Candidates About

 

            Carrie Godinez                                  

 

                                                                                                                                               

 

EDUCATION    

 

St. Cloud State University, Computer Learning Center (CLC) – Programming Graduate

 

Certifications:  

Project Management Leadership

PMI Risk Management

QAI Certified

Oracle Case Tool, UNIX

CA State Insurance/Claims

                                                                                                                                               

 

SUMMARY

• Project Management, Program Management, Release Management
• Sr. Project Manager
• Lead Business Systems Analyst
• Sr. Business Analyst  
• QA Manager                 
• Technical Analyst
• Business and Systems Analysis, Planning and Development, Risk Management, Cost Benefit Analysis, Contract Negotiations, Coso/Sarbanes-Oxley Expertise.

 

Professional Qualities/Expertise

• Focused self-starter with strong analytical expertise, complimented by a proven track record involving process development, project management, and quality assurance.
• Program Manager, Project Manager experience in Defining SOWs, Vendor Acquisition, Contract Negotiations, Contract Agreements, Legal Review with Legal Dept., Resource Planning and Administration for both On-Shore and Off-Shore resourcing, Resource Billing Approvals
• Business Systems Analyst and Quality Assurance Management expertise; Planning, Forecasting, Reporting, QA Release Management.  
• Solid background in use cases, UML, BRD’s, SRD’s and process flow diagrams.

·         Developed and lead process design and improvement initiatives, guiding teams across the business.

·         Responsible for conducting process analysis from beginning to end, including process flows through systems and business rules.

·         Personable and cooperative demeanor for effective cross-functional team success.

·         Business professional, exercising high ethical and quality standards.

·         Effectively able to balance creative thinking with logical process design, while enjoying the opportunity to develop and implement cost effective solutions.

·         Ability to remain flexible, yet disciplined to achieve project objectives in a timely manner.

·         Detail-oriented and hands-on approach to assure maximum performance in quality deliverables.

·         Domestic, International, and Global expertise as it relates to managing and analyzing project and system enterprises.

·         Expertise in Insurance – Medical, Lifestyle Management, Claims, Eligibility, Compliance, etc., Financial Applications, Retail Consumerism

·         Applications, Medical/Pharm Claims, Billing,  Commissions, Genealogy, Nacha, TSYS,  Property Bridge Payment Transaction Application, SAP

PROFESSIONAL EXPERIENCE

Business/IT Consultant                                                                                       10/2013 – Current

Clients/Projects:

 

IEHP – Sr. Project Manager/Business Process Engineer                                      10/2015 – 08/2016

IEHP/ Login Consulting – Rancho Cucamonga

Sr. Project Manager / Sr. Business Analyst

·         Interacted closely with IEHP Chiefs, Department Leads, Technical and Operational Staff, and External Partners (Landmark) to define the project parameters and developed detailed project documentation to include project charter, business requirements, project plans, project schedules, workflow solutions, project status reports/communications, Executive WSR, Issues, Raid Log, and action item tracking.

·         Managed system implementations, internal/cross functional department process improvement initiatives, implementation of program plans.

·         Managed all aspects of assigned projects throughout the development project lifecycle including project scope, schedule, resources, quality, costs, invoices, and change requests

·         Managed SOW, Contracts, and associated deliverables, including budget and invoice approvals

·         Developed and maintained detailed project plan to include milestones, tasks, and target/actual dates of completion.

·         Worked with Legal to obtain BAAs, Contract Addendums, Physician Credentialing

·         Created Charter to include Contractual deliverables, along with managing project to incorporate project deliverables across the organizational departments, systems, and Landmark Vendor processes.

·         Conducted Project Kick-off meetings, JAD, and Process work sessions, joint scheduled project status update meetings.

·         Developed process workflows as it related to internal and external operational departmental processes including claims, member services, CMS, enrollment, accounting, behavioral health, etc.

·         Defined and Developed SRS (Systems Requirements Specifications) File layouts for Eligibility, Claims, Lab, Diagnosis, Rx Claims, Census, Authorization, Engagement, Quality files.

·         Implementation and release manager

·         Co-managed and created agendas for JEC and JOC meeting presentations

·         Project Manager for Business Continuity Program, Crisis Management, Emergency Preparedness, and Disaster Recovery

o    Emergency Preparedness - Active Shooter Plan, Training Video, Communications Plan

o    Crisis Management – Crisis Management Plan, Training Video, Communications Plan

o    Business Continuity – Business Impact Analysis (BIA), Technical Impact Analysis (TIA), Critical Impact Analysis and Recovery to Business Processes, Systems, and Staffing

o    Project Manager for Continuity Logic’s Frontline application set-up and installation

·         Project Manager for Enterprise Facilities Expansion to include the re-construction of two floors impacting over 1k employee relocations

TekSystems– Sr. Business Analyst Consultant                                                  5/15 – 07/15

Harbor Systems – Irvine CA                                                                                          

Sr. Business Analyst

·         Responsible for conducting process analysis from beginning to end, including process flows through systems and business rules.

