Business Analyst Project Manager

Professional Summary

Accomplished Senior Business Analyst and Project Manager with extensive experience in technology governance, compliance oversight, vendor management, and process optimization across public utilities, healthcare, and government sectors. Proven track record in regulatory compliance (HIPAA, ACA), medical and pharmacy claims adjudication/payment, IT security, cloud governance, and business process improvement.

Business System Analysis: Key skills include requirements elicitation, process mapping, IT governance, business intelligence reporting (JIRA, Smartsheet, Azure, SQL, Business Objects, Tableau), and Agile/Waterfall methodologies. Successfully led UAT testing, stakeholder communications, and project lifecycle management, supporting technology projects from intake to execution.

Technology Governance Experience: Strong analytical and strategic planning abilities, exceling at driving technology governance processes, supporting project estimations, triaging requests, and facilitating cross-functional collaboration. Strong ability to work with executives, IT teams, and business users seeking to enhance technology governance and ensure project success.

Compliance & Regulatory Oversight:

oLegal analysis for HIPAA compliance.

oData and regulatory policy standards

oWorking knowledge of claims lifecycle, standards and billing and payment logic

oValidation of state regulations for the Affordable Care Act.

oContract negotiations and compliance validation for providers.

Vendor & Technology Management:

oManaged vendor selection and implementation of a Case File Management system.

oOversaw the upgrade of a server and application to Azure (cloud), including security measures.

oClaim edit for Medicare, Medicaid and commercial management.

oManaged vendor relationships and contract upgrades for IT and print services.

Process Documentation & Risk Management:

oCreated business process flows and data flows for financial and social services.

oConducted gap analysis, business process improvement, and workflow documentation.

oHeld retrospectives for project closure, addressing open risks and creating final status reports.

oComplete Healthcare system process that encompassing all member modules from enrollment to premium and payment.

IT Security & Cloud Governance:

oWorked with networking and IT departments to develop cloud storage and security measures.

oManaged outsourcing processes for print and IT services, ensuring compliance and efficiency.

Project & IT Governance Practices:

oCreated RFPs for vendor selection.

oDeveloped and managed change orders for budget increases and scope adjustments.

oCreated governance documentation such as RASCI matrices, risk assessments, and SOPs.

Soft Skills: Interpersonal skills and work ethic are exemplary, demonstrated through the ability to coordinate cross-functional teams and manage stakeholder communications effectively. Adept at fostering collaboration among diverse groups, ensuring that project goals are met while maintaining high standards of quality and compliance.

State of Minnesota

Office of Cannabis Management December 2024-February 2025

Project Manager/Business Analyst

Working with the Salesforce vendor on the analysis of the modules to deliver a case management and grants management system

oService Cloud

oMarketing Cloud

oCommunity Cloud for the

Case Management

Grant Management

Managed the development of Case Management system using Salesforce Case Management software

oEmail to Case

oHTML to Case

oManual Case

Managed the development of Grants Management process using Salesforce

oApplication creation

oApplicant registration

oApplication review/scoring and award (Grantee)

oGrant Funds award/FSR receipt reimbursement

Creation of a Grant application

oPopulate the application data into Salesforce

Data alignment/refinement to create accounts, contacts.

Application data review for application scoring

Grant and Case swim lane process flow with all communication channels

Requirement documentation for grant and case processes

Salesforce configuration for work queues roles and profiles

Project status to executive management

Managed 4 salesforce developers

UAT and business testing

Ramsey County May 2022-January 2024

Project Manager/Business Analyst/Data Analyst

Managed multiple fiscal projects for Accounts Payable to Account Receivables for new/improved workflows and application enhancement using PeopleSoft

oCreated business process flows and data flows

Analysis and management of the PeopleSoft suites, HR, Contract, Financial and CRM for end-to-end process including procure to pay for invoices, debit and credits, contracts for eligibility for how payments will be disbursed as could be outlined by Federal and State statues and the vendor contract for discounts.

