Business Analyst

Skills

Employment History:

Confidential

Direct Care Counselor, Therapeutic Behavior/Psychosocial Rehabilitation Specialist

• Professional level rehabilitation counseling and case management and provides wrap around employment services for all clients. This includes Intakes, assessments, resume building, interview preparedness, interviews, placement, job coaching and long-term post-employment support services.
• Manage caseload budget, assign providers to complete various parts of rehab plan.
• Monitor progress of plan of care, participate with case analysis.

Behavioral Care Advocate Medicaid

• Making patient assessments and determining appropriate levels of care
• Obtaining information from providers on outpatient requests for treatment
• Determining if additional clinical treatment sessions are needed
• Managing inpatient and outpatient mental health cases throughout the entire treatment plan
• Administering benefits and reviewing treatment plans
• Working toward maturing and institutionalizing the Business Analysis Group and its processes.
• Coordinating benefits and transitions between various areas of care
• You can improve the health of others and help heal the health care system.
• Management functions include case management and utilization review of behavioral health and substance abuse services.

• Created reports and graphs that reported on the productivity Using BI Tools..

• Provides case management services through review and evaluation of inpatient and outpatient behavioral health treatments for medical necessity, emergency status, and quality of care.
• Performs within an innovative culture that's focused on transformational change in the health care system.
• Managing healthcare billing-processing, adjusting and resubmitting of claims while adhering to current healthcare industry regulations and policies and complying with insurance procedures and allotted benefit coverage.
• Requirements gathering for internal and external projects, business analysis
• Lead a business process reengineering project for a large department of an international media company. Worked closely with Executives, Managers and subject matter experts to create detailed process workflows and departmental policies.
• RESULTS: Delivered business processes, requirements, recommendations, and solutions that guided high-level resource decisions and retooled initiatives and operations.
• RESULTS: Established a variety of helpful theories and models provided an overview to the budget development process and expenditures of allocated funds to ensure compliance with federal, state, and local guidelines with the primary objectives of increasing student achievement.
• TECHNOLOGIES: CaseWise, Visio, Excel, Requisite Pro, Wiki-Docs

Confidential

Quality Assurance, Medicaid for Intellectually Disabled ID

• Acted as the Subject Matter Expert SME in Enrollee Member/Client/Beneficiary/Recipient business processes and system functionality.
• Developed and maintained system-wide training program developed and implemented Centers for Medicare Medicaid Services CMS system-wide regulatory strategies.
• Implemented standardized policies and procedures that ensure all information is accurately abstracted and in full compliance with applicable rules for implementation relating to Plan s of Care POC or Individual Support Plan ISP for: Pre-Vocational Day Services Supported Employment Intake Assessment Job Placement, Job Training Support Residential Habilitation Supported Living Host Home In Home, Respite Services and Assisted Living Facilities ALF .
• Developed reports, charts and graphs to analyze critical data

• Gathered, analyzed, digested, and documented complex business requirements and processes.
• Researched and resolved all data quality issues for managed data objects. Proactively reached out to business partners and stakeholders that ensured the integrity of master data consistency.
• Developed and implemented structured processes necessary that ensured captured data accuracy.
• Performed detailed business analysis for new development and system enhancements, user liaison functions, specifications and requirements documentation, workflow, scope documents and solution proposal writing.
• Prepared Business Process Reengineering BPR documents by interacting with SMEs.
• Worked with business partners and stakeholders that defined and documented key performance indicators, metrics, and measures.
• Develop process models and use cases, constructed conceptual data and process models, included data dictionaries. Conducted requirements management activities.
• Updated/maintained Requirements Specification and Detailed System Design documents.
• Participated in collaborative sessions to document Medicaid business processes.
• Led the design, development and implementation of the overall Quality Improvement QI Program.
• Analyzed, updated, and modified standard operating procedures and processes to continually improve QI Department services/operations.
• Developed and conducted Quality Improvement studies.
• RESULTS: Conducted advanced technical and operations research and sensitivity analysis at both the strategic and tactical level for large complex organizations' operating environments. Employed analytical rigor and predictive risk/portfolio analyses and iterate throughout the life cycle from concept through sustainment.
• RESULTS: Created and exercised broad review/prioritization of capability concepts/outcomes and enhanced methodology that identified and described joint needs and capability gaps. Provided joint operations priorities and planned, programmed, and resource prioritizations.
• TECHNOLOGIES: Desktop Support, SAP, QA Tester, PeopleSoft

