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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.

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