SUMMARY:

• To obtain an analytical/management position which will utilize my implementation skills, system configuration, Provider Enrollment/Management knowledge, analytical and project management skills in order to successfully achieve company goals.
• Proficient in Amisys, MetaVance, DXC Healthcare Payer Platform, Oracle Health Insurance (OHI)
• Proficient in Microsoft Word, Excel, Power Point, and Visio, JIRA
• Knowledgeable in interChange
• Knowledge of SQL, HTML, and Java
• Knowledge of Oracle Database
• Application Lifecycle Management Software Application
• Extensive knowledge of EDI
• Business Analysis
• Business Development
• System Implementation
• Ability to adapt and quickly adjust to Change
• Ability to work with Cross - Functional Teams
• Client Relationship Management
• Designing and Implementing Tests of Processes
• Validate Functionality
• Facilitating Meetings
• Detail Orientated

EXPERIENCE:

Confidential, Plano, TX

Business Business Process Consultant

Responsibilities:

• Contribute to client deliverables
• Established relationships with the client and vendors
• Customer focus that results in delivering high-quality service and client satisfactions
• Manage, communicate, and represent requirements throughout the life of a project
• Provide input on processes, procedures, or new approaches
• Consider the business implications of the application of technology to the current and future business environment
• Work with the Business Owners to select or create appropriate scenarios to test all results to determine whether system changes (Business Rules) met project specifications; use scenarios to assist in acceptance testing

Business Systems Analysis Specialist

Confidential

Responsibilities:

• Participate in application implementations and tests end user processes
• Configure benefits in Oracle Health Insurance (OHI)
• Configure providers and provider contracts in Oracle Health Insurance (OHI)
• Work with business users to define and analyze problems and align the most appropriate technical, application or configuration solutions
• Provide input on processes, procedures, or new approaches
• Consider the business implications of the application of technology to the current and future business environment
• Work with the user to select or create appropriate scenarios to test all results to determine whether system changes met project specifications; use scenarios to assist the end user in acceptance testing

Confidential

Business Consultant III

Responsibilities:

• Establish and maintain relationships with several business implementation teams. Use deep business knowledge and business insight to drive improvements in IT engagement for major initiatives
• Communicate specific IT decisions relevant to the business implementation teams.
• Represent the needs of the business, function, or geography during implementation projects
• Communicates standard IT solutions to meet the needs of the business, function, or organization
• Actively participate in Client Implementations to ensure that business, function, and customers receive sufficient and timely communications
• Follows defined processes and implements process changes as needed to meet ongoing Client objectives
• Responsible for system configurations in the Provider Management Module

Confidential, Cupertino, CA

Business Analyst III

Responsibilities:

• Solicit and define enhancement scope and objectives based on client business needs
• Serve as a liaison between client and technical solutions/support groups
• Develop requirement specifications using standardized methodologies, processes, and tools
• Maintain interchange to ensure that when code is deployed, the system performs as expected.
• Develop and maintain internal and external relationships to support management of scope and expectations
• Participate in proposals, implementations, and new business development
• Develop and execute test plan strategies as the Provider Interface was implemented
• Maintain project deadlines and report outcome of testing and configuration to Business Owners and Management.
• State and Local system implementation/Backend Reporting system/Provider Management
• Elicited business requirements from business areas in understanding about key business processes

Business Analyst III

Confidential

Responsibilities:

• Worked closely with clients in determining the needs of new system capability
• Elicited business requirements from business areas in understanding about key business processes
• Analyze and draft business requirements based on client needs
• State and Local system implementation/Release Coordination
• Define and document release recommendations for each release
• Maintain release management schedule for specific/assigned system/subsystems
• Document and communicate all changes for a release
• Facilitate release planning meeting with key stakeholders to identify proper sequencing of release packages
• Support release execution by monitoring each phase of a release
• Provide release coordination and communication during and after deployment
• Work closely with Change and Configuration Management to stay current on all changes, configuration, and internal controls standards and processes
• Formulate and define system scope and objectives based on user needs.
• Act as a liaison between client and technical solutions/support groups
• Document requirements specifications using high level methods, processes, and tools.
• Execute and coordinate requirements management and change management processes.
• Develop and maintain internal and external relationships to support management of scope and expectations.
• Participate in proposals, implementations, and new business development.
• Test plan design and execution
• Maintain project deadlines and report outcome of testing and configuration to Business Owners and Management.
• Upload test plans and test cases and record all defects using Quality Center.
• Executed ICD-10 related testing to ensure clients day-to-day operations were met with capability
• Documentation of results of components of EDI transactions with clients(ie: eligibility, Ccode match, reprice claims, etc.).
• Defect reporting to appropriate departments for Test Director.
• Attend meetings to facilitate a smooth and error free process.
• Maintain project deadlines and report outcome of testing and configuration to Business Owners and Management.
• Use of different software programs affiliated with Multiplan (Axiom transcend, NetworkX, Instamed Portal, Client Data Management system, Enterprice, etc.)

Confidential

Business Analyst

Responsibilities:

• Provide configuration to BCBS of MA configuration team members.
• Provide guidance on configuration workbook structure and use.
• Provide insight on how to best use MetaVance for daily business activities.
• Support Conversions, Interfaces, and Data & Reporting component areas.
• Provide configuration related to new releases and/or Patches.
• Responsible for configuring MetaVance in multiple areas of the system.

Confidential, Plano, TX

Benefit Configuration Analyst

Responsibilities:

• Responsible for any projects or tasks that come into the department.
• Develop and maintain system configuration in accordance with providers, employer contracts, and customer needs.
• Develop, maintain, and disseminate internal and external configuration documentation, including status updates.
• Analyze, design and implement in accordance with the customers needs.
• Provide consultative services by actively participating on numerous cross-functional teams and projects, as well as troubleshooting inquires and issues from other departments.
• When testing out configuration we would use Suprtool to retrieve appropriate data from various departments (ie: claims,, provider).
• All configurations were handled in Amisys.
• Test plan design and execution.
• Documentation of results of Benefit Packages, Medical Riders, and Configuration for Hospital/Ancillary contracts.
• Attended meetings to facilitate a smooth and error free process.
• Maintain project deadlines and report outcome of testing and configuration to Business Owners and Management.
• In July of 2003 became the Project Coordinator for UAT.
• All work was handled in Amisys.
• Responsible for all Service Requests and Benefit Packages for proper distribution.
• Responsible for all projects that came through the department.
• Member of a specialty team designed to resolve high volume, complex claim issues within the HPHC system.
• Actively monitor a team of 12 processor/resolvers and manage their workflow.
• Evaluate team statistics and data as a means to identify and improve individual, team, and department performance.
• Provide coaching to staff that enables them to provide quality processing/research and promote career enhancement.
• Effectively perform root cause analysis of problematic claims and coordinate resolutions with other departments to ensure that issues are fully resolved.
• Successfully complete projects from senior management while meeting deadlines and achieving provider satisfaction.
• Track vacation, sick, and associate time, on a daily basis, to maintain appropriate staffing levels for current workload.
• All work was handled in Amisys.