Janice A Smith
Gallatin,TN
Summary
Medicaid IT consultant and senior business analyst who supports TennCare projects across T-MSIS, managed care claims transitions, MDM, IAM, and encounter processing. Brings long-term experience reviewing requirements, technical designs, and test results to resolve system issues, support compliance, and keep state and vendor teams aligned.
Overview
33
33
years of professional experience
Work History
Information Technology Management Consultant
COGNOSANTE/NTT DATA INC.
09.2016 - Current
- Consulted on multiple projects for State of TN TennCare/Medicaid Account, reviewing Requirement Design Documents, Technical Design Documents, and Test Plans/Cases. Conducted research and analysis of system problems, providing recommendations for resolution. Key projects included transforming Medicaid Statistical Information System (T-MSIS) data for CMS, transitioning TennCare's fee-for-service claims to Managed Care Contractors, and implementing Edifecs HIPAA-compliant X12 837 and NCPDP compliance/validation to Deloitte's HealthTranslate Encounter Processing Data System.
- Delivered Independent Verification and Validation for multiple projects for the State of TN TennCare/Medicaid Account, focusing on Master Data Management (MDM) for recipient and provider data, Identity Access Management (IAM), and T-MSIS.
- Facilitated daily meetings with State and vendor partners to address new projects, issues, requirements, design, and resolutions.
Senior Business Analyst
HEWLETT PACKARD ENTERPRISE SERVICES
11.2001 - 09.2016
- Lead business analyst on the International Classification of Diseases (ICD) 10 project.
- Lead business analyst on the Health Insurance Portability and Accountability Act (HIPAA) 5010 project.
- Lead business analyst on the Long Term Care CHOICES project.
- Lead business analyst on Tennessee's Dual Demonstration project.
- Lead business analyst on Tennessee's Employment and Community First (ECF) project.
- Developed Business Requirement Documents (BRD) and Business Design Documents (BDD) to support enhancements and maintenance changes for the Tennessee Medicaid/TennCare system.
- Delivered critical support and expertise during implementation of State of TN's MMIS interChange computer system, ensuring alignment with business needs.
- Liaison between the Bureau of TennCare business users and Hewlett Packard Enterprise (HPE) system engineer.
- Trained and mentored business analysts, enhancing team capabilities and knowledge.
- Provided expert guidance on claims, encounter, reference, and internet subsystems, ensuring best practices.
Information Systems Senior System Analyst
MEDICAL CARE MANAGEMENT COMPANY
02.1999 - 11.2001
- Provided key support and expertise for two Managed Care system implementations, ensuring successful deployment.
- Conducted quality reviews on all system changes and outputs to maintain operational integrity.
- Monitored and reported on project plans for all system projects to ensure alignment with objectives.
- Collaborated with management and business users to address project needs.
- Created ad-hoc reports using Crystal Reports and Hummingbird BI-Query.
- Supervised all system analyst tasks.
- Ensured contract compliance in the Information Systems Department.
Information Systems Analyst
MEDICAL CARE MANAGEMENT COMPANY
11.1996 - 02.1999
- Developed business requirements and system specifications for MMIS to support project goals.
- Researched and implemented solutions to resolve system issues, enhancing system functionality.
- Liaised with business users to gather feedback and prioritize enhancements to the system.
- Performed quality review on all enhancements and maintenance changes.
- Ensured consistent compliance reporting to the state including all claims and provider data.
Information Systems Technical Assistant
MEDICAL CARE MANAGEMENT COMPANY
01.1994 - 11.1996
- Managed online security for a system to protect sensitive data and ensure user access control.
- Developed business user documentation for the TN Medicaid system to improve user understanding and compliance.
- Trained over 200 employees on mainframe CICS on-line system to enhance user proficiency.
Education
Associate Degree -
Draughons Junior College
Nashville, TN05-1986
Skills
- TennCare expertise
- Managed care organizations
- Benefit management
- Medicare coordination
- HIPAA standards
- Compliance standards
- ICD-10 reporting
- Data interchange
- Analytical problem solving
- Planning and organization
- Team collaboration
- Effective communication
- Enrollment processes
Timeline
Information Technology Management Consultant
COGNOSANTE/NTT DATA INC.
09.2016 - Current
Senior Business Analyst
HEWLETT PACKARD ENTERPRISE SERVICES
11.2001 - 09.2016
Information Systems Senior System Analyst
MEDICAL CARE MANAGEMENT COMPANY
02.1999 - 11.2001
Information Systems Analyst
MEDICAL CARE MANAGEMENT COMPANY
11.1996 - 02.1999
Information Systems Technical Assistant
MEDICAL CARE MANAGEMENT COMPANY
01.1994 - 11.1996
Associate Degree -
Draughons Junior College