- Imaginative IT Professional with meaningful experience as a Business Analyst and proven skills in Business Requirement Gathering, Business Process Workflow, and Business Process Modeling.
- Transformational leader with the ability to develop valuable professional relationships through a commitment to trust and transparency; inspired by big challenges with a passion for helping others succeed through shared learning and teamwork.
- Highly analytical thinker with proven ability and knowledge within the Health Care Industry, Claims Management processes, Medicaid, and Medicare Services;
- Exceptional analyst with proficiency in all phases of Requirement Management including gathering, analyzing, detailing, and tracking requirements.
- Ambitious, high - energy self-starter with demonstrated ability in 4010 and 5010 HIPAA implementation guides related to Claim Testing and Medical Billing and the capacity to excel within fast-paced, deadline-driven situations.
- Hardworking and resilient professional with inspiring leadership ability, excellent communication skills, and a proven ability to analyze sophisticated problems, identify risks, and develop effective solutions to improve productivity, reduce COs, and track progress through all SDLC phases.
Microsoft / Technologies: Advanced Excel, Word, Outlook, SharePoint, SSMS, Service Now
Operating Systems: Windows 2000/7 Enterprise/XP, MacOSX
Languages / Standards: SQL, HIPPA 4010/5010, ICD9/10
Confidential, Philadelphia, PA
- Employed sharp power of observation and analysis in execution of weekly, bi-weekly, and monthly reports; created ad-hoc reports.
- Exhibited superior attention to detail and exceptional work ethic by logging all CSV files, outbound 837 files, and 999/277CA response files.
- Leveraged experience and skill to automate submission of transactions in partnership with IT Department; process imports adjudicated claims into revenue reconciliation manager and Finalized them to enable submission to reporting authority.
- Exercised detailed analysis and judgment by updating BRD to reflect latest business requirements.
- Provided insightful vision and guidance for development of monthly Corrective Action Plans designed to inform client of current errors and rejections.
- Created environment for durable success by ensuring proper development and deployment while assisting QA to test requirements.
- Analyzed data relating to claims, members, and providers through use of existing queries and reports.
- Ensured all claims were successfully made into outbound encounters for submission by checking recon report daily.