Business Analyst II Resume

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst II

Develop Requirements Approach for handling complex project requirements for multiple health plans(9)
Manage all project information using Joint Requirements Document.
Complete complex research and analysis of State legislations to get necessary information for requirements gathering processes
Create Proof of Concept and Statement of Work documentation for project initiation
Elicit requirements using documents analysis, conference calls, and onsite meetings including: Health Plan/ Corporate Leadership, SMEs, IT, and Project Managers
Create applicable visuals for decision making and requirements tracking including: Power Points, Visio workflows, and Excel Documents
Elicit requirements for large, highly complex, Enterprise - wide project consisting of multiple focus points for the 9 Molina Health Plans in scope. (File processing, User Interface Application, and Inbound/Outbound Claims and Encounters systemic validations)
Author and maintain multiple Business Requirement Documents for complex Enterprise-wide project
Create specifications for reports based on business needs and required or available data elements.
Create Requirements Traceability Matrix to track requirements for testing and implementation
Collaborate with key stakeholders from other Corporate projects to ensure seamless integration across projects
Add input during all stages of project develop including design, development, testing, and implementation to ensure end product meets the intended requirements as defined.

Confidential

Provider Information Analyst

Analyze and process provider/hospital/ancillary application data efficiently based on priority and time management for Network participation, claims filing, and directory printing
Research validity of Provider Credentials (education, license, NPI, Tax ID)
Data configuration in multiple systems with high quality and data accuracy
Quality Analysis Review for internal and external audits
Analyze user requirements and software requirement specification documents
Maintain data based on reports/queries for quality control - daily / weekly / monthly
Medical claims research - denials, hold codes, CPT codes, HCPCS, and ICD-9
Interact with claims department using Macess and IPD Suite/FileNet workflow management to correct claim errors
Contract review and processing for Network Management in DocRequest/FileNet document storage and Portico PCMS
Carolina Healthcare Systems (CHS) and Duke Health System stakeholder provider and group system management
Trainer for various courses - class sizes ranging 1 -15+
Create - presentations for internal and external training/JOC’s SOPs / desktop procedures / user guides / training manual / job aids
Testing(UAT) for new systems and/or procedures prior to department usage
SME(Subject Matter Expert) on provider data (enrollment, credentialing, contracting, claims)
Assist IT Team with system clean up and data validation
Business requirements and functional requirements gathering- individual interviews / team meetings
Translate requirements-process mapping/ workflow diagramming/ LEAN Six Sigma
Complete Deliverables- update the business processes and complete system documentation
Assist on various Business Process Projects including for new procedures and new software

We provide IT Staff Augmentation Services!

We'd love your feedback!

Resume Categories

Client Services

Job Seekers

Visa Sponsorship