·         Defined and developed Business and Functional requirements for Web Based applications.

·         Documented Web Application for reverse engineering purposes.

·         Developed requirements for File layouts and file processing relating to Medical and Claims data.

·         Defined Use Cases, Requirements, Wireframes, Technical Requirements, QA Testing, and User Acceptance testing.

·         Provided system and user testing for file processing.

·         Created and processed Invoice Reporting related to Claims Processing for Clients

Ryte Pros– Sr. Business Analyst/Project Manager Consultant                          10/14 – 02/15     

Smile Brands Corp. – Irvine CA 10/14 – 02/15

Sr. Business and System Analyst/Project Manager                      

·         Defined and developed Business and Functional requirements for new BI Data Warehouse, Web Based applications, Legacy (QSI,) systems, Corporate and Operational Metrics Reporting, Marketing Campaigns, and Collections reporting in support of Dental Offices in five states.

·         Developed requirements for File layouts and file processing relating to Market campaign data to include Mongoose data, Ripcord Data, Call-Center data, and Cogensia data.

·         Developed requirements for Analytics reporting.

·         Defined Use Cases, Requirements, Technical Requirements, QA Testing, and User Acceptance testing.

·         Provided system and user testing for file processing. Documented all systems processes, user processes, and user access, for Audit Compliance of all Smile Brand systems.

·         Responsibilities included the gathering and documentation of business and system requirements, analysis documents, entity relationship models, dataflow diagrams, process specifications and business case development. Responsible for conducting process analysis from beginning to end, including process flows through systems and business rules. Developed and lead process design and improvement initiatives, guiding teams across the business.

KForce – Sr. Business Analyst/Project Manager Consultant                                         10/13 – 08/14

Fidelis Senior Care – Newport Beach CA (KForce Consultant) 05/14 – 08/14

Sr. Business Analyst                            

·         Defined and developed Business and Functional requirements for Web Based Medication Therapy Management Programs for Medicare and Medicaid, for 12 states; and Dual Programs for 5 states.

·         Responsibilities included gathering and documenting business and system requirements, analysis, entity relationship models, dataflow diagrams, process specifications and business case development.

·         Included Member Claims, Members RxClaims, Lab, Provider information Processing. Medical Claims billing for Physician, Hospital, Urgent Care, Long term Care, Pharmacy, Dental, and Miscellaneous.

·         Data download support relating to Account Set-up, Member Claims, Member RxClaims, Lab Data, and Provider Data in support of Episource.

·         Defined files layouts for Claims, RxClaims, Lab, Provider files. Defined and Coordinated member data across Client and Episource platforms.

·         Defined Business requirements for MI Demonstration project.

·         Defined Report Requirements for Managed Care, UM, and Quality CMS reporting.

·         Created dataflow diagrams, System applications Upstream and Downstream Process flows for current and Legacy systems. Defined process job processes and timing events.

Molina Health Care – Long Beach CA (KForce Consultant) 10/13 – 04/14                                       

Sr. Business Analyst/Project Manager

Sr. Business Analyst                      

·         Defined SOWs, Vendor Acquisition, Contract Negotiations/Pricing, Contract Agreement, Legal Review for On-Shore (Medication Management Systems, Inc., and Off-Shore Resources.

·         Defined and developed Business and Functional requirements for Web Based Medication Therapy Management Programs for Medicare and Medicaid, for 12 states; and Dual Programs for 5 states.

·         Responsibilities included the gathering and documentation of business and system requirements, analysis documents, entity relationship models, dataflow diagrams, process specifications and design, and business case development.

·         Developed and lead process design and improvement initiatives, guiding teams across the business.

·         Responsible for conducting process analysis from beginning to end, including process flows through systems and business rules.

·         Included Member Claims, Members RxClaims, Lab, Provider information Processing. Medical Claims billing for Physician, Hospital, Urgent Care, Long term Care, Pharmacy, Dental, and Miscellaneous.

·         Data upload and download support relating to Account Set-up, Member Claims, Member RxClaims, Lab Data, and Provider Data in support of Managed Care Therapy Programs for Case work outreach for members with chronic diseases and respiratory illnesses. Data down-loaded to Third-party vendor application, MMS Assurance application. Assurance application used to manage member care services for RxPharmacy recipients; and provide additional one-on-one member care services.

