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Lead Business Analyst Resume

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San Diego, CA

PROFESSIONAL SUMMARY

  • An experienced, disciplined, and highly - motivated professional wif more than seven years of experience in healthcare, business analysis, project support, customer service support, claims, call center, investigation, analytical and support service. Self-confidence, integrity, and commitment to customer service excellence.
  • A fluent communicator wif strong investigation, problem-solving and decision-making skills, combined wif a pragmatic approach and sound business acumen. Strong research, case management, project support, management, workflow, mediation, and negotiation skills gained from work place experience.

TECHNICAL SKILLS

  • Business Analysis
  • Strong Customer Relations Skills
  • Project Management Assistance
  • Electronic Health Records
  • Case Management
  • Claims Management
  • Compliance, Configuration
  • Supporting Strategy Rollout

PROFESSIONAL EXPERIENCE

Confidential

Lead Business Analyst

Responsibilities:

  • Lead a team of twelve plus Business Analyst on various projects that specialized in business process for teh Healthcare Insurance Casework System, case assignment, planning and conducting initial training.
  • Attended various Healthcare Exchange and Vendor calls to develop an understanding of CMS Guidance and Casework process requirements. Managed direct reports for CMS and other matrix staff. This includes participating in interviewing, hiring and scheduling case work for staff based on operation priorities.
  • Applied noledge of state exchange, vendor and Client business requirements in order to successfully resolve HICS cases and complete business requirements as needed. Researched and reviewed enrollment cases to determine severity level and next steps to resolve inquiry. Followed up directly wif consumers and updated member cases documentation in portal.

Confidential, San Diego, CA

Project Support Specialist/ Business Analyst

Responsibilities:

  • Responsible for client progress meetings on and off site, cost control, invoicing, variation claims, invoice payment resolution and conditions of contract. Also worked closely wif other departmental managers to promote overall company TEMPeffectiveness. Performed client set up and UI configuration.
  • Prioritized business and systems problems; analyzed legislation and conducted impact analysis. Developed use cases, workflow, screen mock-ups, and conversion requirements. Co-ordinated wif teh Development Team and Testing team to track teh Defects and Resolution.
  • Gatheird requirements during inception phase, documented and delivered functional specification documents, and assisted architecture analysis and design

Confidential, Baltimore MD

Business Analyst/Project Lead

Responsibilities:

  • Worked alongside project managers during client implementation and upgrade projects to provide configuration, testing, implementation and training support. Participated in software design reviews, and other software meetings by providing subject matter expertise to expedite design process. Worked closely wif Software Engineer team to create design documents. Supported testing and design team in communicating wif various departments.
  • Interfaced wif business users to prepare and update Business Process Requirements (BPR) and Software System Requirements (SSR). Created test cases and test scripts. Performed applications and system testing. Worked wif development teams investigating and correcting software bugs and deficiencies based on teh testing results.
  • Participated in User Acceptance Testing wif Business Users. Processed medical claims when required to resolve customer issues.

Confidential

Project Lead (Consultant)

Responsibilities:

  • Lead a team of analyst to work on teh HIPPA 5010 project. Worked extensively wif teh QA team for designing Test Plan and Test Cases for teh User Acceptance Testing. Performed audit of randomly selected claims to ensure quality processing. Reviewed corporate controls for adequate documentation and evidence of conclusions. Successfully completed audit of Nasco system and uploaded results into SharePoint.
  • Assisted Project manager to create project timelines, milestones, resource planning etc.Documented business needs and requirements. Developed analytics approaches to solve questions in a timely manner. Maintained super quality ratings on all audits in 2010 and processed claims as needed.
  • Created, verified, and provided analytics reports and dashboards for teh business. Utilized various HIPPA transactions in order to complete testing, compliance and audits. Organized and coordinated teh appropriate resources to deliver teh result of teh request in a timely manner.

Confidential

Business Analyst/Project Assistant

Responsibilities:

  • Facilitated requirements gathering sessions wif teh business unit managers and subject matter experts to document requirements. Assisted teh Test lead wif claim testing and also got teh opportunity to work wif teh project manager in preparing teh project schedules, milestone tracking, and resource allocation.
  • Researched and documented data variances reported by managed care contractors.Maintained strong client relationship and provided outstanding customer service. Analyzed troubleshoot and documented client requests/issues in workload tracking system. Provided analytical and reporting support for such purposes as security operational efficiency/quality metrics and production analysis.
  • Worked wif teh SMEs (Subject Matter Experts), IT managers, software architects to identify teh key changes pertaining to HIPAA, and participated in Health Management to communicate TEMPeffectively wif them. Involved in testing of claims processed through Claim Processing Engines like Facets.

Confidential

Operations Specialist/ Project Assistant

Responsibilities:

  • Responsible for developing Business Requirement and Functional Requirement Document. Analyzed Benefit plans and coding to ensure accurate and efficient processing. Provided analytical support to teh research team for successful attainment of teh project objectives.
  • Conducted weekly meetings for deciding teh Policies and Procedures to be followed while constructing new sites.Coordinated timely implementation for new and existing accounts wif outside administrators. Functioned as teh primary liaison between teh business line, operations, and teh technical areas throughout teh project cycle.
  • Work wif Development and QA teams to transition business requirements into QA test cases and assist in UAT. Performed teh hands-on setup for member benefits and activities required to create customer specific business needs.

Confidential

Customer Service Analyst

Responsibilities:

  • Calculated deductibles, maximums, under payment, over payment and resolved all issues in a timely manner.
  • Provided timely customer service to members, providers, billing departments and other insurance companies on teh subject of claims. Processed and reprocessed dental claims. Responded to client inquiries about benefits or disputes about adjudication decisions, ensured teh accuracy of such decisions. Processed dental claims in a timely manner.
  • Trained and educated internal/external customers on teh methods applied. Logged telephone calls in system and followed up on issue

Confidential

Patient Register/Administration Support Analyst

Responsibilities:

  • Created new medical charts and coordinate information contained in multiple files.
  • Faxed and mailed all reports to physicians, professional staff and appropriate personnel.
  • Greet, log in patients and visitors. Confirmed insurance information, process medical claims, referrals, collected patient co-payments and patient health history for services received.

Confidential

Sr. Customer Service Representative

Responsibilities:

  • Answered customer inquiries and resolved problems, working wif diverse clientele. Build customer rapport using diplomacy and tact to avoid confrontational situation.
  • Managed customer accounts, call monitoring and scheduled yearly inspections on products.
  • Handled 100+customer inquiries, escalated calls and resolved billing account issues.

Confidential

Senior Customer Service Representative

Responsibilities:

  • Processed credit line increases, loan applications and new account requests.
  • Processed customer monthly payments and payment arrangement request. Received, prioritized and resolved incoming customer inquiries.
  • Became teh lead "go-to" person for new reps and particularly challenging calls as one of teh company’s primary mentors/trainers of both new and established employees.

Confidential

Senior Customer Account Specialist

Responsibilities:

  • Managed a high-volume workload wifin a deadline-driven environment. Resolved an average of 550 inquiries in any given week and consistently met performance benchmarks in all areas (speed, accuracy, volume). Researched accounts and served as a liaison between creditors and clients.
  • Identified key weaknesses in client’s financial condition. Used call center support applications to enhance assistance to customers and agents. Conducted educational counseling sessions wif clients

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