Business Analyst Resume

SUMMARY

Confidential is a Senior Facets Configuration/Business Analyst with analytical experience including configuration, data analysis, testing and documentation.
Planned and executed client - facing solution implementation.
Supported customers on complex technical issues.
Identified solutions to resolve problems or improve efficiencies.
Strong knowledge of provider contracts and benefits configuration.
Knowledge of lines of business including (EPO, HMO, PPO, Medicaid and Medicare).
Proven ability to learn new application across diverse organizational structure.
Ability to analyze data and understand relationships.
Effective oral and written communication skills.

TECHNICAL SKILLS

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

Gather business requirements for testing environment.
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.
Processing/Updating CPT/HCPCS and ICD10 procedure and diagnosis codes, place and service codes mapping annually for test claims to pay accurately.
Verifying client benefits with phone call.
Auditing new and old test claims accuracy for correct processing.
Perform auditing with vendor on CPT/HCPCS and ICD10 procedure and diagnosis codes other duties on an as needed bases.
Providing recommendations for production problems, preparing required documents for EDI Transactions
Created acceptance criteria and user stories
Created JIRA extract for approval Purpose

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
Validate Variable Components and BDDS for accuracy utilizing FACETS 5.2.
Manage deliverables and timeline developing documentation on BRDs/PRDs.
Manage Project and responsibilities by collaborating with Subject Matter Experts to develop accurate documents
Support development resources on the team and research questions on service ticket errors as needed with client
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
Ran SQL queries to validate Benefits Configuration
Added warning messages and Clinical Editing to prefix
Beyond Compare to verify the changes that was completed during testing phase
Resolve Defects and submit trouble tickets, auditing and validating old claims issues

Confidential, GA

Facets Configuration Analyst

Responsibilities:

Confidential, NY

Facets Configuration Analyst

Responsibilities:

Validate current configuration and Review business requirements and understand business impacts and product related technical requirements.
Troubleshoot Service Request and support Product Owner in writing functional specifications.
Write user stories for Development to understand technical solutions needed and resolve Defects using CMS.
Support UAT and Testing of releases as needed.
Run SQL Queries to validate Benefits Configuration.