Sr. Business Analyst Resume

SUMMARY:

Seasoned, results - oriented professional, with extensive technical experience in providing solutions driving change processes that directly impact the bottom line. Combined technical and strategic planning expertise with an unrelenting commitment to the customer (both internal and external) to develop processes that exceed business needs and improve productivity.
Career-long reputation for designing and delivering cost-effective projects and innovative enterprise initiatives that resolve complex business problems and improve overall operations. Dependable and exercises independent judgment and decision making abilities in establishing technical standards, ensuring adherence, and in evaluating problems and creating manageable solutions. Proactive, with a team-oriented attitude possessing strong analytical and interpersonal skills coupled with excellent written and oral communication skills.

PROFESSIONAL EXPERIENCE:

Confidential, Long Beach, CA

Sr. Business Analyst

Responsibilities:

Currently the primary liaison between IT and assigned health plan and state Medicaid programs. Principle analyst for supporting new projects that address issues within health plan operations. Implemented quality measures to ensure accuracy and consistency of encounter submissions to the state. Perform complex research and analyses on a variety of topics related to the overall support of business processes. Troubleshoot problems related to exchange of data between software platforms and other software applications which rely on accurate data feeds to enable effective, efficient operations.
Researched, defined and analyzed changes and requirements to both state and federal laws affecting the Medicaid Management Information System (MMIS) for Illinois Medicaid account and translated it into proposed system enhancements.
Performed analysis of encounter transportation data and identified gaps in requirements. Implemented new requirements resulting in an increase in acceptance of the encounters by the state.
Facilitated requirements and design sessions and performed gap analysis between client’s system and Molina’s system in order to assess provider issues.
Keep abreast of state requirement changes by registering to receive state notifications
Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.

Confidential

Business Process Analyst II/Enterprise Manager

Responsibilities:

Established and enforced service level agreements in consultation with end users to establish problem resolution expectations and timeframes.
Responsible for responding to inquiries and troubleshoot and coordinated resolution of technical problems and information technology issues related to the Avatar electronic medical record and other division applications
Oversee development and dissemination of help sheets, usage guides, and FAQ lists for end users
Develop documentation process for inventory control, asset replacement and retirement using TrackIt.
Oversee software upgrades, and support for 50 facilities

Confidential

Business Analyst Consultant

Responsibilities:

Oversee business operations to ensure applications are maintained within contract terms and a uniform change management process is followed by different support teams.
Managed Provider Web Portal and Provider Applications
Support MMIS sub-system updates, edit issues, and reports
Implemented and provided support for McKesson Claim Check Application web portal.
EDI Support for clients’ claims submissions
Tracked and maintained stat- requested enhancements and changes to NV MMIS