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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLE PHONE NUMBER AVAILABLE Troy, MI Street Address
Summary8 years of Business Systems Analysis and EDI expertiseProficiency in internal web applications and EDI clearinghousesExtensive knowledge of healthcare claims processes (835, 837I, 837P, 276/277, 270/271)Experience with various types of claims (Medicaid, Medicare Advantage, Commercial, BCN, Blue Cross Blue Shield)Proficiency in editing claims with AvailitySkilled in requirements gathering through JAD sessions and GAP analysisProficient in UML for system design and documentationFamiliarity with Agile and Waterfall SDLC methodologies, including JIRA for project managementKnowledge and working experience on HIPPA, SFTP, FTP etc protocolsStrong communication, negotiation, analytical, and mentoring abilitiesExperience in analysis, documentation and designing business process modelsStrong experience in NASCO NPS System (benefits enrollment & claims)Used extensively internal web applications like UI, NPPES, Crosswalk, Portico, Web-Denis, EOS access, SharePoint and BCN CrosswalkSkillsBusiness Analysis SkillsBusiness process improvementRequirements gatheringUser acceptance testingClient relationship managementKPI monitoringData managementAdditional SkillsSoftware testingAgile and Waterfall SDLC MethodologyProduct developmentTools: Availity, User Interface (UI), EOS, JIRA, NASCO, MS Visio, MS Office (Word, Excel, PowerPoint, Outlook), CherwellDatabase: SQL, Microsoft AccessWork ExperienceSystem AnalystBCBS MI - Detroit, MI 4-11-2022 to 2-16-2024Project: EDI Helpdesk AnalystExperienced healthcare System Analyst supporting both external clients and internal management. Analyzed problems and designed recommendations, including workflows, processes, and proceduresBroad understanding of healthcare data including claims, clinical data, and health outcomesWorked in a team of three to migrate over 45,000 providers from Blue Cross EDI clearinghouse to Availity EDI clearinghouseActively worked on 835 Health Care Claim Payment/Advice, 837 Health Care Claim (Dental, Professional, Institutional), 276/277 Health Care Claim Status request and response reports and 270/271 Health Care Eligibility Benefit Inquiry and ResponsePerformed analysis of multiple areas within the NASCO Processing System (NPS)Worked on edits for Professional and Institutional claims, including P445, P016, P017, and P001Processed claims for clearing houses and billing services like Waystar, TriZetto, Change Healthcare, and Med Data HealthExtended reach to additional providers including doula, ancillary, dental and out-of-state providersManaged claims, benefits, patient records, and remittance using Availity, which provides Blue Cross Blue Shield and providers with synchronized, accurate, and up-to-date informationMaintained daily work records on CherwellWorked extensively on Trading Partner Agreement (TPA) management setup with providerSupported providers on email and phone call enquires on a daily basis.Trained colleagues on the EDI transition, guiding them periodically until they started working independentlyMastered and guided team in locating claims from Loop and SegmentsUsed extensively internal web applications like UI, NPPES, Crosswalk, Portico, Web-Denis, EOS access, SharePoint and BCN CrosswalkParticipated in weekly huddle meetsBusiness AnalystBCBS NJ- Horizon 6-6-2016 to 3-3-2022Project: Member Portal and ClaimsWorked in close collaboration with the product owner and business users to gather, analyze and document functional requirementsGathered functional and non-functional requirements and translated the requirements into user stories for scrum processWorked extensively through Agile development methodology by delivering the application into iterations on JIRARegularly participated in sprint meetings like sprint planning, daily standups and sprint retrospectiveCreated business requirement documents (BRD) and functional requirement documents (FRD). Managed project documents in Microsoft SharePointCompleted requirement gathering, GAP analysis, business analysis and business process model developmentWorked in healthcare domain knowledge including healthcare lifecycle including membership, quoting and rating, products, benefits, claims processing, and membershipManage the delivery and testing of IT services required to support the IT/business strategy, including projects which are federal mandates and BCBS association mandatesSuccessful track record in satisfying the requirements of stakeholders, delivering business value, and meeting time as per the expectationsExcellent project management, team management and software project implementation skillsProvided technical and procedural support for User Acceptance Testing (UAT)Led various reviews with the scrum team to review functional requirement specificationsDeveloped process/data flow, activity and use case diagrams using MS VisioTook lead in identifying and resolving issuesEducation and TrainingDiploma in Information Technology from K K Wagh Womens Polytechnic and Engineering College, NashikSoftware testing from IBM SEED Academy, PuneBusiness Analyst coursework (IIBA-endorsed) from Global Information Technology, Southfield MI |
