Summary of Experience

• Progressively expanding experience in Healthcare Business Analysis, Project Management, Medical Billing/Coding, Business Process Management, Call Center Management, and Information Technology.
• Over fourteenyears of Healthcare Business and Federal Government experience.

Educational Background

• Diploma Program in Information Systems,
• Certification in Project Business Analyst- pBÄD,
• Master Certificate in Business Analysis,
• Master Certificate in Six Sigma Green Belt- IT (SSGB),
• Certified Six Sigma Yellow Belt (6σ),
• Certified Compliance Professional (CCP-P)
• Certified Master Project Manager (MPM)

Applicable Technical Training and Experience

Medical Coding/Billing Applications, Medical Manager and Florida Shared System (FSS), Certificate ICD-9 and CPT Coding 
Requirements Tools: IBM Telelogic - DOORs v8.3 (CMS) and Lighthouse Artifact
Business Intelligence Tools: Cognos (Impromptu) 
Other: HL7 (HL7 v2.x, CCD and CDA), LOINC, HIPAA, CAPM-PMI - PMBOK, IIBA – BABOK, SQL Server 2000, Oracle Administration, HR/PHR, CMMI, XML, Visual Basics, Mainframe - CICS, 508 Compliance, WebSphere Business Modeling and WebSphere Service-oriented Architecture (SOA), IBM Rational RequisitePro and ClearQuest Test Manager

History of Employment Experience

Senior Business Analyst/ Enterprise Architect. Confidential 10/09 – present

Project(s): Enterprise Architecture (eChimp (Change Management), CPIC (Capital Investment /OMB Budget), IT Census Survey, Workman Comp/ECRS (COBC))

• Lead Enterprise Architect Analyst on various projects
• Data Modeling, Application Architecture, Data Architecture, Business Process Modeling/Management

Client: Health and Human Services and Centers for Medicare and Medicaid Services (CMS): OIS (other depts: CMM and OCSQ)

CARE: Lead Analyst for PAC-PRD and QIO (Data Import & Application)
Client: Centers for Medicare and Medicaid Services (CMS): OIS, OCSQ, CPC, CMM, ORDI

• Lead Authored on Business Requirements, Business Rules, User Requirements, Systems/Functional Requirements, Use Cases & Test Cases.
• Validated, stored and tracked Requirements using CMS DOORs and Quality Center (Quality Assurance).
• Lead IT Helpdesk Service Coordination/Liaison and Design for client and client’s contractors.
• Lead JAD sessions, prototypes, storyboarding & Business Process Modeling {“as-is” & “to-be” modeling}.
• Created and conducted the demonstration and training of the Product to end-users and client.
• Lead for User Acceptance Testing, Created Test Cases, Test Files, and Load Testing.
• Lead Business Data Enterprise Architect Planning - HL7 v2.4, HAPI (HL7 Open Source), CMS EFT/EDI Gentran Integrate Suite (GIS)/Connect: Direct (MDCN), Sterling Secure File Transfer Protocol, WebSphere SOA, WebSphere MQ, WebSphere Tivoli, WebSphere Message Broker and IACS (single sign-on).
• SDLC- Iterative Model & CMMI Level 3 / (ESD) CMS IT Integrated Investment & System Lifecycle.
• Authored the CARE HL7 v2.4 Provider User Guide and Training Manuals. HL7 Data Mapping.
• Lead Peer Reviews for Requirements, Testing, and System Design.
• Assisted (Acquisition & Contracts) on Federal (CMS) proposals.
• Applications/Systems: CMS DOORs, J2EE, Microsoft Office (including Project, Visio, Access, Enterprise), HL7, CARE, Remedy, IBM Quality Center, Ajax, SQL DbVisual, Oracle 10g, Gentran/MDCN, IACS, Snagit, ShareCenter, Adobe Captivate, CARE, HETS, HPG/HPTV

Project(s): MAPD – Medicare Advantage PFFS and Medicare Part D (Plans) 
Client: CareFirst Blue Cross and Blue Shield

