PROFILE

Healthcare Business Analyst with **+ years of healthcare industry experience. Mature professional seeking a position where I can maximize my communication, management, quality assurance, program development, training and writing skills. Understands and comprehends managing payment policies, report handling, etc. Successful track record in developing strong provider relationships, utilizing presentation skills, while promoting strong business communications, and serving as a liaison between the business and the provider community. I am solution focused and result driven, in addition to working diligently to solve practical problems and deal with a wide range of variables in situations where only limited standardization exists. Ability to determine clerical functions to delegate so that critical functions such as process observations are properly made, entered, analyzed and communicated. In securing a responsible position, I would also like to contribute my superior experience, insight and business results via continued growth, expansion, and profits.

SKILLS

Excellent writing skills, Proofreader, Great editing skills, Proficient in Microsoft Office Suite, Internet Explorer, Business Objects, Lotus Notes, Excel, PowerPoint, Microsoft Photo Editor, Word Perfect, Adobe Photoshop, MLS Server, AMSI, Oracle, SQL, Facilitated training classes, IVR Knowledge, Strategic Communication Experience, Conducted seminars, Speaking engagements, Handled training software and Employee packets, Quality Assurance/Auditing, SEO knowledge, CMS, LCD, NCD systems, MMIS Systems, ICD-9, HCPCS, Business Objects (BO),Medicaid Web Portal Systems, Healthcare projects such as 5010, ICD-10 implementation/migration, GAP Analysis, BRAT, Citrix capability, ICD-10 Proficient, RMI(Rules Maintenance Interface), MediRegs, Editorial Oversight, Writing Press Releases, Social Media Release, Implementation processes, Test Case/Scenario Development processes, Interfacing, UAT Testing, Access experience, SharePoint, SharePoint editing knowledge, WebEx/Webinar, Strong oral and written communication skills, Rule application to policy expertise, Wiki Knowledge, Communication leadership courses, Quality Center Testing

CERTIFICATIONS

Certified Professional Coding Certification-AAPC

Certified Billing Coding Specialist Certification

PROFESSIONAL EXPERIENCE

WellPoint (CA Medicaid) December 2014 – Present Atlanta, GA

Migration Architect - Consultant

Partners with Business and IT to leverage technology in furthering success in existing and new markets

Leads the high-level requirements development process

Supports elicitation/development of high-level and detailed business requirements for enterprise-level efforts

Partners with Account Managers collaborating on business opportunities and solutions

Defines and redesigns processes that will further Account manager’s effectiveness

Supports the management of integrated (business, functional, and technical) requirements and design, including participation and oversight in defining enterprise-related processes and changes in alignment with industry

Supports development of strategic plans and solutions to meet business requirements across the enterprise

Addresses risks and implements contingency plans to resolve issues impacting business or IT objectives across the enterprise

Anticipates and identifies customer needs and matches products and services to facilitate the fulfillment of those needs across large, complex technology initiatives

Manages enhancements, relationships, and impacts to enterprise solutions.

Serves as a liaison between business and IT

Department of community health (GA Medicaid) April 2013 – December 2014 Atlanta, Ga

Communications Lead (State of GA) - Consultant

Medicaid Division

Works to inform and educate the healthcare community, providers, etc, on compliance mandate initiatives

Holds the primary responsibility within the ICD-10 team to work with the communications department to analyze and prepare valuable outreach methodologies for ICD-10

Manage multiple project communication initiatives

Edit and update communication documents, email blast, etc

Oversee all communication projects and activities

Review, develop, design building for Communication Plan

Assist and communication internal/external testing initiatives and communications

Primary point of contact for all internal and external communications activities related to ICD-10

Assist the communications department with creating fact sheets and FAQ documents related to ICD-10

Conduct onsite presentations for ICD-10 (assessment, implementation, transitioning, training)

Conduct and host ICD-10 webinars and communication initiatives

Conduct presentations for Healthcare Executives, Providers, Specialist

Relationship building with Healthcare Executives/Association-Societies

Developed and conducted presentations for Association, Providers, Business leads, etc. (DBHDD, Provider Relations, Quality)

Create and conduct weekly/bi-weekly webinars

Works and communicates directly with physician executives, health plan executives and/or health system/hospital executives.

Collaborate and strategize with communication department on effective communication tools

Develop PowerPoint presentations

Conduct onsite presentations on ICD-10

Participates in various phases of the Project Life Cycle (PLC) for communications

Presenter at Georgia Medicaid Fair on behalf of the Georgia Department of Community Health

Assists in the development of budget and project charter

Department of community health (Ga Medicaid) January 2011 – April 2013 Atlanta, Ga

Policy Testing Specialist - Consultant

Assist with validating and identifying diagnosis related policy items in the GAMMIS and creating the appropriate ICD-10 policies to handle the ICD conversion

Provide business requirements to ensure applications and software are ICD-10 compliant and assist with ICD-10 conversion project. Writing Business Requirement Documents to ensure the Testing initiatives for ICD-10

Reviewing and updating gap analysis and the developing documents that will be used for ICD-10 requirements deliverables

Create Test Plans and Test Scenarios (Provider relations, DBHDD, Vendors, Quality)

Quality Center use (assisted with documentation and delivery for testing repository)

Assist with System interfacing

Developing test strategies that will measure the massive conversion from ICD-9 to ICD-10

Testing project cycle for gathering requirements and test case validation

Maintain and update traceability Matrix

Defect tracking in documented repository

HP document tracking resources

GAP analysis MMIS system

Research root cases of problems with contributed data and lead effort to remedy the issue with contributor

Provide coding oversight and serve as a reference for ICD 10 coding project

Work with business stakeholders to develop and track metrics necessary to monitor data quality

Develop and manage reporting of coding information necessary to support code changes and management and compliance

Design, develop and present finding of complex data queries necessary to fully understand data quality issues/opportunities.

