Diana Carter             

Brightdesertsky@yahoo.com 801-529-5047

I have more than 25 years of professional information technology experience, with significant experience with business process and analysis, project management, software development life cycle (SDLC), AGILE methodologies, requirements gathering, electronic medical records (EMR), HIPAA compliance requirements,  Medicaid, Medicare and CMS compliance requirements,  data validation,  claims reprocessing and testing, SME on architecture, claims reprocessing, natural language processing (NLP) in medical environment, multilingual and technical documentation, LMS, ERP, statement of work (SOW), and process improvement, project panning using MS Project and TFS, process infrastructure design, collaboration, communication, and management. 

This experience supports the desire to improve the business processes, project value, and quality, all of which contribute to the bottom line with an employer who values a team player. 

 

Employment History

CNSI

Medicaid Architecture Project Management Business Lead

•          Identification and reporting on architecture issues.

•          Identify the need for project change requests, documentation and reporting.

•         Lead a team of business analyst to validate technical requirements and conduct requirement management activities and communicate status, issues and risks. 

•         Conduct requirements management activities, create/update/maintain requirements specification documents, including use cases, general system design documents and detailed system design documents. 

•         Work with developers to define and design solution across all system components, and identifies all configurations and builds task.  Reviews and relates information to customer on "As Is" and "To Be" business process work flows. 

•         Act as the Medicaid subject matter expert (SME) for System Architecture, Program Intergity and Case Management business areas which include Interfaces, HIPAA, Optical Character Recognition - Imaging, Correspondence, Document Control, Common System Components.  Responsible for understanding and implementing business aspect of MITA. 

•         Lead collaborative sessions to document Medicaid business processes.  Review on going MITA assessments and assist in the development of processes to aquire higher MITA levels.   Provides requirements statements and business rules to articulate end-user functionality. 

•         Report and directs assigned MITA business areas to customers and executes deliverables on status, risk, action items and decisions.  Ensure all business area requirements are included in the overall requirements documentation and design documentation and communications (oral, electronic) with State Representatives. 

 

Software Technology Group (STG)              2012- 2013

Business Analyst

Responsible for the development of custom software for clients across multiple industries.

•          Gathers requirements and high level acceptance criteria, and turns them into User Stories and specific acceptance criteria as well as Use Cases and Screen Casts/Wire Frames as needed. 

•          Employs data mapping techniques that allow programmers to reuse SLQ code across multiple reporting platforms.

•          Writes technical documentation surrounding customer requirements and database mapping to include data dictionary creation and application page level elements documented to include API calls, methods, start/send points, validation, unique parameters, triggers, and table and columns used.

Veterans Administration (RHI) (Salt Lake City, UT)              11/02/2009 – 03/30/2012

Scientific Systems Business Analyst             

In support of Open Source Annotation Software, Biometric Natural Language Processing (NLP), Ms. Carter was responsible for the following:

•          Work with product owner to identify and build specific use cases using business and clinical data to determine performance measurements for patient care, clinic and hospital best practices, document process’ and support of implementation(s)

•          Gather requirements for software application to support performance measurements, train clinical staff nationwide on performance pieces of the software application and make adjustments to the use cases as needed to refine the  performance criteria

•          Performed requirements gathering for use cases, QA test cases, user stories for annotation and NLP software. 

•          Created test data, Knowledgebase Engineer providing three-tier escalation support and documentation, training and analyzing performance of first and second tier support staff; worked with technical groups to provide specific process and technical Knowledge Base content and drive IT application corrections to better suit end users, some project management on specific applications; worked with researchers nationwide to gather research requirements to feed into development requirements. 

•          Worked on the applications implementation team preparing demonstrations and training to researchers and research coordinators nationwide. 

•          Used the SharePoint system to create sites, set permissions, create and add content to the lists and libraries and gather requirements for new features.

•          Created (using specific methods and metrics) and distributed surveys to the national NLP and Annotation user community; collected, analyzed and created reports on survey findings; and made recommendations that affected team goals from collected information.

•          Wrote policy and procedure documents required by the government to obtain, and comply with, regulatory and research requirements, as dictated by Congress.

