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Sr. Business Systems Analyst Resume

Tampa, FL

OBJECTIVE:

I am a Senior Business Systems Analyst with experience working in the managed care realm (both Workers’ Compensation and Medicare/Medicaid), working with business requestors, creating requirements, system coding, unit testing various system changes, and post production validation efforts.

SUMMARY:

  • Motivational
  • Highly Organized
  • Receptive to change
  • Process Management experience
  • Flexible
  • Team - oriented
  • Ambitious
  • Detail Oriented
  • Reliable
  • Experience with writing policies, procedures, business requirements, and other corporate communications

PROFESSIONAL EXPERIENCE:

Confidential, Tampa, FL

Sr. Business Systems Analyst

Responsibilities:

  • Interview and elicit from business contacts the issues at hand, discussing both the existing problem and how the business envisions the future state.
  • Work with Application Development to discuss the solutions available to the business, how the solutions would work, and relay this information to the business to help the two parties come to a sound understanding.
  • Draft Business Requirements documentation that thoroughly explains the needs of the business.
  • Draft Functional Specifications documentation that outlines how the solution will work to meet the needs of the business.
  • Work diligently with both areas to control the scope of each request, adhering to timeline specifications.
  • Worked on the Pharmacy Benefit Management (PBM) conversion project, moving Confidential from Catamaran to CVS/Caremark effective January 1, 2016.
  • During the PBM conversion project, worked with a large group to complete needed documentation, including over 100 Project Change Requests needed from October 2015 through March 2016.
  • Operates as a peer reviewer for colleagues when requested.

Confidential, Tampa, FL

Program Business Analyst

Responsibilities:

  • Work with business leaders to collect system needs and collaborate on solutions that are conducive to both IT capabilities and end users.
  • Draft business and technical requirements that outline changes related to requested system changes.
  • Create and change code in a Rules Maintenance Environment (RMA), a system by Fair Isaac.
  • Perform UAT testing as needed, including creating testing documents and investigating testing defects.
  • Perform system testing prior and post production.
  • Manage changes from initial request to production to keep all changes on time and ensure the efforts remain in scope.
  • Work with Quality Assurance and Policy groups to create consistent processes.
  • Florida Medical EDI reporting analyst. Overseeing the transmission of thousands of bills a month to the Division of Workers Compensation, ensuring data is filed accurately and timely.
  • Review regulatory requirements in 52 workers compensation jurisdictions to research billing requirements, including:
  • Billing forms and data element specifications
  • Timely billing requirements for providers
  • Out of state adherence requirements
  • Other components that constitute complete billing
  • Review regulatory requirements related to provider EOR communications
  • Training as needed

Confidential, St. Louis, MO

Sr. Manager

Responsibilities:

  • Researched and maintained fee schedule databases, reviewing systems to verify all operations are in accordance with the various rules and regulations.
  • Compliance contact for the State Reporting Program to verify that processes are in alignment with the various state requirements.
  • Controlled expenditures in accordance with budget allocations.
  • Research new state reporting requirements and upon notification write policies and procedures for compliance.
  • A former member of the IAIABC Medical Pro-Pay Committee and NCPDP Workgroup 16.

Confidential, Jacksonville, FL

Responsibilities:

  • Coordinates the Compliance Research efforts of two Compliance Specialists to ensure that my organization has the most up to date compliance rules, regulations, and fee schedules.
  • Compliance Training Coordinator tasked with communicating to new hires, specific departments, and the entire company the various aspects and importance of compliance.
  • Manages the State Reporting Program to ensure that implementation and prescribed activities are carried out in accordance with specified objectives.
  • Plans and develops methods for implementing various aspects of the state reporting program, directs and coordinates program activities and exercises control over personnel responsible for specific functions or phases of the program.
  • Directs and coordinates personally, or through subordinates, activities concerned with implementation and carrying out objectives of the program.
  • Controls expenditures in accordance with budget allocations.
  • Research new state reporting requirements and upon notification write policies and procedures for compliance.

Confidential, Jacksonville, FL

Responsibilities:

  • Manage and advise injured workers with medical only claims on medical care directives, return to work policies, workers’ compensation legal parameters;
  • Research grievances filed in accordance with AHCA standards and responds within the timeframes allotted;
  • Respond to attorney requests and inquiries regarding workers’ compensation patient cases;
  • Process bi-annual physician applications for membership to the carrier network.

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