System Analyst

Configuration Architect

Configuration Architect for multi-state Medicaid, Marketplace, Medicare, Dual Eligible health plan. Supported plans full product portfolio related to Facets solution design and standards. Also represented Facets platform in coordination with solution architects across the plans entire enterprise solution. Created and delivered end to end Facets based resource competency development program. Configuration automation and QA lead for regional Client Health Plan. Responsible for the development of Service Payment and Benefit automation utility solution Configuration Design Lead for implementation of State Exchange based QHP product line Configuration Design Lead and Project Manager for Health Plan product line expansion into new Commercial and Medicaid lines of business Configuration design lead and team manager of Facets implementation and systems conversion for large regional Client Health Plan. Included analyst and design around Medical Plan, Provider/Network, Capitation, Billing, ASO, Workflow, Customer Service and Subscriber/Member Project Manager over system conversion and Facets implementation of managed Medicaid and Medicare product lines. Implementation and Configuration Lead (Provider, Plan/Product, Capitation, Billing, Claims, Utilization Management, NetworXPricer). SQL configuration-based scripting Configuration team training Project manager over successful Facets system release upgrade.

Most Recent Engagement Summary Facets Configuration Architect o Configuration Remediation Initiative Led effort to harvest benefit configuration data from production system to identify opportunities for improvement against newly developed benefit code sets o Developed program to extract all Facets configuration data into usable format to support analysis of benefits configuration. Solution allowed for the input of procedure code and revenue code data to produce existing configuration reports across all conversion and supplemental conversion tables. o Developed Architect Enhancement Review Program Created and implemented new program to provide cross solution review, solution, and approval with enhancement requests. o Developed logic to extract Pre-authorization information from Facets system to support Pre-Authorization review initiative, and Provider PA Look-up tool o Developed configuration standards and new foundation configuration to support new business expansion and allow for greater scalability and shared code sets between product lines. o Managed 20 staff configuration analysts in support of Break-Fix and Enhancement requests related to Facets configuration. o Developed and implemented Facets Resource Development Program. Program included assessment of staff configuration analyst and training on the entire core Facets system. o Lead configuration analyst in support of complex configuration requests, analysis and build. Role included addressing escalated issues and new configuration from Senior Management. o Facets Configuration Design Lead for pilot fee-for-service Medicaid platform development. Led all aspects of global design to support re-usable platform for multi-state offering. o Led the implementation of new Facets BPA supplemental design and build as part of ICD10 project. Solution included the automated conversion of existing supplemental configuration into the BPA based design.