James Kennedy

• Serves as Scrum Master, Product Owner, and Senior Technical Business Analyst to facilitate strategic decision making and drive data driven insights by bridging stakeholders and technical teams.
• Functions as a claims application SME and point person for all stakeholder inquires. Drove Service Now tickets down 50% due to a great relationship with the stakeholders and an open door policy.
• Facilitate Agile Scrum ceremonies using TFS, Rally, Aha!, and Confluence. Performing daily standups, story grooming/backlog refinement, and retrospectives for team and operational efficiency.
• Oversee the full SDLC lifecycle from requirements gathering, user story creation, wireframing, flowcharts, UAT, deployment, and regression with GitHub, Azure DevOps, and change management via ServiceNow.
• Collaborate with engineering teams on key infrastructure upgrades, security initiatives, data consolidation, merger integrations, SSO/user sign in security, Azure Cloud migrations, API integrations, ETL processes, and workflow automations, reinforcing secure data foundations.
• Execute complex SQL queries on Medicare, Medicaid, Member, Provider, Specialist, and payor claims datasets to drive actionable insights that help executive level decision making.
• Built and maintained PowerBI dashboards to monitor key operational processes, introducing proactive issue detection, and enabled email process notifications.This allowed the team to transition from a reactive to a proactive environment.
• Spearheaded documenting current processes with Visio flowcharts, Data Mapping, and Data Dictionaries. Organized all of the documents in our new SharePoint shared site for convenent referencing.

• Acted as a subject matter expert (SME) and mentor for provider/pcp, specialist, and member network adequacy, fostering network growth and actionable insights for executive level stakeholders.
• Performed as a CMS state provider adequacy SME and point person for all stakeholder inquires. Drove Service Now tickets down 25% due to a great relationship with the stakeholders and an open door policy.
• Produced comprehensive Medicare, Medicaid, provider, and member adequacy reports and dashboards using Alteryx, SQL, SSIS, SSRS, PowerBI, and Tableau. Generated root cause analysis for actionable insights that improved adequacy by 10% across 67 counties.
• Created and submitted quarterly Xcelys and Quest reports to CMS, ensuring adherence to regulatory standards and enhancing data reporting practices. Collaborating with CMS representatives to ensure provider network adequacy gap closures.

• Administrator for a proprietary claims processing and scrubbing application. Ensured that the application ran flawlessly as well as resolved tickets and claim outliers with payors.
• Created PowerBI dashboards for Medicare, Medicaid, and payor claims processing, denied claims, claim trends, enabling real time visibility for increasing revenue and response time.
• Developed complex ad hoc SQL reports and dashboards for root cause analysis, KPIs/Metrics, risk mitigation, operational efficiency, and data driven decision making.
• Designed and presented weekly PowerPoint presentations summarizing key weekly operational metrics, trends, and forecasts.

• Created Ad hoc SQL reports and dashboards, created/maintained Access reports. Implemented new collections criteria for identifying concerns sooner. Reduced collection write-offs by 10%.
• Created Microsoft Visio process flow diagrams for process mapping, process improvement, and process modernization. Presented diagrams to leadership to help decision making.
• Resolved collection department Service Now tickets resulting in a 20% increase in ticket resolution time.
• Utilized Lexis Nexis and CRM for verification and customer updates.
• Built Microsoft Excel reports to include Macros, Pivot Tables, VLookups, VBA, and Formulas for executive level insights and presentations.