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Click here or scroll down to respond to this candidateCandidate's Name
Maryville TN PHONE NUMBER AVAILABLE email: EMAIL AVAILABLEBusiness Analyst in Operations for 8 years; Requirements Lead, Business Process Mapping and Improvement Projects, Agile Software Implementation and upgrade, Data Analysis, technical documentation, reporting and validation. My skills will be an asset to you. Worked with Power BI, Crystal, SQL Server, JIRA, Visio, Confluence, Service Now, Excel. Can learn new software quickly. I changed my last name from Ryan to Hill in 7/2023 so all prior employment is under Rebecca Ryan.EXPERIENCE:MVBCOffice Administrator 4/2024-9/2024Reception, phones, security checkpoint admissionCalendar for Senior Staff and Organization, public and privateNewsletter production, digital signage, website updatesManaged Weekly Staff Meetings and Quarterly Business meetingsSpectraforceOperating Efficiency Analyst 7/2023 12/2023Performed SQL Server Data research as requested, configured Oracle Data Analysis Reports and Excel Dashboards supporting Evicore and Cigna claims systems.Create Data Analysis Presentations for management with Power BI, PowerpointAssembled project teams with SMEs to review business rules, data flows.Writing SQL Server queries to support research projects.Itero Group 1/2022-1/2023Sr Business Analyst for CMS Medicare/Medicaid reimbursementWorking on Medicare reimbursement system Change Requests in Service Now.Agile Software sprints to upgrade various claims Payment systems.Documentation, Create user stories, write requirements and test plans.Perform unit testing and regression testing per plan.Perform Impact assessments; predicted and after system changes are implemented.Use Jira and Slack to communicate with teamSr Business Analyst for Highmark Health HealthplanJIRA -Create Business Requirements Documentation, track backlog, develop test plans, in Agile or Kanban format for up to 6 Projects on claim reimbursement based on Medicare mandates and fee schedule updates.Requirements gathering for IT development, business process improvement, user story writing for user approval and refinement of requirements for IT developers' consumption.Create Visio Business Process Mapping diagrams, Documentation and reimbursement Flow descriptions, meeting/action item summaries, Agile events, Data Processing, SQL research queries, Crystal reports.Perform Impact assessments; predicted and after system changes are implemented.Risk management documentation, identifying potential risk to security and integrity.Completing the Project BRD, traceability matrix, user acceptance test plan for each of up to 6 Projects, conducting stakeholder review and approval sessions and Data processing.Develop Business Readiness plan, Communications and Reporting Plan.Create Transition plans and training materials Documentation as needed.Tracking Development and delivery activities for Projects to align with Business Objectives.Kaiser PermanenteSr Business Analyst 4/2019 10/2021JIRA -Create Business Requirements Documents, track backlog, develop test plans.Requirements gathering for IT development, business process improvement, user story writing for user approval, Agile Software Development DocumentationAttended company Six-Sigma and Lean online learning for internal certification.CRM- Provider Network Maintenance, Provider complaint Case management, create Crystal Reports and Flows as needed, Data validation, Dashboards to support National and local Provider Networks.Service Now- respond to audit requests for data, reports, resolve document production issues.As part of Kaiser Permanente National Claims Administration Business Process Management on the Correspondence Output and Online Initiatives team. Mapping business processes, performing gap analysis, Data Processing and drafting user story to support changes in functional design specifications. Design testing strategies and define acceptance criteria. After testing the new Epic process code, conduct impact analysis to verify the goal has been met.Using SQL Server to research root cause of document production failures.Correspondence includes all documents sent to members, including Explanation of Benefits, Explanation of Payment, letters of request for information, notice of denial, SQL queries to validate document production SLA are met.Managed all EOP production failures to research and resolve for Member Reimbursement.Rebutted internal audit error findings including ICD-10 and CPT coding errors to support QASeagate Inc./ RandstadQuality Assurance Analyst 2/2018 6/2018As Lead Business Analyst of the Business Process improvement project Implementing the new BPM app Signavio with documentation, gathered requirements from all roles in the manufacturing chain, mapping all process flows from Visio to Signavio and writing use cases to analyze functional design and perform a gap analysis to identify opportunities for improvement. Writing functional design specifications, design testing strategies, define acceptance criteria and verify improvement by performing Impact Analysis for Leadership review.Creating Business Process models, then verifying stakeholder information.Eliciting business process requirements and securing Process Owner approval through Webex presentations.Collaborating with co-workers in Thailand and China through Webex, Google docs and JIRA, working from homeUnited HealthCareQuality Assurance Analyst 7/2017 12/2017Develop, implement and report on unique Healthplan programs to focus on employee Call Center performance.Design and implement quality programs throughout the Revenue Cycle process to drive contact center key performance indicators and support business initiatives.Develop and execute auditing programs to improve quality monitoring and recommend solutions to improve quality and integrity.Ensure quality monitoring and auditing practices are consistent across all functions.Investigate and resolve complex issues, including