Rebecca Jones

*** ******* ****, **********, ** **940

845-***-****

ac9mqp@r.postjobfree.com

SUMMARY

Experienced Business Analyst with demonstrated history of working in the information technology and service industry. Highly skilled as both a business and functional solution expert. Strong research professional who is proficient in Microsoft Office programs Excel, Word, PowerPoint and Visio. Workflow Modeling, Use Cases, Use Case Specification Process Modeling. Demonstrated successful use of SDLC methodology. Proficient in healthcare industry and standard Business Analysis Best Practices. Experienced in various products HMO, PPO, POS, Medicare Advantage to name a few. Basic Electronic Data Interchange (EDI) knowledge, previous experience was supporting EDI transaction issues for BCBS trading partners.

EXPERIENCE

Nasco

Atlanta, GA

Plan Advocate Support II (2017 – 2019)

Ensure tickets are worked appropriately based on severity.

Build relationships, communicate, share prioritize/urgency, & work as a team with NDT/PST Technical resources.

Function as the secondary NDT Point of escalation for Plan tickets to all entities internal and external.

Provide escalation notifications to Sr. Management within the same business day, as needed.

Prevent known critical and high severity defects from moving into a SLA environment by escalating to Client Delivery and NDT Management, as needed.

Understand the technology used to deliver function/business value of the Product or Service.

Attend and represent technical area at Product/Service User group calls and meetings.

Participate in process improvement & initiative activities, as requested.

Identify processes and procedures that improve ticket delivery, as evidenced by cost reduction, schedule improvement or enhanced customer satisfaction.

Plan Advocate Consultant I (2016-2017)

Provide escalation notifications to Sr. Management within the same business day, as needed

Participate in process improvement & initiative activities, as requested.

Identify processes and procedures that improve ticket delivery, as evidenced by cost reduction, schedule improvement or enhanced customer satisfaction.

Enhance Plan/project stakeholders understanding of the business and technical solution by coordinating review sessions with the technical team.

Software QA Engineer I (2016-2016)

Followed and promoted established testing practices, processes and procedures. Identifies and champions any new process improvements for the team.

Reviewed high level requirement documents, requirements scopes and other product release documentation (such as file layouts, job parameters, and system specifications) in order to write test plans, test cases and perform impact analysis.

Performed quality reviews of test cases, test plans, test data and test execution artifacts of junior level resources and their peers.

Maintains all test artifacts in the proper storage locations (NSHARE, Extranet, etc.) and follows established procedures in keeping them up to date.

Creates and develops test cases and test data by reviewing high level requirement documents, scope and other product release documentation (such as file layouts, job parameters, and system specifications). This role performs quality reviews of test cases and test data written by junior level resources or peers. Conducts the test case reviews with the Plan customers.

Participates in team meetings to help define the overall test strategy and plans of testing new releases/functionality including developing methods for measuring, analyzing, tracking and communicating test status for internal and external teams.

Performs test execution using test cases/data to ensure current and/or new system functionally works per the requirement specifications. Performs quality reviews of test execution output from junior level resources.

Knowledge of HIPAA and ClearQuest.

Provided presentations on web-based applications processes and procedures to plan customers.

Business Analyst II (2011-2016)

Conduct requirements analysis and verification

Manage requirements traceability information and track requirements status throughout the project effort.

Analyses end user application needs.

Handle projects within predetermined deadlines.

Translates business perspective into technical perspective.

Excellent problem-solving skills.

Created and documented test plans and workflows for various BCBS Plans.

Tested system readiness for migrations and new groups.

Mentored less experienced analysts on internal system.

Jawood

Detroit, Michigan

Business System Analyst (2008-2011)

Conducted requirements analysis and verification

Managed requirements traceability information and track requirements status throughout the project effort.

Analysed end user application needs.

Handled projects within predetermined deadlines.

Translated business perspective into technical perspective.

Created documented workflows for less experienced testers internally and for plan customers.

Excellent problem-solving skills.

Created and documented test plans and work-flows for less experienced testers.

Tested system readiness for migrations, new contracts and benefit updates.

HBCS

New Castle, DE

Hospital Liaison (2007-2008)

Serve as first point of contact for Hospital Administration on billing issues

Handle projects as assigned

Performs trend analysis for training customer service associates at home office

Provides training and process improvement to hospital billing staff

Handles escalate customer service inquiries

PBS Medical Billing

Valley Cottage, NY

Sr. Account Representative (2007-2007)

Responsible for account reconciliations.

Communicate with insurance companies to resolve pending claims.

Input claims and payments into Medical Manager and Micro MD.

Handle patient billing inquiries and issues.

Empire BlueCross BlueShield

Middletown, NY

Supervisor (1996-2006)

Supervised a staff of 18 adjusters, successfully maintained inventory levels and met/exceeded departmental goals.

Coached and developed staff to ensure compliance with all workflows and goals.

Viewed as an “expert” in hospital claims processing and was a central contact for questions on hospital benefits throughout the organization on both NASCO and CS90.

Created a document detailing all workflows for facility claims processing.

Conducted formal performance reviews.

Worked closely with Human Resource area on Short Term Disability, FMLA approvals, Payroll issues.

Actively participated in the recruitment process, attended various job fairs.

Senior Claims Examiner (1995-1996)

Assisted junior claims examiners with questions and workflow issues.

Assisted with benefit testing and new account implementations.

Provided accounts with on-site training on usage of claims system.

Facility Claims Adjuster (1994-1995)

Excelled in all aspects of facility claims adjudication. Responsibilities included account receivables, cash receipts; add pays and HUR and DRG adjustments.

Worked in Customer Service for 6 months due to the business need for a bi-lingual representative.

Facility Claims Examiner (1991-1994)

Successfully completed the required corporate training program that consisted of two twelve-week training sessions on NASCO claims processing, ICD-9, CPT-4, HCSPS, Revenue Codes and medical terminology.

Coded and data entered paper submitted claims on UB92 forms for processing.

Handled all post computer claims suspended for resolution of all edits and prepared the claims for accurate finalization.

Maintained the highest quality and production status in claims processing.

Identified system issues and escalated to supervisor for production support to address.

EDUCATION

Orange County Community College, 1988-1989

Business Administration Courses

Proficient in Access, Word, Excel and Power Point.

University of Phoenix, 2008

Associates in Business Administration

LANGUAGES

Proficient in Spanish

AWARDS

Various Perfect Attendance Awards

Team Award for 16 consecutive months of 100% quality

Various “Circle of Stars” Awards

Outstanding Achievement Award Feb 2016

Member of NASCO’s Brand Champion

Contact this candidate