PROFESSIONALSUMMARY:

• Over 10 plus years of professional IT experience in Insurance and Healthcare domain as a Business Analyst with extensive knowledge and experience across project life cycles.
• Strong knowledge of project management skills, such as time estimation, task identification, and scope management.
• In - depth knowledge of data modeling and mapping and design using UML
• Gained an experience of a project coordinator as a bridge between Client, Operations and Information Technology team.
• Ability to come up with innovative business solutions to meet company’s strategic, tactical, Analytical and operational requirements.
• Motivated self-starter with exceptional team building, leadership, and interpersonal skills.
• Proficient in working with stakeholders to elicit, analyze, communicate and validate issues using brainstorming, process flows, and JAD.
• Expertise in translating business requirements into workflow models, activity charts, and swim lane diagrams. Good working knowledge of UB-04 and CMS1500 claim forms.
• Adept at reading medical reports, EOB (explanation of benefits) statements and correspondences.
• Skilled in collection of medical information such as diagnosis, prognosis and dates of treatment from patient records.
• Current on HIPAA safety and security guidelines. Good working knowledge of MS OFFICE Suite.
• Knowledge of medical terminologies for inpatient and outpatient provider setups.
• Proficient with patient accounting systems such as IDX, SMS, NDB and Phycon.
• Meticulously accurate with figures in spreadsheets. Experienced in training other claims analyst.
• Excellent analytical, communication, management and interpersonal skills.
• Currently working on the implementation of Six Sigma for Efficiency in Billing.

TECHNICAL SKILLS:

Software Tools: MS Office, MS Visio, JIRA

Operating Systems: Windows XP, Windows 7, Windows 10

Methodologies: SDLC, UML, JAD, Scrum, Agile, Waterfall, SWOT, Six Sigma

Client Systems: CMS, SMS, Invision, EPIC, NDB, Phycon, Meditech, Horizon, HCHB

PROFESSIONAL EXPERIENCE

Confidential

Senior Business Analyst

Responsibilities:

• Analyzed MA/MAPD data and developed dashboards from scratch to help improve efficiency of the team.
• Developed Process flow documents which enhanced gaps and areas of improvements.
• Provided guidance, assistance, coordination and follow-up on complex problems and ensures resolution.
• Created reports for agent sales oversight FTE analysis
• Worked on mapping letters and OEV letter coordination
• Have IKA system knowledge for MA Fulfillment
• Created and maintained a segregated data library for all kinds of project related assistance.
• Performed unit testing to ensure the accuracy of the data being provided to the third party.
• Worked with operations personnel and generated documents about project processes and procedures for training the new joinees.
• Worked on PHI data and analyzed the same to track the time vs effort per resource.
• Active participant in decision making tier which helps improve the overall project performance.

Environment: MS Word, MS Access, MS Excel, Go to Meeting, Microsoft Outlook, Windows 7, IKA

Confidential, Ann Arbor, MI

Senior Analyst

Responsibilities:

• Primary responsibilities included receiving and processing back-end documentation needed to meet month end deadlines assuring accurate billing.
• Generated all billing documentation needed to bill in a timely manner assuring industry standards are met. Monitored and processed the Billing Data Verification Report, On-Hold Billing Report and Client Audit Report on a weekly basis to assure timely and clean billing.
• Analyzed data and recognizing trends to implement processes that increase agency’s monthly revenue.
• Worked closely with the Business/Facilities Manager in the tracking of untimely documentation and resolution of problematic billing issues.
• Utilized the CQI Process Improvement technique, responsible for implementing and monitoring changes to processes to ensure continued integrity of client accounts. Worked closely with the Intake Department to identify processes for improvement ensuring the accuracy of the billing process.
• Acted as the liaison between the physician’s office and the agency to assure the compliance of the physician’s documentation.
• Prepared and mail/fax 485s and physician orders when the situation warrants additional attempts to,
• get signed documentation back to the Agency. Coordinated tracking system to monitor outstanding orders and utilizes appropriate monitoring reports available.
• Assisted to the Business Manager in the training of new billing coordinators.
• Coordinated the flow of billing related paperwork between the branch and THHS centralized regulated billing department. Actively participated in all billing conference calls between the agency and THAH.

Environment: MS Word, MS PowerPoint, MS Excel, Visio, UML, Agile Scrum, Go to Meeting, Microsoft Outlook, Windows 7, Use Case Analysis, Homecare Homebase, Horizon

Confidential, Santa Ana, CA

Senior Analyst

Responsibilities:

• Reviewed, analyzed and translated business requirements into functional specification documentation.
• Gathered requirements from businesses and different source systems.
• Facilitated walkthroughs of test basis documents for business users and stakeholders both within and outside software discipline.
• Prepared functional specifications documents for reviewing with the quality assurance team.
• Interpreted user requirements and produced detailed documentation.
• Involved in betterment of patient eligibility verification process.

