PROFESSIONAL SUMMARY:

• A goal - oriented team player that has excellent communication skills, training skills and has a keen ability to manage responsibilities and priorities.
• A detailed-oriented, enthusiastic, problem solver that has a good sense of humor, the ability to work well under pressure and meet deadlines.
• Is self-motivated, and has excellent conflict resolution skills.
• A good planner with specialized skills in analysis, customer service and health care.
• A positive, energetic, assertive, flexible, results-oriented and a quick learner with transferable skills.

SKILLS:

Typing-45 WPM, Operate Apple IIe, Prime and IBM PC (Lotus 123), Operate the 10 key adding machine and office calculator, Excel, Amisys, Access, Epic, Eureka, Cognos

EXPERIENCE:

Confidential

Implementation Consultant

Responsibilities:

• Created Business Requirements for the implementation of the Confidential System For Star Kids
• Created Gap Requirements Documents
• Documented Test Scripts for State Readiness review
• Configuration of Screen Designs in the Harmony System
• Testing of Screen design controls to assure appropriate triggers
• Document test results on Shared drive for review of customer
• VISIO diagrams of Case Management Work Flow
• Creation of Word Merge Letter Templates
• Assure requirements were appropriate for interfaces between New system and QXNT

Confidential

Principle Functional Business Analyst

Responsibilities:

• Attend Product Sessions to discuss requirements for Benefits
• Created GAP stories for system enhancements
• Created Business Process Documentation
• Created BRD’s
• Assuring Benefits are configured for Confidential and 10
• Attend sessions with system vendors to review and discuss requirements
• Testing in DEMO/Testing environment to assure requirements were implemented correctly

Confidential

Sr. Business Analysis

Responsibilities:

• Review documentation on Clients processing system and created desktop policy and procedures
• Worked the Provider Unknown queue
• Assisted in documentation for new client implementations
• Audit Hospital pricing configuration
• Updates for Confidential to ICD10
• Testing of new provider contracts configuration
• Testing of ICD10

Confidential

Sr. Implementations Consultant/ Pricing Lead

Responsibilities:

• Managed a team of 10 Configuration Consultants
• Conducted meetings with business users to determine current system functionality and translated into business requirements
• Reviewed business requirements to determine if the new system meet current business needs
• Produced Business Requirement Documents for functionalities that the new system currently handle with exception to specific business needs
• Produced Gap Requirement Documents for items that were not currently in the system
• Presented documents to the system software developers as requirements for enhancements to the existing system
• Reviewed documents with software vendors
• Created System Requirements Documents
• Posted Premium Payments
• Enrolled members into Amisys Advance from Market Place - Membership Reconciliation
• Conducted system upgrade training sessions with MHC clients
• Client Support with system issues
• Created PowerPoint Presentations for System Upgrades
• Client Training on System Upgrades
• Prioritize configuration needs and assign to team based on priority
• Attend meetings with Clients to discuss system configuration ability and work a rounds
• Review and assign defects
• AA Pricing Configuration
• Testing of pricing configuration to assure correct pricing per provider contract/CPT and or HCPC
• Assisted in the creation of Test Scenarios for testing of new platform for implementation
• Care Analyzer Configuration
• Medicare Benefits requirements
• 834 EDI field mapping and validation

Confidential

Implementation Configuration Analyst

Responsibilities:

• Configured Plan Benefits per Product Plan Management system and compared to Summary of Benefits
• Completed defects associated to plans created
• Answered questions or concerns presented by client and or co-workers
• Configuration completed on excel spreadsheets and uploaded by IT
• Reviewed prior configuration and made adjustments per plan updates
• Assured excel configuration migrated successfully

Confidential

Implementation Business Analyst

Responsibilities:

• Conducted meetings with business users to determine current system functionality and translated into business requirements
• Reviewed business requirements to determine if the new system meet current business needs
• Produced Business Requirement Documents for functionalities that the new system currently handle with exception to specific business needs
• Produced Gap Requirement Documents for items that were not currently in the new system
• Presented documents to the system software vendor as requirements for enhancements to the existing system
• Reviewed documents with software vendors
• Created System Requirements Documents

Confidential

Implementation Business Analyst

Responsibilities:

• Conducted meetings with business users to determine current system functionality and translated into business requirements
• Reviewed business requirements to determine if the new system meet current business needs
• Produced Business Requirement Documents for functionalities that the new system currently handle with exception to specific business needs
• Produced Gap Requirement Documents for items that were not currently in the new system
• Presented documents to the system software vendor as requirements for enhancements to the existing system
• Reviewed documents with software vendors
• Created System Requirements Documents for reporting team
• Review and test reports created by the development staff that was generated in new system to assure the new reports met business needs.
• Document test results
• Update requirement documents with more detailed explanations of requirement
• Areas of concentration
• Enrollment- Assuring ika Gateway captured Medicare enrollment of Confidential Medicare population
• Claims- Ensuring claims where adjudicating based on Confidential claims rules along with Confidential (State of Washington) COB rules. Translating these rules to ika for system updates
• Reporting- Creating report specifications and auditing reports for accuracy
• Testing of reports to validate correct data fields

Confidential

BUSINESS ANALYST

Responsibilities:

• Created SNP electronic application that filtered to the enrollment department once the SNP Sales team entered into SharePoint
• Review CMS contract language to determine how to process Seamless Enrollment
• Once process was determined I designed and implemented the process into production
• Conducted meetings with all necessary departments to get the Seamless Enrollment Process implemented
• Investigate Medicare/Medicaid changes to contracts and inform internal departments of necessary changes.
• Reviews claims data to ensure correct payments per Medicaid/Medicare increases/decreases
• Investigate internal and external questions surrounding AMISYS and respond appropriately
• Review the state’s system to assure accurate membership eligibility
• Input membership data into System
• Investigated EDI data to assure accurate membership data received
• Reconcile PMPM capitation payments
• Prepare reports for over and under paid claims
• Run reports using Eureka reporting system
• Update Daily eligibility files including COB information
• Review member history to investigate why capitation payment was not received
• Reviewing configuration of subsystem to assure accuracy for our new Community Living Product
• Reviewed HMS files to compare COB information to information on file
• Reviewed HMS claims to assure payments were not Medicare co-insurance and deductibles
• Assisted in mapping of 834 Enrollment files
• Reconciliation of Capitation payments via 834
• Configured Premium billing rates into AA subsystem
• Reviewed DPW’s system for COB information