System Analyst Resume Atlanta, GA - Hire IT People

PROFESSIONAL EXPERIENCE:

Confidential, Atlanta, GA

System Analyst

Responsibilities:

Responsible for processing medical insurance claims, testing, test scenarios and validating of Benefit for Healthcare claims on the NASCO System
Created and executed test claims for Professional and Hospital from Benefit Contract and Business Requirement to ensure that system accurately reflect negotiated terms
Reported defects and performance results
Problem solving skills
Experienced in a health insurance, managed care environment,, provider contracts, pricing, medical reviews, referral authorizations, code review, fee schedules, healthcare benefits, benefit administration and health care delivery
Experience working on HMO, PPO, EPO, CMS, Indemnity, Medicare, Medicaid
Validated testing desired outcome, documented and upload test results
Communicate with coder and retest in support of defect
Worked daily with Claim Data, Claim Codes, Claims Processing and Data Analysis
Communicated with Coder to validate testing desired outcome
Analyzed and tested problems as related to customer assigned problem log (PLOG, PG Audit, Change Request)

Confidential, Detroit, MI

Test Specialist

Responsibilities:

Working knowledge of ICD 9 and impacts related to ICD 10
Reported defects and performance results
Tested Healthcare Claims on NASCO System
Performed and validated test scripts
Data analysis
Prepared spreadsheet for Documented testing results (defects)
Trained on 835 and 837 transactions
Validation of test results for Healthcare claims
Regression, End to End, Parallel, Baseline, UAT, JCL and Model Office testing

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

Gathered, researched and documented business and technical requirements for Medical Insurance Contract
Specified wrote, modified and documented requirements
Present and articulate business requirement in a clear and concise manner
Monitored requirement activities to meet deadlines
Assisted Testing Team
Translated business requirements to technical to ensure that requirements are incorporated into system design
Act as liaison between the Client and developmental team
Entered Business Requirements into System
Triaged Claims to resolve issues
Recommended solution for defect

Confidential

Billing Specialist

Responsibilities:

Worked daily with Claim Data, Claim Codes, Claims Processing and Data Analysis
Processed and resubmitted all types of Insurance Medical Claims (Medicare, HMO,PPO)
AMISYS and Payer Path Systems
Working knowledge Cost Share
Worked daily with CPT, ICD - 9, HCPCS, UB92, Medical Terminology
Medicare Appeals and Redeterminations
Closed Weekly and Monthly Reports
Responded to Patients request and inquiries
Preauthorization, Posting Payments, Medical Billing, Coding, EOB, Insurance verification, Pre-, Accounts Receivable, Research, Medical Records
Processed medical insurance claims
Worked daily with Claim Data, Claim Codes, Claims Processing and Data Analysis
Experienced working on ACARE, QCARE, NASCO (All Application) and PEGA System
Experienced in a health insurance, managed care environment,, benefits, provider contracts, pricing, medical reviews, referral authorizations, code review, fee schedules, healthcare benefits, benefit administration and health care delivery
Experienced working on HMO, PPO, EPO, CMS, Indemnity, Medicare, Medicaid
Working knowledge of Cost Share (co-pay, co-insurance, deductible, ect)
Read and understand Benefit and Contract Agreement
Working knowledge and extensive coding of claims using ICD-9, CPT, HCPCS,UB92,CMS-1500,HCFA, Red Book, Medical Terminology
Verified Benefit, provider contract agreement, pricing and cost share
Processed Hospital and Physician medical claims billing and payments
Audited, Claims Adjustments, Flushes, System Pricing, Manual pricing, Coding, Research, Billing, Insurance verification

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System Analyst Resume

Atlanta, GA

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