Manage and lead business analysts dedicated to Illinois Medicaid Managed Care Organization (MCO) requirements development and implementation. Position includes working with several matrixed corporate teams as well as matrixed strategic vendors and partners to communicate Illinois Medicaid business needs for state, provider, member policies related to Illinois Medicaid. Additionally, team serves to reverse engineer program requirements for Illinois Managed Care Medicaid via analysis of the state of Illinois MCO claim encounter process. Passionate and motivated advocate to drive opportunities with partners such as the Illinois Association of Medicaid Health Plans (IAMHP) as well as Illinois Department of Healthcare and Family Services (HFS).

Hired to assist and manage Encounter Operations performance for Illinois Medicaid for Blue Cross Blue Shield of Illinois as one of the operations’ business owners.

Contracted for TransTech IT’s client, HCSC’s Blue Cross Blue Shield of Illinois, assisting IT functions that supports government programs on Encounters.

Hired to assist in IT modernization efforts at a large self-funded union health and welfare fund. Responsible for providing business support and analysis, understanding and documenting business requirements, facilitating the design of business requirements in system configuration that support the processing of claim and enrollment transactions within the core processing systems within the organization. Involved reviewing business functionality across many internal business units and recommending new solutions and approaches to solving business issues with technology.

Duties include: Learning and understanding the client’s business requirements, the impact of the new solution(s) on business processes, and translating that into detailed configuration requirements. Developing detailed business requirements documenting the needs of the client department/agency. Working to optimize business performance by recommending balanced approaches to configuration/system design and maintenance. Facilitating system/configuration design sessions Validating system/configuration and documents issues Creating mapping documents and handling loading configuration into the core system Assisting with development of business requirements and technical design for reports, letters, conversions, interfaces, extracts and file inputs. Executing system tests (unit, integration, regression) with appropriate analysis. Facilitating business process alignment sessions. Identifying risk and/or issues and escalating appropriately. Assisting the Project Manager with planning and development of the system configuration and other business activities associated with the project schedule. Identifying change requests and presenting change control documentation for the client to submit for consideration. Maintaining a favorable working relationship with all project stakeholders to foster and promote a cooperative and harmonious working climate. Keeping immediate supervisor promptly and fully informed of all problems or unusual matters of significance and take prompt corrective action where necessary or suggests alternative courses of action. Develop and mentor junior staff individuals

9/2015 to March 2016 - Manager /Lead Analyst of Network Operations Area of business operations that is responsible for leading business analysts within the operationsteam. Additional responsibilities included working with the corporate team to communicateconfiguration for state and provider contract rate changes; as well as data reporting to the State ofIllinois for claim encounters. This area of operations is on a claim system platform dedicated toMedicaid claim adjudication.8/2014 - 9/2015 - Manager of Delegation Oversight Focused on being the point of contact for the Illinois Health Plan for all delegated providers per business objectives. Worked with internal Health Care Services team for resolution on member’sissues with vendors. Also began focus on third party transfers for encounter purposes with the state of Illinois. Additional responsibilities included assisting team members with third party relationships dedicated to core services that were delegated to vendors.

Responsible for analyzing and specifying user interfaces, data, and workflows among business systems. Responsible for functioning as link between the business operational areas internally and the IT systems teams at MultiPlan as well as end external clients. Works independently or as part of a team to improve the relationship between the business and IT systems teams of MultiPlan and acts as resource for other Business Systems Analysts.

Responsible for developing and executing detailed test plans based off system requirements. Job entailed validating test conditions, identifying and documenting all results including defects for enterprise discounting system.

Charged with the testing and implementation of business and system development changes for the division. Duties included writing business specifications, detailed test conditions, and validation of test. Also identified system defects and possible enhancements to the claim payment system. Position included identification of the cost benefit analysis to the organization.