Business Systems Analyst
Resume:
Claire R. Hull
Columbia, SC *****
***********@*******.***
Summary of Qualifications
IT Business Analyst specializing in systems implementations, business
process management, process optimization, and data analysis
Professional Experience
Molina Healthcare, Sr. Configuration Analyst II Aug 2013 - Present
. Configure Medicaid and Health Exchange benefits on the QNXT platform.
. Responsible for preparing claims testing scenarios to ensure correct
system configuration.
. Project Manager for Provider file update and transfer after Molina
purchased SC Solutions to get into the SC Medicaid market..
Insight Global, Business Analyst Jun 2013 - Aug 2013
. Contracted with NASCO to test claims processing for a Blue Cross Blue
Shield plan running on the NASCO Processing System (NPS).
. Input claims for adjudication in NPS and reviewed results that were
moved into the Blue Cross Association (BCA) Interplan Teleprocessing
System (ITS) for claims payment.
. Maintained testing log, noted expected and actual test case results and
followed up on test cases that did not return results as expected.
CSC, Business Analyst Principle Leader Jan 2013 - Apr 2013
. Participate in the Integrated Customer Platform project for State Farm
bringing together health, life, auto, property & casualty insurance and
financial services. Preparing to conduct stakeholder interviews in
order to gather information and complete documenting business
requirements.
IBM, Business Analyst Senior Consultant Sep 2011 - Dec 2012
. Conducted analysis of health plan and provider functional areas to
identify impacts, opportunities and risks related to the implementation
of ICD-10 coding
. Completed business requirements enabling client to reconfigure system
software.
. Utilized SQL Server to analyze claims history and identify coding
priorities.
. Following Business Process Modeling standards, prepared current state
and future state process flows, updated end user forms and prepared
training materials for new environment.
. Interacted with clients and worked closely with team members to test
creative solutions.
Insight Global, Business Analyst Nov 2010 - Sep 2011
. Contracted with NASCO to provide technical and business application
support for claims operations and pricing.
. Assisted with initial EDI conversion activities to ensure HIPAA 5010
compliance.
. Responsible for business process modeling and process flow analysis.
. Responsible for system testing matrix including use cases for all
identified potential issues.
. Maintained system log identified in use case testing and followed up
with technical analysts and programmers on open items.
COMSYS, Business Analyst May 2010 - Sep 2010
. Contracted with HP to develop and implement a claims processing system
for CIGNA utilizing best practices in healthcare operations.
. Assigned to the pricing and contract verification segment of the
project.
. Responsible for information gathering and writing business requirements
and business rules.
AMERIGROUP Corporation, Business Analyst Jan 2009 - Sep 2009
. Assisted in implementing a new Medicaid client, working effectively in
a rapidly moving environment.
. Worked with Facets data modeling and attended Facets Technical boot
camp.
. Attended Facets End User boot camp and learned to navigate the software
applications and tie GUI fields to the data model.
. Utilized SQL Server and Oracle databases to query the claims processing
system.
. Identified information gaps for new business requirements based on
government directives.
Blue Cross Blue Shield of South Carolina, Business Analyst Dec 2006 - Sep
2008
. Provided technical and application support during the implementation of
the Blue Cross Blue Shield Association (BCBSA) web-based software for
processing inter-plan claims (ITS), designed to improve the flow of
provider payments.
. Conducted stakeholder interviews to confirm end user expectations.
. Reviewed iterations of ITS software release documentation from BCBSA
and translated technical requirements and procedures into well-
implemented business solutions.
. Prepared testing matrices for testing use cases. Conducted initial
software testing and managed test problem resolution, maintaining logs
and tracking issues.
. Identified opportunities for product development and customized
solutions.
Carolina Care Plan, Data Analyst May 2006 - Dec 2006
. Prepared financial and business related reports for senior management.
Conducted focused data analysis upon request.
. Developed business models to evaluate proposed changes in provider
reimbursement. Evaluated the potential impact of proposed reimbursement
changes on revenue and utilization.
. Prepared spreadsheets and documentation to drive discussions concerning
benefit administration and revenue management.
. Assisted in identifying security and access issues within data
warehouses.
Trizetto (QCSI), Consultant Sep 2003 - May 2006
. Responsible for new customer implementations on the QNXT product.
. Proficient in all aspects of QNXT configuration including eligibility and
enrollment, provider reimbursement and network management, referral and
authorizations, claims processing, and premium billing and accounting.
. Assisted with development of detailed specifications for project tasks
such as EDI interfaces, code set updates and system configuration.
. Conducted workflow analysis and business requirements gathering sessions.
. Responsible for system testing utilizing appropriate coding, including
CPT and ICD-9.
. Provided recommendations for redesign or integration of existing
processes.
Work History
Aug 2013 - Present, Sr. Configuration Analyst II, Molina Healthcare,
Columbia, SC
May 2013 - Aug 2013, Business Analyst, Insight Global, Columbia, SC
Jan 2013 - Apr 2013, Principle Lead, CSC, Columbia, SC
Sep 2010 - Dec 2012, Senior Consultant, IBM, Columbia, SC
Nov 2010 - Sep 2011, Business Analyst, Insight Global, Columbia, SC
May 2010 - Sep 2010, Business Consultant, Comsys, Columbia, SC
Jan 2009 - Sep 2009, Business Analyst, AMERIGROUP Corporation, Virginia
Beach, VA
Dec 2006 - Sep 2008, Business Analyst, Blue Cross Blue Shield of SC,
Columbia, SC
May 2006 - Dec 2006, Data Analyst, Carolina Care Plan, Columbia, SC
Sep 2003 - May 2006, Business Consultant Trizetto/QCSI, Phoenix, AZ
May 2001 - May 2003, Educator, CMSE, Ansbach, Germany
Sep 2000 - May 2001, Employment Coordinator, U.S. Government Civilian
Employee, Germany
Jan 1996 - May 2000, Business Analyst, Blue Cross Blue Shield of SC,
Columbia, SC
Aug 1994 - July 1995, Project Assistant, Barclays Global Investors, San
Francisco, CA
May 1987 - Aug 1994, Business Analyst, State Street Bank & Trust Company,
Boston, MA
Aug 1985 - May 1987, Teacher, New England Center for Children, Southboro,
MA
Sep 1983 - Aug 1985, Teacher, Perkins School for the Blind, Watertown, MA
Skills: Microsoft SQL Server, Access, Project, Excel, Word, Visio,
SharePoint, PowerPoint, Oracle
Certifications
HP Enabling Delivery & Global Excellence July 2010
HP Caliber Requirements Management June 2010
Trizetto Boot Camp for Technical Users, July 2008
Trizetto Boot Camp for End Users, May 2008
Documenting Requirements, Oct 20007
Techniques for Project Quality, May 2007
Database Concepts, March 2007
Bachelor QNXT 2.6/3.0, Feb 2006
Bachelor QNXT 2.0, December 2005
Business Process Mapping & Analysis, Aug 2005
Introduction to SQL, Nov 2004
Consulting Skills for Professionals, Oct 2003
Professional, Academy for Healthcare Mgmt, Dec 1999
HIAA Managed Healthcare Professional, July 1997
Education: BA, Franklin & Marshall College, Lancaster, PA, 1983
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