Advanced Business Analyst/pm Resume
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PROFESSIONAL SUMMARY:
- Results - oriented Lead Business Analyst with expertise in partnering with customers to understand requirements and coordinate with technical resources to deliver business solutions with focus on quality to achieve objectives.
- Recognized as a successful team/project manager with a Medicare claims processing background and consistent ability to deliver solutions within defined scope and timelines.
- Strong team contributor with highly valued organizational, communication, time management, problem solving and decision making skills.
- Other strengths include ability to multi-task and work independently or within a team.
CORE COMPETENCIES INCLUDE:
- Coordinated activities with internal cross-teams and directly with customers following Centers for Medicare Services (CMS) compliance guidelines resulting in the successful implementation of Medicare claims processing standardizations and enhancements.
- Lead BA in the implementation of the HIPAA ANSI X12 version 5010 and 5010A1 versions to include 835, 837, 276 and 277 transaction sets supporting Southern and Northern California, Massachusetts and New England for the Medicare Part B contract
- Validated remediated testing issues to ensure that identified issues have been successfully remediated and do not negatively impact customer requirements.
- Defined and analyzed business requirements; defined cost impact analysis; designed system solutions; coordinated testing and coordinated production implementation with customer and release team.
- Developed new procedures to standardize documentation release updates and instructions and coordinated efforts with customers.
PROFESSIONAL EXPERIENCE:
Confidential
Advanced Business Analyst/PM
Responsibilities:
- Project Manager of a team of 9 with a successful history of improving processes, reducing costs and developing solutions for customers within the Digital Document Management team to assure DME enhancement projects followed business processes according to CMS requirements and deliverables.
- Established timelines, created cost estimates, developed project scope/requirements, developed test cases and coordinated production implementation for project enhancements.
- Interfaced and served as a liaison with both internal levels and external customers for the investigation of processing errors related to claim batch processing failures.
- Developed and maintained a production incident report tracking tool to be used as a to easily identify root cause and resolutions.
- Developed a customized project flow/documentation process to follow HPE standards for audit purposes.
- Monitored the processing of paper medical 1500 and scanned dental claims and time card processing for Home Health Care workers for CA.
- Resolved issues encountered with batch flow and SQL database.
- Developed step-by-step procedure instructions to be used in internal resources on the workflow process, the resolution of issues and daily monitoring and tasks involved in the claims process.
- Developed and trained help desk users and the customer on a check list when reporting claims processing issues assuring all information was received on the first call reducing the volume of incoming and outgoing follow-up calls.
Business Analyst
Confidential
Responsibilities:
- Analyzed and developed design documents, specifications and test plans per CMS requirements, thereby ensuring directives were met according to CMS guidelines
- Coordinated system installations and developed cost impact analysis
- Lead BA in the implementation of the HIPAA ANSI X12 version 5010 and 5010A1 versions to include 835, 837, 276 and 277 transaction sets supporting Southern and Northern California, Massachusetts and New England for the Medicare Part B contract
- Served as main point of contact with NHIC customer for production support issues pertaining to translation of Medicare Part B claims; investigated and researched discrepancies with electronic claim submissions; assigned resources for follow-up to ensure timely completion of reported issues
- Analyzed and developed specifications based on customer needs and government mandates
- Assured successful and timely implementation of projects through test plan development, analysis and system testing
- Ensured deliverables were implemented within Health Care Financing Administration (HCFA) guidelines
- Tracked/researched/resolved system abends
- Monitored and researched critical path job issues
- Created incident reports related to system abends and production issues when SLAs were not met for distribution to upper management and customer
- Tracked claim volumes to assist customer with ICN batch range assignments and submitter transition to 5010A1
Confidential, Hartford, CT
Advanced Business Analyst
Responsibilities:
- Played a major role in the success of the Confidential Contingency Planning Project as a member of the Home Office/Field Office Project Team
- Assisted and guided Field Office (FO) sites in the development of a Contingency Plan, ensuring all possible scenarios were supported
- Developed, organized and controlled Confidential documentation and flow between FO/HO and HCFA for accurate record keeping
- Facilitated, coordinated and participated in a 3-day seminar and weekly follow-up meetings
- Developed, updated and distributed HO/FO procedure manuals with clear instructions across all impacted
Confidential, Hartford, CT
Business Analyst
Responsibilities:
- Responsible for the transfer of claim history to new carriers for canceled business
- Corrected system discrepancies and increased production efficiency by 5%
- Played a major role in the transition of the Dental System to MetLife
Confidential, Hamden, CT
Technical Advisor, Customer Service
Responsibilities:
- Supervised staff of 12; performed performance evaluations, interviewed new candidates and distributed work
- Developed individual and team goals; call-volume goals and monitored to ensure goals were met
- Coordinated weekly classes to ensure customer service accuracy, efficiency and consistency
- Managed irate calls, researched customer complaints and ensured customer satisfaction