership, Billing, batches and configuration to manage claims processing, data warehouse, reporting, and billing. Additionally measured outcomes and traceability. NYS Division of Criminal Justice Services (DCJS/ ITS) Albany, NYSr Business Analyst/Project Asst 05/2014 –10/2018

● NY Alert, Orders of Protection, Domestic Incident Reporting (DIR) Electronic Submission Analysis, Statewide Financial Systems (SFS), LAWMAN, NG911, Incident Based Reporting/Uniform Crime Reporting (IBR/UCR), National Incident Based Reporting (NIBRs), Sexual Offense Evidence Kits (SOEK), National Data Exchange (NDEx), NY Data Exchange (NYDEx), LEEP – responsible for developing and maintaining system documentation including business requirements, and project process documentation, training plans, test plans, quality assurance and contingency operations plans, and reports.

● Utilize NG911 to support NYS constituents and local, state, county and the sheriffs office to distribute the key information required to support emergency response to support public safety. Support the upgrades and analysis of data based on metrics related to NG911 including the ability to support text, images, video and voice calls from the responders. Provide expertise and hands-on participation in the following activities:

● Work with end users and review/analyze existing documentation or system artifacts to elicit and document business system requirements and processes, develop process models, and document requirements for Public Safety Cluster applications/projects. Provide root cause analysis and corrective action.

● Support marketing of NY Alert product ensuring enrollment of NYS constituents in the Weather, Amber, Sexual Offender, Order of Protection, and Shelter/Stay systems. Promote awareness of NY Alert through marketing using electronic, in person and printed methods.

● Develop and maintain system requirements in detailed, clear and well-organized functional documents (business requirements documents, business or system use cases, reports) and/or process flow diagrams. Translate high-level business needs into detailed requirements.

● Provide root cause analysis and corrective action. Utilize SQL tools to replicate defects/bugs and to support data analysis. Deliver quality documentation, identify, rate and resolve enhancement requests, risks, defects and issues.

● Develop and maintain test plans and detailed test cases. Document As-Is and future state of the program. Develop and maintain training or user acceptance testing plans and Tier 1 support guides. Develop detailed functional and system tests from documented system requirements. Benchmark the program’s productivity. . Lead and actively support the initiation and implementation of multiple Agile and Waterfall projects which included identification and mitigation of issues, risks and support of development/architecture and the business. Ensure appropriate test coverage by mapping system requirements to test cases. Develop and contribute to the development of regression tests and/or user acceptance tests.

● Execute functional and system tests, including regression tests. Participate in user acceptance testing. Automated testing is performed using Quick Test Pro and ALM Quality Center. Create SQL queries and link tables when testing and searching the database using TOAD for Data Analysts and TOAD for Oracle. Nicole H. Daniels Page 4 of 7 ***********@*****.***

● Identify and document application defects and track to resolution, performing retesting as required. Identify and document deficiencies in system documentation (e.g., missing or ambiguous requirements) identified during the testing process and/or development of updated requirements due to changes.

● Survey and interview end users and/or their vendors to review/analyze existing documentation or system artifacts to document business system requirements and processes related to Records Management Systems. Identify areas for improvement as well as opportunities for automation. Utilize RACI Matrix and SWOT diagram to prioritize, monitor and track project tasks/efforts.

● As the SME analyze and document current law enforcement Records Management system capabilities, including the ability to store and transmit Domestic Incident or other data using trend analysis and statistical analysis. Analyze transmission options to determine impact on or compatibility with DCJS systems.

● Identify commonalities between Records Management systems across NYS to identify opportunities to create cost-effective solutions for submission of Domestic Incident Data to DCJS. Identify and remediate inefficiencies in system documentation business processes/systems. Identify automated solutions. Identify missing or ambiguous requirements, document application defects and track to resolution, performing retesting as required.

● Support the use of COTS applications to include IBM DataCap, IBM Business Process Modeling & Business Animation Workflow, NY ALERT, and OOP. Ensure integration was as expected. Capture metadata from internal documents and verify the COTS tool accurately captured the information and produced documentation as needed.

