SUMMARY:

• To acquire a position as a Business Analyst supporting one or more projects while contributing to the overall success of the organization.
• Former Health Insurance Agent
• Experience with Remedy, Target Process, Salesforce, MARX, MBD, HPMS, and other CMS Systems.
• Extensive knowledge of Confidential along with private insurance plans, catastrophic coverage, Hospital Indemnity, Medical Expense, Long Term Care, and other types of Insurance.
• Fluent in MS Word, Excel, Outlook, PowerPoint.
• Basic Knowledge of MS Access and MS project.
• Strong expertise in Health Insurance Claim processes, social services, Confidential eligibility and entitlement.
• 4 years of IT Business Analysis Experience
• 5 years of experience as a licensed health insurance agent
• 10 plus years of healthcare experience (7 of which deal with Confidential )

PROFESSIONAL EXPERIENCE:

Business Analyst / Salesforce Implementation

Confidential, Baltimore, MD

Responsibilities:

• Performed duties of a Business Analyst supporting the Center for Confidential Innovation's payment and service delivery models.
• Excellent communication skills, writing skills as well as presentation skills. Experience working with business users as well as senior management.
• Solid understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment).
• Capable of managing multiple projects simultaneously.
• Experience writing requirements for the Salesforce Application via epic stories, user stories, acceptance criteria and business rules.
• Experience writing change requests and service requests for Salesforce.
• Experience implementing applications in Salesforce.
• Developed user manuals for applications developed in Salesforce.
• Provided training classes (both on - line and via remote webinar) for Salesforce applications new system users.
• Experience performing operations and maintenance on Salesforce applications.
• Experience in User Acceptance Testing and Functional Testing.
• Experience working in Confidential projects.
• Extensive experience in conducting Joint Application Development sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema and system design.
• Experience developing and presenting UI mockups for requirements gathering, development and presentation to clients using Axure.
• Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document ( Confidential ).
• Flexibility in adaption to a wide range of work environments.
• Good in requirement gathering including Joint Application Development (JAD) and requirement analysis.
• Ability to inculcate new relevant skills with ease in a time sensitive frame.
• Ability to write requirements for existing systems and Salesforce along with the ability to design systems from the "ground up".

Business Analyst

Confidential, Maryland

Responsibilities:

• Excellent communication skills, writing skills as well as presentation skills. Experience working with business users as well as senior management.
• Solid understanding of all phases of Software Development Life Cycle methodology (such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment).
• Capable of managing multiple projects simultaneously.
• Exceptional problem solving and sound decision-making capabilities.
• Experience in User Acceptance Testing and Functional Testing.
• Experience working in Confidential projects.
• Extensive experience in conducting Joint Application Development (JAD) sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema and system design.
• Well versed with Confidential, Facets claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document.
• Flexibility in adaption to a wide range of work environments.
• Good in requirement gathering including Joint Application Development and requirement analysis.
• Ability to inculcate new relevant skills with ease in a time sensitive frame.
• Ability to write requirements for existing systems and Salesforce along with the ability to design systems from the "ground up".

Business Analyst

Confidential

Responsibilities:

• Responsible for analysis and evaluation of Confidential beneficiaries’ entitlement data along with Medicare Advantage Prescription Drug plans’ enrollment, premium and plan payment data.
• Submitted “resolutions” (in the form of either written documents or verbal presentations, sometimes both if requested by the Confidential plan) to Confidential plans once analysis of the Confidential plans issues’ were completed that effectively communicated the root cause of the submitted issue as well as all necessary corrective actions to the Confidential plans in a concise, organized and grammatically correct manner. These resolutions were periodically reviewed by the contractor ( Confidential, Inc. ) as well as the business owner (CMS) to ensure that provided resolutions exceeded quality guidelines listed in the contractor’s statement of work and service level agreement(s).
• Reviewed communications (“Memos”) created by CMS for distribution to Confidential plans prior to their release. These memos typically advised plans of (including but not limited to) system changes and updates performed by CMS, changes to monthly enrollment cutoff dates, and availability of monthly plan reports. As the primary of contact with respect to 90% of all memos distributed by CMS to MA-PD plans all relevant and necessary information was learned prior to distribution and explained to the MA-PD Plans as needed.
• Responsible for review and creation of Medicare Advantage Prescription Drug Help Desk troubleshooting and resolution processes, including Analyst training documents. Verified that all process documents contained best business practices for the operation of the Help Desk.
• Acted as the intermediary between Medicare Advantage Plans (client) and CMS with respect to plan’s requirements for CMS operating software (MARx, MBD, etc. enrollment and billing software, etc.)
• Submitted process improvement documents to QSSI management monthly to improve Confidential plans’, SSA’s and CMS’s’ enrollment, billing and payment practices. QSSI management distributed these documents CMS management for review and consideration.

Maryland Insurance Admin

Confidential

Responsibilities:

• Submitted process improvements to companies whose operational practices were determined to be non-compliant with Maryland Law. Prepared acquisition documents, conducted training and performed facilities management duties.
• Reviewed all new and updated Life and health insurance laws as amended and enacted by the Maryland State Legislature and entered into the Confidential (code of Maryland regulations), Confidential 's Annotated Code of Maryland and the Health-General insurance Article.
• Interacted with Insurance carrier compliance directors, vice presidents and presidents while communicating Insurance administration policies and procedures.