Objectives

• Motivated, detail - oriented, problem solver seeking a Business Analyst opportunity within an organization that supports critical thinking and innovation.
• Offering a strong understanding of business change needs, planning and execution of project requirements, research and analytics to achieve and deliver teh most desirable results, prior to teh expected time frame.

PROFESSIONAL EXPERIENCE

Confidential - Atlanta, GA

IT Business Analyst III

Responsibilities:

• Apply Waterfall or Agile (sprint) methodologies according to business needs
• Analyze teh business objectives of stakeholders and develop solutions for business issues
• Define and implement new processes or modify existing processes and procedures that impact both teh business units and IT.
• Assist business operations of State Medicaid program across teh carious technical processes (including member, provider, medical claims, financial and third-party liability management)
• Translate business requirements to System/Functional requirements and/or technical specifications, in preparation for submission to Application Developers.
• Document and model end to end business processes
• Served as Lead BA and liaison for Healthcare TEMPEffectiveness Data and Information Set (HEDIS) and Transformed Medicaid Statistical Information System (T-MSIS) as it relates to fee-for-service and encounter (CMO) data reporting
• Serve as lead/backup to teh NASPO all-states claims lead and Subject Matter Expert (SME) for assigned IT functional areas and Categories of Services (COS)
• Assist senior management in process development related to future system modifications, defects and enhancements
• Assist stakeholders in automating manual processes
• Conduct peer reviews of Business Requirements Documents (BRDs) and Test Scenarios/Plans/Cases
• Provide extensive training to new employees regarding departmental processes and system navigation, also create training documents that can be utilized for both internal and external users
• Serves as lead in evaluation of new technologies or solutions to improve service and efficiency of GA Medicaid services
• Develop test plans, test/use cases, and associated test data needed to execute User Acceptance Testing (UAT)
• Identify, analyze, and document business requirements and deliver work products throughout teh project life cycle.
• Define “As-Is” and “To-Be” processes of business
• Develop Customer Service Request (CSR) and participate in Change Control Board (CCB) processes
• Consult with vendors or technical staff to ensure that functionality of automated system is consistent with adherence to laws, regulations, and best practice standards by users.
• Manage any change requests related to teh working project plans daily to meet agreed deadlines.
• Analyze both technical designs and specifications and communicate changes in functionality to stakeholder(s).
• Define and implement best practices relating to system life cycle development.
• Aid stakeholders in teh development of business goals and objectives for projects and Customer Service Request (CSR).
• Represent business units in Change Control Board (CCB) and be able to fully translate decisions made to business.
• Identify system defects and serve as key point of contact for troubleshooting and resolution
• Serve as an interface between DCH IT, policy, and teh fiscal agent

Confidential, Atlanta, GA

Lead Claims Billing Specialist

Responsibilities:

• File claims to Georgia, Pennsylvania, and Alabama Medicaid, Medicaid CMOs, and Medicare; and monitor account statuses to ensure timely and accurate payments are received.
• Utilize GAMMIS, PA Promise, and Alabama Medicaid portals to verify patient eligibility, claim reimbursement, and denial edits of UB and 1500 claims including CPT-4, HCPCS, and ICD-9/ICD-10 coding
• File and enter billing for patients on customer’s billing list for assigned hospitals and analyzes patient accounts to ensure billing is accurate.
• Review Medicaid denials and resolve claims as needed.
• Perform charge corrections, as well as billing inquiries and problems such as adjustments, outliers, pre-certs, and GMCF appeals.
• Analyze Medicaid, Medicare and some commercial Remittance Advices with noledge of CPT codes
• Review medical coding as necessary and enter patient charges into billing applications.
• Generate monthly reports, tan monitor accounts over $10,000 and provide Billing Manager with detailed bi-monthly status of each account.
• Review and resolve Medicaid claim denial edits such as reprocessing

Confidential, Atlanta, GA

Treatment Coordinator/ Front Office

Responsibilities:

• Billing/Coding: Review patient chart to properly code accounts, submit and work edits for claims forwarded to Medicaid, Medicare, CMO, HMO, and other commercial insurance companies for claim processing of primary and secondary coverages
• Ensure friendly interaction and communication between patients and coworkers
• Accounts Receivables: Collect payments, copayments, prepare receipts, process and post auto draft payments to ledger and maintain petty cash
• Accounts Payables: issue patient refunds, pay bills for supplies, etc.
• Training: Provide extensive, hands - on training to all new employees regarding management software improvements, scheduling, billing, insurance verification and patient interaction
• Determine payment eligibility and financial arrangements for patients with insurance and private pay patients for services
• Receives, screens and refers calls, patients and/or guests to designated staff members
• Accept, receive and sign for all mail, packages and supplies as they arrive in teh office
• Maintain appointment book s for scheduling, canceling, or reappointing as necessary for services.
• Ensure patients are registered accurately and treatment plans are calculated correctly