SUMMARY

• Responsible for driving moderate to highly complex systems requirements (7+ participants and/ or budget of $400K+).
• Over 20 years of business analyst, project management and operations. Successful in gathering new business requirements, goal definition, scope control, project planning.
• Lead discussion sessions working with cross - functional groups including Project Manager’s, Business Analyst, IT Configuration’s, SME’s, Business Cross-Functional Group’s, not limited to.

TECHNICAL SKILLS

• AS/400
• DB2database
• Visio
• PowerPoint
• Excel
• Access
• Word
• IDX
• Diamond
• Blue Cross “Star Billing/Membership System
• MS Project
• SharePoint
• Planview
• HP Quality Center.EHR/EMR
• Confidential
• Remedy
• Primera
• Quality Center
• JIRA
• CMS/FMS
• Cerner (Radiology
• Laboratory
• Pharmacy)
• Soft Med
• PACS
• EDM- Enterprise Document Management
• 3MCoder
• HL7
• Web Med X
• Any queue
• Legacy
• QXNT
• Clinical Programs (UM/CM)
• CRM Salesforce

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

• Supporting through the analysis and interpretation of data in business operations for the team working on various “Enterprise Initiatives” for Clinical Programs (UM/CM).
• Assists in the development, preparation, and uses critical thinking skills to provide analysis of reports for management review.
• Creates business requirements and provides analysis to increase operational efficiency for deliverable's thru out the project lifecycle (Agile, Waterfall) E2E.
• Works cross-functionally in analyzing, designing, and developing business solutions, while working on multiple projects, establishes work plans, and timelines; coordinates with internal and external resources.
• Develops and uses communication skills to make presentations to various levels of management.
• Project Manager/Business Analyst in order to manage project resource allocation, plan and schedule project timelines.
• Lead BA facilitating JAD sessions working with cross-functional groups including Project Manager’s, Business Analyst’s, IT Configuration’s, Business Cross-Functional Group’s, in order to develop Business Requirement’s, business system design documents, customer acceptance test plans, and post-implementation plans.
• Multiple Salesforce provider services implementations, including system enhancements for claims, billing, finance, including Telehealth Virtual services implementation.

Confidential

Business Systems Analyst

Responsibilities:

• Providing basic analytical support through the analysis and interpretation of data in support of cross-functional business operations for the team.
• Assists in the development, preparation, and uses critical thinking skills to provide analysis of reports for management review.
• Creates business requirements and provides analysis to increase operational efficiency for deliverables. While identifying opportunities for improvement in operational performance and notifies management of issues and problems requiring immediate attention.
• Works cross-functionally in analyzing, designing, and developing business solutions, while working on multiple projects, establishes work plans, and timelines; coordinates with internal and external resources.
• Develops and uses communication skills to make presentations to various levels of management.
• Collects, gathers and analyzes quantitative research and competitive data to gain insights into health insurance strategies.
• Develops specific project plans and manages implementations / execution of low to high complexity.
• Performs as Project Manager in order to manage project resource allocation, plan and schedule project timelines.
• Tracking of project deliverables using appropriate tools which provide direction and support to project team and quality assurance.

Confidential

Business Systems Analyst

Responsibilities:

• Projects implemented per CMS mandates for Medicare and Medicaid/Medi-Cal. Implemented new products such as Medicare Silver Sneakers and Duals. Vendors migrated to AS/400 I Series in house for Life Products.
• Lead Analyst working with Claims, IT & Finance in order to identify, create a process that would leverage an application/systems to provide Risk Adjustment. Process was a need to implement a Concurrent Review Mechanism. Thus increasing HEDIS compliancy and STAR Ratings.
• Lead JAD sessions working with cross-functional groups including Project Manager’s, Business Analyst’s, IT Configuration’s, Business Cross-Functional Group’s, in order to develop Business Requirement’s, business system design documents, customer acceptance test plans, and post-implementation plans.
• Provides analytical support for initiatives, including business functional support for system migrations and consolidations, business area process improvement projects and product installations. Performs data analysis to support evaluation of system defects or to develop test scenarios.
• Works directly with internal/external customers in implementing new technology (e.g., web user, interfaces, outsourced vendor arrangements, and EDI interchanges) and resolving customer issue’s. Triages and troubleshoots user-reported system defects.
• Lead Project Analyst for small / large projects coordinating the planning and implementation of project. Facilitating the definition of project scope, goals and deliverables, defining project tasks and resource requirements new products, minor enhancements and full scale enterprise initiatives.
• Managing project resource allocation, plan and schedule project timelines.
• Tracking of project deliverables using appropriate tools which provide direction and support to project team and quality assurance.
• Constantly monitor and report on progress of the project to all stakeholders, present reports defining project progress, problems and solutions.
• Implement and manage project changes and interventions to achieve project outputs.

