Candidates About

Anthony Sullivan

SUMMARY OF QUALIFICATIONS

·         Possess excellent communication and interpersonal abilities

·         In-depth understanding of Software Development Life Cycles

·         Demonstrates the ability to prioritize and manage both small and large project deliverables

·         Strong analytical, research and problem solving skills

·         Prioritize and manage concurrent projects

·         Ability to meet deadlines and ensure internal customer satisfaction

·         System knowledge includes, FEP Direct Claims Processing System, NASCO Mainframe and eFDE Claim Processing System, Total Processing System Mainframe, Cognos Data Warehouse, SharePoint, Benefit Workstation, IBM Rational Clear Quest, HP Quality Center, Transaction Management, Blue Serve Connect,  SharePoint, Worksite, Project In Vision, Microsoft  applications (Word, Excel, PowerPoint, Project Server, Access and Visio)

PROFESSIONAL EXPERIENCE

Blue Cross and Blue Shield of Massachusetts                                                                 2014 to Present

Federal Employee Program (FEP) Senior Business Analyst                                          

·         Leads work associated with NASCO initiatives with a primary focus on claims processing.

·         Represents the FEP Business with decision making responsibilities in meetings and workgroups

·         Leads small, medium and large scale projects to completion

·         Perform impact review for BCBSMA Corporate projects to determine if there are any impact to the FEP Business

·         Coordinates testing to ensure positive outcomes and results   

·         Identifies and implements operational improvements that increase member satisfaction and improve the FEP performance goals

•      Prepares documented responses to the FEP Business Unit regarding updates on system

        issues/problems
•     Actively communicates with leadership and other key stakeholders to summarize results

       using reports, data and other methods
•     Develops and makes recommendations and alternatives based on fact driven data and

       analysis
•     Fosters a cohesive team environment  
•     Provide subject matter expertise and actively contribute in planning and requirement

       sessions

·         Conducted daily, weekly, Monthly , Quarterly as well as adhoc reporting 

·         Other projects as assigned

 NASCO Migration Program (NMP)                                                                                

System Business Analyst                                                                                                     2012 o 2014

·         Acted as a liaison between internal customers, IBM and NASCO Business partners

·         Facilitated requirement gathering sessions with BCBSMA stakeholder

·         Developed Change Requests for NASCO enhancements as needed

·         Created NASCO Change Requests in the NPS system as needed

·         Provided testing areas with recommendations and strategies as needed

·         Provided assistance to the NASCO Configuration Team with GENO Table, Files and other application updates when needed

·         Identified, researched and reported system-related discrepancies and suggested recommendations for resolution

·         Performed root cause analysis of post-production issues while following through to resolution

·         Performed system validation to ensure that all pertinent data to membership and claims was migrated

Into the NASCO system accordingly 

·         Fostered and maintained solid working relationships with NASCO, IBM and internal customers

·         Developed and distributed NASCO Production notifications to IT and Claim Operations 

·         Monitored NASCO Migration Mailbox

·         Conducted periodic and adhoc reporting for NASCO Command Center, Claims Production Support, Sales and Operations as needed

·         Other projects as assigned

Customer Relation Management (CRM) Application Analyst                                     2011 to 2012

·         Performed gap analysis on business rules in Total Processing System and NASCO Processing System for product migrations to NASCO

·         Performed minimal Pega configurations in Blue Serve Connect (CRM)

·         Facilitated requirements gathering sessions with  stakeholders for enhancements to Blue Serve Connect

·         Conducted periodic and adhoc reporting

·         Other projects as assigned

MERCER                                                                                                                                 2010 to 2011

Health and Benefit Analyst

·         Acted as point of contact to Columbia Broadcasting System(CBS) Human Resources on behalf of retirees and active employees

·         Maintained a close working relationship with CBS point of contacts  

·         Coordinated with internal subject matter experts to ensure that deliverables were met timely

·         Communicated escalated  issues to CBS Human Resources for resolution on a weekly basis

·         Reviewed daily, weekly and monthly CBS  HR files and made necessary updates in Benefit Workstation when applicable

·         NDMd and FTPd files to Health Insurance carriers, Prudential Insurance and Ceridian

·         Created test plans and executed testing on customized web application as well as Benefit Workstation  when coding changes were implemented in Benefit Workstation

·         Other projects as assigned

Hewlett Packard @ BCBSMA                                                                                             2006 to 2010                         

Business Service Analyst

·         Performed stakeholder analysis and requirement gathering sessions for enhancements   

·         Prepared business documentation defining the project requirements and  functional scope for developers

·         Developed test cases, scripts and test data to support all phases of system integration testing

·         Communicated defect to developers timely

·         Performed QA testing while providing assistance in UAT testing

·         Identified issues ensuring that they are reported, tracked, and resolved in a timely manner

·         Assisted in the enforcement of project timelines

·         Provided direction to Business and Quality Analysts as needed

·         Responsible for the configuration of GENO Table, Files and other application in the Total Processing System

·         Extracted reports from Total Processing System and customized them per customer requests

·         Carried out various internal audits  

·         Conducted periodic and adhoc reporting

Accomplishments - Proposed and received EDS/BCBSMA leadership approval to implement “eApproval”, which replaced the manual sign off of pertinent documentation related to projects.  This process eliminated paper as well as distorted documentation as a result of fax transmissions.   Due to this method of sign off the Audit and Risk Management department was provided legible documentation.    Received the 2008 Process Improvement Award.

Perot Systems - Harvard Pilgrim Health Care Account                                                1999 to 2005                                                 

EDI / UAT Business Analyst                                                         

·         Coordinated testing for all phases of AMYSIS configuration

·         Prepared test scripts while building necessary test data

·         Identified new and evaluated previously discovered defects

·         Provided analysis of the testing progress, defects and relevant information to IT developers

·         Provided  training to new and fellow UAT associates as needed

·         Tracked and troubleshot high priority issues with both business and IT

·         Researched and the resolved phone and written inquires pertaining to electronic claim submissions

·         Identified root cause of rejected transmission and denials after batch uploads into the AMYSIS

·         Developed and provided training to claims divisions and the provider call center

·         Participated in monthly HIPAA guideline meetings to review system upgrades and determine the impacts to the current EDI claim processes

·         Initiated bulk claim recycles when required.

Harvard Pilgrim Health Care                                                                              1996 to 1999

Provider Service Representative

Accomplishments - Implemented an excel concatenation that allowed the entry of 1000+ claims into batch processing.   This process expedited testing efforts, eliminated the need to hire 3 FTEs and amounted to a $100,000.00 + saving.

Innovation Award recipient 202 and 203

EDUCATION

·         Boston State College - Medical  

·         Boston Business School - Business Administration

·         Roxbury High School - Business Administration