Business Analyst Front End
Resume:
Gene Isaiah
ad3546@r.postjobfree.com 430-***-**** Lindale, Texas
WORK EXPERIENCE
Centene Corporation –September 2014 – Current
Business Analyst I (Remote in TX) - May 2020 – Current
Position purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function
Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
Identify and analyze user requirements, procedures, and problems to improve existing processes
Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation. Perform front end operational audits and assist in the development of value-added feedback regarding the potential negative impact to claims accuracy.
Investigate and report conflicts and/or variances of operational processing guidelines that are not compliant with state regulations and/or executed provider contracts.
Claims Macro Developer (Tyler, TX) – October 2018 – May 2020
Position purpose: Develop, edit and distribute Macros utilizing Macro Express software. Run, analyze, and review batch reports for macro processing to ensure accuracy of claims data. Duties include but are not limited to validating eligibility for macro processing, to ensure accuracy of claims data upon project completion, maintaining appropriate records, creating trend analysis reports and providing excellent customer service.
Program Coordinator (Dallas, TX) – May-2017 – October 2018
Position purpose: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. • Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to responsibility.
• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.
• Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to; contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
• Coordinate services with community-based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material.
• Data enter assessments and authorizations into the system.
Claims Analyst (Tyler, TX)– September 2014 – May 2017
Position purpose: Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices.
Smith County Tax Assessor Collector’s Office
Auto Clerk (Tyler, TX) - June 2011 – September 2014
Duties include: Transfer car titles, register cars and trailers, cash handling, assisting customers with all inquiries concerning state regulations on car information.
Regions Bank
Operations Specialist III (Tyler, TX) - August 2010 - July 2012
Duties include: Balancing credits and debits, research missing checks and deposits, process mail.
EDUCATION
Continuing Education Courses:
Tyler Junior College (Tyler, TX) - 2001 – 2008: Courses in accounting and business management.
Graduate:
Tyler High School – Tyler, TX
SKILLS
10 Key (Expert)
Customer Relationship Management (Expert)
Microsoft Office Excel (Expert)
SQL (Intermediate)
PYTHON (Intermediate)
REFERENCES
Sheridan Williams
Auto Clerk, Smith County
ad3546@r.postjobfree.com
Relation ship: Professional
Anna A. Roth
Claims Macro Developer, Centene Corporation
ad3546@r.postjobfree.com
Relationship: Coworker
Kesi Buckles
Training NCO, Texas Army National Guard
ad3546@r.postjobfree.com
Relationship: Friend
Contact this candidate