SUMMARY:

• A detailed oriented person with strong analytical skills.
• Candidate is exceptional with regards to maintaining data integrity while ensuring continuous quality improvement throughout all aspects of the process.
• Strong ability to follow detailed instructions, yet quite effective designing and implementing strategic initiatives to ensure timely goals are met.
• As a results driven, self motivated individual with solid leadership, organizational, time - management and communication skills, this candidate will excel in a team oriented environment or as an individual contributor.

TECHNICAL SKILLS:

Hardware and Software Systems: IBM Compatible Personal Computers, Microsoft Office Suite of Products

SPECIAL KNOWLEDGE AND/OR SKILLS:

• Healthcare with Medicare and/or Medicaid Operations
• Strong quantitative, analytical, organizational and problem solving skills
• Experience in the health insurance claims processing, operational and/or data analysis experience; knowledge in database structures and standard query and reporting tools
• Proficient in statistical use of Microsoft Excel and Access
• Experience in process management and process optimization

SUMMARY OF EXPERIENCE:

Confidential, Richmond, Virginia

Operational Analyst

Responsibilities:

• Develops and analyzes business performance reports for transportation, call center and enrollment data; provides notations of performance deviations and anomalies.
• Perform monthly enrollment process.
• Research, gather and document requirements for adhoc reporting, project initiatives for new vendor, or business development opportunities.
• Monitor, test and support system changes for the Member Operations department systems.
• Develop advanced knowledge in IDX MCA, QNXT, DBMS queries, canned reports, referral module and interface with transportation scheduling/dispatch system.
• Create and modify transportation requests entered into transportation scheduling/dispatch system.
• Create and revise Standard Operating Procedures and process maps for all Member Operations processes.
• Complete scheduling and assignment of trips to providers in transportation scheduling/dispatch system.
• Analyze issues related to transportation reimbursement process and make recommendations to management for resolutions.
• Build advanced reports and filters using call center reporting software.
• Performs moderate to complex queries; applies proficient understanding of database tables, relations, data types and values.
• Lead projects related to all Member Operations Systems.
• Other duties as assigned.

Confidential, Richmond, Virginia

WOTC Coordinator/EMP Security Specialist

Responsibilities:

• Reviewed ETA (Employment and Training Administration) forms 8850 & 9061 (Work Opportunity Tax Credit applications) for specific criteria of timeliness, required signatures, residency requirements, and target group eligibility in compliance with Confidential regulations and policies
• Requested needed additional documentation from other state agencies; analyze documentation submitted by employers/consultants/agencies to determine if applicant meets the criteria of target group.
• Retrieved information from Internet, Social Services database, appropriate Confidential UI and wage record screens, HUD information
• Interpreted and apply that information per established federal program guidelines.
• Maintained, monitor and update unit’s Power of Attorney data for all consultant information.

Confidential, Richmond, Virginia

Data Analyst

Responsibilities:

• Identified problematic areas and conduct research to determine the best course of action to correct the data.
• In collaboration with others, developed and maintained databases and data systems necessary for projects and department functions.
• Analyzed and problem solves issues with the current and planned systems as they relate to the integration and management of data.
• Performed and monitors applications daily operations and supports application changes management processes across multiple platforms and environments when applicable.
• Wrote data queries based on customer, user or management request.
• On occasion, interacted with management and team members by attending and participating in application/project conference calls, status meeting, and planning sessions; provides advice and guidance to management regarding options and alternatives and assessing the impact of business and operational decisions.
• Trained and assists team members with understanding of policies, procedures and application functionality.
• Updated and maintains test plans and scripts. Coordinates and executes quality assurance and application user acceptance testing, and contingency testing.

Confidential, Richmond, Virginia

Clinical Business Analyst

Responsibilities:

• Implemented, analyze, and interpret business and clinical outcomes on multiple populations. Evaluate and validate results. Write outcomes reports and assist in preparing presentations summarizing the outcomes or related activities for the client.
• Completed clinical rules request on patient database files and verify results. Ensure that clinical rules select patients that meet initiative requirements
• Submitted test cases to Senior Clinical Analyst to allow them the time to determine which course of action should be used to correct defects in a timely and accurate manner. Also allowing the Senior Clinical Analyst to review test scripts to appropriate personnel giving detail instruction on how defects were tested and corrected
• Submitted test scripts to appropriate personnel giving detail instruction on how defects were tested and corrected
• Performed ad hoc analyses, using T-SQL and other tools, in support of quality assurance activities and customer inquiries.
• Answered incoming written or verbal inquiries from internal and external clients and coordinates responses with clinical and other appropriate departments.
• Developed PA Rules parameters based on clinical documentation. Perform data mining and test PA Rules to ensure that requirements are met. Coordinates changes with the clinicians ensuring all changes are tested and documented.
• Tested new and existing software to confirm that applications are complete and efficient.
• Provided functional guidance to technical staff, customers, and testers to resolve issues during all software lifecycle phases. Communicates working knowledge of business rules and environmental components. Has a basic knowledge of integration of system functionality.
• Resolved application-related user problems, created data queries, and acted as user liaison for the Texas Medicaid Senior Clinical Analyst.

Confidential, Richmond, Virginia

Technical Implementation Specialist

Responsibilities:

• Coded custom edits from detailed program specifications, debug and perform programming revisions to existing programs to improve their efficiency using programming language of Delphi.
• Reviewed test cases from various departments to determine which course of action should be used to

Confidential, Richmond, Virginia

Technical Implementation Specialist

Responsibilities:

• Submitted test scripts to appropriate personnel giving detail instruction on how defects were tested and corrected.
• Preformed unit testing on existing code and new code to ensure the code meets its design and behaves as intended.
• Utilized Microsoft SQL to access system database to implement client files and to document test results to make sure detailed specification are meet.
• Supported the new implementation, quality assurance and the testing of client files from start to finish. Made sure that any defect in the client files are noted and either corrected by writing new code or by advising the site of the necessary changes that they need to make on their end through written communication.
• Interacted with Clients, Customer Support and Upper Management on an as needed basis.
• Assisted other programmer in researching problems to satisfy a client’s needs.
• Performed database migration analysis tests on projects as needed.
• Provided Internet-based financial transaction solutions for health care providers and hospitals and their clients.
• Updated and created backlog reports and statistics for technical implementation of programs, including claims management, eligibility verification, code checks, code corrections, secondary billing and patient statements.