Business Systems Analyst Resume Profile PA - Hire IT People

Career Summary:

Provide analytical testing of the Power MHS System in relation to Medical Claims processing. Provider setup, claim payment s , benefits testing, member claims processing, group processing, and MHS GUI issues. Ability to process medical claims from submission edi to finalization check processing . Knowledge of Power MHS, Clear Cycle, Provider/Member Portal, medical claims processing, fee schedules, member/group benefit relations and setup, and related IBC support systems. Dealing mostly with business processes, financial reporting, and testing output of newly installed software and provider/member communication documents.

Professional Profile

Desire to bring a professional and unique profile to the Medical Claims Processing Testing field, whereas the process is treated as one instead of individual stand alone segments.
Able to analyze data in relation to system guidelines and understand how this gives way to payment or non-payment of medical claims submission.
Experienced in use of the Internet and technical software.
Dedicated to generating a complete and logical test case/scenario that provides accurate real time processing logistics.

Key Qualifications

CONGOS 10.1 Report Studio pull data for requested reports in relation to financial disbursement issues.
Cash Management System CMS review claims activity and related general ledger data for claims processed via MHS/Highmark Systems
Claim Overpayment Recovery COR System Highmark's claims processing system
Total Reconciliation Solution T-RECS System Highmark's Check Writing System access to view and process check transactions
Manual Payment System MPY Highmark's cash receipt, stop, void, and re-issue check writing system
Taradata SQL Assistant 13.10 giving the ability to pull data as required to support and gather information provided/produced during a testing project
Microsoft Office operation of MS Tools that support the testing efforts providing notation, charts, reports, and screen prints
Power MHS extensive use of medical claims processing system which includes reports, processing, setup, GUI testing
Incident Service Manager log and link defects and test scripts/scenarios relative to implementation via HP: Quality Center QC , Mercury Quality Center MQC , Application Lifecycle Management AML , or Service Center HPSM
Claim Payment Policy verify claim setup in reference to member policy and provider fee schedules CPP

Sr. Business Systems Analyst

Designed Test Plans for: Medicare interest tables, product benefits, and claim processing limitations/exceptions. Created Test Scenarios on Business Requirements and Functional Designs for IRS 1099 Processing, Clear Cycle Generic Check Writing Systems, Group Benefit Setup, Provider Fee Schedules, Member Benefits, special Court Ordered Interest Processing, etc. Assisted with EOB/SOR upgrades for Medicare Advantage and Late Interest Payment requirements.

Computer Skills

Microsoft Windows and DOS, WordPerfect, Lotus123, Microsoft: Word, Power Point, Access, and Microsoft Office . Teradata SQL Assistant 13.0 and IBC job specific applications/operations: GACH, Valutech, Clear Cycle, SLIQ, PHILPROV, INSIQ, CONGOS, MQC/HP Quality Center, etc.
Working knowledge of the Internet/Intranet
System installations and debugging terminal mid-level /printer operations minor
Employment Professional Development in Testing

Sr. Business Systems Analyst

Confidential

Business System Test Specialist Confidential Provider Service Help Desk Confidential MHS Help Desk Analyst I/II Confidential Claims Payment Adjuster, Confidential Claims Adjuster, Confidential Claims Processor, Confidential

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Business Systems Analyst Resume Profile

PA

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