For the given job description <<Our client is looking for experienced professional with a strong background in healthcare, including Pharmacy Benefit Manager (PBM) expertise. Proficient in SQL for data management and analysis. Skilled in working with messaging and event-based systems, facilitating seamless communication. Knowledgeable in optimizing prescription drug programs and navigating the complexities of healthcare dynamics for enhanced patient outcomes.
QualificationsBachelor's degree or equivalent experience10+ years of progressive experience in requirements gathering and management using both Waterfall and Agile SDLC methodologies.Extensive Healthcare experience is mandatoryPBM (Pharmacy Benefit Management) experience is mandatory Process development and implementation experience.Proficient in using SQL, Visio and Office Suite, including Word, Excel, and PowerPoint.Experience working with messaging or event-based systems
ResponsibilitiesAssists andor leads in requirements management practices and principles.Participates andor provides product ownership.Creates business requirement documents, user stories, use cases, and supporting diagrams including sequence diagrams as needed.Contributes to the planning process with the Scrum Master andor project manager to plan activities including requirements gatheringrefinement, design reviews, SOPwork instruction development, training, and go-live.>> the resume: <<Professional BackgroundHighly motivated professional seeking opportunity to obtain a challenging position with Florida Blue that will fully allow me to utilize my education, skills, loyalty and work ethics where initiative and accomplishments will be the basis for professional advancement and mutual growth.
Technical SkillsMicrosoft Windows 8, Microsoft Word, Excel,  Outlook, PowerPoint,  Access.Provider Information Platform (PIP), Diamond DFS, Diamond Maintenance Tool PROD DFS (DMT), PFE, IMS,  EVerify, FedEx shipping and tracking, UPS shipping and tracking.Siebel queue inventory management, and Client Letter.Experience in building and Maintaining strong business relationships.Experience with health care industry, business related process and delivery system.Strong written and verbal communication.speak and write both French and Creole.Critical thinking
Education and TrainingBachelor of Science:Health Service Administration,Expected in2014toUniversity of Central Florida-Orlando,FLGPA:Health Service Administration
Professional ExperienceProvider Data Service Analyst II,04/2010to09/2015National Vision–Grand Rapids,MI,Duties include preparation and execution of provider contracts, loading contracts fee schedules and benchmarks, maintaining provider data such as demographic information.Problem solving to ensure contract arrangements enable the accurate adjudication of claims payments and assistance in contract administration.Identify trends and problems through an assessment of practices, and develop new processes and activities and build a business case for execution, incorporation or adaptation.Participation in the creation of, and compliance with, provider policies and procedures dealing directly with dedicated provider groups.Ensure appropriate investigation  and issue  resolution, loading and maintenance of contracting arrangements containing several lines of business for provider contracts and provider demographic data in multiple claims administration systems, including but not limited to PIP (Provider Information Platform) and Diamond DFS.Configures provider payment arrangements through integration of provider contractual arrangements, product & benefit standards, in order to facilitate accurate claims payment.Coordinate with operational areas and other departments within the delivery system such as network management for due diligence.Resolves provider data and payment discrepancies by interpreting contract language and apply appropriate pricing methodologies and contractual arrangements to facilitate accurate and timely resolution of provider claims payment issues.Build and maintain strong relationship business relationship whether internal or external.Provide dedicated management of provider demographic data and contract arrangements for Minute Clinic, Take Care Health, and CareSpot.Ensure integration and coordination with all Florida Blue Operational areas.Consultant on development of business requirements for provider maintenance and contracting under new Provider Information Management System (PIMS).(Analyst II) Contractor,04/2010to01/2012Blue Cross Blue Shield Of Florida–City,STATE,Duties include coordination of contract loads and maintenance of provider data files.Experience in collaborating and building strong relationships with internal and external business partners promoting positive results.Negotiating with external business partners to achieve and influence customer outcomes and meet the targeted set leadership goals.Coordinate activities for continuous improvement efforts.Perform special projects tied to managing territories targeted for Network expansion and associated priorities, action plans and tasks set to meeting targeted outcomes.Perform and lead special initiatives by identifying, developing, recommending, and implementing process, procedure and product.Proficiency in interpreting provider reimbursement methodologies.Coordination with business partners and network management on fee schedule builds that apply to contract reimbursement.In depth knowledge of provider payment programs and billing practices such as coding, subject matter, expert tools (PIP, Diamond, Siebel, DMT, Online Provider Directory and other delivery system tools) and processes to support temporary resource projects.Responsible for following all process and procedures for the four core PPDO business processes, of which include Contracting, Registration, Maintenance and Termination.Confirming that information loaded to provider's files interface to all systems and loading necessary fee schedule history of HMO, MM, NWB, NWMBA, PPC, PPS, MDS, MDB, BSC and PFS lines of business.Assistant Manager,11/2006to07/2009Seven-Eleven–City,STATE,Prepared and presented training materials to new employees.Ensured that the store met CDC regulations by regularly performing inventory reports.Monitor, evaluate, and take action to improve individual and team target goals.Planned and established work schedules (e.g., vacations, work shift, coverage for absent team members.)Provided motivation, inspiration, and developmental support to staff through coaching, providing feedback, reward and recognition.
Skillsbilling, BSC, business case, business processes, cashiering, coach, coaching, Consultant, continuous improvement, contract administration, contracts, Client, excellent customer service, delivery, due diligence, French, health care industry, IMS, inspiration, Internet Explorer, inventory management, inventory, team building, leadership, leadership skills, managing, Microsoft Access, Microsoft Excel, Microsoft Outlook, Microsoft PowerPoint, Microsoft Windows 7, Microsoft Word, Negotiating, network management, Network, organizational skills, performance appraisals, policies, presenting, pricing, Problem solving, processes, producing, coding, project management, shipping, Siebel, training materials, verbal communication skills, written>>. The result is, 

Fit assessment: No Fit