SUMMARY:

I’m a proactive and performance driven individual, seeking an analyst position where my business and technical skills can be utilized to improve a company’s efficacy and profitability. Dedication, perseverance and the ability to adapt within a changing environment are my tools for a successful candidacy.

TECHNICAL SKILLS:

Skills: Expert in Software Configuration/ Implementation and End - User Training UX Design and Prototyping Product Management Interface Design Requirements Gathering Process Mapping and Reengineering Extensive knowledge of Practice Management and Operations Including Enrollment and Eligibility Claims, Payer and Provider EDI Transactions Call Center Billing and Commissions Trained in Agile and Waterfall Software Development Methodologies.

Software: NaviNet, IDX, Sharepoint, People Soft, Basic SQL,Wildcat, Jiva, Balsamic, Axure Athena Net Suite (Oracle DBMS), Medicare Gateway, ikaBilling, ikaCommissions, ikaClaims, ikaEnterprise, Elite, Meditec, Quicken, Web M.D, Medical Manager, and proficient in all Microsoft Office products

RELEVANT EXPERIENCE:

Confidential

Sr. Business Analyst

Responsibilities:

• Managed product support teams for various health plans including BCBS and United Healthcare
• Lead data migration from existing platform to new platform
• Configured parameters for clinical system
• Designed UI prototypes
• Overseen transition from ICD - 9 to ICD-10
• Served as the SME for the provider and member portals
• Created end user training documentation lead training modules
• Documented business processes “current and future state”
• Created test plans and user stories, managed internal system testing and UAT
• Tested functionality and design of the Case and Disease management system to ensure it aligned with clients requirements
• Lead JAD sessions, gathered and managed business requirements to be submitted to software vendor
• Created decision tables and managed import/export between systems
• Served as system administrator creating and updating user profiles
• Built rules for the sentinel engine
• Configured data and parameters for the production region preparing for go-live

Confidential

Sr. Business Analyst

Responsibilities:

• Managed the Affordable Care Act (Healthcare Reform) implementation and created all business and functional design specifications
• Analyzed and transcribed federal requirements needed to support the Accountable Care Act
• Managed and Defined project scope for internal departments
• Interviewed clients/ end-users, identified and validated business needs and software requirements
• Created end-user training modules and managed all user acceptance testing
• Lead requirements workshops/JAD sessions
• Documented current business processes, business flows, rules and artifacts, and propose To-Be/Future business processes, business flows, rules and artifacts
• Produced detailed requirements documents, including use cases and requirements traceability matrices
• Produced wireframes, screen flows, prototypes
• Overseen execution of user acceptance cases and reviewed /documented results; provided input for all release ‘go/no go’ production cutover governance meetings.

Confidential

Sr. Business Analyst

Responsibilities:

• Managed software/data migrations
• Interface design and maintenance including EDI form generation
• Solved complex system design issues
• Trained end users on system functionality and design
• Lead Joint Application Design and discovery sessions
• Created file structures to support various data loads
• Facilitated requirement gathering sessions and mapped requirements to product/system functionality
• Gathered, analyzed and validated requirements from multiple sources
• Created test plans and user stories, managed internal system testing and end user UAT
• Developed UI designs using modeling tools
• Documented workflows and results of business analysis and obtained sign-off from client on specifications. Strong analytical and problem solving skills. Ability to work in both structured and unstructured environments
• Assisted the technical team in translating application functionality into application architecture and the production of a System Functionality document
• Designed and executed test plans, tracked defects and resolved issues

Confidential

Sr. Business Analyst

Responsibilities:

• Managed and supported the system conversion from ICD9 to ICD10
• Supported all SDLC phases
• Facilitated requirement gathering sessions and mapped requirements to product/system functionality
• Worked closely with developers to create custom product designs and system solutions, Drafted mockups for new software enhancements and facilitated testing on all new functionality
• Created test plans and user stories, managed internal system testing and UAT
• Subject Matter Expert for Billing, Commissions and Call Center product lines/software
• Configured sales and broker relationship, Providers and fee schedules for claims and groups and individuals for billing
• Traveled with the sales team and lead product demonstrations for potential clients
• Supported multiple clients, assisting and resolving all day to day issues as per SLA specifications
• Captured business requirements for Projects (Multiple Modules and Systems) and translated these into functional Specifications, Database Designs and Detailed Test Plans
• Investigated/resolved all system design issues reported from users
• Partnered with clients to formulate business rules and translated those into application functionality, understanding the value proposition of the project, deciding when to advocate and when to compromise to arrive at mutually acceptable solution
• Tested new code/ functionality and reported any defects to the development team
• Managed the code release process for new product rollouts and existing systems enhancements
• Assisted in the design (front end and back end functionality) for developing the Commissions and Billing modules
• Manages and resolved defects reported by end users
• Created/ maintained end user documents for Multiple Product Lines

