Gwen Brown Email and Phone Number

Automated outbound and inbound vendor files for consistent data verification. Analyze data and document requirements for the ICD-9 to ICD-10 Conversion Project Analyze current system functionality for the Health Care Reform (HCR) On and Off Exchange project. Acted as the team leader to create a database for provider practices by location for tracking purposes.Acted as the BA support for a Network project to bring in and reformat business partner files to upload provider data into the appropriate Highmark systems. Analyze moderately complex processes to support the dental provider operational business areas Analyze and develop business requirements by interpreting the dental systems documentation to create valid solutions. Ability to analyze system requirements, functional specifications, create and execute test cases. Document and track system defects in RUPAbility to plan and lead user acceptance testing with the customer and project team. Advanced ability to develop and promote effective working relationships with all levels of personnel. Experience with organizational and problem solving skills and ability to focus on details.

• Collaborate and Implement cross-functional Highmark claims projects and enhancements. • Analyzed and developed business requirements by interpreting the claims system functionality to create valid solutions.• Performed unit, user acceptance and regression testing with software developers and clients.• Promoted and supported a customer service focus in the daily performance of all project assignments and service activities.

• Collaborate and Implement cross-functional Highmark claims projects and enhancements. • Analyzed and developed business requirements by interpreting the claims system functionality to create valid solutions.• Performed unit, user acceptance and regression testing with software developers and clients.• Promoted and supported a customer service focus in the daily performance of all project assignments and service activities.

Pharmacy Benefit Manager (PBM) project: As the Business Analyst I defined and validated detailed system requirements necessary to implement system changes for the new business. Collaborated with the project cross functional teams to develop a testing database for multiple department use and track all testing. Created a PBM crosswalk document to perform a Gap-Analysis for the 3 pharmacy clients associated with the project.Created and executed test cases.Managed system defects and reported project issues to the team lead. Created end-user documentation.Trained the EDI support staff on using the new testing database.

Managed the coordination of projects tasts across all functional departments. Scheduled all project meetings, document meeting minutes and followed up with the PMO project team to resolve outstanding items. Analyzed the National Plan & Provider Enumeration System (NPPES) registry for verification of provider NPI’s. Updated provider NPI's in the appropriate database systems in preparation for the May 23, 2008 NPI compliance date.Analyzed electronic claims to identify provider NPI billing issues. Contacted providers to explain the billing analysis, provided provider education how to correctly submit future claims to ensure proper payment based on the EDI X12 billing guidelines.Prepared provider profiles for high volume accounts in preparation for Marketing Representatives to do face to face site visits.

Collaborated with individual departments, analyzed departmental information to identify a process to clean up outdated departmental Macros no longer used. Gathered and documented the requirements to satisfy each departments needs for the clean up. Coordinated with program developers to discuss possible impacts before implementation of the task. Analyzed the daily work flow of Accounts Receivable department to identify a process to streamline their manual verification process. Based on my analysis I developed 2 mainfame reports that elimanted the manual verification process and increased the departments processing time by 85% and enabled the department to decrease the number of days they were in a backlog situation.

Analyzed and designed client server n-tier application, windows and business processes for Sales and Marketing department.Successfully served as implementation coordinator and lead analyst for corporate software enhancements.Recognized for being instrumental in successfully implementing a projected 18-month project within 4 months.Documented system requirements, test plans for system application changes for assigned projects. Provided technical support, consultation and problem solving help for a sales staff of over 200 employees.Lead and performed unit, string and regression testing with software developers and clients.Promoted and supported a customer service focus in the daily performance of all project assignments and service activities.Provided technical application, training sessions, documenting system user guides for end-users.Recognized for exceptional service in performing within a fast-paced, multi-faceted work environment, while achieving and exceeding daily goals set forth by senior management.Advanced ability to develop and promote effective working relationships with all levels of personnel. Experience with organizational and problem solving skills and ability to focus on details.