Business Analyst Resume

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

Enrollment using 834 transactions and CMS Companion Guide including effectuations, cancellations and terminations.
Used Trizetto HIPAA gateway and custom programming to generate CMS required format for 834.
Premium reconciliation process with CMS.
Gather requirements and create requirement documents for Connecture implementation of InsureAdvantage product using agile software development methodology including:
Individual business off federal exchange
Small group business off federal exchange
Gather requirements and create requirement documents for Stop Loss claims tracking application including:
Specific Stop Loss
Aggregate Stop Loss
Provide Facets subject matter expertise
Use SQL scripting skills to analyze WPS Facets data
Provide test cases for unit testing
Setup Control - M automated jobs

Confidential

Business Data Analyst and Facets Subject Matter Expert

Responsibilities:

Gather requirements for data warehouse subject areas and create requirements documentation
Provide Facets subject matter expertise
Create source to target mappings using Mapping Manager
Create code sets in Code Set Manager in Mapping Manager
Work with WPS to close data warehouse issues of various types including requirements and mappings
Perform data profiling on WPS Facets data using SSIS
Use SQL scripting skills to analyze WPS Facets data
Define source and target data attributes for data warehouse
Provide support in the development of solution test cases and test data sets
Provide support and guidance during execution of test cases
Support remediation of defects found during test cycles

Confidential

Senior Facets Solution Analyst

Responsibilities:

Creation of Paper Remittance Advice, Electronic Remittance Advice(835) and EFT payments. Key responsibilities included:
Requirements gathering including scheduling and running meetings with print vendor and business subject matter experts from Finance
Facets mapping document creation
Solution summary document creation
Working with testing team on development of test cases, identification of defects and remediation of defects using HP Quality Center
Health Care Reform EOB Changes. Key responsibilities included:
Requirements gathering including scheduling and running meetings with print vendor and business subject matter experts
Changes to Facets mapping document to add new required fields such as primary diagnosis codes and CPT-4 codes. Also changes related to age specific rules for dependents and when the subscriber can receive dependent EOB information.
Worked with testing team on development of test cases, identification of defects and remediation of defects using HP Quality Center
Additional Projects
Automated Maryland Member Rate Cell interface to Facets
Prospective 2.0 claim audit interface
Automated Maryland Member Emergency Contact interface to Facets