QUALIFICATIONS SUMMARY

• Accomplished technical expertise with multi-faceted information technology experience. Strong
• combination of technical and business knowledge within banking/mortgage, insurance and healthcare.
• Business Systems Analyst Database Administration
• Technical Lead Management / Project Management
• 14 years Healthcare experience Claims, Provider, Eligibility, Recipient, Prior Authorization, Financials
• 4 years Medicaid experience MMIS
• 14 years working with HIPAA
• 14years experience with X12 EDI Healthcare Transactions
• 14 years in Business Systems Analyst role and Technical Lead
• 20 years in Information Technology
• 12 years as Database Administrator

BUSINESS SKILLS

• Design/Redesign Web Applications Functional specs
• Business specs Technical specs
• Sarbanes-Oxley SOX Detailed test plans
• CMMi Systems testing
• Six Sigma HP Openview / Quality Center / Test Director
• Compliance 360 / Sharepoint / VSS SDLC / JAD / Lean Agile
• EDI X12 healthcare transactions 4010A, 4050, 4060, 5010
• Sharepoint, Compliance 360, Clearcase

TECHNICAL SKILLS

• Windows 2000 2003 Support for IBM Websphere MQ, QPASA
• Support for WebServices, Weblogic JAVA / XML , .net VB
• SQL Server 2008, 2005, 2000 Data Warehousing / Informatica
• DB2 / UDB ETL/DTS/SSIS
• ORACLE UNIX/HP/AIX Visual Studio
• Sybase UNIX/HP
• Data Modeling tools ERWIN, System Architect, Third Normal Form

Confidentia

Consultant/ Data Warehouse Business Analyst

• Working on changes for the Federal Government Marketplace Exchanges for the State
• of New York for two major clients NorthShore and Universal American.
• Responsible for modifications to the EDI transactions for Core modifications for Membership
• Enrollment 834 for on-exchange and off-exchange, individual and group enrollment.
• Working with Claims processing system Amisys Release 6.4.2
• Working with 834 Enrollment inbound and outbound for New York State,
• NorthShore and Universal American. Trading partners include CVS, Davis and Healthplex.
• Working on TotalCare, a New York Health plan for Medicaid and Children's Health Insurance Program CHIP for 834 enrollment inbound and outbound Business Requirements, Mapping of 834 Amisys Release 6.4.2
• Processing of 834 inbound vendor files BSWIFT Analysis/resolution of issues with mapping
• Problem analysis and resolution of issues for the 834 inbound and outbound files
• Training on Claims processing system, PowerSTEPP, to test EDI transactions
• 837s, 835, 270/271, 276/277, 834, 277 unsolicited
• Creation of test cases for new pricing structure for Marketplace Exchanges in Amisys

Confidential

Consultant / Business Systems Analyst

• Interacting with providers, billing services and clearing houses to test EDI transactions
• X12version 5010 835 Remittance Advice 834 Enrollment 270/271 Eligibility 820 Payment
• EDI testing of Medicaid claims for Professional and Institutional claims 837I, 837P
• Supported the efforts of MeckLINKto become a Managed Care Organization. MeckLINKis designated as a Local Management Entity LME and was successful in becoming a MCO effective March 1, 2013 for NC Medicaid.
• Support of State claims for NC Division of MH/DD/SAS integrated payment and reporting system IPRS uses the claims processing engine of NC MMIS to process and pay claims
• IT support to claims processors, finance for issue resolution with processing of claims
• Working with AlphaMCS vendor software for claims processing and authorizations provided
• Supporting providers, clearinghouses, billing agencies for Secure File Transfer Protocol SFTP
• Assisted with debugging of files, ISA envelope, 999/TA1 X12 EDI errors IK3,IK4 CLAREDI/Velocedi
• Working with Mecklenburg's Behavioral Health, Mental Health and Substance Abuse MeckLINK
• for Medicaid Fee-for-Service, Medicaid B, Medicaid C and State claims
• Creation of test cases, testing with AlphaMCS, volume testing, working with AlphaMCS technical support to provide resolution to issues
• Creation of process improvement strategies, forms, verification policies and procedures

