NICOLE N. MACK
Healthcare Professional
Troy,US
Summary
Meticulous Business Analyst with 31 years of experience in the healthcare industry, recognized for driving effective systems improvements and enhancing operational procedures. Proven track record as a decisive leader and collaborator, known for building strong teams that achieve organizational success. Demonstrates exceptional critical thinking, advanced technical expertise, and customer service skills that contribute to positive change. Committed to leveraging extensive experience to foster innovation and operational excellence.
Overview
35
35
years of professional experience
1
1
Certification
Work History
Senior Business Systems Analyst
Blue Cross and Blue Shield of Kansas City
Kansas City, MO
07.2024 - 12.2024
- Diagnosed and addressed technical system malfunctions with in-depth analysis.
- Coordinated the resolution process for user stories linked to bugs and system improvements in ADO, attaining a 5% increase.
- Facilitated processing of Request for Change to address production issues.
- Developed comprehensive documentation for National Program Release 24.5.
- Presented National Program Release 24.5 change proposals at CAB meetings.
- Facilitated requirements sessions with business stakeholders and technical development team.
- Coordinated with IT, business units, and external vendors to develop systems aligning with business goals.
- Participated in BlueCard Modernization discussions to outline SASs and claims requirements.
Business Manager II
NASCO
Atlanta, GA
02.2022 - 03.2024
- Updated Jira and Confluence to reflect Customer Service Requirements for the system technical design team.
- Facilitated meetings with customers to gather requirements for system updates.
- Defined specifications for new plans on NASCO claim system as part of BlueCard MA implementation.
- Provided subject matter expertise on Medicare Advantage billing principles and BlueCard operational processes to facilitate collaboration.
- Created BlueCard specifications for developers to evaluate system solutions based on client needs.
System Advanced Analyst-ITS Software
Blue Cross Blue Shield of Michigan
Detroit, MI
02.2020 - 12.2020
- Identified root causes of system and program malfunctions to restore functionality.
- Developed detailed diagrams for systematic workflows.
- Analyzed business needs to ensure efficient distribution across various departments and IT teams.
- Partnered with interdisciplinary groups to assess viable system options per client specifications.
- Conducted GCT testing with partner BCBS plans to confirm implementation of BCBS Association changes according to requirements.
- Executed comprehensive software testing to identify functional errors.
- Partnered with clients to define requirements and design systems.
Project Consultant
Blue Cross Blue Shield of Michigan
Detroit, MI
10.2014 - 02.2020
- Organized and assigned responsibilities to optimize coordination with pharmacy vendors.
- Executed key strategies that enhanced efficiency in authorization procedures and cut down medication costs by 50% using non-hospital settings.
- Prioritized tasks and assignments to maintain project momentum and meet critical deadlines.
- Facilitated communication between project stakeholders to align expectations and project goals.
- Assisted project managers by identifying gaps and establishing best practices for existing and upcoming project initiatives.
- Conducted meetings with stakeholders to identify objectives, scope, and requirements for projects.
- Implemented strategies for improving quality control measures related to specific projects.
Business Analyst-BlueCard Program
Blue Cross Blue Shield of Michigan
Southfield, MI
09.2008 - 10.2014
- Enhanced on-time completion of corporate projects through efficient operational management.
- Evaluated business processes for improvement opportunities through automation or streamlining.
- Designed automation workflows to minimize errors and reduce workforce demands
- Developed strategies for recovery and restoration efforts in payment reimbursement systems.
- Ensured accurate translation of business client needs into specifications for IT department.
- Utilized ad hoc analyses for solving persistent and emergent operational problems.
Team Leader-ITS Program
Blue Cross Blue Shield of Michigan
Southfield, MI
10.1998 - 09.2008
- Managed execution of strategic and routine activities to drive claim vendor success.
- Distributed responsibilities among team members and vendors for enhanced productivity.
- Managed 25 professionals in attaining above-target operational goals every month and year.
- Addressed underlying problems and executed improvements leading to increased efficiency among low-performing staff by 25%.
- Conducted routine evaluations of employee performance on a monthly and yearly basis.
- Maintained open lines of communication with senior management, reporting team progress and challenges.
- Reviewed completed work to verify consistency, quality, and conformance.
- Coordinated skill enhancement strategies for team growth.
- Interviewed potential candidates and contributed to hiring decisions.
Claim Quality Adjudicator
Blue Cross Blue Shield Michigan
Southfield, MI
10.1989 - 10.1998
- Entered HCPCS, revenue, and diagnosis codes for facility and professional claims.
- Evaluated claim information for correctness, thoroughness, and relevance in relation to services provided.
- Efficiently input data into billing software systems.
- Processed claim system updates with payments, adjustments, and denials.
Education
Master of Science - Information Resource Management, Software Engineering and Technology Management
Central Michigan
Mt. Pleasant, MI, US05.2010
Bachelor of Science - Business Administration
Rochester College
Rochester Hills, MI, US01.2003
Skills
- Effective Leadership
- Operational Efficiency Enhancement
- Requirements Analysis
- Lead Analyst for Testing Coordination
- Scrum Methodology Proficiency
- Effective Team Collaboration
- Proficient in ADO
- Expertise in MS Office Applications
- SharePoint Administration
- JIRA Proficiency
- Systems Integration
- Vendor Relationship Management
Certification
- Agile and Scrum Training, 2019
- Project Management Certificate, 2018
Accomplishments
- Volunteer for an urban community youth basketball program. (2005 to current)
- Pride in Excellence Award received for successfully implementing a tool that reduced paper by 40% first year at Blue Cross Blue Shield. (2008)
References
References Available Upon Request
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Location
RemoteTimeline
Senior Business Systems Analyst
Blue Cross and Blue Shield of Kansas City
07.2024 - 12.2024
Business Manager II
NASCO
02.2022 - 03.2024
System Advanced Analyst-ITS Software
Blue Cross Blue Shield of Michigan
02.2020 - 12.2020
Project Consultant
Blue Cross Blue Shield of Michigan
10.2014 - 02.2020
Business Analyst-BlueCard Program
Blue Cross Blue Shield of Michigan
09.2008 - 10.2014
Team Leader-ITS Program
Blue Cross Blue Shield of Michigan
10.1998 - 09.2008
Claim Quality Adjudicator
Blue Cross Blue Shield Michigan
10.1989 - 10.1998
- Agile and Scrum Training, 2019
- Project Management Certificate, 2018
Master of Science - Information Resource Management, Software Engineering and Technology Management
Central Michigan
Bachelor of Science - Business Administration
Rochester College
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