Perform system analysis of claims payment system and supporting processesAssist in the development and management of project plans through the project and software development lifecycle process, reporting progress and risks in a timely and effective mannerDevelop functional requirements including operating procedures; feasibility studies; process and system architecture and workflow diagrams; data dictionaries; prototype/mockup of ad-hoc, and enterprise reports; unit test cases and data validation plansWork with customers and functional areas to identify functional business requirements (contract deliverables), ensure scalability, and identify/resolve any conflicting prioritiesCreate, test, support, and troubleshoot scripts, procedures, charts/diagrams, work flows and business analysis solutionsFacilitate and coordinate design and planning sessions among multi-disciplinary teams comprised of key customer stakeholders, end-users, software engineers, etc. for the purpose of defining application and report specific requirements

Perform daily data validation according to established Business RulesPrepare and deliver daily, weekly and monthly reports to the Americas and non-Americas divisions Develop and maintain documentation of validations, reports and business process management Develop and manage daily file transfer automation processes Develop automation for data validation processesAnalyze system issues and prepare system tickets for development resolution

assist with development of data collection systemassess work flow to determine system objectives, behaviors and featuresdetermine project milestones, deliverables and timeframescoordinate development progress and testing with clientdevelop tables, screens, reports for data collection system

AchievementsImplement vendor developed XML-based API (EDI Gateway) to enable import and export of data contained in Claims Payment Management System (PLEXIS)Develop and implement automation process for production and distribution of reports Develop and implement electronic funds transfer (EFT) services including electronic remit creation and distributionImplement and administer vendor developed web based provider portal Member of Policy and Procedure CommitteeMember of Cross Functional TeamDutiespart of sunset team - answer inquiries regarding claims, eligibility, authorizations, payment issues in addition to analyst dutiesadd/extract claims and eligibility data from/to HIPAA compliant transactions and other formats as necessarydata mining, collection, update and correction utilizing SQL via Microsoft Access and Microsoft SQL Server Enterprise Managerreport development according to end users needs via Microsoft Office Suite and Crystal Reportssubmit and analyze encounter data; document and report identified trends and data anomalies to CFO; develop business tools for pend resolution team; track data to ensure accuracy, timeliness and completeness test vendor developed system and application upgrades, patches and logic changes to determine impact on work flow trouble-shoot errors, debug performance issues and develop and applying fixes for end usersmanage EFT services and electronic remitsadministrator and customer liaison for web based portal designed for claims status, eligibility look up and network directory, including end user trainingprepare yearly contract performance deliverable for electronic claimsdocument process, including graphic work flows regarding the encounter submission process including pend resolution, encounter validation and remediation process as requested for operational review and bid proposal responseattend regular technical consortium meetings sponsored by state reporting agency

Dutiestracking and reporting service cost trends and proper utilization of criteria by healthcare providers investigating and reporting findings of concerns involving non-professional servicestrain healthcare providers regarding organization's utilization criteriaprepare quarterly contract deliverables including complex graphs and aggregated data hiring and supervising staff of one - including goal setting, analysis and coachingtrain staff regarding authorization criteria as set by Medical Programs Director and Chief Medical Officermanage calendar of Medical Programs Director and Chief Medical Officerlayout and production of contract deliverables including annual work plans, business operation review and bid proposals via Microsoft Office Suite and Visiomeeting minute scribing and distributioncoordination of team calendartechnical support for Microsoft Office Suite and OS/hardware related issues

Achievementsconducted non-profit board of director work sessions/retreats to establish scope of work or project objectives and the subsequent plan to realize set goals including funding alternatives and community outreach programsdeveloped comprehensive plan for local wastewater district treatment facility upgrade, including community relation activities, aimed at attaining low-interest loan from WIFA (Water Infrastructure Finance Authority) and grant fundingsaw successful voter approval for district to enter into debt agreementattained low interest loan for entire project from WIFA