SUMMARY:

• Talented business professional with 14 years of experience in healthcare and financial industries.
• Also continual knowledge gathering of financial processes.
• Outstanding leadership, communication and project management skills in both Waterfall and Agile environments.

TECHNICAL SKILLS:

• Expert in business process requirements gathering and BRD document development
• Daily system analysis, testing and implementation of software applications.
• Participate in daily scrums and ensuring releases meet the targeted dates.
• Participate in and hold daily Scrums to meet project deadlines
• Strong knowledge of HIPAA privacy rules /compliance and medical ICD - 9/10 and procedure codes
• Strong knowledge of loan creation and development processes
• Experienced in Realtime, X12, Java, UNIX, Oracle, FACETS, and SDLC and SQL queries, and Atlassian software

PROFESSIONAL EXPERIENCE:

Confidential

Retail Business Analyst

Responsibilities:

• Sole B.A for Confidential ’s Retail division business within the IT department.
• Responsible for the gathering requirements for the Retail LOS to improve the current SDLC
• Responsible for setting and holding Kick off Meetings the client for project development reviews
• Responsible for meeting deadlines monthly and weekly for releases.
• Provide technical support for daily software issues before they reach 2nd level support for the division.
• Provide 2nd level QA testing for the new projects once it has been developed on the Beta environment to ensure changes/updates meet the specs.
• Assist project managers regarding gathering information for daily scrums regarding assigned projects.

Confidential

Infrastructure Systems Business Analyst

Responsibilities:

• Responsible for the gathering requirements for the current separation of Walgreens and TakeCare facilities
• Responsible for keeping track of the daily requested d Confidential transfer jobs (Moveit Jobs to eXact jobs)
• Assist with monitoring of support EMR queue for incidents reported from different store locations.
• Provides support for the current email migration process of all users.
• Directly assist my project managers by working with the development teams to keep the current project moving.

Confidential

Business Analyst

Responsibilities:

• Gathered requirement details used for programming system changes the state has required
• Serves as a point of contact between the State of TN and HP to provide requirement documentation and business design documentation created per work request from the state.
• Monitors the progression of the testing done in order to complete the request through development
• Responsible for setting and holding Work Progression Meetings with team and the state for project development reviews
• Responsible for meeting deadlines weekly, monthly, and quarterly
• Analyzes test results to verify the proper changes have been developed before sending it for state approval
• Assist project managers regarding gathering information and explaining the claim and encounter systems.

Confidential

Provider Relations Business Analyst

Responsibilities:

• Serves as liaison to providers and is responsible for performing activities designed to establish and maintain positive and productive relationships with Confidential network providers
• Responsible for several single and multi-doctor practices associated with Tennessee participating hospitals such as HCA, Vanderbilt, Baptist and Summit
• Identifies and monitors provider issues and concerns, recommends solutions, and worked with local and corporate staff to resolve the issues.
• Analyzes provider network for adequacy in addressing members’ medical needs and assists in the identification and recruitment of key providers where network gaps exist
• Lead project manager for state Medicaid applications.

Confidential

Business Analyst

Responsibilities:

• Trained providers regarding procedures to submit claims and how to resolve issues to ensure that providers and health care insurance policyholders are satisfied with their services.
• Resolves administrative problems effecting network providers, Confidential ts, and plans within contracted guidelines for which the network is responsible.
• Worked with over 2,000 providers in a single month using CIGNA’s products and services
• Improved EDI process by compiling and analyzing d Confidential and identifying areas of improvement.
• Managed caseload of 80 client’s daily, providing enrollment of Cigna's process and education.

Confidential

Lead Business Analyst

Responsibilities:

• QA'ed and documented specifications related to test files and reports for system and edit changes.
• Thoroughly analyzed elements of customer's business needs and request for system enhancements.
• Instructed customers on how to file claims successful for governmental base insurance programs.
• Processed monthly reports for departmental analytics and performance.

Quality Assurance Business Analyst

Confidential

Responsibilities:

• Maintained project plans for professional/institutional lines of business for new and existing contracts.
• QA’ed and tested 270/271 system formats for errors and accuracy prior to production.
• Evaluated implementation and project plan to ensure deliverables are met on time.
• Processed monthly reports and statistics for improved business performance

Claims Business Analyst

Confidential

Responsibilities:

• Responsible for trouble shooting and resolving daily payer production issues for Aetna, Horizon BCBCSNJ, Coventry and Cigna.
• Conducted product demonstrations for existing customers to grow their EDI business with Emdeon.
• Assisted with training newly hired and existing staff on the functionality and application of product/ systems.
• Documentation specialist for team; created new hire educational manual.

Batch Systems Technical Specialist

Confidential

Responsibilities:

• Proactively monitor reports to track monthly volume, rejections, usage of services and act according to ensure client is maximizing services.
• Support customers with set-up and enrollment certification to submit claims electronically to government and commercial payers.
• Assisted Customers with support issues, transmitting files and understanding reports, set-up and enrollment certification to submit claims electronically to government payers.

Real-time/QA Support Analyst

Confidential

Responsibilities:

• Provided customers with credit card/billing resolutions and reported functionality problems.
• Tested new products prior to rolling out to vendor and provider communities.
• Trained newly hired staff on the functionality of the VeriFone POS systems, and departmental rules.