SUMMARY

• Claims and Business Analyst with over 7 years of IT healthcare experience including data analysis, testing and documentation. Seasoned in PI planning and client solution implementation.
• Knowledge of Diagnosis (dx), Procedure (cpt) codes, units and place of service (POS)
• Full understanding of membership, claims and providers
• 6 years of Facet application and Business Systems Analysis
• Great skills in recognizing and understanding business and client needs
• Performed Grooming, Prioritization and Elaboration Session with Team and Clients
• Knowledge of healthcare transactions: Electronic submission (835/834) and provider submission
• Identified solutions to resolve problems or improve efficiencies.
• Proven ability to learn new application across diverse organizational structure.
• Effective oral and written communication skills.

TECHNICAL SKILLS

• Facets
• Healthcare rules
• Member provider claims and billing
• Auditing
• User Acceptance Testing (UAT)
• Application Troubleshooting
• Requirements Documentation
• Client Interface Experience
• Management Consulting
• Microsoft Excel
• Reporting and Analytics
• Data Validation
• ALM
• JIRA
• Rally & AHA
• Agile

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

• Gather business requirements for testing environment and documented workflows.
• Tracking and reporting status on JIRA workload cases to Team Lead for assignments.
• Performed root cause analysis on implementation issues, documented findings and made recommendations to management.
• Documented Auditing new and old test claims accuracy for correct processing.
• Perform auditing documents with vendor on CPT/HCPCS and ICD10 procedure and diagnosis codes other duties on an as needed basis.
• Providing recommendations for production problems, preparing required documents for EDI Transactions
• Created acceptance criteria and user stories
• Created test scripts
• Created JIRA extract for approval Purpose

Confidential

Business Analyst

Responsibilities:

• Performed research on healthcare requirements for specific departments and created user stories
• Gathered criteria details from the business and technical team to ensure requirements are documented.
• Created test template to execute claims, members and providers while using facet application
• Created configuration document for business rules and lead implementation efforts with selected claims systems supported reimbursement policies
• Interpreted data for complex requirements and assisted in GAP analysis for members tables and fields
• Created tracking and defect documents to ensure the QA teams and product team are aligned.
• Provide recommendations and solutions for claim testing and benefit configuration.

Confidential

Claim Tester Analyst

Responsibilities:

• Performed research on healthcare requirements for specific departments and created user stories
• Gathered criteria details from the business and technical team to ensure requirements are documented.
• Interpreted data for complex requirements and assisted in GAP analysis for members tables and fields
• Created tracking and defect documents to ensure the QA teams and product team are aligned.
• Provide recommendations and solutions for claim testing and benefit configuration.
• Maintained SharePoint and confluences sites to ensure process are documented and logged Participated in procedures for enhancements and bug fixes and additional modification to improve business needs
• Communicated bridge between IT and the business stakeholders to understand and respond to their needs in rapidly changing business environments.
• Engaged in daily Agile Methodology meetings to discuss weekly deadlines and business requirements

Confidential, NY

Facets Business Analyst

Responsibilities:

• Created test template to execute claims, members and providers while using facet application
• Created configuration document for business rules and lead implementation efforts with selected claims systems supported reimbursement policies
• Assisted in the document creations for functional steps for member. Claims and provider processing
• Used ALM to execute and upload test cases from member and claim creation.
• Facilitated in Daily stand up with test teams to ensure requirements are being tested correctly.
• Ensured testing and configuration is completed to guarantee standard processes, polices, guideline, and templates are being utilized

Confidential, MD

Facets Configuration Analyst

Responsibilities:

• Benefit configuration and maintenance of requirement gathering services.
• Validate current configuration and Support Product Owner in writing functional specifications.
• Provide daily status to management with reviewing business requirements and understand business impacts and product related technical requirements.
• Created, Audit, Review and tested of SEPY Prefix, Service Rules and Business Rule
• Manage deliverables and timeline developing documentation on BRDs/PRDs.
• Working with Product Owner to develop documentation, reports and presentations for all level within the organization including executive leadership.
• Support Product Owner in writing functional specification.
• Created test scripts, Benefit configured, unit testing, defect management using CMU.
• Auditing new and old test claims accuracy for correct processing.
• Worked on 837/claims and 834/enrollment EDI transactions
• Maintained SharePoint and confluences sites to ensure process are documented and logged Participated in procedures for enhancements and bug fixes and additional modification to improve business needs
• Communicated bridge between IT and the business stakeholders to understand and respond to their needs in rapidly changing business environments.
• Created user stories and acceptance criteria for on - going requirements
• Engaged in daily Agile Methodology meetings to discuss weekly deadlines and business requirements
• Uploaded and created stories in Jira to ensure requirement development is planned properly
• Interpreted results of testing and reviewed continuous improvement plan
• Engaged in performance training and communication strategy for new processes and tools
• Knowledge of Business requirement (BRDs) to execute test case scenarios

Confidential, NC

Junior Facets Configuration Analyst

Responsibilities:

• Benefit configuration and maintenance; validating current configuration.
• Troubleshoot Tracer request via Facets system by correcting the existing issue in a configuration environment.
• Assist with documentation of Facets benefits/authorizations and claims configuration assessment.
• Provide and recommend solutions, processes and procedures for additions and/or modifications to existing systems.
• Analyze Facets for benefits and medical definitions.
• Document benefits and medical definitions in Facets.
• Created test scripts