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Senior Business Analyst

SUMMARY

• Extensive experience as information professional, focusing on the development and support of system implementation, system configuration, business analysis, Jad Sessions , HIPAA, and testing on various platforms. Experienced in claims process and adjudication in the Medicare, Medicaid and Private Insurance Sectors. Effective at coordination of other data between systems for information needs, using industry standards including HL7, XI2, and ANSI. Conducted usiness requirements gathering and writing EDI. Versed on HIPAA regulations and requirements. Extensive Project Management, process engineering and Q.A. experience. Certified in 4 Amisys sub-systems. HBOC STAR Financial and Clinical System experience. Management experience includes configuration of claims adjudication systems, process engineering for hospitals and health plans, development of patient care and financial data processing systems, management of analysts and programmers, interfaces between systems, data conversions, HBOC healthcare applications and quality assurance of software development. 

PROFESSIONAL EXPERIENCE

New York State Department of Health Medicaid HIPAA Project - Sub-contracted to CSC

Aug. 2002 - Jan. 2003

Sr. Business Analyst Transactions 270/271, 278 Transactions

• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for New York State Department of Health Medicaid for processing of Medicaid Claims. Developed gap analysis document, logical and physical design and remediation plan for State. Responsible for mapping documents, creation of test plan, test scenarios, test cases for unit, system and system integration testing.
   

Blue Cross/Blue Shield of Nebraska

Sep. 2001 - Jun. 2002

Sr. HIPAA Business Analyst and Team Lead, HIPAA Transactions

• Gathered business and system requirements. Created Project Charter, Requirements, Logical and Physical Design Documents for EDI Transactions and Code Sets.  Made recommendations for business process re-engineering for QMACS implementation.  Documented business process for Utilization Management, Case Management, in VISIO. Team Lead for X12 270/271, 278, 835, 837 Transactions. Was responsible for training and testing of transactions. Designed screens and application for 278 Business Users. Created Mapping documents, test plan, and Provider Companion Guides.
   

State of Idaho Dept. of Health and Welfare HIPAA

May 2001 - Aug. 2001

HIPAA Sr. Business Analyst

• Responsibilities included assessment of current State of Idaho business processes for the as-is and recommendations for the to-be presented in gap analysis deliverable. Responsible for 278, 835, 837 transactions.  Responsible for mapping documents, test cases, test scenarios, test plan, unit testing, system testing, system integration testing, remediation and configuration of EDS system for HIPAA compliancy. 
   

St. Alphonsus Regional Medical Center

Jan. 2001 - May 2001

HL7 Interface Consultant-HIPAA

• Tested of HL7 Interfaces between clinical system including HBOC STAR, Pathways Health Scheduling, QuadraMed Coding, Pharmakon Pharmacy, and Phyxis Pharmacy Dispensing.  Insured completeness of various messages between systems. HIPAA analysis of systems and applications for as is and to be gap analysis.
   

Harvard Pilgrim Health Care Quincy Mass Sub-Contractor to Perot Systems

Aug. 2000 - Dec. 2000

McKesson-HBOC Amisys Configuration Analyst

• Configured new benefit packages for HMO, PPO, POS, for states of Massachusetts and New Hampshire. Performed keyword changes for all benefit packages for all states.
  Analyzed existing benefit packages and changes in benefits for new mandates for chiro, mental health parity, alcohol, substance abuse.  QA'ed existing and new benefit packages .  Tested of claims for newly created benefit packages and changes made to existing benefit packages. 
   

PacifiCare

Jan. 2000 - Aug. 2000

HealthCare Business Analyst HIPAA - Contractor

• Performed data mapping of UB92 and HCFA BL1500 from form through HL7 and X12 data exchange files to VMS database.  Identified additional data elements to be captured that were needed to comply with Balanced Budget Act requirements. Created test scenarios and test cases necessary to validate software changes.
   

Dayton Area Health Plan

Oct. 1999 - Dec. 1999

Business Analyst - Contractor

• AMISYS Configuration Analyst for the implementation of State of Kentucky Medicaid business.  Analyzed twenty-nine State of Kentucky programs in order to create benefit package. Performed business requirements gathering and writing from various levels of the organization.  Q.A'ed claims to insure that they hit the correct benefits. Created and configured code sets, procedure codes, auth. Qualifiers.
   

Sierra Healthplan -Las Vegas, Nevada Erisco Facets Implementation

Jan. 1999 - Sep. 1999

Business Analyst/Team Lead

• Analyzed and configured benefit plans and membership.  Conducted business analysis and configuration of Claims and Membership Sub-Systems.  Designed test plan, test scenarios, test cases and test scripts.  Performed User Acceptance and Integration testing.
   