Confidential

Consultant / Data Warehouse Business Analyst

• Supporting the Corporate Data Warehouse and the Enterprise Data Warehouse
• Replacement of MAXMC Landacorp software with Trizetto software
• Using SQL Server database OLTP , SSIS packages Also Analytics database using Informatica ETL workflows
• Working with data models and database designs, data access and code sets, database performance issues, database capacity issues
• Business Requirements, Technical Specifications, System Context diagrams, Business Architecture, Integration Strategy for new Trizetto software
• Loading of data into the EDW for direct vendors, members, eligibility, claims, symmetry segmentation,stratification/identification
• Numerous meetings JAD sessions with Trizetto and Subject Matter Experts elicitation meetings
• Disaster Recovery, archiving, strategy for Change Data Capture/Replication
• Using Lean methodology, QFD, CBR, RAMP, COBIT requirements

Confidential

Consultant / BusinessSystems Analyst

• Initial setup of software definitions, variables, file structures, testing of projects within software
• Linux operating system
• Replacing EDI communications server Connect Enterprise with LinomaGoAnywhere software on
• Work closely with trading partners to migrate to the new server
• Setup of trading partners creation of documentation/procedures, verifying tests, issue resolution
• Creation of business flows work with EDI Team Lead to modify current business flows
• Resolve EDI X12 5010 compliance issues interface with EDI help desk team
• Business requirements, functional specs, technical specs for modifications on 5010 compliance

Confidential

Senior Data Warehouse Consultant

• Created structured environment for Change Management and Release Management
• Testing of SSIS, DTS and Informatica ETL packages for loading of data into the Data Warehouse
• Implemented Tidal scheduling software used to test job streams, dependencies, predecessors Executed schedules in system test Worked closely with Tidal administrators
• Performed testing for major projects including loading of data for new Information hub for membership, provider, claims, lab and dental/vision
• Directed production control of migration of objects Visual SourceSafe Alloy for Incidents, Work Orders, Emergency production fixes
• Established procedures for migration of all software including Informatica, SSIS, DTS packages, database objects from development to test and production
• Oversaw testing efforts for projects using 4-Blocker status reporting, dashboard, risks, issues, percentages

Tools: Visual SourceSafe VSS , Visual Studio, SQL Server 2008, 2005, 2000, SQL, ETL, DTS,SSIS, Tidal, Alloy, Sharepoint

Confidential

Database Analyst

• Team lead on multiple projects
• Backup and recovery monitoring, performance and tuning
• Physical and logical design of databases for projects work with application developers to determinerequirements technical requirements: Data modeling with ERWIN
• Sybase 12.5 15.0 on UNIX/HP supporting 99 Carmax stores and 25 corporate servers
• Support of Enterprise Data Warehouse worked closely with Data Warehouse team
• Supporting SQL Server 2000 and 2005 on Windows 2000 and 2003 failover clusters supporting 47 SQL Servers DTS and SSIS
• Creation of development, test and production environments for testing, maintenance and implementation

Tools: Clearcase, DBArtisan, Putty, Magic, Lotus Notes, Sharepoint, Remote Desktop

Confidential

SQL Server Database Administrator / Testing Coordinator

• Supporting SQL Server 2000 2005, clusters in Windows 2000 2003 installation/service packs and implementation of new servers
• Creation of DTS/ETL packages Import/Export SSIS SQL Server Integration Services , backup and recovery database maintenance plans performance storage management
• Responsible for Sharepointimplementation Farm Web/App server, Database Server, Crawler and Search Engine Installation of development and production servers
• Responsible for 52 distribution center SQL servers and consolidated servers
• Database creation, DDL, DML, security access across complex Development, QA, UAT and production environments
• Release software Remedy request management, release management, incident management
• Setup of test environments for Web applications using Oracle and mainframe environment
• Created process improvement for refresh of environments that was cost savings to the company
• Coordination and interfacing with Intel, Server, Application, 3rd party software, users and developers
• Supported Owens Minor Healthcare Account, support of merger with McKesson
• Monitoring of EDI transactions 4010A MQ queues using QPASA Websphere
• Used Clearcase to release versions of software Coordination with multiple developers/users/groups

