Human Resources Project

FRANCIS D. CABRERA S.

Calle Horas **** Urb. Venus Gardens, San Juan Phone: 787-***-**** / 787-***-**** *******.*******@*****.***

Subject matter expertise oriented professional. Gathering, documenting, analyzing and engineering business processes identifying the organization’s strengths and weaknesses, suggesting areas of improvement using technology and process reengineering based on knowledge and experience. Managing projects including deadlines and deliverables as well as resources always assuring focus is on parallel with corporate goals, budget security/compliance standards and strategies.

Expertise Highlights

Project Management Healthcare Provider Business Process SME Strategic Technology Planning Data/Business/Systems Analysis Data Flow & Process Mapping Business and IT Liaison and Negotiator Major Software/Systems Implementations Systems Security & Disaster Recovery Planning Testing/Scripting/Documentation Technical Writing (Manuals/System Specs)

Professional Experience

MMM HEALTHCARE INC– SAN JUAN, PR 2005 to 2011

IT Business Analyst

Assigned as Business Analyst to various departments including: Provider Relations, Credentialing, Provider Network, Contract Loading, Compliance (Fraud and Abuse), Coding, Contracting, MSV, Health Services, Human Resources, Customer Services, Health Quality and Appeals & Grievances. Managed small, medium and large-scale enterprise migration projects, systems conversions and performance tuning and monitoring of applications/systems. Helped determine development and business processes roadmap for all assigned departments.

Translated business needs and requirements into data and application structures. Developed effective metrics for business, process or project objectives. Created metrics from qualitative information. Analyzed business issues and proffer recommendations. Effectively used data and information to drive positive business actions and business outcomes.

Key Results:

Managed all phases of CMS Compliance triggered projects for assigned departments including resource and deliverable assignment, business requirements specifications, design, modeling, tests, post production monitoring and due dates resulting in major overhauls and optimization of business processes.

Led projects related to automated calling services based on AVAYA IVR Voice Portal technology for the Provider Network Business Area, projects covered changes in call flows, flow definition, reporting

Resume Francis Cabrera S Page 2

specifications, web services definitions, authentication protocol definition and PBX and CTI integration among others.

Documented and led implementation of Blackberry Enterprise Services Security Monitoring procedures and protocols for SMS, PIN, BB Messenger, calls and email while assuring client privacy policies are met.

Led projects related to healthcare providers including pharmacy and hospital networks managing all interaction points from contracting, contract loading and credentialing to provider relations using technology as the base for process implementation and optimization.

Led projects in mapping geographic specific healthcare provider networks according to business strategies and requirements, segmenting networks under various criteria including specialties, claims tendencies, fraud and abuse scenarios.

Led projects triggered by REFORMA initiatives assuring all business and technological requirements were met within the government specified timeline.

Led projects directed at measuring performance and quality of healthcare providers employees in order to award incentives based on company and provider employee agreements resulting in substantially improving the service provided to plan members and driving costs down.

Managed application acquisition projects. From the vendor selection process to testing and training to post implementation monitoring while maintaining within assigned budget.

Analyzed and designed business applications, reports, processes and integrations targeted at different company initiatives for all assigned company departments. Solutions were based on .NET, SQL, Microsoft Access, OnBase, Oracle and other platforms.

Generated business application and process assessments used for business strategic planning.

Automated previously manual, time-consuming processes to drive gains in data tracking/accuracy, workgroup efficiency and profitability.

Education

UMET– SAN JUAN, PR

Bachelor of Information Systems Management, 2011

EXECUTRAIN– SAN JUAN, PR

Certification ITIL Foundations v3, 2011

Technology Summary

Applications knowledge:

Microsoft Project, Microsoft Visio, Microsoft World, Microsoft PowerPoint, Microsoft Excel, Microsoft SQL Query Analyzer, BizAgi, Alchemy, Capture Perfect, OnBase, EDIWATCH, EZCAP, Market Prominence, Ingenix GeoNetworks, etc.

Programming Language Exposure:

ASP.NET, SQL, PHP, MYSQL, HTML, CSS, C, C++, etc.

Spoken and written Languages:

Fully bilingual in English and Spanish.

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