● Document business objectives using digital document management for versioning. Utilized Agile SDLC process during multiple engagements. Experience with documentation of sprints and success in the ongoing development of business needs. Used Agile Rapid Application Development (RAD)/SCRUM project \methodologies. Apply IIBA BABOK, Six Sigma and LEAN standards. Using Quick Test Pro and HP Quality Center software to conduct automated testing. Develop and maintain test plans, detailed test cases, execute test cases, log/track related defects. Ensure compliance with State, Local and Federal policies and applicable laws and regulatory changes. Lead requirements gathering sessions giving direction and mentoring to subordinate analysts. Elicit/extract detailed business requirements from customer/project stakeholders or system artifacts. Translate requirements into system requirements. Assist in webpage design. Support development of electronic submission solutions for Domestic Incident Report (DIR) Form. Demonstrated ability to interact with all levels of management to include the office of the Governor, Sherrif’s Department, Directors and Managers.

● Provide leadership to large teams. Manage large, medium and small business analysis work or projects with distinct deliverables to a solution. Work with external vendors on both COTS and custom products to support the business. Utilize Agile, Scrum/RAD and Waterfall implementation approaches. Work with Data warehouse, SSRS, PSC Audit, WSDL, and ETL in support of NIBRs project. Create complex pivot tables and dashboards using Excel.

● Manage subordinate staff, provide guidance, and create performance reviews, monitor work assignments, support improvement and professional growth. Utilize ADP Workforce management cloud-based software to create employee and team specific dashboards, manage and centralize employee projects, and time/attendance. Utilize Kronos to Track projects and invoice clients, automate workflows and maximize utilization. Gain real time insights into staff utilization, resource projections and forecasting. Utilize Power BI, SQL, Visio, OneDrive, SharePoint, and APIs. Maximus/ NYS Health Benefit Exchange (Albany, NY) Lead Business Analyst 05/2013 - 03/2014

● Provide leadership and work guidance to subordinate staff, managing performance and career development. Participate in marketing of the NYS Health Exchange to prospective enrollees utilizing printed, televised, telephonic and in person outreach methods. Lead and drive the successful implementation of the project to include Operations, Claims and Backend. Support identification of gaps and mitigation to ensure success in meeting project timeline and promote upsell opportunities to existing customers and increase RFP success to new customers while promoting available products.

● Work with Project Management, Development, and Stakeholders providing support planning, execution, monitoring, and completion through a Project Life Cycle. Automated testing is performed using a COTS tool, HP Quality Center Quick Test Pro. Defect tracking is performed using a COTS tool, JIRA. Provide root cause analysis and corrective action. Utilize PEGA SOI.for communication, documentation and automation of processes. Utilize SQL tools to replicate defects/bugs and to support data analysis. Utilize Power BI, SQL, Visio, OneDrive, SharePoint, IBM Business Process Modeling & Business Animation Workflow SmartSheet and APIs.

● Deliver quality documentation, identify, rate and resolve enhancement requests, risks, defects and issues. Supported the implementation of the SDOH, Health Equity program including program implementation, management, and monitoring.

● Apply COBIT 5 methodology supporting the integration, work flow, event tracking and task management, with the use of CRMs and hierarchical structure to prioritize requirements Review and recommend changes to system design and architecture as described verbally or through written artifacts to collaborate with team delivery lead to identify, assess impact of, and track change requests throughout project life cycle using Agile, Scrum/RAD Six Sigma and Waterfall approach theories based on the assignment. Utilize Facets core functionality to support all phases of the SDLC. Support alignment of requirements to meet functional and business needs. Meet governance and strategic goals by partnering with development/architecture/operations and the business. Monitor IVR and redirect agents to High volume queue if needed. Nicole H. Daniels Page 5 of 7 ***********@*****.*** Monitor queue status to ensure ASA and other KPI goals are met. Review agent and Call Center metrics. Message agents using Workforce Management tool based on average talk time and ASA.

● Implement and create and test electronic health record (EHR) capturing provider, relevant clinical data, demographics, progress notes. Complied with CMS guidelines with EHR. Maintain electronic medical records and coordination with Clinical, Operations, and Back End management during implementation, deployment, and as records and data transmission was initiated. Document processes, requirements, and create test plan and cases. Utilize multi-line claims management processes and systems.

