| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateJOSEPH EGBE / US CITIZENStreet Address TEL: PHONE NUMBER AVAILABLE EMAIL: EMAIL AVAILABLESUMMARY:Joseph is an accomplished Senior Business Analyst with a track record in Healthcare IT (EHR, EMR, Medicare, Medicaid and Pharmacy Benefit Management(PBM)). He has over 12 years of experience with Electronic Health Records / Healthcare IT. He is very knowledgeable in QA/Analysis/Manual and Automation Testing, UAT & Requirements documentation in the SDLC process. He has Served as an Agile/Scrum Master facilitator in core healthcare IT programs. He Liaised between IT and business Stakeholders and managing project Metrix. He is proficient in design, build and Validation of clinical workflows with the Epic Healthcare Product Modules(Ambulatory, Willow RX, Beaker., Facets Truprovider app, and TruCare app. Has worked on Utilization Management(evaluate patient care plans), Specialty Pharmacy Benefits Management (SPBM)(to evaluate specialized Pharmacy services), PBM Administrative Services(RX Networks, Mail Order Operations, Contracts and Pricing, and Member Services).TECHNOLOGY TOOLS:FACETS Healthcare Product ConfigurationTRUprovide /Provider Credentialing& ManagementEpicCare: EMR, Clinical Practice ManagementIBM CURAM SPM Business AnalystTRUCare Artifacts Config, and TruCare SecuritySQL Server: - RDBMS, T-SQL,Project Management: - MS Project2013, JiraMicrosoft Office 2019 Suite (Word, Excel, PowerPoint)Data Modeling: Erwin 7.3.1Workflow Design with Visio 2013Agile/SCRUM MasterEDUCATION:Master of Science in Manufacturing Systems Engineering, Minnesota State University, Mankato, MNBachelors of Arts in Economics, Minnesota State University, St. Cloud, MNBachelors of Science in Computer Science, Southwest State University, Marshall, MNPROFESSIONAL EXPERIENCE:KENTUCKY STATE MEDICAID/MEDICARE SYSTEM JUNE 2023 PRESENCEBUSINESS ANALYST MEDICAID/MEDICAREDocument the as-is infrastructure of the legacy system. Analyze of Provider Enrollment Management System(PEMS)Managed Provider Onboarding, Credentialling/recredentialing, Provider Data Management, Sanctions and MonitoringAnalysis and Designing Provider Data Management and Unifying ProviderID, NPI, MedicaidID, and Taxonomy code.Analysis, requirements and design of Contracted providers in MCOs and FFSMaintain real time Provider information to include: MCO affiliations, PCP status Type and Start and End date.Define Business Strategies on how to deploy the Healthcare tools and several interfaces to other healthcare productsInterface with the Gainwell Technology View 360 for Managed CareManage the patient Portal to enable patient facing communications with providers.Analysis, Requirement, and Designing of Member Enrollment and Eligibility.UAT Testing, Design Specifications to ensure requirements metBuilding as-is process flow in Visio design documentation.Interface with the Gainwell View 360 Medicaid Managed Care Solution.Utilized Jira to streamline project management and enhance collaboration within healthcare settings, ensuring efficient delivery of critical initiativesPBM:-Participated in the Analysis, Requirements, Design of Pharmacy and PBM Management and related InterfacesoAnalysis, Requirements and Design of criteria for Utilizations strategies and prior authorizationoCreating forms, and Templates: - Hepatitis c Form, PA form, Drug Classifications, FFS templatesAnalysis, Requirements and Design for PBM Clinical services: Disease Management, Utilization Management Therapeutic Substitutions, Formulary Management, and Clinical Programs ManagementCENTENE HEALTHCARE Configuration and Security Access Control. JAN 2022 JUNE 2023 CONTRACT ROLE: BUSINESS ANALYST, QA, and UAT/HEALTHCARE ITBuilding as-is process flow in Visio design documentation.Configured and Test Clinical workflows, Artifacts, and communication letters in TruCare EHR tool for multiple provider services across CENTENE operationsApplied analytical expertise in healthcare operations to improve human service outcomes and patient care deliveryManaged Security Access for TruCare Classic Controls (Add and Remove, Modify) access for Provider Services on multiple clinical platforms.Used the Role Metrix Information to determine the right application access role for each providerConduct a QA analysis of the Role Metrix Table and Test Functionality of the roles granted and Validate with UAT.Proactive in Security Team Discussions to modify, fix and or re-organization various clinician Practice access modes, privileges and platforms.Ensure the patient-Provider communications portal is simple and user friendly. Developing to-be process diagrams (Future State), developing Web use cases, developing test cases, Developing requirement traceability matricesConducting UAT/unit testing, ensuring System is working as designed.Managed the entire TruCare Classic access portfolio in coordination with the Manager and Team LeadCreated, update, track and trace the Access Security Metrics template for Understanding/Interconnectivity Security Agreements and access to the TruCare Classic PlatformCollaboratively identifying opportunities for increasing process efficiencyFunctioned as part of an integrated team sharing, advising and receiving peer reviews of products, best practices, and information across the TruCare Classic portfolio.Take the first shot at UAT by completing the Unit Testing of every completed task to see how it matches with the requirementsEBLEM HEALTH - NEW YORK / NY- MEDICARE / MEDICAID APRIL 2019 NOV 2021COGNIZANT / FACETS HEALTHCARE PRODUCT CONSULTING BUSINESS ASSOCIATEPart of Configuration team, and Change management plan to migrate from legacy systems to Facets ModulesMitigate the anticipated impact of change on resolveConfigured and supported the requirements configuration in Facets Claims Adjudication, Fee for Services (FFS) metrics, and Health plan Benefits configuration.Supported the Provider Enrollment Management System(PEMS) in the Facet Model, TRUPROVIDER.Configure Provider Enrollments, Provider Networks, Contracts Assignments, Credentialling and Provider Operations.Work with IT in a Collaborative effort to identify opportunities for increasing process efficiencySupported Facets Healthcare Product models Member enrollment and Eligibility, Plan Benefits, Provider Networks,Trained Team Members on TruProvider :- Configured and Supported Provider Credentialling and Provider Data Management, Provider monitoring and sanctions all tracked in the EHR process.Managed the provider-patient portal(HUB) to improve the patient experience by simplifying patient-provider communication.Facilitate System Testing, Unit Testing, and user acceptance testing (UAT) prior to release to production Facets Workshop Healthcare Products Configuration Analysis: - Networx Pricer and Modeler with Analytics, TruProvider, Claims Adjudication-360, Provider NetWorks, Enrollment and Eligibility, and Health plan benefits 360Used SQL to validate the backend data RDBMSSTATE OF MARYLAND- HEALTHCARE SYSTEM (DPSCS) JUL / 2017 APRIL 2019PMO / BUSINESS ANALYST ELECTRONIC PATIENT HEALTH RECORDS (EPHR)Worked as member of a PMO team, acting as a business analyst to outline, Project Purpose, Scope and directives.Developed contingency plan and Directives for the new EHR Product Design and Configuration.Manage the Change Management implementations in Modular steps to minimize errors and resistanceDocumented the current and Future State of the EHR.Analyzed the Impact of Change Management,Documented requirements for the following service programs: Labs, Medical, Mental Health, Dental, Pharmacy,Manage the documentation Human Service while assisting patient with the organization.Facilitate communications across functional tracks of the project for the project Management TeamHEALTH PARTNERS HOSPITAL SYSTEMS (EpicCare CONTRACT), OCT 2015 - JULY/2017BUSINESS ANALYST / Electronic Medical Record (EMR)Gather Clinical/Revenue cycle reports requirements in JAD sessions with Clinical/ Financial Management teamsDeveloped and build Clinical/Revenue cycle reports in BO Crystal Reports XI and visualization Dashboard reports in Reporting Workbench, and Verify all Diagnostic codes, CPT codes, and