Business Analyst Resume Profile

SUMMARY

l A healthcare analyst and writer with a diverse technical background in creating clear and easily consumed documents for requirement and business designs.
l Experienced in end to end system testing, user acceptance testing UAT and regression testing.
l Interviewed business process owner, subject matter expects to develop a clear understanding of business and system documentation.
l Worked with software developers to document system behavior or functions to execute system testing
l 21 years of Medicaid claims processing experience

Technology Summary

Systems:Medicaid Management Information System MMIS , Windows 2003/XP/7, Business Object, Web Interchange
Software:MS Word, MS Visio, MS Excel, MS PowerPoint, MS Access, MS SharePoint, MS Lync 2010 Communicator, MS Outlook

IT Experience

Confidential

Business Analyst

Create an industry checklist for end-to-end testing
End-to-end pilot project
Create requirements and testing

Confidential

Business Analyst Regression Testing Coordinator

Acted as a liaison between external and internal customers, and other support groups to identify business processes, systems, and product requirements
Documented customer specifications and interacts with other support groups to understand customer's business needs
Used the System Life Cycle process to gather information for requirements document, business design document with MS Visio flowcharts and created test cases plan to execute for system testing
Researched, identified, and developed solutions to customer problems
Made recommendations to management on project related actions
Conducted testing with Electronic Data Interchange EDI transactions which includes Claims submission 837I, 837D, 837P MCE eligibility file 834 , Provider Remittance Advice 835 Eligibility transaction 270 inquiry/271 response , claim status transaction 276 inquiry/277 response , Prior Authorization transaction 278 inquiry/response , and Biller Summary transactions 999
Completed gap analysis for ICD-10, Edifecs 5010 HIPAA transactions, National Provider Identifier NPI , National Claim Correction Initiative NCCI
Generated quarterly regression system end to end test cases and reports to external customers
Trained new business analysts over system life cycle change order process
Presented claims processing presentation to new business analysts
Served as claims business analyst subject matter expert SME
Trained business analysts in claims submission via Web Interchange system, paper submission and EDI claim submission
Presented requirements, business designs and testing results documents to internal and external customers.
Used business objects to run query for find testing data for recipients and provider
Conducted post implementation review testing
Used edit configuration to create new edit in the system
Updated business process manuals and system process manuals
Used requirements traceability matrix to map requirements through the change order process
Trained to use IBM RequisitePro Client for Use Cases.
Implemented new Medicaid programs Presumptive Eligibility PE and Healthy Indiana Program HIP for the State of Indiana Medicaid program.
Use the Service Manager system to trace defects in system testing

Confidential

Team Coordinator /Training Coordinator

Served as requirements gathering subject matter expert
Created and executed system test cases
Documented customer specifications and interacts with other support groups to understand customer's business needs
Researched, identified, and developed solutions to customer problems
Made recommendations to management on project related actions
Trained new and current employees participated in interviewing and hiring new candidates
Researched and resolved complex claim and provider issues
l Performed quality checks to assure claims were processed correctly and in a timely manner
l Led team meetings and served as a Subject Matter Expert SME in various meetings
l Managed and coordination work efforts for 16 claims and adjustment clerks
l Conducted quality check work for 16 claims and adjustments claims
l Created, documented and updated edits and audits processes
l Processed all claims types for payment through the claims processing system
l Processed all claim types for adjusting or voiding a claim through the claims processing system

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