Environment: MS Word, MS PowerPoint, MS Excel, Visio, UML, JIRA, Go to Meeting, Microsoft Outlook, Windows 7, Meditech

Confidential, Santa Ana, CA

Senior Data Analyst

Responsibilities:

• Prepared and published Quality reports/dashboards on a weekly basis.
• Communicated and worked with inter/intra departments.
• Maintained track of productivity reports and shared performance feedback with the team on monthly basis.
• Analyzed, verified and updated provider’s demographic information.
• Worked on a process improvement initiative and was awarded the “Best Performer”.
• Worked on NDB to load provider demographics.
• Worked on Triage process including analyzing Healthcare Provider demo requests.
• Conducted “quality feedback session” on a daily basis to improve team’s quality.
• Published reports on backlog and production numbers on a daily basis.
• Conducted PKTs for the team on a regular basis to increase process knowledge and provided feedback to management on team’s performance.
• Responsible for special project as assigned by Manager, Director a/o Vice President.

Environment: MS Office Suite, Visio, UML, Agile Scrum, NDB & Phycon

Confidential, Columbus, OH

 Senior Business Analyst

Responsibilities:

• Was responsible for people management and the role included - selection of a right team - effectively led and cohesive, quantitative and qualitative analysis of team’s performance,
• Maintained track of productivity reports and shared performance feedback with the team on monthly basis.
• Co-coordinating with the coding team and resolving claims pending for being billed with incorrect procedure/diagnosis codes.
• Responsible for yearly performance appraisals & feedback of team members and counseling.
• Produce and analyze standard monthly reports that assist in the monthly forecast process.
• Liaise with leadership team and office staff to resolve issues and outstanding problems in the area of A/R management and revenue cycle process.
• Analyze ATB volumes and dollars across Financial Classes and Ageing groups. Analyze Payment, Collection Reports.
• Reduce outstanding accounts receivables and denials through process improvement and workflow tools.
• Responsible for managing the submission and reimbursement of claims aged greater than 90 days. Manage actions relating to delinquent accounts.

Environment: MS Office Suite, Windows XP, UML, Agile Scrum & Waterfall, EPIC

Confidential, Princeton, NJ

Senior Data Analyst

Responsibilities:

• Handled all Medicaid, Medicaid HMO, Medicare, Medicare HMO, Blue Cross, and Commercial High Cost Outlier claims from billing to payment/resolution, ensuring effectiveness and accuracy of claim submission and processing for timely payment.
• Reported, analyzed, and resolved all High Cost Outlier claim denials for Medicaid, Medicaid HMO, Medicare, Medicare HMO, Blue Cross, and Commercial Insurance Carriers.
• Organized data from team members on accounts receivables status requests.
• Prepared and presented daily, weekly and monthly reports using MS Office suite.
• Worked on developing process flow, documentation and updating of documents.
• Provided accounts receivable trend reports on a monthly basis.
• Mentored/coached project team members.
• Headed the IMPACT day program and served on the entertainment team of Deloitte.
• Followed-up on medical claims of Federal payers like Medicare and Medicaid.
• Tracked the status of accounts receivables with insurance companies.
• Worked on resolutions of account denial issues.
• Collated and kept a record of all insurance correspondences and helped in claim resolutions.
• Interacted with patients to resolve payment disputes/queries.
• Handled the customer service line of project.

Environment: MS Office Suite, Windows XP, UML, CMS, SMS, CITRIX & Invision

Confidential

Senior Data Analyst

Responsibilities:

• Understood and translated business requirements from business uses into BRS Specifications.
• Managed workflows and user security requirements to optimize claims operational efficiency.
• Documented business processes for Personal Auto and Homeowner’s insurance into the BRD.
• Documented project processes, procedures, and versions using Microsoft Visio.
• Ensured good performance of assigned efforts to the mutual satisfaction of business partners and sponsors.
• Worked on the continuous improvement of QA Processes by reviewing and evaluating existing practices with standard testing guidelines.
• Elicited business requirements by conducting structured interviews, JAD sessions and workshops across various Commercial and Personal lines within the P&C business unit.
• Implemented capacity model reports and assisted in maintaining SLA’s with optimal utilization of resources.
• Identified, investigated, analyzed, defined and documented business processes and Use Case Scenarios.
• Worked on identifying changes to the organization in order to achieve goals and prepared balance score cards.

Environment: MS Word, MS PowerPoint, Visio, Windows XP, UML, Microsoft Outlook