Business Analyst

Sandra Brunson

acedap@r.postjobfree.com

**** ****** ***** *****

Home: 501-***-****

Sherwood, AR. 72120

Cell: 501-***-****

Government System Business and Test Analyst - Health Care Sector

Experience in analysis of problems, submission of project requests,

training relative to procedural changes and perform assigned activities to

ensure the efficient and effective implementation of additions or

modifications to the Fiscal Intermediary Shared System (FISS). Strong

knowledge in gathering, analyzing, developing, interpreting, documenting

and defining business requirements.

EXPERTISE HIGHLIGHTS

Data/Business/Systems Analysis, Testing/Documentation, Disaster Recovery

Planning, Researched & Resolution, Customer Service, Training / PCACE

software, CEM Translator HIPAA Transactions (ANSI X12 5010 format).

TECHNICAL SKILLS

CEM (common edit module), PCACE (claims software), PC Print (remittance

advice software-payments), MCE (Medicare claims software-part B claims),

AMISYS, UNIX, CICS system, SDLC, Medical Terminology, Java, SQL, HIPAA

4010/4010A1/5010/5010A1/5010A2, SharePoint, Micro Focus, AHIN, FTP, ACS,

ADR, ESRD, MSP, ARU, ICD-9, ICD-10, VA claims, HIPAA X12 transactions

(837,835,270,271,834,810,277,276, and 997), Windows XP, Windows Vista, CM-

1500, UB92, EMC, HCFA, DDE, HCPCS, and DRG. Microsoft Office - Word,

Excel, Access, PowerPoint, Exchange and Outlook.

EXPERIENCE

Arkansas Blue Cross & Blue Shield (Medicare Sector)

2004-2014

Role: Lead Business and Test Analyst

2007-2014

Role: Sr. Business and Test Analyst

2004-2006

. Promoted to Lead Business and Test Analyst role to provide leadership,

training, resolutions, and oversee the business/test analyst group.

. Formulated logical statements of problems and devise effective solutions

to the problem

. Leaded and conducted specific customer related requirements

. Developed and input workable solutions to business requirements for the

Centers for Medicare and Medicaid (CMS) Change Requests

. Communicated with varied spectrum of expertise, Plan and prepared

comprehensive test data, Identified, supported, and document system

modifications

. Coordinated/conduct on-site client visits and assist with user training,

required on occasion to travel to various locations throughout the

country

. Reviewed output of test cycles and verify results, document and explain

any variances, assist technical staff in analyzed and researched reported

system problems, maintained a cooperative and productive climate with all

customer and inter-divisional contacts

. Interpreted CMS Change requests, communicate with other Government

Systems, other organizations under contract, CMS coordinators and

Business experts

. Provided telephone support to FISS Users, as required. Assist in

conference call with user staff to discuss concerns/problem and propose

system changes

. Contributed to and support the goals of Pinnacle through performance

accomplishments, goal setting and continuous self-evaluation to ensure

Pinnacle remains a mainstay in the industry

Arkansas Blue Cross & Blue Shield (Private Sector)

1998-2004

Role: Health Information Networks Analyst

2001-2004

Role: Health Information Networks Specialist

1998-2001

Advanced health information network analyst provided instruction,

leadership, and support. Provided administrative and technical support for

Electronic Health Data Interchange (EDI) programs and ensured that all

claims files received electronically are system ready and adhere to the

prescribed formats.

. Functions included claims submission problem resolution, provider/billing

agent claims submission training.

. Assisted and evaluation of EDI operations and data submission tools to

ensure ABCBS adhere to the standards defined by HCFA for EDI and other

Health Information Network business.

. Provided claims submission and related services to the Health Information

Networks, Customer providers, billing agents, software vendors and work

with internal personnel in conjunction with the claims processing area of

ABCBS, Health Advantage, USABLE Administrators, First Source, Medicare,

other P.B., and serves as consultant to Government Systems, Government

Systems Services, Regular Business System, and USABLE Systems on projects

related to EDI services

. Provided medical providers, Billing Agents/Clearing Houses, and software

vendors in Arkansas, Missouri, Louisiana, Oklahoma, New Mexico, and Rhode

Island with superior EDI support on a daily basis

. Trained and promoted, coordinated, analyzed and assisted in communication

software/hardware, telecommunication protocols, claims status

information, provider access eligibility transactions, claim format

testing, EDI technical specifications, support of the Medicare B

software, AHIN system claims flow, and all related functions of EDI

procedures and operations

. Responded to providers, vendors, billing agents, user area and systems

staffs to address problems and make recommendations regarding changes and

improvements to electronic processes.

. Provided Telephone support and Contacted providers and billing agents to

promote EDI services.

. Managed daily reports to determine file problems and rejects.

. Monitored all communication lines are open and available to receive data.

. Maintained security control file for EDI BBS, EDI Gateway, and AHIN

. Maintained HIN customer files that include ERA, PCF, TSOB, and Imaging

. Promoted, assisted and coordinated the transition of providers from

paper billing to electronic claims

submissions.

. Implemented and coordinated specification changes to enhance

electronic billing and facilitate growth.

. Maintained and display a professional attitude and appearance as a

primary contract for EDI

Arkansas Blue Cross and Blue Shield (Usable Life/Private Sector)

1995-1998

Role: Claims Examiner

. Processed regular business, medical, dental, DME, Medicare hospital

(A/B), vision claims for RB and individual group contract (Amtran).

. Team leader and Resolved pending reports with errors and problems

. Verified and approved patient and billing codes

. Approved and corrected claims with error codes

Delta Health Center

1985-1995

Role: Credit and Collection Agent

. Process Medicare, Medicaid, and Private Business insurance claims.

. Credit Vouchers

. Claims processing

. Accounts Receivables and General Ledger

. Fraud and abuse of insurance claims

EDUCATION

A.A.S Degree - Business Office Technology

Arkansas College of Technology, Little Rock, AR

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