OBJECTIVE:
To obtain a position in which over 13 years of business analyst experience will add value to operations

QUALIFICATIONS SUMMARY

• Experience testing inbound transactions from clearinghouses and OCR vendor, testing outbound extract and translation for multiple outbound payers
• Thorough knowledge of the software development process including supporting disciplines, such as configuration and quality assurance
• Thorough knowledge of X12 formats, EDI, OCR technology, data conversion and mapping, validation and error resolution
• Implementations, enhancements, migrations, conversions and go-lives
• AMISYS, MMIS, McKesson Code Review, Facets, FileNet, Emdeon Transform, SharePoint, Suprtool, Data Warehouse, AS400, NextGen, CaliberRM, RoboHelp, Application Xtender
• Experience in a complex managed care environment with multiple products and entities, with an emphasis in claims
• Strong knowledge of medical terminology, HCFA, UB and ADA claim forms
• Knowledge of coding structures, i.e, HCPCS, CPT4, Revenue codes
• End-to-end service portfolio encompassing several complimentary lines of businesses, including Medicare and Medicaid
• Highly creative, goal-oriented professional with solid business analyst experience
• Strong work ethic combined with a commitment to excellence in all projects undertaken
• Work effectively with multiple stakeholders, including internal and external customers
• Software applications that interface with MS Office products
• CHISP - Certified Health Informatics Systems Professional
• CPMB - Certified Professional Medical Biller

PROFESSIONAL EXPERIENCE

Business Analyst Consultant - Confidential,10/2003 - Present
Responsible for designing, developing, and implementing scalable and up to date MMIS applications. Perform assessment, gather data and analyze interchange to determine impact to pre-adjudication systems. Perform in-depth research and address client inquiries. Interact with the client to gather requirements for system changes, developing test cases, execute test cases and conduct walk thru of test results with the client.

• Analyzes business processes and performs needs assessments in an effort to align information technology solutions with business initiatives
• Interprets business needs and translates them into system requirements
• Prepare business/functional design specifications and requirement traceability matrix and forward to technical and end-user staff for system development
• Interpret systems specifications and configuration to develop, maintain and support automated business processes
• Provides technical expertise in identifying, evaluating and developing systems and procedures that are cost effective and meet user requirements
• Configures MMIS and legacy system settings and options, plan and execute acceptance testing, and create specifications for systems to meet business requirements
• Perform assessment, gather and analyze data to determine impact to pre-adjudication
• Provide expertise in re-engineering efforts
• Perform in-depth research and address client inquiries concerning implementation, review and maintain layout and crosswalk guides
• Interact with the client and end-users to gather requirements for system changes, develop use case and test case scenarios, conduct walk-thru sessions to document business rules
• Configure subsystem settings and options according to business rules across several lines of business

Confidential,TN 1989-2003
Amisys Configuration Analyst
Amisys Business Analyst
Business Analyst Supervisor
Design, implement and maintain Amisys Managed Care Software configuration to support business rules for several lines of businesses. Provide analytical and technical support to users and other stakeholders. Manage medium to large-scale projects involving Amisys configuration and interface systems, including mainframe. Responsible for process improvement and total quality management in the front end claims process, including imaging technology.Represent the corporation’s interest in efforts related to system design and future enhancements to software systems and testing of such enhancements to ensure minimal impact to claim adjudication. Gathering information from end users, acting as a liaison between IT department, and making recommendations for the existing applications.

• Amisys migration, implementation and conversion team – analyze legacy system and develop use cases for Amisys implementation, validate converted data, create codes sets to be used across all subsystems, configure pricing, benefits and provider subsystems, data mapping, interact with developers
• Install/Implement and train on Amisys releases
• Investigate to resolution extraordinary claim, eligibility, pricing, provider, benefit, third party liability, medical management/authorization and correspondence issues
• Assist in re-engineering efforts to processing systems from the mainframe to new technologies
• Identify process, workflow, configuration and system-related issues requiring improvements
• Define business needs and communicate with all levels of staff
• Remain current with changes in business rules for all lines of business and Amisys/Facets systems
• Direct staff in the maintenance of existing configuration
• Assist in the direction of information systems technical staff
• Coordinate the work among staff when operating in a supervisory role
• Ensure accurate and timely resolution of operation and system issues
• Serve as control point on user-defined problems and solutions
• Update policies and procedures and communicate changes to internal and external customers
• Perform special projects and ad hoc assignments in accordance with specifications established by the management team