oOCS Grant funds for social services on subsidies and rebates for low-income children and adults when contracts and invoices are submitted for payment

Managed multiple project plans for resources of Development, Business Analysts, Database administrators and testers for project budgets of $20,000 - $900,000

Managed the vendor review, selection and implementation of a Case File Management system for the Financial and Social Services area.

oLegal analysis with resources for application compliance for HIPAA

oValidation of state regulations for the affordable care act

oContract negotiations for providers

Managed the receipt and validation of providers invoices as the payer against provider contract

Updates to the portal directory of Care Providers

Creation of change orders for budget increase, resource addition and project scope change

Management of a contract upgrade for print equipment with 3rd party vendor

Managed the vendor relationship with the print vendor for onboarding new capability teams, invoicing and process issues

Managed the upgrade of a server and application to Azure (cloud)

oWorking with the networking and IT department for assigned resources for developing cloud storage, security measures and resource availability

oWorked with the business SME on the application testing

Managed/coordinated the data & business process for outsourcing printing to a 3rd party for two business areas. Upgrade of processes and automation of a process for auto movement of print files. For a saving of about $90,000. A year

Create bi-weekly status report for 8 project I am managing sending to the project team and executive management

Managed project for the creation of an application for employee on-boarding/departure/department move for asset assignment, asset return for software and hardware integrating with HR Workday

Participated with the Better Together project initiative for the organizational change for the consolidation of the financial area business process and the documentation of the standard operating procedures

Held Project Retrospectives for project closure, project plan closing addressing all open tasks, review an appropriately close all risks, create final status report for EPMO and Project Team, Chang lifecycle of project to closing

Presented status of projects monthly to program management meeting

Rochester Public Utilities (Kantola Consulting) November 2018 – April 2024

Senior System/Business Analyst/Project Manager

Managed the elicitation and documentation of high-level business and system requirements for application enhancements (TOU, Customer Portal, Neighbors chipping in etc.,)

Documented detailed processes with gap analysis between the requirements and the proposed implementation of the CIS system

Managed the upgrade of the Cayenta application to 9.1. Communicated all upgrade functionality, reviewed all process flows and SOP for IT, business and testing

Managed CIS vendor relationship for incident, release patches, enhancement requests and application upgrades

Managed Salesforce release and implementation for sandbox, development, QA and production environments

Created CIS business process flows for Customer Care, Billing, Collections, Marketing and device (elec & water)

Creation of the Solar process flow

oImplementation from sales vendor to customer setup

oAnalysis of the power grid site assessment infrastructure

oAnalysis of the customers meters and the needs

oProcess for the connection of the customer solar system to the utility grid

oAssessment and configuration of the excess solar energy conversion for buy back on utility invoices

oProcess for obtaining permits and contracts

oApplication workflow for reporting and rebates

Provided process improvement and guidance for compliance for Federal and State requirements

Coordination on the efficiency of processing and accuracy for rebate processing and payment

Process flow for Purchasing using the Salesforce CPQ and billing integration

Implement workflow processes for marketing initiatives using the Salesforce CRM

Analyst performed for the billing and invoice process for a new look and feel

Created project plans using Smartsheet for multiple projects and budget tracking, with assigned resources

Coordinated and managed all incidents identified from the CIS implementation and the upgrade of the CIS system, Coordinated and reviewed all incidents with a core team of Customer Care, Billing, Device and IT

Developed and implemented a process for environment refresh for QA, Dev, and Test

Created a RASCI, Resource organization chart, Risk assessment, project plan and budget tracking for the AMI project. Scheduled and held executive and stakeholder meetings

Created process flow for meter and IRT ordering, receipt and implementation for the AMI project.

