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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

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