Rachel Chambers
Hollywood,FL
Summary
Senior-level professional with over 20+ years of overall healthcare experience. 10+ years spent in Medicare/Medicaid and HIX space and 4+ years leading PBM transitions. Solid work as a project manager/ business analyst in Agile and Waterfall environments. Demonstrated success in managing complex processes and implementing data-driven solutions. Work with senior-level executives/stakeholders to ensure project scope alignment.
Overview
20
20
years of professional experience
Work History
Program Manager/Advisory
Performance Improvement Partners
Shelton, CT
10.2020 - Current
- Oversee the execution of IT integration projects, scope, and project plans
- Execute program governance, including status reporting, risk issue management, decision tracking, and Steering Committee reporting
- Manage workstream leads and facilitate communication across projects and cross-functional workstreams
- Drive execution of IT program/project delivery
- Monitor and communicate issues relative to workstreams to operate a transitional environment
- Prioritized tasks and managed teams throughout multiple projects.
- Managed external client and business partner relationships.
- Perform QA on Due Diligence reports for M&A practice
Advisor / Implementation Specialist/Project Manager
Pyramid Consulting Group Inc, PBM
Fort Lauderdale, FL
05.2020 - 02.2023
- Supported multiple healthcare clients on PBM transitions to ensure current state and future state needs are defined and documented
- Identified key program stakeholders through discovery phase to ensure all operational areas are properly represented
- Conducted requirements gathering sessions leveraging requirements gathering tool for traceability and signoff
- Provided feedback and clarified requirements as needed to support system build
- Advised on best practices defect resolution process with client and PBM vendors
- Provided insight on gaps in testing
- Ensured benefit designs adjudicating as expected during the testing phase
- Document and communicate lessons learned post-go-live
- Enhanced development and drove continuous improvement of project delivery process by providing strong program leadership.
Manager
Deloitte Consulting
Miami, FL
- Manage teams of business analysts and senior consultants to provide guidance on client-specific deliverables
- Develop the detailed, quantitative analysis work associated with developing meaningful insights to address Health plan clients’ biggest challenges
- Lead in setting engagement objectives and scope
- Develop work plans for components of engagements, coordinate activities between workstreams, and identify changes in scope
- Design deliverable content to precisely reflect the engagement contracts and clients needs
- Strive to improve deliverable quality through verification and validation of results
- Cultivated professional client relationships by asking appropriate questions, identifying needs and providing insightful information regarding products.
Business Analyst/Consultant
Anthem/TekPartners
Fort Lauderdale, FL
- Provide consultation for integration activities to ensure successful implementation (pricing engine)
- Ensure the quality, development, review, approval, hand-off, and traceability of business requirements
- Leverage JIRA and confluence to create user stories and EPICS for all requirements
- Work closely with scrum team to determine release schedules and align on user acceptance testing results
- Ensured the quality, development, review, approval, handoff, and traceability of business requirements
Manager - Senior Business Analyst
Complex Care Solutions
New York, NY
- Developed data-specific requirements for HEDIS measures, STARS, Annual Wellness Visits, and HIX (Health Information Exchange)/Medicaid
- Assessment designed to be robust in gathering extensive data to drive diagnosis and conditions
- Led transition from the legacy platform to Salesforce, creating a system interface that calls out to Medispan (drug database) when user is performing a medication reconciliation
- Drafted requirements to create systematic flags to call out any contraindication during clinical medication review
- Managed Medicare / Medicaid membership pool to determine how members are risk stratified
IT Business Analyst/Supervisor
MCNA Dental Insurance
Fort Lauderdale, FL
- Maintained and documented migration from the current system to the new system
- Facilitated meetings with operational business units to better understand the systems outliers by incorporating agile methodology
- Identified key performance indicators and incorporate into reporting tools
- Conducted UAT sessions with the business and development teams to ensure seamless deployments.
Business Analyst
gMed
Weston, FL
- Developed requirements specifications and collaborated with developers and subject matter experts to establish the technical vision and analyze tradeoffs between usability and performance needs
- Prepared requirements and testing for Meaningful Use certification
- Critically evaluate information gathered from multiple sources, reconciled conflicts, and distinguished user requests from the underlying true need
Business Systems Analyst, •Lead analyst
Simply Healthcare Plans
Coral Gables, FL
- On PBM transition from Envision to Catamaran
- Responsible for leading requirements gathering sessions and assisting in mapping data elements
- Liaison between the business units and the IT dept
- Responsible for creating workflows and speck out business requirements
- Continuously remain updated on CMS guidelines around reporting requirements for HEDIS/Stars measures
Business Operations Analyst
United Health Group
New York, Miami, NY, FL
- 7-year tenure at United Health Group, holding several operational leadership positions
- The full timeline can be disclosed during the interview process
Education
Masters - Health Informatics And Data Analytics
Florida International University
12.2018
Lean Six Sigma -
Skills
- Project Management Business Analysis
- Requirements Gathering
- User Acceptance Testing
- Medicare/Medicaid Expertise
- Strategy & Planning Healthcare Consultant
- Compliance/Regulatory
- PBM Implementation Quality Assurance
- HEDIS/STARS/HRA/AWV/EHR
- M&A Diligence
- Team Leadership
- JIRA/Confluence
- Microsoft Office Cross-Functional Collaboration
- Modern Requirements /Azure
- Nasco Claims Platform RxClaims/Optum (PBM)
- Salesforce (CRM - Healthcare Cloud)
Timeline
Program Manager/Advisory
Performance Improvement Partners
10.2020 - Current
Advisor / Implementation Specialist/Project Manager
Pyramid Consulting Group Inc, PBM
05.2020 - 02.2023
Manager
Deloitte Consulting
Business Analyst/Consultant
Anthem/TekPartners
Manager - Senior Business Analyst
Complex Care Solutions
IT Business Analyst/Supervisor
MCNA Dental Insurance
Business Analyst
gMed
Business Systems Analyst, •Lead analyst
Simply Healthcare Plans
Business Operations Analyst
United Health Group
Masters - Health Informatics And Data Analytics
Florida International University
Lean Six Sigma -
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