·         Defined files layouts for Claims, RxClaims, Lab, Provider files. Defined and Coordinated member data across Client, MMS Assurance, and Caremark platforms.

·         Defined and wrote all test cases, test scenarios, and test scripts to support Functional, Integrated, End-to-End, and User Acceptance testing. Performed Functional, Integrated, End-to-End, and User Acceptance testing across three platforms. Validated File details relating to Initial and Supplemental data attributes, size, format, qualifying conditions, data range within specific date parameters, file naming conventions.

·         Defined and developed Business and Functional requirements for Data Conversion for Claims, RxClaims, Provider, Lab, and Member Eligibility for HEDIS measures and reporting for Conversion to Inovalon QSI ver 17. Conversion of Medicare/Medicaid Current/Historical activity for IL and SC.

Project Manager

·         Interacted closely with internal staff, external corporate departments, and Health Plan program managers to define the project parameters and developed detailed project documentation to include project charter, business requirements, project plans, project schedules, workflow solutions, and project status reports/communications.

·         Managed system implementations, internal/cross functional department process improvement initiatives, implementation of new state health plans, and implementation of new product lines.

·         Managed all aspects of assigned projects throughout the development project lifecycle including project scope, schedule, resources, quality, costs and change requests.

·         Developed and maintained detailed project plan to include milestones, tasks, and target/actual dates of completion.

·         Revised project plans as appropriate to meet changing needs and requirements.

·         Prepared and submitted project status reports and dashboard reports to management.

·         Scheduled and conducted project meetings which included: logistics, agendas, and meeting minutes. Conducted regularly scheduled project status update meetings.

·         Developed process workflows as it related to assigned projects and the support of internal process improvement initiatives.

·         Interfaced, when appropriate, with all areas affected by the project to include internal subject matter experts, external corporate departments, and Health Plans; and worked as the liaison for department on enterprise wide projects.

·         Created project management deliverables such as Project Charter, WBS, schedule, roles & responsibilities document, meeting agendas/minutes, issues and action items tracking.

·         Implementation and release coordinator for MTMP project implementation for 4 project delivery installs.

StrataCare an ISG Co. – Irvine CA                                                                                 08/12 – 07/13

Sr. Business Analyst

·         Developed requirements for Web Based Workers Comp Claims Processing, with focus on the processing of Medical billing for Physician, Hospital, Urgent Care, Long term Care, Pharmacy, Dental, and Miscellaneous. Emphasis on Financial billing and balancing. Data upload and download support relating to Account Set-up, Claim Incident Detail, Billing Claim Detail, EORs. File Processing of 837 – 5010X222, 223, 224, 221; NCPDP. Acknowledgment files 005010 TA1, 231 (999), 214/213 (277), 210 (275). Configured Application to be in support of State Compliance Regulations for all US states and 3 territories. Supported Customer Service Application, and Reporting application.

·         Served as Sr. Business Analyst Liaison between Business and Technical Team for Application development

·         Supported thousands of clients; including three major Insurance Carriers and their client base.

·         Defined Business Requirements and Systems Requirements for over 200 project requests.

·         Defined Business Requirements and Systems Requirements for StrataWare Premium Application Suite.

·         Defined Business and System Requirements to support Automated or Paper Billing processes.

·         Supported thousands of transactions per day.

·         Reviewed all QA Test Scenarios, Test Scripts to ensure traceability to requirements.

·         Provided approvals for all QA phases.

·         Reviewed all test results and worked with QA to address QA test scenarios and scripts.

·         Wrote User Test Cases. Wrote Training Documentation. Performed Testing/Testing Oversight.

·         Worked with QA and IT to resolve test issues.

·         Ensured Testing conformed to Company mandates and expectations.

·         Sr. Business Analyst for Workers Compensation Medical Claim System. Responsible for ensuring that user needs were defined, organized and articulated in the form of actionable requirements that could be validated with users and acted upon by IT.

·         Primary focus was on the interpretation and documentation of user requirements, and providing a bridge between stakeholders and IT throughout the development life cycle. Agile was the preferred methodology at StrataCare.

·         Created Business Requirements Documents (BRD) and System Requirements (SR) as it related to system applications and processes.

·         Validated requirements with stakeholders, ensuring user needs were clearly and accurately captured.

·         Applications: StrataWare, Enterprise Mngt Suite; QA Test Suite – multiple environments. Language base: Java J2EE, WebSphere, PL/SQL, Oracle, DB2, HTML.

 

Harvey Nash Consultant - Riverside CA                                                                        07/11 – 05/12

York Risk Services Group, Inc. - Sr. Business Analyst

·         Developed requirements for Web Based Claims Processing, Accounting System, Customer Service Application, and Reporting application.

