Business Analyst Resume NEWARK, DEÂ - Hire IT People

SUMMARY:

An energetic results - driven client focused professional with 17 years of experience in the health insurance industry, 15 years’ experience in customer relations.
Currently pursuing a Bachelor’s in Information Systems Management.
I have a strong expertise in adapting to new and changing environments in addition to having superior problem solving, communications and management skills.

TECHNICAL SKILLS:

PROFESSIONAL EXPERIENCE:

Confidential, NEWARK, DE

Business Analyst

Develop and implements general insurance and health policies in accordance with state and federal laws.
Interpret E.H.R Business Design Documents from CMS in support of the Delaware Customer.
Execute UAT Testing.
Knowledgeable in running SQL queries/ Use of Business Object Tools.
Coordinate and complete multiple complex assignments simultaneously.
Facilitate conference calls and virtual meetings to support the E.H.R project.
Proficient with statistical reporting and conducting power point presentations.

Confidential, Newark, DE

Provider Recruiter

Served as Subject Matter Expert: In-state and out of state provider recruitment.
Performance consulting.
Implemented and continued improvement of New Hire training program.
Managed project to transition providers from Legacy to new MMIS system for NPI implementation.
Analyzed business requirements and created test cases for the Medicaid system.
Interpreted and provided recommendations for contract requirements and business rules related to industry and legal regulations.
Processed 1099’s and B-notices for Medicaid providers and the IRS.

Confidential, New Castle, DE

Senior Insurance Representative

Served as Subject Matter Expert on insurance collection for Froedtert Memorial Lutheran Hospital.
Identified processing issues and implemented solutions.
Manage inventory and maintained productivity standards on a monthly basis.
Resolve accounts including secondary billing, appeals process, and patient liability
Prepared weekly/month-end reports and managed high-value claims at risk of exceeding timely filing limits.
Process and balance pricing reports

Confidential, Wilmington, DE

Senior Credit analyst / Account Manager

Provided training to new employees and internal/external clients on policy updated and changes.
Created and trained employees on various technical and soft skills.
Processed limit increase request and reinstatements on closed accounts.
Performance Consulting.
Distributed batch work into units personal ques. Prepared weekly payroll (Taz) reports.
Tracked weekly stats for units consisting of 15 employees.
Performed quality review on employee’s batch work and phone quality.
Prepared weekly payroll reports.
Managed Supervisor calls to satisfy irate cardholders.
Manned help-gate, product gate, & TDD line to satisfy customer needs and expectations.
Processed charge-back request resulting from customer disputes and corporate complaints.
Prepared monthly goal and expectation charts for each employee.