Catholic Healthcare West

Mar. 1999 - Aug. 1999

Business Analyst - Contractor

• Implemented Y2K testing methodologies for extended project with Catholic Healthcare West on those systems critical to both patient care and financial processes. Q.A'ed both clinical and financial software applications on mainframe and client server platforms. Performed process engineering for current business processes.  Developed testing methodologies include Functional Hierarchies, Test Scenarios and Test Cases. After the creation of a test environment, all critical date fields are assessed for Y2K readiness. HBOC Series 2000 - Developed Functional Hierarchy, Test Scenarios and Test Cases in preparation for testing. Performed Medical Manager Analysis of application for critical date related fields.  Prepared final documentation for client sign off. Ascent Contract Management - Interacted with client users to review business process.  Analyzed, testing and documentation of 29 non-tier one applications.
   

FHP/Presbyterian Health Systems, Albuquerque, New Mexico

1997 - 1998

Sr. Configuration Consultant - HBOC AMISYS Implementation

• Performed process engineering of existing business processes in order to integrate lines of business.   Analyzed benefit plans and provider contracts. Configuration of providers.  Created and configured benefits, components, riders and benefit plans. MappedFHP benefit plans and riders to new Presbyterian benefit plans for conversion. Developed benefit plan prototypes and clones, i.e. HMO, POS, PPO, Indemnity, etc.  Performed On site user support and training and testing.  Developed ad hoc reporting system   Performed data conversion from proprietary system. Knowledge of COBOL, Quiz and Suprtool. Certified in four Amisys sub-systems Benefits, Provider, Membership, Pricing.
   

Carondelet Health System Los Angeles Information Services Center, Marina del Rey, CA

1996 - 1997

Manager/Analyst. Manager of Information Systems at Santa Marta Hospital, Los Angeles, CA

• Performed process engineering of current business processes and systems and documented into VISIO. Technical Project Manager for HBOC Pathways Managed Care, Contract Management Systems, and Star Financial and Clinical Systems.  Daily involvement in the configuration of HBOC Pathways Managed Care and HBOC STAR Financial and Clinical System. Developed all technical operational policies and procedures for HBOC Pathways Managed Care and Contract Management Systems. Trained Computer Operations staff and hospital personnel on HBOC Systems.  Managed and directed all technical Go Live activities for HBOC Pathways Managed Care, Contract Management and STAR System implementations.  Worked with HBOC to ensure that all facility Go Live requirements were achieved. Installation of enterprise wide desktop computer devices.  Administrator of HBOC Pathways Contract Management and Managed Care Systems for Daniel Freeman Memorial and Marina Hospitals and Santa Marta Hospital.  Technical Project Manager for HBOC STAR Implementation. Provided on going support for production environments for HBOC STAR, MANAGED CARE and CONTRACT MANAGEMENT Systems.  Security Administrator for HBOC Pathways Managed Care and Contract Management Systems.
   

FUELMAN/Gascard, Carlsbad, CA

1995 - 1996

Tandem Operations Analyst

• Created system generation (SYSGEN) of Tandem Operation system. Monitored system performance and made improvements to optimize computer capacity. Improved Client Billing System. Card swipe (credit card) transaction processing. Modified computer application software for non-stop operation. Responsible for Tandem system TCP/IP configuration. System developed in COBOL 85, COBOL74, SCOBOL, TAL, Enform and Enscribe.
   

Antelope Valley Hospital Medical Center, Lancaster, CA

1985 - 1994

Manager of Software Development (1990-1994)

• Managed a staff of analysts and programmers who supported a 341bed district hospital in a Tandem environment.  Management responsibility for Patient Accounting, Census, Billing, Accounts Receivable, General Ledger, Accounts Payable and Radiology.  Worked on Film Tracking systems; including Electronic Data Interchange interfaces. System developed in COBOL 85, COBOL74, SCOBOL, TAL, Enform and Enscribe.  Responsible for fiscal budget. Managed Software Development Group's Novell network. Experience implementing LASTWORD ADT, Order Entry and Patient Accounting systems; creating custom reports from LASTWORD data base and building interfaces to non Lastword Pharmacy and Laboratory systems.

Project Analyst (1986-1990)

• Developed user requirements for Data Center Patient Accounting projects. Designed, developed, and executed test plans, scripts and programs to determine software products' acceptability for installation into production environment.  Installed and implemented new software.  Supported production software products. Investigated data base anomalies and provided corrective solutions. Business requirements gathering and writing from various levels of the organization. 

Operations Systems Specialist (1985-1986)

• Monitored computer system capacity, and analyzed and projected system saturation.  Received, recorded and diagnosed computer system problems. Provided advice and assistance to system users regarding proper operation of computer equipment.

Jet Propulsion Laboratory - Science Data Technician - Contractor (1984-1985)

• Monitored several science instruments during live system testing of Galileo spacecraft to insure proper instrument health and function.  Reviewed test data to verify proper instrument operation.  Wrote problem reports and followed-up engineering changes to assure correct redesign and modification of components in support of Cognizant Engineers .  Researched and compiled information for inclusion in System Command and Telemetry Dictionaries.

EDUCATION

• Columbia Pacific University, San Rafael, CA
• Bachelor of Science in Aviation Science and Computer Science, October, 1984.

Professional Associations:

• HIMSS (Health Information Management System Society)
• TIMES
• National Managed Care Congress û NMCC (National Managed Care Certification awarded 11/97)