Sr Business Analyst Resume

OBJECTIVE

To apply and enhance my claims knowledge, auditing and resolution skills at a reputable and stable company which encourages growth and advancement for their employees.

TECHNICAL SKILLS

ICD - 9; ICD-10, CPT, HCPCS, CMS-1450; CMS-1500
Facets, NextGen, Macess, Amisys, Clear Claim Connection, Diamond, Xcelys
Webstrat, Encoder, Sidewinder, Quest; ClearQuest, ClaimMiner, Racer Admin, Rally, Safari, TruCare, Cenpas
HIPPA, Facets Certified, UAT Testing; Claims Detail Reporting, Reading SQL

PROFESSIONAL EXPERIENCE

Sr Business Analyst

Confidential

Responsibilities:

Assist to develop, implement, and/or evaluate health information technology applications and tools, processes and structures to aid with the development of new enterprise care management from current legacy system to enhance outcomes of quality indicators.
Responsible to review, analyze and create Utilization and Care Management workflows to design, develop, and build best practices documentation.
Assist with defining detailed information for Authorization and Appeals and Grievance workflows.
Review workflows for gaps and provide possible solution.
Create Use Cases and Test Cases. Provide click by click instructions for Use and Test Cases.
Performed and provided Time Study details and reports.
Assist with translating Health Plan authorization grids into configuration tables.

Sr Business Analyst

Confidential

Responsibilities:

Identify patterns of claim payment abnormalities that will lead to new rule development through data analysis. Research new leads for viability.
Create client test files and gather all supporting documentation for trend approval.
Develop metrics to provide forecasting on new client rule profitability.
Maintenance of existence rules to drive maximum performance output.
Facilitate new rule kick off calls with Operations, Centers of Excellence, and the Recovery Team.
Focus on developing concepts in partnership with Analytics and Operations partners to identify and research potential claim trends.
Gather data requirements for SQL queries. Write SOPs.