Use commercial data quality tools (DRG Grouper, Business Objects, etc) to analyze, improve and control data quality

Create test cases/test scripts, perform system testing and document test results

Create and handle test cases for COS for vendor system, policy system, acute and ambulatory

Conduct end-to-end web application testing, including unit tests, system integration tests and user acceptance testing.

Log any issues/defects encountered during test cycles and conduct fix verification

Oversee development and execution of code changes in performance tests

Access and update documents in SharePoint

UAT testing (Preparation/Development and Execution/System validation

iHealth Technologies June 2010 – January 2012 Atlanta, Ga

Onboarding & Research Education Specialist

Functions as the point of contact for all new staff during their onboarding experience (prestart to approximately 6 months of employment – once staff meets performance/quality standards).

Works and communicates directly with senior level management

Provide business requirements to ensure applications and software are ICD-10 compliant and assist with ICD-10 conversion project. Participated in a committee on the upcoming implementation of ICD-10 in 2013.

Assisting in collaborating the approach on making system changes and identifying any obstacles that may occur.

Work with developers and testers to thoroughly test solutions for external Client configuration request

Develop test scenarios and assist with UAT testing for quality assurance, and software enhancement.

Identifies opportunities to improve the processes and quality of software deployment

Create and Formulate Process Procedures and Guidelines

Create/update job-aids that are step by step approach to job at hand, Develop content for departmental manual

Assisting with ICD-10 Implementation/system Training and facilitating, Developed all ICD-10 related material and training documents for defined departments

Facilitate successful assimilation of new staff and accommodation of existing staff to ongoing changes with process and technology. Develop and implement onboarding plans for all new research staff

Participates in departmental audits, focused quality reviews, peer reviews, and quality improvement projects

Assist management with process improvement, structure and procedural development

Coordinates with new staff and Management to customize and modify plans for implementing and updating new processes and procedures

Assist in mandating departmental formalities, and training on cultural and role expectations

Maintains materials, coordinates and participates in delivery of Research-related corporate training.

Responsible for ensuring data input, and management for accuracy with our internal client documentation

Develops and implements annual, quarterly and monthly training plans to address new materials and reinforce existing materials.

Develops materials and provides training/coaching to close performance gaps for individuals/small groups/departments.

iHealth Technologies February/2009 – June /2010 Atlanta, Ga

Testing Auditor

Testing Auditor

Performs data quality reviews for testing analyst

Reviews records for completeness, accuracy and compliance with documentation standards within the Testing department.

Assist with mandating the auditing formalities within the Auditing department

Assist with creating the auditing practices for validation within the testing department

Document auditing findings to assist analyst for improvement towards quality efforts

Assures data quality through accuracy, consistency and completeness of the RMR database and its practices

Review accurate and thorough test scenarios created by testing analysts

Review to make sure that analyst handle auto-adjudication by testing the application of medical policies in test and production environments

Audit and Identify valid expected outcomes based upon test scenarios for complete file testing within Quality Assurance

Review to make sure analyst closes rule maintenance request accurately and timely

Exhibit proficiency with critical applications to meet client needs (external/internal)

Validate that analyst document test results in an accurate, precise and complete manner in communicating test and analytical results during the scenario testing method

Provide auditing support for internal clients

Conducted BRAT training cross departmentally

iHealth Technologies June/2006 – February/2009 Atlanta, Ga

Testing Analyst

Test provider file for implementation and quality assurance testing

Exhibits behaviors consistent with department service standards of accuracy, precision, knowledge, and consistency

Build accurate and thorough test scenarios for client applications

Handle auto-adjudication by testing the application of medical policies in test and production environments

Identify valid expected outcomes based upon test scenarios for complete file testing within Quality Assurance

Closes rule maintenance request accurately and timely

Completes comparative reviews during monthly release cycle

Exhibit proficiency with critical applications to meet client needs (external/internal)

Document test results in an accurate, precise and complete manner in communicating test and analytical results during the scenario testing method

Handle facilitating review for updated training material assigned

Provide auditing support for external clients

Demonstrate expertise in assisting with BRAT training and support for new hires

Blue cross blue shield/WellPoint January/2000 – may/2006 Atlanta, Ga

Senior Claims Associate

Provided excellent customer service

Managed medical claims processing files, followed-up with inpatient & outpatient coding/review

Assist with making sure that the file analysis is clear and complete

Experience in client management with a strong focus of healthcare setting

Experience in claim payment/adjudication, or medical payment policy, and exposure to both professional and facility claim forms

Processed ADA codes, extensive Medicare & Medicaid experience, HIPAA knowledge

Provides timely and accurate resolution of inquiries and issues regarding benefits, policies, contracts, claims, etc.

Thorough knowledge in billing, denials, medical records & office notes

Handled accounts with accuracy, correct problems, managed records

Solid background in bill/claim review/processing, CPT, HCPCS, and ICD-9 codes, DRG

QCARE/QSTATE

EDUCATION

Marist College MA Graduate

Master of Arts in Communication

American Intercontinental University BBA Graduate

Bachelor of Arts in International Business

Bauder College AA Graduate

Associates Of Arts Degree in Business Administration/ Marketing

Vice-President of Student Government (Fall ‘98’)

Overall G.P. A. 3.5/4.0

ACCOMPLISHMENTS

Author: Self-Publisher 6/2006

"The Good, The Bad, The Blessing"

Free-Lance Writer/Journalist

Bob Wood Realty 10/1998-12/1998 Lilburn, GA

Real Estate School 82% (Certificate)

References upon Request

Contact this candidate