● Submitted claims from different input methods to include mainframe and web portal and verified the claims loaded to correct platform for further processing. Audit/validate submissions from Claims Billing System. Supported transmission, receipt, processing and responses for EDI transactions 837, 835, 834. Utilized TriZetto Facets Provider, Claims, Finance, and Membership. Quality regulatory experience (QPMs, CMS, NCQA, Medicaid state programs). Demonstrated use of PDSA/PDCA. Manage multiple claims lines of business and coordination with secondary payors. Computer Sciences Corporation (CSC)/ Medicare Part D, Drug Discount Card Program, NYS Medicare

(Rensselaer, NY and Menands, NY) 02/2006 – 05/2013 Business Analyst/ Systems Analyst (Workforce Management/Technical Writer/System Administration)/ HIPAA Compliance and Security Analyst HIPAA Compliance and Security Analyst

● Maintain and update billing guidelines and training materials for NYS Medicaid providers. Document technical changes made across multiple subsystems. Review technical documentation to ensure all changes are made. Create new guidelines as new processes/provider-types are identified. Research upcoming changes to ensure proper documentation is completed. Estimate hours required to document changes. Answer Help Desk inquiries for end users experiencing problems falling outside documentation. Create SQL queries and link tables when testing and searching the database. Utilize SQL tools to replicate defects/bugs and to support data analysis. Utilize Power BI, SQL, Visio, OneDrive, SharePoint, SQL Server, Excel, Access Databases and APIs.

● Utilized Agile SDLC process during multiple engagements. Experience with documentation of sprints and success in the ongoing development of business needs. Used Agile Rapid Application Development (RAD)/SCRUM project methodologies. Quality regulatory experience (QPMs, CMS, NCQA, Medicaid state programs). Demonstrated use of PDSA/PDCA. Work cross-functionally to maximize customer experience, address SDOH, and improve HEDIS scores and population Health outcomes. Utilize PEGA SOI for communication, documentation and automation of processes/Utilize CDH to analyze data and enhance the overall customer experience using real time interactions/communications creating and managing segments and notifications.

● Performed database validation in Mainframe to ensure the data entered through the front end reached the database. Attend meetings with NYS DOH, PMO and development teams. Update Web Based Training (WBT) and hold training seminars as needed. Research, write, edit, and proofread technical data for use in documents or sections of documents such as manuals, procedures, specifications, special reports, and any other customer deliverables and documents. Ensure technical documentation is accurate, complete, meets editorial and government specifications and adheres to standards for quality, graphics, coverage, format, and style. Support alignment of requirements to meet functional and business needs. Meet governance and strategic goals by partnering with development/architecture/operations and the business.

● Ensure compliance with Health System policies and applicable laws and regulatory changes. Engage resources as appropriate to resolve challenges, technical solution and participate in the SDLC process. Apply COBIT 5 methodology during analysis and audits; use TMMi tools during design and implementation of new methods, procedures, and systems

(both automated and manual) to improve the processing and flow of information within the company. Assist with development integration and quality assurance testing as needed. Prepare, maintain, and complete the work plan activities for regulatory compliance, SDOH and Health Equity standards.

● Utilize the following COTS applications, Quality Center Quick Test Pro, FACETS, multi-line claims management processes and systems, Claims Billing System, Enrollment and Client Management (ICIS), JIRA, and PEGA applications to capture release cycle, requirements, test cases, defects, unified functional tests and full traceability. Apply IIBA BABOK, Six Sigma and LEAN standards. Utilized TriZetto Facets Provider, Claims, Finance, Membership, Billing, batches and configuration to manage claims processing, data warehouse, reporting, and billing. Additionally measured outcomes and traceability. Supported the implementation of the SDOH, Health Equity program including program implementation, management, and monitoring.

● Use workforce management software and call volume history to help manage intra-day staffing levels and to determine the most effective methods for staffing adjustments. Introduce staff to CORBIT 5 step process. Engage staff in use of decision tools to support ongoing product development and to support model office exercises. Serve as SME in the workforce management area. Review and recommend changes to system design and architecture as described verbally or through written artifacts to assess impact of, and track change requests throughout project life cycle using Agile, Scrum/RAD, Waterfall, Six Sigma and Waterfall approach theories based on the assignment Audit key functions of the Development Office to verify processes and identify compliance issues. Create methods to mitigate risk and reduce errors. Assist with the Nicole H. Daniels Page 6 of 7 ***********@*****.*** development and execution of the comprehensive Compliance Program including the development of tools and execution of audits to measure the organizations’ effectiveness in meeting the Compliance Program standards knowledge of CMS HHS, NYS Medicaid, and Medicare regulations and provisions. Effectively assist and educating all business associates and covered entities of the rules related to data security and assessing any/all risks. Work cross-functionally to maximize customer experience, address SDOH, and improve

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