Created and implemented the plan for the AMI Elec and Meter installations (40,000 elec, 20,000 water)

oCoordinated and managed the vendor integration with the existing CIS system, Headend and MDM based on meter id and customer

oImplemented the Pilot program for the installation of 1,500 customers meters for elec and water

oCoordination of the Water installations with customers for access

oManaged the storage of all meters and tracking of installation

oCoordinated the storage and disposal of the old meters

Created SOW for yearly contract work for Kantola Consulting

Created RFP for vendor selection for the Customer portal

Created the analysis and RFP for the Customer Care (service) Avaya phone system

Collective Health (through Eleven / Twenty Consulting) February 2021- Nov 2021

Implementation Manager/Project Manager

Setup 10 High profile clients for enrollment and eligibility, benefit and claims administration as the TPA

Setup/update payer system with benefits, new plans, deductibles & employee contributions

Setup the healthcare providers for claims payments by client

Management of reimbursement amounts from the client fee schedules, eligibility, in-out of network and employee contributions

Manage resource across the client executive manager, eligibility, financial for claim payment, enrollment and Icreation of Id Cards

Managed client Member, Provider portals for employee selection of network, benefits and plans

Create test cases and strategy of mock Id cards for clients, sent tested cards to network partners for validation and client approval

Schedule health partner vendor coordination between the client and partner for enrollment and eligibility

oRequest/receive policy holder records

Worked with Clients on the PBM for setup on rebate processes and guidelines

Manage all Jira tickets for plan September 9th - 20th, 2024changes, eligibility changes

Create issue/NSA documents for Steering Co review and approval

Provide weekly status summary for each client and present to executive management

Ensure all clients projects stay on schedule.

Prime Therapeutics (through Ambient Consulting) Sept 2020 – January 2021

Business Analyst

Create high level business requirements for clients for the MyPrime.com eligibility and open enrollment for 2021, upload approved Requirements document into JIRA

oProvide forms and links for content for provider directory, and cost compare

oManaged the data migration from providers and employers to the portals for employee’s plan, benefits

Used TFS to create and manage tasks for assignment, create and manage epics and user stories with acceptance criteria for product backlog. Prioritize stories for sprints and assign for releases

Manage integration and relationship between clients and the vendor Connecture DRX health plan data addressing data issues that clients report

Review Claims for Medicaid rebate reporting and analytics

Business process optimization for the performance of rebate processing

Create test strategy for UAT test cases and perform UAT testing and uploaded into Application Lifecycle Management

Schedule requirement sessions with multiple business entities from benefits, formularies, claims, client engagement, QA and System analysts

Create JIRA tickets for content uploads for files links to be placed on the clients MyPrime.com site

Long Term Care Group (LTCG) (through Ambient Consulting) February 2020 – July 2020

Business Analysis/System Analysis/Data Analysis

Create business requirements for clients where changes are needed for the LTCG application

Manage and hold Scrum standup for Data Services team with 15 resources.

Created reports using Business objects or Azure to run within the databases for annuity plans, payments and eligibility

Managed Service Now incidents for the Data Services Team daily

Created monthly analysis and report using SQL, Business Objects for LTCG client for policy claims submission vs claims payment and eligibility

Worked on the execution for LTCG infrastructure projects for server capacity, phone (Avaya) upgrade, print server upgraded

Created requirements and analysis for infrastructure projects

Aetna TPA (consultant) November 2019 – January 2020

Business Analyst

Managed the elicitation and requirements documentation for the areas of Claims Configuration & Integration, Provider Demographic’s & Configuration

Managed the integration of the Medicare data from the vendor Department of Defense for eligibility and enrollment

Setup the healthcare providers for claims payment

oSetup the policyholder’s eligibility files

Created an application/process draft of all NextGen functional specifications

Assisted with the updates and planning of a “Playbook” for presentation to executive management

Assisted with the creation and input of questionnaire for consistency of information gathering across all the functional area of NextGen

Assisted with the creation and input of Organizational Structure which contains all information gathered that will not be in the “Playbook”

Assisted with the creation and input of Scalability document using information of additional resources, pain points and what is migration and build-out vs on-going

Prime Therapeutics (consultant through Ambient, then converted to FTE) April 2018 – November 2019

Senior System/Business Analyst/Project Manager

Managed elicitation and documentation of business and system requirements for application automation and BI reporting.