RxAmerica (Salt Lake City, UT)                                         08/01/2007 – 11/01/2009

Compliance/Lead Risk Systems Business Analyst

Ms. Carter was responsible for HIPAA compliance requirements, CMS compliance requirements, and Medicare and Medicaid compliance requirements

•          Work with Medicare and Medicaid claims data to audit/ review and validate against production and data warehouse databases, identify possible issues, research (all or specific) providers, pharmacies and system software to determine cause of issues and put a fix in place and set up process alerts for possible future issues..

•          When provider and pharmacy problems are identified I compiled all of the data, facts, testing scenarios and the emails (from providers and account managers) for the abuse and fraud group to follow up on

•          Gather new regulation business requirements from Medicare and Medicaid and turn them into system requirements and create and implement new performance processes( to ensure compliance (system, providers, pharmacies)

•          Wrote statements of work (SOWs) to optimize compliance performance and tracking.

•          Tested and debugged Pharmacy Benefit software, set up testing scenarios, and helped with software upgrades.

•          Analyst assigned to Claims Reprocessing and Prescription Drug Event (PDE) claims resolution and error reduction, found a system anomaly that affected all providers and the individual prescription payouts reclaiming 250+k in overpayments.

•          Worked with account managers and clients to resolve claims issues.

•          Created processes to mitigate continued processing issues.

•          Researched, defined, and created compliance/performance policy and procedure documents as required by Medicare and Medicaid for government compliance, as well as trained departments on new compliance regulations.

•          SME on claim processing provider services for Medicaid and Medicare/compliance performance.

•          Set up Medicaid payment processes, risks, and metrics for cross departmental and customer performance evaluation and continued improvement (set up benchmarks).

•          Provided enrollment and claims services for account executives and providers.

The Possibility Forge (Hurricane, UT)              01/15/2005 – 07/30/ 2007

Project Manager/Business Analyst

Responsible for various Open Source software applications, including: Open Electronic Medical Records (EMR), Compiere, Enterprise Payroll Software applications, Nations Information Health Network (NIHN), HIPAA compliance, and Medicare compliance requirements.  Documentation delivery both printed as well as web delivery.

•          Supported existing marketing processes and aligned project objectives and expectations across client, marketing, finance, and development groups.

•          Gathered client business, user, and software requirements, and charted and analyzed client business and user processes into use case and process flow diagrams for software programmers.

•          Supported application implementation with follow up testing and client training.

•          Wrote users manuals and guides for client adapted open source and enterprise software projects.

•          Tested alpha and beta level development software prior to client review.

•          Collaborated with individuals throughout the internal and external organization at many different levels of management.

•          Defined and created organizational policy and procedure and departmental work standards  documentation

•          Regional provider clinic software implementation in:

•          Electronic Medical Records (EMR) interoperability

•          Provider management using ICD and SNOWMED coding

•          Medical clinic: streamline patient record capture through claims submission and collections.

•          Worked with providers to ensure correct claims are captured and optimized per clinic

•          Open Source software solution with integration solutions.

•          Private business CRM, accounting, payroll, inventory management, and logistics.

•          Government payroll systems.

LearnKey              09/15/2004 – 01/10/2005

Project Manager Technical Support/Programs & Services

Responsible for the Enterprise Software.

•          Managed and directed the daily budget, customer interaction, and business training activities of the Technical Support, Programs and Services Team of nine to include software, printed materials, custom dvd’s and program rollout implementation.

•          Supported a worldwide client base of 50K direct site customers and 750K end users of enterprise e-learning software through technical and business implementation at client sites, and continued monitoring and follow up of staff and administration training and business use and contract renewals.

•          Presentation of e-learning format, key customer statistics, and success stories to sales representatives and resellers worldwide through demonstrations and documentation, as well as helping sites to build website content.

•          Created, documented, communicated, and implemented customer and end user e-learning goals, metrics processes, and training cross functionally; and increased new administrators and users trained in one day from 50 to more than 850 with a customer contract renewal rate of 75%.

Builder Network              08/01/2002 – 09/20/2004

Marketing Director/Business Development Analyst

•          Presentation and training of construction enterprise software to investors, construction developers, contractors, and tradesmen.

•          Gathered customer business, user, and software requirements.

