Description
Summary of Qualifications: Results orientated Business analyst with 8+ years track record improving customers' performance through collecting, analyzing, and reviewing information. Proven ability to document and collaborate to foresee end to end solutions due to business challenges and limitations. A team player who is known for excellent verbal and written communications Managed project for client's Claims Editing Software (CES) implementation and support * Provided support with vendor data mapping specifications on new utilization management software for authorization 278 file mapping * Assisted in developing automatic transactions processing (ATP) routines which lead to an increase of claims auto adjudication rate +20% * Contributed in development of Medicare/Medicaid (Medi-Medi) claims from csv files to 837 file submissions in core claims processing application * Maintained several platforms of software and applied updates/patches as required Developed and implemented customizations per client specifications within designated software Interpreted change control requirements and Request For Proposal (RFP) * Communicated among vender and client on basic specifications of software Developed validated and documented User Acceptance (UAT) criteria * Trained internal staff/client on new/updated business processes * Created and revised policies to reflect changes in business processes * Measured project efficiency for business process solutions and best practices * Created SQL queries for data trend analysis to identify areas of process improvements * Forecasted results on areas of process improvements * Proposed solutions during project management developments * Designed internal process maps for business new/update business processes * Prepared yearly 1099 data and convert to IRS flat file submission * Created monthly membership reports compliant with state Medicaid program for healthcare reporting
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