PROFESSIONAL PROFILE

A professional, multi-talented , team player with 16 years of soft skills and technical experience including healthcare information systems, business analysis, EMR, MMIS implementation, management, and customer service.

TECHNICAL SKILLS SUMMARY

Software:

Microsoft Office Project Web Access 2003, TeamTrack, Trackrecords, CARS, QA Director, RRI, Oracle, GeoAccess Software, GeoCoder, Medecision, Adobe Acrobat, PowerPoint, Access, Excel, Crystal Reports, SQL, FoxPro, MS Word, Siebel, Power Builder, Passport Communications Software, Great Plains Financial Software, XML, Visio, Microsoft Project, Visual Basic, AS400, GTEDS Mainframe, Medgate, Primesuite

Operations Analysis:

Writing and analyzing test cases, Project Management. HEDIS Access database reports, Accounts Payable forecasting, Physician network development, Medicaid compliance, customer service, fraud abuse, database integrity, quality improvement, budget/variance preparation. Security management, enrollment, EDI testing, and Claims administration

Professional Training:

GeoAccess, AS400 Query, HIPAA Standards Training, Passport Communications Software, Medecision: Clinical Decision Support Software, GeoNetworks Software, Beyond Compare, AS/400 claims system, Erisco Facets claims system, Fraud Abuse Training, Business Writing for Result, Benchmark Course, Unix 101 201 Vi 101 , Communication Skills for the IT Professional, Problem Solving by Nashville State Community College, Introduction to the Project Management Office, Overview of NPI, Introduction to Revenue Cycle Management

Operating Systems:

Windows: 95, 98, 2000, NT, and XP, Interchange MMIS, AS400 mainframe, Erisco Facets claims system,

Soft Skills

Communication and teamwork, Business and process knowledge, Customer interface and negotiation, Systems analysis, Project management, Adaptability to change

CAREER EXPERIENCE

Confidential

Information Technology, Business Analyst

• Successfully wrote requirements that are actionable, definable, relevant, measurable and testable. o Perform site visits for our health care clinics to address any technical and systems issues. o Held meetings telephonically with Fortune 500 companies to discuss eligibility file business requirements. Document and articulate program business needs to meet goals and objectives. o Consulted with identified colleagues or clients to define requirements.. Applied analytical and problem-solving skills to help validate IT requirements. o Resolved and/or escalated application related issues in a timely fashion. o Responsible for time management tracking by project using SharePoint and TrackIT. o Working knowledge of the eligibility verification processes as it relates to EHR. o Knowledge of electronic medical record applications o Responsible for HL7 data conversions, data mapping, and data translation.
• Utilized BizTalk software and InfoPath to map clients.
• Interacted with internal customers including the QA, Development, and other stakeholders.

Confidential

Information Technology, Senior QA Analyst

• Large-scale systems implementation project for the Department of Human Services to serve 7,000 users. o Functional lead for the Notices functional group on VIPS project with a FORTUNE 500 company. o Successfully learned the functionality of the ACS Vantage Framework. o Utilized the V-Model method using Compuware tools, Track record, and Eroom applications. o Ability to work autonomously with a diverse team while meeting deadlines. o Participated on the Compuware testing automatation team. o Experience testing Website application functionality on the VIPS project. o Generated test cases and scripts according to the design documents and business requirements. o Demonstrated communications skills with programmers, business analysts, and other test engineers.
• Experience with various software testing methodologies like Waterfall, Iterative Development, Agile.

Confidential

Information Technology, Senior Quality Assurance Analyst

• Top performer on the governmental EDI quality assurance team utilizing the SDLC methodology. o Participated in a CPU cost savings project that will realize approximately 30 -40 ROI. o Assisted the project manager with prioritizing EDI transaction priorities. o Maintain the departmental Helpdesk tickets using an Internet application.
• Successfully completed over 300 EDI related tickets using JCL, X12, COBOL, Foresight HIPPA validator and CompareX.
• Executed testing for CPU cost savings that saved the company 25,000 per month.
• Trained new staff on the standard operating procedures for QA testing.
• Create test plans, test cases, and test suites utilizing testing tools and scripts for exercising builds.
• Demonstrated positive soft skills with both technical and non-technical personnel.
• Tracked bug fixes, defects, and enhancements utilizing the Mercury IT Governance Center System.
• QA Payer specific edits to ensure HIPPA 4010 compliant translations outputs.
• Engaged in highly visible projects NPI Crosswalk Projects CMS mandated Print Maps project .

Confidential

Information Technology, EDS , Senior Applications Tester

• Large-scale systems implementation for TennCare MMIS with a FORTUNE 500 company.
• Tested data translation requirements from UNIX to the Client Server application.
• Evaluated, recommended, and implemented automated test tools and strategies using relational databases.
• Successfully lead efforts in MMIS Security initiatives for over 2,000 users .
• Developed, maintained, and upgraded automated test scripts and architectures for application products.
• Wrote, implemented, and reported test case management for the testing team using Access SQL .
• Successfully executed and gained user acceptance approval of over 700 test cases.
• Participated in RV sessions, including testing for Avaya Telephony system, eligibility, Security Mgt, HIPPA and EDI.
• Experienced writing and executing EDI test cases through user acceptance testing.

Confidential

Information Technology, Systems Analyst Team Leader

• Promoted to the position of Team Leader in the Systems Department and managed 12 team members.
• Developed several relational database applications to assist the Medical Director and the Provider Services Department using MSAccess SQL .
• Created directories for flat files related to Mainframe AS400 queries.
• Lead and trained the System Analyst in performing their daily functions.
• Assisted in an EDI project for outbound file transmission to external entities Ex. Blue Cross, Vision services .
• Provided assistance in coordinating projects utilizing project management skills..
• Responsible for HEDIS reporting by assisting the Quality Improvement department.
• Analyzed and resolved software related problems logged by the IT Help Desk, performed maintenance on system references as required, researched, documented, and communicated to programming staff when development was required.
• Provided MSAccess application training and support to over 50 end users.
• Updated the organization's billing system fee schedules, according to reflect the Medicaid TennCare contract requirements.

Provider Services Network Analyst

• Promoted to Network Analyst to lead the data integrity process, housed in the AS400 Mainframe Xantus HealthPlan a Medicaid MCO served 150,000 members in the State of Tennessee .
• Trained provider representatives on applications that serve as a reporting mechanism for Director's, Managers, and staff.
• Analyzed areas such as membership absorbment, network development, provider and member accessibility.
• Participated in developing the Corporate website as a member of the Interdisciplinary Team.
• Developed tools in Access that quantified the financial impact of fraud and abuse measures.
• Assisted in the standardization of mainframe data to reflect a 2 error ratio.
• Created information databases to track quality and productivity issues to meet compliance that are mandated by State and Federal agencies such as EQRO, HCFA, TennCare Bureau and TN Commerce and Insurance

Provider Relations Coordinator

• Conducted physician surveys for the improvement of customer service. Recorded results to assist the Director in meeting physician satisfaction.
• Assisted the marketing department with the creation of a company logo, including working with vendors on logistical information and developing the first in-house provider directory.
• Worked closely with the executive management team on database integrity issues, which resulted in an annual savings of 8 million.

Provider Relations Representative

• Assisted providers with resolving questions related to claims issues, payment issues, and member assignment items.
• Averaged 100 calls per day, while developing a customer service relationship with our callers, decreasing wait time and the number of repeat callers.