Confidential

Contractor /Business Systems Analyst/ DB2 DBA

• Overseeing the implementation of large scale project for the National Provider Identification number using Capability Maturity Model CMM and Sarbanes-Oxley SOX for business requirements, technical requirements, traceability matrix, design, detailed test plans, cost analysis, risk assessment, prioritization of tasks and deliverables.
• EDI X12 4010A transactions: Claims for Institutional and Professional, Encounters, Eligibility, Claims Status Inquiry, Enrollment, Remittance Advice, Prior Authorization Request and Response
• Monitoring of project schedules, workplans, resources, performance, milestones and deliverables. Planview used for project plans Phases include Requirements, Design, Construction, Testing and Implementation.
• Working with Data Architects using the Metadata Repository and Data Dictionary
• Utilizing Enterprise Data Warehouse to extract information for analysis of providers and claims for NPI
• Design and business requirements for translation application of NPI to Legacy Provider numbers
• Conducted impact analysis across 200 major systems within Wellpoint.
• DB2 Database Administration May-Sept creation of multiple DB2 subsystems for testing, creation of objects, DDL, loads, unloads, reorg, recovery backups support of production abends Interfaced with ACS and IBM DBAs

Confidential

Contractor / Business Systems Analyst / EDI Technical Lead

• Large scale project to implement National Provider Identification number mandated by Centers for Medicare and Medicaid CMS encompassing all EDI HIPAA transactions 837s, 276/277, 270/271, 835, 834, 278 Request and Response Version 4010A
• Claims for Institutional and Professional, Eligibility, Claims Status Inquiry, Enrollment, Remittance Advice, Prior Authorization Request and Response
• Designed Web HUB for provider information, design of collection/registration of NPI via Web application utilizing cross-functional platforms and multi-departmental analysis.
• Conducted design, enhancements, specifications and testing of real-time eB2B Web applications for EDI transactions used by providers to input claims, eligibility, claims status and admissions notification. Web applications XML build and route X12 transactions to the BCBS home plan via Blue Exchange to the BCBS Association.
• execution of test cases, defect logging, worked with developers for resolution of defects, re-testing of test cases, SOPs and Business Charters
• business requirements, functional specifications, creation of detailed test cases and scenarios
• Followed all phases of the project lifecycle in accordance with Six Sigma Methodologies for the following:
• Coordinated and worked with 3rd party vendor to identify modifications to software package MAXMC
• Regression testing, volume/stress testing Used Test Director to record defects Led coordination of revisions with developers to resolve issues

Confidential

Contractor / Business Systems Analyst/ EDI Technical Lead

• Member of management team who successfully implemented large scale multi-million dollar new Medicaid Management Information System MMIS with HIPAA compliant EDI transactions 837 Institutional, Professional and Dental, 276/277, 270/271, 835, 834, 820,unsolicited 277 for pends, 278 Request and Response Encounters and Claims version 4010A
• Claims for Institutional, Professional and Dental Claims Attachments, Encounters, Eligibility, Claims Status Inquiry, Enrollment, Remittance Advice, Prior Authorization Request and Response
• Managed multiple projects delivering integrated business-focused IT solutions that supported the effort to not only meet the needs of Medicaid, but meet the needs across the entire enterprise of providers, managed care organizations and state agencies within the Commonwealth of Virginia.
• Worked on 4010A, 4050, 4060 and 5010 with X12 to ensure future Medicaid needs were met
• Represented VA Medicaid at external conferences, outside agencies and vendors Member of numerous X12 committees, workgroups and organizations that led adherence to compliance efforts
• Familiar with ICD-9, ICD-10, HCPCS, CPT and diagnosis codes UB-92 and HCFA-1500 Medicaid Waivers
• Worked with new MMIS subsystems, including claims, provider, recipient, eligibility, financials, prior authorization also familiar with MARS
• Managed all project activities in a cross-matrix team environment with specific attention to users, providers, and X12 compliance.
• Managed client expectations, scope and deliverables, risk assessment, critical path and milestones
• Responsible for business case and scope development, application of project management methodology, managing tasks, resources and change management through all phases of the project lifecycle SDLC .
• Liaison between business and technical teams Oversaw technical specifications for software development, mapping of X12 transactions
• Resolved requirements and issues while communicating project status regularly to numerous levels within the organization and adjacent agencies.

