Misty Nelson Mahmood
Monticello,WI
Summary
20+ Years of overall IT experience with 20+ years in the Healthcare industry. Strong experience as a Project Manager\ Senior Business Analyst with deep knowledge of HIX/HIE Medicare, Medicaid, HIPAA compliance, Payer Enrollment process, and Medical Management Information systems (MMIS), EMR, and Commercial Health Plans, as well as IV & V services.. Strong working knowledge of the IT side and Clinical side of Health Information Technology for Economic and Clinical Health (HITECH) Act to improve health care quality, safety, and efficiency through the promotion of health information technology (HIT), including electronic health records and private and secure electronic health information exchange. Develop integrated systems with seamless communication to achieve Medicaid goals through interoperability and common standards. Promote flexibility and adaptability, and shorten response times to program and technology changes. Promote an enterprise view that supports technologies aligned with Medicaid business processes and technologies. Provide data that is accurate, timely, and easily accessible to support business analysis and decision-making for program administration and effective health care management. Coordination with public health partners. Provide performance measurement for accountability and planning. Strong knowledge of Requirements Gathering, Requirements Management, Business Process Modeling, Business Process Research, Analysis & Documentation, Use Case Modeling, Workflow Design and Analysis, JAD Sessions, Checkpoint Meetings, and Gap Analysis. Strong understanding of UML, RUP, Rational Suite, Clear Quest, Clear Case, Microsoft Visio, and Corporate Modeler Suite.Excell, SQL, CRM Excellent Project Management skills with an ability to understand the business domain, formulate business goals, and ensure they are met. Dynamic and assertive team player with excellent verbal and written communication skills.
Overview
20
20
years of professional experience
Work History
SR. Level Analyst
Logic Technology Inc.- CSG Government Solutions IV&V HIX State of Massachusetts
04.2024 - 06.2025
- Review of Functional and Technical Requirements: Reviewed functional and technical specifications to verify that they align with business goals and project objectives.
- Business Process and Workflow Analysis: I analyze existing business processes and workflows to identify inefficiencies or areas for improvement.
- Quality Reviews of Design Documents: I conduct thorough quality reviews of design documents to ensure that all requirements are accurately captured and that the documentation adheres to industry standards and best practices.
- Quality Reviews of Test Plans and Procedures: Evaluate test plans and procedures to ensure they provide comprehensive coverage of the requirements and are designed to assess system functionality adequately.
- Requirements Traceability: Analyze and maintain requirements traceability throughout the system development life cycle, ensuring that all requirements are tracked from initial conception through to final delivery and testing.
- User Acceptance Testing (UAT) Support: Facilitated the development of detailed test scripts and necessary test data for conducting user acceptance testing. This ensures that the product meets the expectations and requirements of stakeholders before it is deployed.
- Creation of Project Documentation: Prepare essential project documentation, including detailed meeting minutes, deliverables lists, project status reports, and presentations for stakeholders. This documentation serves as a vital resource for tracking project progress and communicating updates.
- Tracking Issues, Risks, and Decisions: Utilize standard project management techniques and tools to track issues, risks, action items, and decisions rigorously. This proactive approach helps mitigate project risks and ensure the timely resolution of challenges.
- Communication of Project Issues and Risks: Maintain open lines of communication with the project management team by regularly updating them on project issues and risks, ensuring that informed decisions can be made swiftly to address potential obstacles.
- Observations: Track and observe open observations in KANBAN to ensure they are kept up to date for our monthly reporting.
- Interviewing Clients: Conducting weekly or monthly interviews with all active clients within my project area to ensure that all possible concerns and risks have been identified and addressed.
Requirements Manager SAAS DHS WI
SAAS Technology – Department of Human Services, DHS, Wisconsin
02.2023 - 02.2024
- Worked as a senior-level Health Care IT consultant for SAAS Technology.
- This vendor was implementing their SAAS platform for DHS Wisconsin.
- DHS was upgraded from a Business Object reporting platform and data warehouse to SAAS platform.
- SAAS offers DHS access to a fully supported software application through an internet connection through Cloud Services.
- The clients I worked with on this consulting tour were Gainwell (MMIS Team), DHS WI Family Care, Pace, Pace Partnership, EVV, and the Leadership Team. SAAS Team.
- Worked directly with DHS to manage requirements for reporting.
- I also worked directly with the reporting team, DAR, to ensure the design was what DHS approved.
- Worked with the ETL team to ensure all interfaces and table structures were mapped correctly for each requirement.
- Worked directly with the DHS Leadership team to approve all the requirements for each report or upgrades needed for the data warehouse.
- Worked directly with DHS on the new requirements for the claims processing edits for Family Care. Pace, Pace Partnership.
- DHS waiver programs.
- Also worked on requirements needed for converting DHS waiver programs claims in the SAAS EDW data platform.
- This ensures all claims data from Gainwell is in the SAAS EDW warehouse.
- HEIDIS Reporting
- SQL to pull data needed for reports
Report Manager Cognizant Internal Team Medicaid/Medicare and Commercial Plans
Cognizant
08.2016 - 08.2022
- Managed and facilitated the Sprint Sessions for the DDI Implementation of the Client's Reports.
- Worked directly with our state counterparts and reported directly to our director.
- Facilitated Sprint Meetings.
- Managed Action Items.
- Managed Project Plan.
- Captured the logical flow of the system/business through use case documentation.
- Provided training and knowledge transfer in transitioning the new system to the client.
- Collaborated with the project team to achieve State client and team objectives.