Confidential

Business Systems Analyst

Responsibilities:

• Lead JAD sessions working with cross-functional groups. Documented and communicated throughout from end-to-end process.
• Senior Analyst supporting process improvements, system implementations for clinical “ Confidential ” application (patient financial services) as it relates to end to end revenue cycle process.
• Identification, evaluation, planning, coordinating, and implementation of potential business improvements in order to increase revenue cycle.
• Performed analysis with reporting applications and cost of care experience for all product lines.
• Serving as a lead project manager ensuring the accuracy of all data and the preparation of procedure and protocols as required by the regulatory agencies.
• Lead project manager over helpdesk incidents and requests ensuring that off shore consultants meet deliverables. Coordinated the prioritization of deliverables.
• Validation of data quality, reporting of statistical data, implementation of changes, reconciliation, and control plan in order to reduce system errors.

Confidential

Senior Claims Analyst

Responsibilities:

• Lead Project Manager for small/large projects coordinating the planning and implementation of project.
• Facilitating the definition of project scope, goals, deliverables, defining project tasks and resource requirements. Managing project resource allocation, plan and schedule project timelines.
• Tracking of project deliverables using appropriate tools which provide direction and support to project team and quality assurance.
• Lead analyst for ICD9 migration to ICD10. Key measures were implemented leveraging the best practices described in ICD-10 codes described in ICD-10-CM/PCS Coding Maintenance Operational Guidance, in order to ensure HEDIS Compliancy.
• Extracting, analyzing, reconciling, trending, and forecasting data, auditing uploads of data to ensure the quality and timeliness of the data. Identifying, researching, analyzing, and trouble-shooting issues within QXNT / Legacy claims and membership systems.
• Lead JAD sessions working with cross-functional groups. Documented and communicated throughout from end-to-end process for new products, minor enhancements and full scale enterprise initiatives.
• Identification, evaluation, planning, coordinating, and implementation of potential business improvements in order to increase EDI adjudication of Legacy systems.
• Implementation of changes, reconciliation, and established processes within Legacy and QXNT. Define, create and implement policy procedures.

Confidential

Lead Client Support Analyst

Responsibilities:

• Clinical Application analyst and standardization of current business operations as it relates to office production need and efficiency. Analysis of medical collections, billing, batching, bad-debt, and write-off’s and cash postings.
• Lead support analyst working on EMR enhancements in order to reduce error’s and identify the root cause, implement enhancement to ensure correct HEDIS codes captured and that HIPPA is complaint.
• Identified/created/developed a control plan in order to ensure standardizations of processes are producing value and reducing of non-value adds.
• Lead analyst/project manager for off shore team in India for complete automation of “Night Shift Operations”.
• Developed business requirements, functional design, implementation and results analysis. Coordinate with developers to support solution design, testing, deployment, training and ongoing support for Clinical Applications and EHR/EMR Application.
• Standardize departmental operations from registration, order entry, through work list management and image interpretation, to image and result distribution and business analysis.

Confidential

IT Business Analyst

Responsibilities:

• Performed application and system analysis of business or user needs in order to develop or modify procedures by leveraging technology onsite for “ Confidential ’s claims and membership applications / systems.
• Lead JAD sessions working with cross-functional groups. Documented and communicated throughout from end-to-end process.
• Analyzing user requirements and developing business requirement specifications.
• Prepares and executes test scripts, interprets results and prepares all test documentation for small/large product implementations. Assist in user regression testing for small/large products.
• Supporting clients in order to modify the Star Premium Billing System customer segments, without any interruption of quality service to members, groups, providers and brokers while maintaining the integrity of existing financial and actuarial systems.