Other responsibilities:

• Facilitated meetings between various departments within the organization to meet functional business needs as well as the requirements.
• Gap analysis of all HIPAA compliant X12 EDI 4010A transactions
• Oversaw mapping of X12 transactions
• Creation of test cases and scenarios
• Reviewed and evaluated test results
• Project lead on specific transactions - Prior Authorizations, Claims Status Inquiry and Attachments
• Created project matrices for issues/problem resolution to facilitate delivery of compliant transactions
• Evaluated, tested and recommended prospective vendor software products for compliance
• Liaison for EDI technicians and business analysts overseeing the following:
• facilitation of group meetings with users and technical experts
• analysis and feasibility of alternatives
• issues and resolution of problems
• creation of HIPAA compliant EDI transactions
• creation of Companion Guides, Provider Impact Documents, Trading Partner Agreement and crosswalks for all healthcare transactions
• creation of policies, procedures and contracts for providers and trading partners
• Successfully coordinated the efforts of integrated teams to complete assigned tasks and maintain the integrity of the project for HIPAA compliance. Owned the responsibility for quality deliverables and identifying proper skill-sets to pull resources onto the team to implement the appropriate solution.

Confidential

SQL Server Database Administrator

• Configuration and installation of SQL Server databases and service packs.
• Lead DBA for upgrades to new SQL Server versions.
• Data modeling tool - ERWIN
• Installed SQL Server and established OLAP server to define a data warehousing environment.
• Worked with DTS to transfer data from Oracle to SQL Server databases. Worked with developer to create datamart/cubes/dimensions.
• Conducted troubleshooting, problem resolution and optimizing databases, physical and logical design, analysis, creation of objects tables, views, indexes, stored procedures, triggers and security.
• Established change management procedures and documentation for implementation across various environments Created forms for migration to environments.
• System development life cycle for software development SDLC Used ERWIN modeling product.
• Project manager, as well as, DBA with a successful implementation of accounting systems and software packages Hyperion Best/Budget Manager . Managed project for Saxon, Meritech and Dominion Capital.
• Supported Gallagher Financial Systems application software, as well as, in-house developed applications using PowerBuilder.

Oracle Database Administrator

• Installed Oracle for eCommerce use Created database object creation, roles/users and security in the Oracle environments.
• Oracle Enterprise Manager SQL Plus tools Informatica's ETL tool.

Data Warehousing / DB2 UDB

• Managed a Enterprise data warehouse implementation project for Dominion Capital, working with IBM and the CIO to assess, design and configure the servers, databases, applications and fail-over recovery process.
• From the inception worked with IBM, Unix Administrators and CIO to configure servers with DB2 Universal Database HCAMP failover recovery.
• Created UDB instances and databases DML DDL , security and logins, backup and recovery.
• Utilized Informatica's ETL tool to build a repository for datamarts and metadata.
• Created Enterprise Data Warehouse to be used for eCommerce Created repositories using Informatica'sPowerMart and PowerCenter Repository Manager, Server Manager on Oracle 8i database NT platform.
• Installed DB2 OLAP server, worked with Unix Administrator to install Essbase DB2Connect load balancing UNIX/AIX.
• Configured Production/Development/Test servers to be used for data warehousing.

Confidential

Database Administrator SQL Server

• Created and maintained databases, objects, logins and security in test, user acceptance and production
• Lead DBA to upgrade new versions of SQL Server and service packs
• Conducted troubleshooting and problem resolution on numerous SQL Server boxes.
• Installed SQL Server applications that were shared throughout the Federal Reserve System.
• Conducted systems analysis and design all aspect of system life cycle for software development JAD sessions Logical and physical design of databases.
• Used data modeling tools - System Architect and Third Normal Form

Database Administrator DB2

• Applications database administrator in numerous DB2 subsystems with multiple LPARS Installation and maintenance of Resource Shared application software Backup, recovery and disaster recovery
• Conducted logical and physical design JAD sessions System development life cycle SDLC System Architect modeling tool Endevor.
• Support of FRIT for Centralized LPARS and applications
• Created and maintained databases, objects, logins and security in the numerous DB2 subsystems for multiple LPARS DML DDL
• Utilized DB2 mainframe/TSO utilities SPFUI, QMF, RC tools SQL coding Problem/issue resolution and constant interaction with developers and users EXPLAIN tables, queries trace optimization of queries.
• Saved Federal Reserve 98,000 by optimizing multi-volume DB2 database using Platinum Fast Unload/Reload utilities.