Business analyst Resume Nashville, TN - Hire IT People

SUMMARY:

Master of Business Administration in Finance, a Bachelor of Science in Interdisciplinary Studies combined with experience in fast - paced, highly detailed research and decision making processes.
Highly adaptable and resourceful — rapidly learns new procedures and processes, quickly adjusts to changes in schedule, environment and organizational objectives.
Detail-oriented with exceptional multi-tasking abilities, self-motivated and goal-oriented, thrives in independent operations and team dynamics, with effective interpersonal and communication skills.
Demonstrate professionalism, tenacity, thoroughness and dedication, with solid work ethic, insightfully responds to tough situations and finds innovative solutions for complex problems.
Comfortable performing queries and creating pivot tables on large data sets with millions of rows.
Experienced with EDI standards and processing.
Working knowledge of Health Insurance Portability and Accountability Act (HIPAA)Transactions and Code Set rules such as 837-Institutional, 837-Professional,835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, ICD9-ICD10.

TECHNICAL SKILLS:

PROFESSIONAL EXPERIENCE:

Confidential, Nashville, TN

Business analyst

Responsibilities:

Support the Medicaid Management Information System (MMIS) by working collaboratively with stakeholders to elicit high-level and detailed business requirements.
Document business requirements and track all phases of the Software Development Life Cycle (SDLC) using application lifecycle management (ALM).
Participate in each phase of the Software Development Life Cycle including Requirement gathering, Design, Development, Testing and Deployment.
Create test plans and test cases to validate that all system components are operating correctly as defined in the requirements.
Hold regular meetings with System Engineers, Testers, System Architects, Project Managers and other project team members throughout the duration of the project to assure that all issues are resolved and the project remains on track.
Facilitate the smooth transition of the project from the project environment to the live environment by performing user acceptance testing (UAT) to confirm system changes are accurate and no defects are present.
Act as a liaison between business customers and technical teams.
Proactively manage multiple projects concurrently while maintaining quality and meeting sensitive deadlines.
Create visual models using MS Visio that help customers understand complex business and data flow processes.

Confidential, Nashville, TN

Claims Analyst

Responsibilities:

Evaluated and processed complex healthcare claims for six business accounts.
Analyzed policy guidelines to determine whether to accept or deny coverage.
Interpreted plan benefits from the Explanation of Coverage and other various plan documents to ensure proper payment of claims while meeting established productivity goals of 750 claims per week.
Courteously resolved customer service inquiries, and effectively communicated adjudication rationale to providers, patients and auditors.
Calculated coordination of benefits (COB) with Medicare and other insurance providers as well as determine Medicaid reimbursement based on policy and procedures.
Authorized and prepared drafts for claim payments in a timely manner.

Confidential, Nashville, TN

Disability Claims Examiner II

Responsibilities:

Requested and evaluated relevant information such as medical records and vocational and educational data to determine a claimant's medical eligibility for Social Security Disability and Supplemental Security Income claims.
Completed residual functional capacity assessments to outline the combined effects of impairments on the claimant's abilities then used this information to ascertain what type of work-related activities and tasks the applicant could perform.
Created technical rationales, explaining the decision, and sent proper federal disability determination notices to claimants and authorized representatives.
Managed and prioritized workload in order to meet established production of 15 claims per week.
Determined credibility and weight of evidence provided by claimant and medical sources and made recommendations for specific benefit duration.
Utilized federal and state electronic technology and databases to gather and compile data