Confidential

Sr. Business Analyst

Responsibilities:

• Technical team liaison for other internal departments and external customers
• Developed policies and procedures creating efficiency and effectiveness within the billing/claims departments
• Managed client system migrations from legacy billing/claims software to new system applications
• Ensured that all billing/claims transactions were HIPAA compliant during migration testing
• Monitored state and federally regulated Medicare statues updating procedures/systems as they changed
• Facilitated data dumps, tested refreshed environments to ensure system integrity
• Managed GUI and system configuration
• Work within release engineering team to develop highly effective and repeatable processes for the build and release of code.
• Technical resource for all departmental system/ end-user issues for various client sites
• Created training modules, updated staff on all procedural changes,

Confidential

Business Analyst/ Manager

Responsibilities:

• Manage the closing process (monthly, quarterly, annually)and assisted in meeting internal and external reporting requirements
• Responsible for the preparation, maintenance, and reconciliation of all billing cycle activity
• Provided day to day product support to clients i.e, issue analysis and resolution
• Worked with auditors on Sarbanes Oxley and audit reviews.
• Responsible for quality assurance verification for billing system tables and processes.
• Assisted with implementation of process and control measures to increase operational efficiency.
• Responsible for all contract billing training and implementations
• Demonstrate strong project management skills.
• Audited and analyzed revenue impacting issues and propose suggested resolutions
• Performed monthly revenue assurance audits: contract validation versus billing and entitlement validation versus billing.

Confidential

Senior Reconciliation Analyst

Responsibilities:

• Supervised a team of 7 employees in conjunction with being the go to person for all departmental reconciliation inquiries and training
• Managed a portfolio of billing and A/R for physicians across the United States, specializing in problematic accounts
• Worked directly with high profile clients to resolve any billing system/ reconciliation issues
• Maintained and reinforced a strong relationship between physicians and billing department
• Primary liaison between clients and their preferred bank
• Created and implemented medical billing training modules for clients, staff and new hires.
• Developed processes to create efficiency within the billing department
• Managed all lock-box transactions
• Gathered requirements from clients and created technical specifications for the tech team
• Performed all levels of AR and bank reconciliations
• Investigated deposit differentials in order to identify missing transactions
• Successfully lead a Medicare fee schedule project that consisted of investigating and processing over 100,000 claims containing corrupted data
• Researched and clarified complex claims and made necessary edits to ensure “clean claim” status
• Conducted statistical and trend analysis of various claim issues and developed resolution plans to rectify errors
• Managed special projects, meet strict deadlines, provided quality analyses of claims and payment discrepancies
• Analyzed data and documented findings to report the level of quality/quantity of transactions posted to claims
• Created various reports and forms of correspondences to document and manage projects

Confidential

Payment Posting Analyst

Responsibilities:

• Analyzed all posted claim adjudications and monitoring transaction to ensure client SLA integrity
• Responsible for researching unpostable transactions
• Reconciled payment posting errors and investigated transactions that were erroneously posted to claims
• Managed overpayment disbursement by initiating refund requests
• Reviewed the quality of data entry received from our vendor in India in order to ensure the accuracy for claim posting
• Provided potential/existing clients and new hires with demonstrations of Athena’s posting process and functionalities
• Assisted with developing policies and departmental procedures for payment posting and billing

Confidential

Medicare Billing Associate

Responsibilities:

• Specialized in Medicare/Medicaid billing and follow up
• Worked aging and denial reports
• Billed using both paper and electronic methods
• Prepared and distributed A/R reports
• Updated ICD-9 and CPT codes for accurate billing
• Managed A/R portfolio
• Responded to billing inquires from patients and payers
• Implemented payment plans for patients and enforced deadlines
• Reconciled and determined the root cause of all over/ under paid claims

Confidential

Patient Account Representative

Responsibilities:

• Provided outstanding customer service to patients inquiring about billing/ insurance issues
• Worked aging reports maintaining all potential accounts receivable
• Worked with various departments within the hospital to compile information on patients that had overdue balances in need of collection
• Specialized in Medicare, Medicaid, HealthNet contracts and billing policies
• Finalized patients accounts preparing them to be moved to collections
• Developing and monitoring payment plan contracts held between patients and hospital facility
• Conducting background checks on patients, verifying income and residency.
• Screened patients to determine who qualified for the Massachusetts free care program
• Based on government guidelines, I determined who was eligible for Free Care.
• Attended various government payer conferences, reporting back all new federal/ state mandated billing laws or changes
• Entered and updated patient demographic information