ICD-10 and CPT coding errors.Develop and analyze quality reporting, to identify trends and recommend improvements.Collaborate directly with the business implementation and training to analyze educational needs based on quality performance and call monitoringLatitude 36Business Analyst 10/2016 4/2017This Process Improvement Project focused on legal document production systems and online Member Portal functions. I contributed several improvements that decreased the post production work required by half using Six Sigma methods.Identify and present business and technical issues and errors in the Benefit Plan Summary online Member Portal delivery system.Using JIRA, Salesforce, Shieldlink, Facets and proprietary systems for review, data validation and upload of Plan Benefit data to online Member Portal.Review, design and implement Benefit Contract data processes and applications to improve Member satisfaction ratings.Provide application support for project investigations, identify process or system changes needed to improve operation and provide documentation.Northhighland agencyBusiness Analyst 12/2015 5/2016Identify product requirements, business and technical issues and errors that result in decreased revenue on the Claims Data Analysis Team of the Process Improvement Project.Using SQL queries to identify opportunities for system improvement, design and implement processes and applications to improve CMS reinsurance results.Provide end-user application support for project investigations, identify process or system changes needed to improve operations, maintain Documentation.Use Remedy to complete incident or change order work tickets.Use Business Intelligence to produce reports using various Business Objects. Perform data validation and cleansing as needed.Provide business analyst support for various process improvement initiatives and strategic products.Consult and coordinate with programmers to develop system solutions to process problems. On this project I was able to make a significant contribution in solving a coding-based issue on SNF claims.Sutter Health/ KellySr. Government Account Rep 11/2013 11/2015On the EHR Transition Project, transferring Hospital claims processing from the old MS4 platform onto the new Epic Tapestry platform, moving hospitals in several groups.Testing new Epic claims processing for glitches.Researching Medicare Coding and Billing Guidelines Manual for compliance with regulations.Auditing error Reports to identify processing error trends.Billing Claims to Medicare by resolving claim level errors per Provider contract.Reviewing documents in the DI Database to correct account errors.Maintaining tracking spreadsheets for issues to present at monthly meetings.Participation in testing rollout of new claims on theEpic system, looking for system and process improvement opportunities.Billing claims from MS4 and Citrus.Compiling and reporting performance measure data for HEDIS using Oracle Reports.Reviewing Sutter Policy and Procedure documents for compliance.Dignity HealthPatient Financial Services Rep 9/2011 6/2012Follow up for process improvement per Lean guidelines, improving time to pay and correct payment rates.Claims data analysis on Cerner systems, AR Reports analysis and claims follow up.Research medical files, Fee schedule, ICD-10 and CPT billing regulations and correspondence to compose effective Appeals.Management of AR balances, leading to lower AR totals and improved billing cycle times.Responsible for Medicare risk plans, VA and Tricare claims follow up.Research rejections and denials, writing appeals and calling insurance companies to facilitate payment of outstanding claims per contract rates.Regional Cardiology AssociatesMedical Biller ; Medicare Reimbursement Specialist 10/2009 1/2010Responsible for researching and resolving claim denials, drafting Appeals, reconsiderations, and re-determinations per Provider contract with deadline compliance follow-up.Post adjustments to accounts as necessary to reflect take backs, billing errors, Fee schedule, payment recovery and physician based write offs.Handle private pay patient accounts and collections for ten providers to increase reimbursement through tracking coding accuracy and writing successful appeals.Answer questions from patients and staff about Medicare plans and reimbursement.North Valley Dermatology 10/2009 1/2010Medical BillerPost insurance payments in batches, balancing batches and performing month-end closings.Auditing patient accounts for accuracy.Implementing collections on past due accounts.Drafting appeals for denied claims.Follow-up and resolution of billing and claims payment errors, retrospective, cleaning up substantial backlog.Increase collections and bring accounts current during this temporary assignment.Accucode Medical Billing ServiceMedical Biller 8/2006 4/2009Managed medical billing and AB for up to five medical clinics, including Anesthesiology and Pain Management, Internal medicine, Cardiology and General Practitioner practices per Provider contract.Coding and billing for medical claims, AR posting and billing for all insurances.Responsible for private pay accounts customer service and collections.Helped to reduce outstanding AR balances while increasing insurance revenues through accurate coding corrected Fee schedule and diligent follow-up.I was awarded several bonuses for productivity and quality by exceeding the industry benchmark of 15% or less over 120 days.Achievements:Business Analyst 8 years: Seagate: enterprise-wide process mapping and conversion from multiple sources into BPM app Signavio, improved manufacturing chain efficiency by 20%. Health Net: Process Improvement Project using SQL, Database mining, Claims Data Analysis improved claim processing system. Blue Shield: Benefit Plan Data Analysis and Validation to upgrade online portal. United Healthcare: Quality Analysis Reporting across multiple Revenue Cycle roles improving efficiency and establishing KPIs.EDUCATION:M.B.A. University of Phoenix 2005 |
