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Click here or scroll down to respond to this candidateCandidate's Name
Street Address C: PHONE NUMBER AVAILABLE E: EMAIL AVAILABLEPROFESSIONAL SUMMARYExperienced Business Analyst IV with over 24 years experience in Applications and Business Analysis in the healthcare field. Assisted in multiple systems implementations such as Amisys, QNXT, Optum ICES, and Facets. Energetic presenter and confident communicator with the ability to circulate information clearly and efficiently for end-users. Creative in finding solutions to problems and determining modifications for optimal use of organizational data. Expert at providing realistic projections and establishing various scenarios to determine viable process strategies to utilize. Organized and timely in providing staff, departmental members, and executive management with reports on specific data findings and their impact on organizational growth and success.QUALIFICATIONS & SKILLSProblem-solving and troubleshooting MS Office Software EDI Encounter Process Data analysisProcess implementation Strong written & verbal communication Business Process Documentation CenPass Reporting Amisys Teradata Golden Provider Payment Systems (PPS)PROFESSIONAL EXPERIENCEBusiness Analyst IV Meridian Health Plan/Centene Corporation 9/2023 08/30/2024 Encounter errors MicroStrategy queries to locate errors within Amysis EDI files 835- Claim Payments, EDI files 837P- Professional, EDI files 837I Institutional Deliverables and yearly Compliance update Business Process Documentation creation, maintenance, and update Development of Business Process Documentation for multiple departments Implementation of workgroups to close gaps within departmental procedures Issue Management, provider claims complaints, claims research. Check Run Reporting Service Now Ticket resolution Medicare and Medicaid Claims researchBusiness Analyst III Sunshine Health Plans/Centene Corporation 4/2015 9/10/2023 Encounter errors MicroStrategy queries to locate errors within Amysis EDI files 835- Claim Payments, EDI files 837P- Professional, EDI files 837I Institutional Daily communications with multiple departments on provider updates being processed correctly Assist with Compliance P&P creation, approval, and maintenance for Invitation to Negotiate (ITN) deliverables and yearly Compliance update P&P maintenance and updates Business Process Documentation creation, maintenance, and update Assist multiple departments with ITN deliverables Development of Business Process Documentation for multiple departments Lead for Onsite meeting with AHCA and DXC Implementation of workgroups to close gaps within departmental proceduresImplementation Consultant MedeAnalytics 7/2021 01/2022 Conducting assessments of current project capacities and timelines. Performing implementation planning and setup activities for projects. Developing sound business practices and procedures for the project. Directing team members as needed to ensure successful project implementation. Liaising with management and stakeholders on project details and deadlines. Training and onboarding new team members as required. Presenting feedback and suggestions relating to the implementation of assigned projects. Identifying, reporting, and resolving key project issues. Ensuring that all project and implementation related documents are up to date.Intermediate Applications Business Analyst HealthSun Health Plans 03/2015 - 04/2015Randstad Staffing Agency Assessing user needs, analyze business requirements, and translating into business functional and technical specifications Developing test cases and executing testing procedures Troubleshoot databases, reports, and form issues reported by users Provide training, documentation, and implementation of tools as needed Process improvement, workflow, benchmarking and/or evaluation of business processes Problem-solving, including multiple priorities and research conflicting and/or inaccurate data Present analysis and interpretation for operational and business review and planning, Working under contract for Modis for Children's Medical Center of Dallas Created test scripts for QNXT ImplementationSenior Encounters Technician Independent Living Services 6/2014 - 9/2014 Work with Encounter and Ran MS Access queries to quantify the errors Made corrections on the file to resubmit to the state Encounter Pro software (minimal use) Communication daily with Medicaid Customer Service with Provider inquiries Process documentation for Encounters EDI files 835- Claim Payments, EDI files 837P- Professional, EDI files 837I InstitutionalSystems Analyst Simply Healthcare Plans 8/2013 - 5/2014 QNXT 4.7 currently in QNXT 5.01 (Hosted by TZG) ICD-10 configuration in preparation for CMS go-live date of 10/01/2014. Procedure Codes - add/terminate codes as requested by the Claims Department ICD Procedure Codes - update and terminate ICD Procedure Codes Diagnosis Codes - update and terminate ICD-9 codes Run and submit FTPs for Medicare and Medicaid Files Testing and troubleshooting system issues EDI files 835- Claim Payments, EDI files 837P- Professional, EDI files 837I InstitutionalSystems Analyst Simply Healthcare 8/2013 to 5/2014 QNXT 4.7 currently in QNXT 5.01 (hosted by TZG) ICD-10 configuration in preparation for CMS go live Procedure Codes - add/terminate codes as requested by Claims department ICD Procedure Codes - update and terminate ICD Procedure Codes. Diagnosis Codes - update and terminate ICD-9 codes. Run and submit FTPs for Medicare and Medicaid Files Testing and troubleshooting system issues EDI files 835- Claim Payments, EDI files 837P- Professional, EDI files 837I InstitutionalApplications Analyst Leon Medical Center Health Plans 4/2010 - 8/2013 ICD-10 configuration in preparation for CMS go-live date of 10/01/2014 User-Defined Codes configures User requested codes to be specific departments User Warning Messages - configure User requested messages for the Claims, Appeals Case Management and Utilization Management modules Procedure Codes - add/terminate procedure codes as requested by the Claims Department ICD Procedure Codes - update and terminate Diagnosis Codes - update and terminate ICD-9 codes Explanation Codes maintaining and updating codes from third-party applications/Facets Translate business requirements into system configurations Evaluate user proficiency and define training requirements to assist in improvement in level of understanding of the users Responsible for making necessary enhancements to add or maintain functionality of the ApplicationSubject Matter Expert Amerigroup Corporation 12/2006 - 4/2010 Medicare product/Amerivantage Updated staff daily on CMS news and mandates Provided training for new employees on a one to one basis Processed and assigned projects to staff Processed claims adjusted paymentsEDUCATION & CERTIFICATIONSSQL - Beginner to Expert https://www.udemy.com/ Jan. 2024 - currentCertificate MS Excel Beginners-Advanced https://www.udemy.com/ December 2022Certificate - MS Access Intermediate Level New Horizons Miami, FL 2010Bachelors Degree in business administration Science University of Phoenix Tampa, FL 2005 2009 |