• Lead Analyst for CMS & Business Service Level Agreement.
• Lead Analyst for Implementation of the MAPD Compliance (HPMS, CTMs, Appeals & Grievances).
• Lead the Quality Assurance (IT) Systems Testing & Documentation.
• Lead the Medicare Part D Call Center Operations.
• Lead the Implementation of the Call Center Quality Assurance and Implemented Learning & Development.
• Lead the Call Center Design and Performance Metrics project.
• Worked on Medicare Part D Enrollment & Billing.
• Assisted on Interfacing systems, Software Configuration and Software Specifications.
• Acted as Vendor Mgmt liaison assessing Vendor Systems readiness and monthly financial deliverables.
• Coordinated the operations of the Member and Provider Call Centers for Highmark and CareFirst.
• Wrote Business and Systems Requirements for Business Process Re-engineering projects.
• SDLC- Waterfall and Iterative Model / PLC: CMMI Level 2.
• Lead and coordinated JAD Sessions for Project Stakeholders from CareFirst, Highmark and Argus.
• Consulted as Medicare and Medicare Compliance Subject Matter Expert.
• Applications: CMS Avaya, Microsoft (Project, Visio, Access, PowerPoint, SharePoint), IBM Mercury Quality Center, HPMS/CTMS, MARx (MAPD),

Project(s): 1-800-Medicare Reference Center 
Client: Centers for Medicare and Medicaid Services (CMS): CBC

• Supervised Team Leads and Reference Center Specialists (Day to Day Supervisor Operations: Employee Evaluations, Employment Recruitment).
• Medicare Subject Matter Expert: Part A, Part B, DMERC, (MAPD) Medicare Advantage (all plans), Medigap, ESRD, Part C Medicare Drug Discount Cards & Part D (Prescription Drug Plan) eligibility & enrollment, assisted Medicare Providers, Pharmacy & Drug Plans -Enrollment Issues, Low Income Subsidy (LIS) / Dual Deemed issues, IT issues (E1), Payments issues, Assisted Medicare Providers on payments issues, detected Medicare Programs Fraud & Abuse and CMS Initiatives (demonstrations).
• Other Federal and State Departments: Department of Veterans Affairs (Tri-Care/ChampVA), all 50 states Medicaid programs, Railroad Retire Board (RRB), Office of Personal Management (OPM) and Social Security Administration (SSA) (Retiree and Disability), State Health Insurance Program (SHiP), Office of Inspector General (OIG), Quality Improvement Organization (QIO) and Home Health Agencies.
• Conducted Systems UAT.
• Lead Quality Assurance for Call Centers and Reports.
• Inbound Workforce Analyst and Created Call Center Metrics and Dashboards.
• Worked on Information Escalations, Verified Members Medicare Eligibility (NGD: Siebel 7.x, and CWF).
• Monitored performance compliance with contractual timeliness and quality Service Level Agreements
• Applications: NGD (Siebel 7.x), CWF, Medicare.gov, Cognos (Impromptu), CMS Avaya, Witness System, Microsoft (Word, Excel, Access, PowerPoint)

Current Private Business

President / Project Manager. Confidential 01/2009 - Present
Project(s): Professional Business Analyst Development (pBÄD®)
Business and Technical Recruiter

• New Business Creation (Business Name, Tax (federal and state), Business Insurances, Financial, Trademark, Copyright, Vendors, Accounting)
• SDLC: Waterfall Model - PLC: Working towards CMMI – Level 1
• Project Planning, Monitoring and Control, Risk Analysis, Cost Management
• Contracts Negotiations and Vendor Management
• Development Business, User, Non-Functional, System Requirements
• Developed Education Materials
• Developed Business and Technical Process Modeling
• Developed Business Continuity and Disaster Recovery
• Developed Shared Documents Access
• Developed Corporation Marketing, Business Concept and Sales Strategy
• Developed Certifications Program to meet Accreditations Standard
• IT Development Administrator, Programmer, Web Designer
• Applications: MS Visio, MS Project, Yahoo! PHP MySQL, Yahoo! Web Hosting, Adobe Dreamweaver, Adobe Captivate, MS Presentation, IBM Rational RequisitePro,