•          Analyzed and charted client construction building process and user processes into process flow diagrams for software programmers.

•          Performed process analysis, process flow of subcontractors processes (all subcontractors throughout the home building and business plaza development process) and timelines, as well as risk factors and dependencies

•          Provided on-site training to subcontractors

•          Created proprietary project templates and documentation for customers to print or upload and use with the enterprise software program.

Iomega              10/01/1986 – 07/30/2002

Project Manager /Software R&D/Technical Publications

•          Program scope, schedule, budget resource and planning to support company initiatives and product launches.

•          Worked with the Customer Satisfaction Team to reduce customer returns by analyzing returns information and implementing documentation testing and incorporating needed changes prior to product launch.

•          Led technical publications team in the creation of new a multilingual, template based, end user documentation and system software package enabling the company to successfully introduce new products worldwide at launch.

•          Worked with International partners for pre-release documentation of product features to prime the sales pipeline.

•          Captured one year of worldwide revenue on all the following corporate product launches.

•          Six Sigma Certification Project saved the company $2 million in cost reduction and was key to the success of the Hip Zip Product Team winning the Rochester Institute of Technology and USA Today Quality Cup Award.

Project Assistant Hardware R&D

•          Offloaded projects for CTO, Sr. Director’s and Engineering staff, including Gap analysis, establishment of department and organization processes for ISO certification, and creation of expanded bill of materials (BOM), with costs, for possible new products.

•          Researched new technologies, product returns, regrettable engineering changes, firmware changes, and revision changes on 2D mechanical drawings.

•          Hardware and software testing and reporting.

•          Support team infrastructure for new and existing product development and launches.

Manager Customer Satisfaction /RMA Returns

•          Managed corporate and end user customer satisfaction returns group of 15 in daily activities of stock rotation, issue credit, defective returns, and unapproved returns. Responsibility also included a two-day turn around on testing and tear down of product returns and recovery of salvaged parts usage according to legal requirements with an average inventory level of $2 million.

•          Collaborated with sales, order entry, customers, purchasing, and product suppliers worldwide to reduce customer return rate of CDRWs from 32% to 3% using solid statistical approaches and process controls.

Human Resources Administrator /Specialist

•          Administration of corporate education and training.

•          Directed and administered the education program including college/university program acceptance and tuition reimbursement.

•          Administered the on-site National Technological University course work and testing community scholarship program and candidate selection.

•          Coordinated compensation and benefits government compliance, employee questions and inquiries.

•          Gathered and recorded employee retention statistics.

•          Participated in recruitment and job fairs for the research and development department.

•          Screened and interviewed potential employees.

 

Education

Business Administration, Weber State University, 1983 – 1985

University of Phoenix, 1995 – 1997

Privacy and Information Security Awareness and Rules of Behavior, Veterans Administration, 2012

HIPPA Compliance, Veterans Administration, 2011

Privacy/Human Subjects, Veterans Administration, 2011

Six Sigma Black Belt, Iomega Corporation, 2000

PMP, Iomega Corporation, 1999

 

Other Training:

•          MRP/MRP II

•          Business Requirements Management

•          ISO9001 R&D Compliance Administrator

•          Product Life Cycle (PLC)

•          Effective Communication

•          Team Building

•          Call Center Success

•          Business Communication

•          The Art of Organization

•          Successful Hiring/Termination

•          Quality Customer Service

•          How to Supervise People

•          Project Management: Scope, Schedule, Budget

•          Resource Planning

•          IT LOBI Model

•          TQC

•          Organizational Development

•          Configuration Management

•          Inventory Management

•          Capacity Planning

•          Production Control

•          Supply Chain Management

•          HIPPA Compliance

•          Privacy and Information Security Awareness and Rules of Behavior

•          Business Analyst

•          Privacy/Human Subjects

 

References

Full Name: Matt Excell, Chief Technology Officer at Possibility Forge

Street Address: Hurricane, Utah

Current Telephone: 435-277-0211

E-mail Address: Matt@Excellclan.com

 

Full Name: Shirley Nielson, VA Business Analyst

Street Address: 590 Foothill Drive, SLC Utah 84113

Current Telephone: 801-588-5074

E-mail Address: Shirley.Nielson@Va.gov