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Title: |
Business Analyst
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Location: |
US-Georgia-Atlanta
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Work History: |
AFFILIATED COMPUTER SERVICES, INC. May 2006 - August 2008
Atlanta, GA
Systems Consulting Senior Analyst
o Familiarity with standard concepts, practices, and procedures within the healthcare field and MMIS.
o Interprets business needs and translates these into system requirements by interaction with Business Analysts and Developers.
o Create test deliverables (i.e. cases, scripts, and results) based on a use case approach along with sequence diagrams.
o Develop and review manual test case scenarios for functional, system, and product validation
o Participates in testing, across multiple project organizations to meet multiple requirements (i.e. functional, stress, endurance, etc.).
o Document testing results including incorporation of appropriate artifacts.
o Document defects and track these through successful resolution.
MATRIA HEALTHCARE, INC. April 2005 - May 2006
Marietta, GA
Senior Client Data Analyst
o Implemented clients into the company's disease management programs.
o Understand the business flows and overall healthcare process and how health insurances work.
o Interface with the company's clients, Account Management, Data Developers and Data Analysts in performing analysis and creating data processing requirements for clients.
o Execute work with company's partners regarding file format and content requirements.
o Create SQL queries for data set analysis.
o Analyze and map client data to company's standards and assist in defining requirements.
o Review client data for required field content.
o Acknowledge general database experience and data warehousing.
CONNOLLY CONSULTING, INC. May 2001 - April 2005
Atlanta, GA
Senior Associate
o Perform review of health claims' payment accuracy for insurance companies.
o Conduct analysis of claims based on contractual terms and documentation.
o Interface with medical providers to recover overpayment made on claims via telephone or written request.
o Consult with clients to implement the recovery process.
o Train staff on the auditing and recovery practices, policies, and procedures.
MERIDIAN HEALTHCARE STAFFING, LLC April 1999 - March 2001
Atlanta, GA
Healthcare Consultant
o Performed insurance follow-up to commercial carriers, Medicare, Medicaid, and Tricare for medical providers.
o Implemented billing procedures to insurance carriers and government programs.
o Interfaced with patients and insurance personnel in reference to financial services and accounts receivable.
o Reviewed and tracked accounts for light collections processing.
Medical Claims Consultant
o Adjudicated and reviewed medical and dental claims in a managed care environment.
o Processed telephone inquiries from policyholders, service providers, and other medical personnel regarding claims status, plan coverage, provisions, and exclusions.
INSURANCE OVERLOAD SYSTEMS, INC. April 1994 - January 1999
Nashville, TN
Trainer/Healthcare Claims
o Provided training to company personnel in processes and practices for using payment, benefits and claims systems software.
o Performed remedial training when required.
o Received excellent training evaluations from students based on written surveys.
Recovery Coordinator
o Perform transaction analysis of doctors', hospitals' and medical centers' financial computer data records to process claims adjustments, recover overpayments made to providers, and issued payments not received.
o Interfaced professionally with customer service representatives, claims, auditing, accounting and training departments.
Senior Healthcare Claims Examiner
o Performed claims adjudication on commercial medical, dental, and vision accounts.
o Implemented various insurance plans, including PPO, HMO, MCO, and coordinated benefits with commercial medical carriers, TPAs, Tricare, Medicare, and Medicaid.
o Processed telephone inquiries from policyholders, service providers, and other medical personnel regarding claims status, plan coverage, provisions and exclusions.
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Skills: |
o Offering a diverse background of healthcare experience and training in customer service, claims adjustment, internal claims auditing, PPO, HMO, MCO, data processing, CPT and ICD-9 codes, provisions and exclusions, payments and refunds, recovery auditing, federal and state insurance laws, personnel training and supervision, and implementing procedural policies.
o Strengths include excellent organizational, time management, leadership, interpersonal, and problem solving skills. Highly motivated, self-starter, with team player abilities.
o Consistently receive excellent performance evaluations in all positions held.
o Able to easily establish and maintain effective business & customer relationships.
o Computer proficient (WindowsXP, MS Word, MS Excel, MS Access, Test Director, Data Junction, Healthcare Claims Software, Healthcare Accounts Receivable Software, IBM Rational Suite, Silk Central Suite, Oracle SQL, Microsoft SQL Server, Citrix, SharePoint).
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Education: |
JACKSONVILLE STATE UNIVERSITY
Jacksonville, AL
Bachelor of Science Biology, 1980
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