- Reported status to management.
- Initiated appropriate action on correspondence and Change Requests to ensure compliance with the new system requirements and design criteria.
- Coordinated with appropriate client and team staff to ensure compliance with the project management methodology, documented work scope, and technical standards, policies, and procedures.
- Ensured controls, quality expectations, critical tasks, and State requirements and expectations are met or exceeded.
- Senior Consultant for TriZetto QNXT Software.
- Part of the Product Team and working directly with the client for the implementation of the QNXT software solution for three Medicare states. (Alabama, Arizona, and Colorado).
- Defined the Design of the QNXT platform.
- Defined Use Cases for testing.
- Designed and recommended solutions to be considered.
- Mapped 'to-be' processes that are aligned with the MITA maturity model and the CMS certification checklist.
- Facilitate the process for requirements validation that follows the MITA process/sub-process business model.
- Recommended, revised, and/or improved business processes for the new QNXT implementation.
- Identified and managed related tasks and activities within a given process and sub-process business area.
- Collaborated with the client to develop acceptance test criteria.
- Collaborated with the client to execute acceptance test(s) to confirm QNXT functionality.
- Created appropriate documentation (e.g., requirements validation documentation, business, and technical design documentation).
- Captured the logical flow of the system/business through use case documentation.
- Provided training and knowledge transfer in transitioning the new QNXT to the client.
- Collaborated with the project team to achieve client and team objectives.
- Reported status to management.
- Initiated appropriate action on correspondence and Change Requests to ensure compliance of the new QNXT with system requirements and design criteria.
- Coordinated with appropriate client and team staff to ensure compliance with the project management methodology, documented work scope, and technical standards, policies, and procedures.
- HEIDIS Reporting
Product Owner by Proxy, State of Montana/New York DDI Claims Adjudication
Xerox
07.2015 - 08.2016
- Managed and facilitated the Sprint Sessions for the DDI Implementation of the State of Montana.
- Assisted as a Subject Matter Expert in Claims Processing, Managed requirements, managed Gaps, and managed Action Items.
- Worked directly with our state counterparts and reported directly to our director.
- Facilitated Sprint Meetings.
- Managed Action Items.
- Managed Project Plan.
- Captured the logical flow of the system/business through use case documentation.
- Provided training and knowledge transfer in transitioning the new system to the client.
- Collaborated with the project team to achieve State client and team objectives.
- Reported status to management.
- Initiated appropriate action on correspondence and Change Requests to ensure compliance with the new system requirements and design criteria.
- Coordinated with appropriate client and team staff to ensure compliance with the project management methodology, documented work scope, and technical standards, policies, and procedures.
- Ensured controls, quality expectations, critical tasks, and State requirements and expectations are met or exceeded.
Education
Associate of Science - Information Technology
ILCC
01.2001
Skills
- Healthcare
- IV & V
- HIPAA
- CMM
- MITA 20-30
- CMS
- Medicare\Medicaid
- MMIS
- EMR\EHR
- HIE
- Health Benefits Exchange (HBE) (HIX)
- Meaningful Use Framework
- American Recovery and Reinvestment Act (ARRA)
- Health Information Technology for Economic and Clinical Health Act (HITECH)
- Patient Protection and Affordable Care Act (PPACA)
- Medicaid Information Technology Architecture (MITA) 20 and 30
- Medicaid Enterprise Certification Toolkit (MECT)
- HEIDIS Reporting
- NCQA
- Requisite Pro
- RUP
- Rational Suite
- UML
- Rational Rose
- Visio
- ClearQuest
- CRM
- ClearCase
- SDLC
- Six Sigma
- MS Project
- Agile Methodologies
- Cognos Business Objects
- Business Objects
- Provision
- Waterfall
- QTP
- LoadRunner
- TestDirector
- WinRunner
- Test Manager
- SAMS Harmony Software for Aging and ADRC
- Healthation
- SALESFORCE
- SAAS
- KANBAN
- SQL
- HTML
- Database
- SQL Server
- Oracle
- MMIS/Medicare (HE-eCAMS-InterChange-QNXT)
- Provider
- Eligibility Enrolment
- PA
- Claims
- Managed Care
- Reporting
- Birth to 3 Program
- HEDIS
- IRIS/ADRC/LTC (Waiver)
- ADRC
- Provider Training
- Department of Aging
- LAHC\KYHC Co-op HIX
- Plan Design
- Medical Coding
- CPT/HCPC/REV/DRG/ICD-9/10
- Claims Processing
- 837-CMS1500-UB04
- Claims Edits and Business Rules
- Encounter Reporting
- Provider Management and Rate Setting
- Prior Authorizations
- Enrolment\834
Certification
- HIPAA Certification
- Fundamentals of the Health Care Industry
- QNXT and Faccets (Cognizant)
- Project Management and Product Owner (Cognizant)
Work Type
Full TimeContract WorkWork Location
RemoteHybridTimeline
SR. Level Analyst
Logic Technology Inc.- CSG Government Solutions IV&V HIX State of Massachusetts
04.2024 - 06.2025
Requirements Manager SAAS DHS WI
SAAS Technology – Department of Human Services, DHS, Wisconsin
02.2023 - 02.2024
Report Manager Cognizant Internal Team Medicaid/Medicare and Commercial Plans
Cognizant
08.2016 - 08.2022
Product Owner by Proxy, State of Montana/New York DDI Claims Adjudication
Xerox
07.2015 - 08.2016
Associate of Science - Information Technology
ILCC
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