Kathryn B. Email and Phone Number

In this role I act as a business analyst to work within our Data Integration/Warehouse Team. I have worked to acquire an in-depth understanding of the business units served and the products they offer to facilitate the negotiation between stakeholders and the development team about what to build, while instilling a keen sense of urgency in that delivery.Essential Functions:• Analyze data in legacy mainframe systems as it passes to our cloud environment using Intelligent Data Management Cloud (IDMC - Informatica)• Act as a liaison between business units and IT. Develop and maintains knowledge of customer’s business and data needs• Create clarity around needs and requests by leading requirements gathering sessions with business unit and end user • Document end user requirements for data capture, program functions, data quality, reports and analysis, and training• Support Developers and Data Modelers through the project lifecycle• Work with QA to develop and execute test plans based on appropriate coverage for the functionality being delivered• Utilize my understanding of data systems & objects as well as SQL to perform data validations against a variety of data warehouses• Perform analysis for production support of systems and applications• Create associated documentation and coordinates resolutions

In my role, I ensure timely and accurate filing of encounter files (Claims) on behalf of Trusted Health Plan (THP) to DHCF and MDHHS. I work closely with the THP upper management and state finance departments, reporting high level submission statistics and analysis around acceptance, rejections and timelines for corrections. I also oversee THP’s vendors who process all encounters submissions to ensure all encounter data reporting requirements are met.Essential Functions:• Reconciling Claims system extracts, 837I, 837D and 837P files and state response files to account for all qualifying claims processed in a specific pay cycle.• Tracking work assigned to vendors, analyzing and resolving all claims data identified as “Bad” during the validation process and all claims identified as “Rejected” by state entities (errors are included in the 999, 277CA and 835 response files) according to Service Level Agreements (SLAs).• Coordinating error correction analysis efforts with external vendor staff on a Daily, Weekly and Monthly basis.• Communicating effectively with vendors, Federally Qualified Health Centers, Health Plan management and internal business owners.• Automating manual processes to enable more accurate and timely deliverables

As a Regulatory Reporting Analyst, I provided analysis related to all regulatory data submissions by CareSource to state and federal agencies of claims and case management data. This includes adhering to the various state and federal requirements regarding these submissions and working with internal business and operational units, as well as external regulatory agencies, to assure CareSource has the appropriate data submitted as accurately as possible with minimal rejections. I also work collaboratively with application and database developers to maintain all components of the encounter and case management programs.Essential Functions:• Adjudication of Medicaid, Medicare, and Dual eligible insurance claims submitted on a HCFA 1500, ADA & UB04 form utilizing Trizetto Facets Enterprise for state and federal markets• Utilize SAS Enterprise Guide and SQL query knowledge in conjunction with comprehension of EDI ANSI X12 standards (HIPPA 5010) and EDI structure to strategically develop mapping requirements for implementation of Edifecs Encounter Management Tool Medicaid, Medicare, and Dual eligible markets• Reduce state issued rejections significantly by introducing enhancements by way of in-depth research and analysis, writing business required documents, preparing test cases and testing out the enhancements in various testing environments to mitigate adverse effects• Lead documentation efforts and maintain document versions, workflow and access control on Department SharePoint site that provides traceability for all regulatory data, as well as, knowledge sharing among team members• Coordinated Requests for Change (RFC’s) with Change Management team by conducting/collaborating with teams involved in testing and deployment. This responsibility also involves presenting changes and answering questions at Change Action Board (CAB) meetings.

Essential Functions:• Installation and configuration of proprietary applications in a WebLogic, J2EE environment• Improving and clarifying medical providers meaningful use reports to aid in their meeting regulatory measures• Coordinate the internal teams on resolving provider application and connection issues.• Coordinated the Software Development Life Cycle (SDLC) in new product releases • Led Documentation efforts for application knowledge and instructions for team members and internal customers

Essential Functions:• Responsible for Software Support of Web based applications • Proactively communicated and collaborated with external and internal customers to analyze information needs and functional requirements and deliver the following artifacts as needed: Functional requirements, Business Requirements Documents, Use Cases, GUI, Screen and Interface designs• Successfully engaged in multiple initiatives simultaneously • Served as a conduit between the customer community (internal and external customers) and the software development and business teams. • Led Documentation efforts for application knowledge and instructions for team members and internal and external domestic and international customers

Essential Functions:• Responsible for the analysis, design, development, testing and implementation of relational database projects and associated dynamic web application interfaces in accordance with U.S. Air Force requirements. • Delivered scalable and secure solutions in an advanced technological and mission critical environment which is a crucial component of the War on Terror. • Provided formal technical recommendations to senior military officers and civilian personnel.• Senior technical resource for the implementation of a dynamic database search solution. Project utilized Google search technology.• Successfully served as a technical resource for the effort to convert several disconnected data stores to a centralized architecture consisting of a web based interface and MS SQL backend. This project (known internally as IDE) has greatly enhanced the ability of other Air Force bases and aerospace partners to access required data for successful completion of their assigned missions and projects.• Served as technical evangelist in “selling” the IDE concept to other U.S. Air Force organizations interested in overcoming similar informational challenges.• Developed an award-winning solution to automate the collection of business process scorecard data for the Air Force Inspector General.• Leveraged research conducted for my Master’s Degree thesis to introduce the concepts and develop an adaptation of the Rational Unified Process (RUP) to guide systems development within the Air Force Reconnaissance System Program Office.