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• Collaborate with the project team to establish a project plan that accelerates adoption and delivers both short and long-term benefits.• Garner experience working with myAvatar, CarePOV Clinician and various other modules; demonstrate knowledge of assigned areas of expertise including integrated software, including designing workflows in conjunction with permissions structure.• Create a strategy for data migration and federation while understanding the integration points of the solution, including data stewardship.• Interpret technical requirements and business needs into innovative solutions to meet business need while working within the constraints and budgets. • Identify and lead the mitigation of any technical gaps or risks. • Represent IT at client governance meetings to review technical aspects of projects and offer recommendations to boost the efficiency and progress of the solution. • Operate as the senior lead on assigned projects, tasked with directing and mentoring all team members and project resources. • Oversee and manage various concurrent customer requirements providing a balanced assignment to each project, working simultaneously in pre and post implementation situations.

• Compiled all necessary business requirements for various projects while simultaneously producing technical documentation for IT Operations, training, workflow and analysis, and ensuring full HIPAA compliance. • Ensured all systems and clinical applications were operating at optimal performance levels. • Served as a key contributor in identifying and designing solutions and improvements for numerous clinical systems and applications, offering User Acceptance Testing (UAT) to ensure products were efficiently released.• Functioned as Business Analyst/Tester during the updating of Windows Server 2012 and QNXT Application from version 5.2 to 5.2.2 working in conjunction with a Developer.• Worked as a collaborative team member regarding the configuration of Benefits, Enrollment, Utilization Management, Authorizations, Provider Contracts, Claim Test Pro (CTP), and Medical Claim Processing. • Performed data mapping of interfaces for dental, pharmacy, vision benefits, nurse triage, and electronic membership files while monitoring configuration of QNXT relating to provider demographics.• Outlined and reviewed contract terms, Term Restriction Groups (TRGs), and ensured services groups were configured correctly to assure proper scoring of claims for reimbursement to the provider in the contract module.

• Conducted routine research and updated information needed to verify Medicare eligibility utilizing Web based applications, client systems, and/or internal systems applying Rules of Coordination of Benefits (COB) for Commercial and Medicare policies and updating Client Systems with the correct order of benefits.• Partnered with business units to streamline the process of identifying, reviewing, and analyzing claims and overpayments• Reviewed and verified overpayment, which included Duplicate Payments, Contract Compliance, Authorizations, Eligibility, Coordination of Benefits, and Medical Reviews.• Prioritized, assigned, and managed queries and action plans while reviewing members on the VDSSA/MIR files. • Mentored and educated new COB Analyst/Validation Analysts on understanding the complete process for multiple clients while providing all necessary documentation for projects on hand.• Designed and deployed modified queries that enabled increased growth and revenue by an additional 15% to 20% each quarter.

• Communicated with clients to effectively analyze initiatives, build business cases, provide cost/benefit analysis, devise project measurement objectives, and identify business-staffing requirements for IT projects and user training.• Utilized project management methodologies, such as SCRUM and Waterfall, to coordinate all involved parties and techniques while initiating change requests from the business to ensure timely and accurate depositions and coordinated user acceptance testing and signoff regarding various projects such as the WCP policy management system.• Oversaw the entire project lifecycle, including investigation, design, testing, and implementation, to ensure business requirements were successfully implemented. Served as a liaison between end users.• Managed the daily operational activities of the Oracle and SQL Server Database Administrator resources.