Used TFS to create and manage tasks for assignment, used to create and manage epics and user stories with acceptance criteria for product backlog. Prioritize stories for sprints and assign for releases

Process flows for application development/enhancements for requirements review

Used Azure for reporting analytics, this was the product that was used for the data lake for querying across

Working on multiple requests, projects and business areas (clients) with fluid functionality changes and updates

Performed analysis as the payer for unpaid claims, validating eligibility, network and provider services

Created project plans, assigned resources, created kick off decks, and wrote status reports.

Created system requirements from business requirements and provided traceability matrix

Created test strategy and QA test cases for traceability to support system requirements

Business Intelligence mapping data models to reporting needs

Reporting for audits on the Medicaid contracts and the rebate programs

Process optimization and documentation for application creation compliance with federal and state requirements related to rebates

Adding, deleting and modifying data within datastore

Used Business Objects to gather member information for paid/unpaid claims,

Worked with Tableau developers for training on and report generation for dashboards

Business Intelligence process documentation for process improvement for requirements, DTP’s. and QA

Created a tracking process for business UAT through change management

Department of Human Services/Consumer Choices Team January 2016 – April 2018

Project Manager/Senior Systems Analyst

Upgraded CRM and public website.

Managed and implemented workflow application to automate manual processes.

Managed business analysts, developers, UX/UI and DBAs from project charter to implementation.

Created requirements documentation for upgrades including data, data models, online forms, and navigators.

Created reports using multiple tools such as Business object or SQL scripts for address duplications and members within the database.

Created and implemented testing template and strategy

Created Jira stories for workflow application and ran standups

Coordinated all production deployments and testing of deployed code

Created project plan for STR application API/data mapping for federal government

Created draft data model for workflow application for data creation, ensuring data integrity, quality and usability

Ability to perform data manipulation, editing, updating and deleting information within the database

Merrill Corporation June 2015 – January 2016

Project Manager/Senior Business Analyst

Managed enterprise project upgrade of client and internal application

Created epics and stories for business and system requirements

Documented business rule requirements.

Conducted gap analysis of Salesforce system functionality implemented for enhancement

Designed wireframes from new business requirements to be build within Salesforce

Worked with product owner to define sprint prioritization of stories

Delta Air Lines December 2014 – May 2015

Project Manager/Release Manager

Migrated IBM 4.1 to zTPF.

Created and managed all RFC for production deployment for OSS and RES platforms.

Ran all go no go calls for production deployment.

Documented plan for simulations for 1052, co-existence and migration state.

Express Scripts April 2013 – December 2014

Project Manager

Managed Medicare and Medicaid Medco system integration and rollout

Coordinated multiple claims releases per month

Executed gap and capability for packaging for releases

Coordinate multiple projects, and teams for the migration (enrolment, claims, product etc.,)

Best Buy (Geek Squad Online Agile) June 2012 – April 2013

Project Manager/Senior Business System Analyst/Business Analyst

Set up SharePoint project.

Addressed issues and mitigated risks.

Created epics and stories for business and system requirements.

Created and executed test strategy and scenarios for stories.

Analyzed stories and business rule requirements.

Coached teams in Agile and conducted standups and retrospectives.

Prepared BRP for multiple projects.

Designed wireframes for business and development walkthroughs.

Target Corporate December 2011 – June 2012

Project Manager/Senior Business System Analyst

Managed Internet Explorer 8 and Windows 7 upgrades.

Assessed corporate applications for compliance on upgrades.

Conducted gap analysis of impact to applications based on risk assessment.