Confidential

Quality Investigative Surveyor/Medicaid Document Reviewer

• Planned, developed, and coordinated Medicaid Quality Improvement Program.
• Provided direction for all quality improvement initiatives and implements effective quality improvement measures
• Performed requirements gathering and business analysis of all aspects of the databases to identify and document all impacted reports, GUIs, tables, procedures, etc. .
• Managed monitoring and compliance with specific regulatory and government programs related to healthcare quality improvement, Maryland State Department of Education MSDE in compliance with Code of Maryland Regulations COMAR .
• Conducted executive level meetings and presentations for performance review

• Developed reports and graphs that reported on the productivity.

• Developed quality measurement systems and processes to include quality of care measures, customer feedback, and initiatives.

Confidential

Medicaid Specialist

• Determined guidelines for data management and attainment of corporate quality objectives.
• Worked with Medicaid program directors, agencies, and grantors to develop quality measurement systems and processes.
• Assisted in the design, development and testing of a custom Automobile Loan Origination package by performing requirements gathering and business analysis of loan origination workflow processes in order to create a unique, highly flexible automated system

• Provides research and analytical support for strategic planning, training development, problem solving, quality management, financial analysis, and business process reengineering.

• Provided Program and Planning Committee updates and status of corporate quality improvement programs and improvements to clinical and service outcome measures.
• Identified potential risk factors and coordinates and implements action plans to minimize liability and risk. Assisted Program Directors with development of plans for correction and aggressive follow-up on repeat, recurrent deficiencies.
• RESULTS: Designed and streamlined a system to handle each step of this operation efficiently. RESULTS: Processed 75-100 subsidies on a daily basis. TECHNOLOGIES: MS Office, Excel, SharePoint, Visio, MS PowerPoint, MS Project.

Confidential

Medicaid 3rd Party Billing

• Supported quality improvement efforts throughout the organization.
• Collaborated with the management team and developed, implemented and evaluated performance improved Quality Review Improvement training programs for finding of fact Medicaid documentation and investigation methods.
• Used internal and external resources that determined performance improvement and training initiatives.
• Developed reports and graphs that reported on the productivity.
• Establish a business Analysis methodology around the RUP Rational Unified Process .
• Maintained records to track employee required education and training as identified under CMS.
• RESULTS: Launch into production mode with new commercial clients. TECHNOLOGIES: MS Excel, MS Word, Flow Chart Analyzer, Adobe Acrobat.

Confidential

Medicaid 3rd Party Billing

• Facilitated presentations regarding the Medicaid Quality Improvement program.
• Conducted on-site visits to monitor programs and improvement processes.
• Developed, evaluated, and recommended policies, procedures, and systems to improve program operations.
• Led business analysis and reviewed and validated BA deliverables

• Provides research and analytical support for strategic planning, training development, problem solving, quality management, financial analysis, and business process reengineering.

• Ensured that practices and procedures reflect current rules and regulations that govern organization systems and professional practice.
• Developed reports, charts and graphs to analyze critical data
• Coordinated quality improvement efforts with program staff to ensure consistent implementation and management of all quality improvement and safety activities.
• RESULTS: Delivered re-engineered business education processes and documentation on time, within budget, and to all stakeholder expectations. TECHNOLOGIES: MSDE on-line IEP, Medicaid CMS /Third Party Billing, MS Office.

Confidential

• Served as the second most senior teacher step from the Principal Director Head Master Teacher trained several assistant heads, who acted as subordinates to the Principal Director managed the school in absence of the Principal Director.
• Ensure federally funded Medicaid regulatory standards for Plan of Care and quality improvement.
• Prepared Business Process Reengineering BPR documents by interacting with SMEs.
• Verified staff's education and certification, training background in a Healthcare or Healthcare related facility or a Public Health program or agency.
• Coordinated customer satisfaction surveys to monitor quality of care and facility performance.
• Analyzed project expenditures for SharePoint implementation presented cost-benefit options and managed client relationships for business strategy, workflow refinement, and user expectations.
• Prepared reports, charts and graphs to analyze the statistics