Business Systems Analyst Resume Profile

Summary

SYNOPSIS Healthcare professional with nearly seventeen years experience. Experienced in various entities including process mapping, software testing, data analysis, benefit coding, adjudication, claims scrubbing, conversions, collections, billing, appeals and customer service in physician and hospital environments. In addition, required to research and troubleshoot issues regarding patient eligibility, providers, insurance carriers, and benefit data to ensure prompt effective service to ensure client and customer satisfaction within revenue cycles. Possesses strong interpersonal and organization skills and ability to work in high-stress situations. Excellent verbal and written communication skills. Displays cognitive capacity and willingness to learn and operate multiple computer systems effectively and efficiently. FDCPA and HIPAA compliant

EXPERIENCE

Confidential

Business Analyst

Contracted through TM Floyd
Defined customer needs in technical and business contexts.
Ensured the proposed technical and business solutions meet the customer's objectives for the work effort.
Provided guidance with planning and prioritization of business support-related activities.
Elicited and documented user requirements to meet a business objective.
Identified and validated requirements and organized the information into a logical document that is understood by the customer and Information Systems.
Guided technical and customer departments in the development of the systems that support the business solution.
Facilitated the transfer of knowledge about the direction of the business units to others who support them.
Ensured the accurate deployment of solutions through review of problem logs, assisting with test plans and test matrices, and other analysis activities.
Provided input on the business direction for system changes.
Validates the business need for solutions to business problems and process improvements.

Confidential

Billing Supervisor Advise executive leadership proposed changes, developments, and opportunities affecting the organization. Responsible for all functions related to benefits, accounting and reimbursement endeavors.
Provide oversight, coordination and prioritization of projects ensuring timely and accurate completion of each.
Maintain compliance of all credentialing rules and regulations for all practicing physicians.

Confidential

Patient Account Analyst

Duties include reviewing pended and denied invoices for various physicians.
Tasked with identifying coding, ICD-9, and CPT irregularities
Responsible for interfacing with Medicaid, Medicare and Commercial insurances.
Accountable for executing all required steps for immediate payment reimbursement.
Maintain accurate reports for internal management and auditing purposes.

Confidential

Business Systems Analyst

Contracted by Jawood Incorporated as Consultant within IT Department.
Data update for resolution of P-Logs and Out-of Balance spreadsheets.
Duties included researching pended and denied claims for reprocessing.
Tasked with validating ticket issues for accuracy and finalization.
Tasked with process mapping, troubleshooting and testing issues related to business analysis.
Duties included noting claim edits and reworking for proper adjudication.

Confidential

Patient Account Analyst

Contracted by Bearingpoint Incorporated as Collector.
Responsible for overseeing revenue cycle activities for various accounts.
Responsible for the recovery of over 5 Million for Duke PRMO.
Tasked with identifying revenue cycle trends for quality assessment.
Researched payer regulations, guidelines and revenue cycle practices.
Duties include claim filing, spreadsheet updating, and letter generating.
Duties included researching pended and denied claims for reprocessing.

Confidential

Business Analyst Consultant

Consultant contracted for State of LA, BCBSNJ, BCBSMA, and BCBSNC.
Responsible for researching claims and modifiers for claim resolution.
Tasked with document imaging, deductible, and maximum issues.
Researched, processed, and audited hospital and professional claims.
Gathered and analyzed user requirements.
TECHNICAL Microsoft Office, Lotus 123, Excel, Paradox, Mega west, ECI, OSCR, Cirius, GE, MMIS, Blue-E
SKILLS Med MC, Power Point, RIMS, GBAS, Star Navigation HBOC , Medicare Florida Shared FSS ,
Diamond 725/950, QBLUE, OPS Database, Lawson, MOBIUS, Siemens, IDX, Cirius, Hyland, EMR
IMACS, RAS, Facets, TPX, SQL, NASCO NPS , QNXT, Formats Database, Med Assets, SMS, All-Scripts, MCINFOPK, FISS, MRTS, Microsoft Access, Mainframe, Iflow

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