Revenue billing codes.Develop Test Case and Test Scripts for User Acceptance testing.Design contingency plan for new Clinical / Financial Report Release or OptimizationSupport all the phases of EpicCare Ambulatory Product Configuration and Change Request.Design and Build Clinical and Claims/Financial Reports for the Clinical Practice Management team.Modify existing clinical Reports, Design and build new ones, and make data available for DashboardsWork with IT to resolve, optimization issues, Data Deprecation and Data Inconsistences.Exert knowledge of HIPAA and Healthcare Compliance standardsEAST BOSTON, NEIGHBORHOOD HEALTHCENTER, BOSTON, MA APRIL 2013 - SEP 2015FUNCTIONAL BUSINESS ANALYST-Electronic Medical Record (EMR): -Analyzed data, logical data modeling, created class diagrams and ER diagrams in Rose for designing databasesBuild, maintain, and support Ambulatory Clinical Reports in Epic RWB system and SAP BO Crystal ReportsBuild, maintenance, and support Clinical Reports in Epic RWB system and BO Crystal ReportsProvide expert advice to Epic report Users on BO Crystal and Reporting Workbench (RWB).Define data requirements, evaluate data and technology needs, and formulate solutionsAnalyze data needs and requirements of existing and proposed systems.Develop technical, structural designs specification.Develop Ad-hoc Queries and reports using Epic Clarity RDMS.Utilize ticket tracking software to manage priorities and optimize customer supportKAISER PERMANENTE HEALTH SERVICES, PLEASANTON, CABUSINESS ANALYST-(EPIC Care) JUL 2010 MARCH 2013NCAL RBO: ePremis Billing and Claims Processing SystemManaged Configuration Build and maintenance for Epic Care AmbulatoryGathered Requirements, write specifications, design work flow analysisManaged Off-Shore data base Development Team and Coordinated onsite teams to resolve major build issuesManage new facility enrollment in ePremis and Facility mapping issuesManage the User security Access by User Group Templates or by Role Access PointManage Updates of Provider Data and Specialty Types ETL from CPM to ePremisManaged, Capture and Analyze all NCAL RBO ePremis Issues and resolved with ePremis-IT ACsPerform Analysis to determine Ruth causes of ePremis Issues (KPHC or Epremis-IT)Track and Drive ePremis Issues, and Escalate to Upper Management for quicker solutionsConduct JAD sessions to fine solutions for outstanding billing errors on ICD-9 transition (4010 - 5010) to ICD-10Validate date from the epic Clarity RDBMS for QA .LOCKHEED MARTIN, WINDSOR MILLS, MDBUSINESS ANALYST ON SSA DIET AND DICARS PROJECTS AUGUST 2005 JUNE 2010DIET: - Division of Integration and Environmental Testing:Conduct JAD sessions to Initiate process improvement and managed the Change controlsGathered Requirements, write specifications, design work flow analysis and mark-ups.Review test plans and validate UAT test resultsManual Testing and Analysis using SQL scripts on Disability Claim Adjudication SystemWorked on both the Client Server Software Testing and LAN Software Testing TeamPerform coordinated testing on multiple benefits and claims adjudication apps to track and catch FraudUsed SQL Scripts to build customized ad hoc reports on SSA payment verification systemsRan Automation testing on Web Based applications to complete some tasks.DICARS: -Disability Case Adjudication and Review System:Gathered Requirements in Rational Requisite ProThis application provides the State disability determination services (DDS) with a description of SSAPerforming business systems analysis on Dicars Systems and impact Analysis on multiple systemsReversed Engineered the entire Dicars Database into a Data Model Using Erwin 5.2.3Remodeled the database and Created data dictionary and meta-data into a spread sheet for business usersDevelop traceability matrix for business and software requirements using RUPDeveloped Work flow Analysis, Business process models and Architecture infrastructure diagrams in Visio 2003Design and build integrated prototypes using Rational Process ModelerAttend brainstorming JAD Sessions for Dicars Report System Project |