·         Main Sr. Business Analyst Liaison between Business and Technical Team for Application development

·         Defined Business Requirements and Systems Requirements for 30+ projects

·         Defined Business and System Requirements and Conversion processes to support Automated Billing

·         Primary liaison between York staff and the offshore vendor to oversee application requirements.

·         Train the QA staff on the claims application.

·         Reviewed Master Test Plan to provide approvals.

·         Reviewed all QA Test Scenarios, Test Scripts to ensure traceability to requirements.

·         Provided approvals for all QA phases.

·         Reviewed all test results and worked with QA to address QA test scenarios and scripts.

·         Wrote User Test Cases. Wrote Training Documentation. Performed Testing/Testing Oversight.

·         Worked with QA and IT to resolve test issues.

·         Ensured Testing conformed to Company mandates and expectations.

·         Sr. Business Analyst for Workers Compensation Medical Claim System. Responsible for ensuring that user needs were defined, organized and articulated in the form of actionable requirements that could be validated with users and acted upon by IT.

·         Primary focus was on the interpretation and documentation of user requirements, and providing a bridge between stakeholders and IT throughout the development life cycle.

·         Interviewed stakeholders to clarify improvement opportunities.

·         Created application specifications for Financial Application, EDI transmission/E-Billing, Network Modifications, Management and Detail Report Automation for 1K+ Clients.

·         Developed Business Requirements Document (BRD), based on user interviews and review of current state workflow/systems.

·         Created System Requirements Documents (SRD) as it related to system applications and processes.

·         Validated requirements with stakeholders, ensuring user needs were clearly and accurately captured.

·         Evaluated process workflow/system functionality within context area; identified improvement opportunities.

·         Worked with IT team to interpret requirements into actionable specifications. Served as liaison to User and IT throughout system development life cycle.

·         Coordinated communication and resolution of all issues pertaining to the BRD and SRD.

·         Applications: Claims Connect, WorkLink, TechOne, QA Test Suite – multiple environments. Language base: Java J2EE, WebSphere, PL/SQL, Oracle, DB2, HTML.

 

Prescription Solutions (UHG) – Consultant, Irvine, CA                                       08/10 – 02/11

Sr. Systems Analyst – Lead

Reason for leaving: Hired to specifically deliver RX Claims by January, 2011; project was delivered.

 

·         Technical liaison between IT and business users for the RxClaim System,a client server and web application using WebServices and legacy system using DB2.

·         Responsible for business system requirements; gathering artifacts and working heavily with end users.

·         This included project oversight, coordination of activities, and oversight of testing and training for a number of deliverables.  

·         This RxClaim System was a client server and web application using WebServices and legacy system using DB2.

 

Robert Half Technologies, Contractor, Bloomington MN                                  10/08 – 03/10

 

Selected Clients/Projects included:

 

SuperValu – Eden Prairie MN (09/09 – 02/10)

QA Lead/Business Systems Analyst

Reason for leaving: Project completed and relocated to California

 

·            Defined SOWs, Vendor Acquisition, Contract Negotiations/Pricing, Contract Agreement, Legal Review for Off-Shore Resources (TaTa) and Staffing from Portugal.

·            Provided fiscal budgetary estimates and acquired and managed TATA on-shore and off-shore QA resources.

·            Managed TATA on-shore and off-shore resources to ensure Test Plan, Test Scenarios, Test Scripts where met to address the requirements for testing through full stream test processes, including regression testing. Ensured that the appropriate training was provided so that testing could be conducted successfully across entire Enterprise.

·            Monitored TATA staffing to ensure staff retention was adhered to for project success. (Monitored revolving door of staffing, to ensure off-shore staff was not using different QA staff (less qualified new-comers) under the same name. (Experienced this with TATA for both SuperValu and CIGNA.)

·            Worked with QA and IT to ensure all test issues were resolved.

·            Provided Reporting of QA results through all phases of testing.

·            Ensured Testing conformed to Company mandates and expectations.

·            Responsible for a cross-functional conversion project from 10 legacy systems to centralized web based and client server applications. Used an Oracle platform across multiple applications in support of business objectives.

·            Responsible for working with end users and gathering business requirements.

·            Wrote use case and UML diagramming.

·            Created comprehensive Roadmap to manage the overall pipeline of project work.

·            Created program and project level test strategies and plans.

·            Developed and implemented project plans consistent with project objectives, business requirements, and financial parameters.

·            Provided guidance to IS, IT, and Client team members with the goal of process improvement and overall project management quality.

·            Accountable for the project scope, planning, scheduling, execution, and completion of projects while managing risk concerns, and budgetary objectives.

·            Worked with team members in Domestic and International countries.

 

Prime Therapuetics, Eagan, MN (06/09 – 08/09)

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