WellPoint (Anthem) August 2010 – December 2011

Senior Business System Analyst

Created high level use cases and business rules for consolidated medical management system

Performed gap analysis of existing system functionality to the new management system

Validate receive provider contracts with payer for claims submission

Validate enrollment and eligibility from input files from employers for provider accurate payment

Management of provider data and directory information for multiple portals

Creation and documentation of claims business rules for the claims system for efficient claims processing

As the third-party payer for multiple claims system performed the administration for managing the claims for regulations and quick and clean payments

oValidated claims business rules for the resolution of disputed claims

Requirements documentation for client employee enrollment ad eligibility data files

Facilitated cross functional meetings.

Created data mapping of elements from current systems to new system.

Designed business object tools for data reporting for mined data.

Perform data manipulation within multiple databases to edit, change, deleted information within the data tables.

Blue Cross Blue Shield May 2010 – August 2010

Senior Business Analyst (Consultant)

Worked on claims modernization project for claims migration

oRequirements for payer migrate and automate processes.

Created high level use cases requirements and business rules for new claims system.

Facilitated cross functional meetings.

Participated in assessment and gap analysis of existing system functionality.

Mapped data elements from current system to new claims systems.

Wells Fargo February 2010 – May 2010

Project Manager/Business Analyst (Consultant)

Created PDD for WFI project to implement IRS cost basis requirements.

Created BRD for WFI cost bases requirements.

Reviewed all BETA work requests for impact analysis.

Documented cost basis business process flow.

Ceridian Signature January 2010 – February 2010

Senior Business Analyst/System Analyst (Consultant)

Created epics and stories for business and system requirements.

Analyzed stories against release objectives.

Analyzed business rule requirements.

Analyzed system and process requirements to assess impact of proposed development.

UnitedHealth Group June 2009 – December 2009

Functional Analyst/Business Analyst (Consultant)

Reviewed DoD manuals for requirements analysis.

Documented the billing process flows.

Created billing and payment BRD.

Created issue and risk assumptions and questions.

Thomson Reuters January 2007 – June 2009

Project Manager and Lead Senior Business Systems Analyst (Consultant)

Assisted in modeling and analysis activities in Oracle.

Created metadata and data dictionary.

Created epics and stories for business and system requirements.

Created and executed test strategy and scenarios for stories.

Analyzed system and process requirements to assess impact.

Conducted business process modeling.

Blue Cross Blue Shield January 2008 – December 2008

Test Manager/Senior Business System Analyst/Data Analyst (Part-time Consultant)

Wells Fargo Home Mortgage March 2006 – January 2007

Lead Senior Business Analyst (Consultant)

Blue Cross Blue Shield July 2004 – March 2006

Project Manager and Senior Business Analyst (Consultant)

US Bank March 2004 – July 2004

Senior Business Analyst (Consultant)

Ecolab October 2003 – January 2004

Project Lead/Business Analyst/Data Architect (Consultant)

Blue Cross Blue Shield January 2002 – October 2003

Project Manager (Consultant)

Blue Cross of Seattle January 2003 – June 2003

Project Manager for Premera (Consultant)

Blue Cross Blue Shield of MN July 2001 – January 2003

Project Lead/Senior Business Analyst (Consultant)

MN Department of Agriculture Dec 2000 – April 2001

Requirements for the prevention, handling of pesticide and fertilizers spills

Requirements for the map search for chemical contaminated sites and data

Documentation for work plans, reports on assistance for preventions of spills

Cargill Feb 1998- June 1999

Analysis and requirements for each of the supplier’s engagement with Cargill

oReporting on how much product/interaction do they have with the supplier

oData gathering from multiple service area’s agriculture, meat & poultry, foodservice for product usage

Defined data standards for data analytics reporting

Data mapping for the data lake population

oAnalysis of data duplication

oAddress standardization

Skills

Microsoft office suite

Peoplesoft

LaserFiche

Business Objects Business Intelligence (BOBI) reporting, Tableau, Cognos,

SQL

JIRA – Confluence

SharePoint

Salesforce

Claims processing tools

Oracle/PeopleSoft

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