Project Analyst

Dyane M. Wilson

*** ***** ****** **** *********, NY 11552 Phone: 347-***-**** ******.*****@*****.***

OBJECTIVE

To take on a challenging role in business operations and give an efficient and effective solution that would

help the organization achieve the best solution in business in order to increase its productivity in the market.

PROFILE

* Strong expertise in Health Insurance Claim process.

* Excellent communication skills, critical-thinking skills as well as presentation skills.

* Experienced working on Medicare and Medicaid as well as HMO and PPO projects.

* Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim

review, identifying claims processing problems, their source and providing corresponding solutions.

* Broad knowledge of Test plans, Test cases and test scripts from the Requirements Document.

* Experience working with business users as well as senior management.

EXPERIENCE

EMBLEMHEALTH – NEW YORK, NY

Senior Business Analyst 2011 - Present

* Design Test Plans and Test Cases for User Acceptance testing (UAT).

* Interface with business users to prepare and update Business Process Requirements for the new releases.

* Serves as a liaison with the IT team and Project Team.

* Lead and serve as a trusted advisor and Subject Matter Expert to the business regarding how the system can

be used to support desired business processes and requirements.

* Interface with the project team and project stakeholders to translate their requirements into specification

documents where users can understand.

* Prioritize outstanding defects and systems problems, ensuring accuracy and deadlines are met.

* Track and maintain Stakeholder requested enhancements and changes using Requirement Traceability

Matrix (RTM).

Testing Analyst 2009 - 2011

* Collaborated with team members to develop test plans, test cases, test scripts and summary reports.

* Coordinated all UAT testing activities with end-users and document recommendations / improvements and

enhancements.

* Reviewed requirements and design documentation to ensure traceability and testability, review deliverables

for adequacy and completeness prior to systems implementation into production.

* Performed functional, regression and stress testing.

* Performed testing in Mainframe, Client/Server, and Web environments.

* Executed test scripts both manually and with automated test tools.

* Documented and provided support; resolved issues to ensure that the system was functioning according to

specifications.

HEALTHFIRST – NEW YORK, NY

Claims Analyst 2001 - 2009

* Conducted analyst of claims processing and researched ways to increase auto-adjudication.

* Investigated and handled requests from providers regarding erroneous information.

* Processed claims suspensions from the system to correct processing discrepancies and other edits.

SKILLS

Microsoft, Project, Microsoft Office Suite, SQL, Six Sigma Green Belt, EDP Testing

Procedures and ICD 9/10 coding and reimbursement methods.

EDUCATION

LONG ISLAND UNIVERSITY, BROOKLYN CAMPUS- BROOKLYN, NY

Masters of Public Administration in Health Administration, 2014

BROOKLYN COLLEGE, CUNY- NEW YORK, NY

Bachelor of Science in Business Management and Finance, 2007

BOROUGH OF MANHATTAN COMMUNITY COLLEGE- NEW YORK, NY

Associate of Arts in Business Administration, 2005

References

Available Upon Request

Contact this candidate