Business Analyst Project Management

JOEL DOMINICK

Business Analyst

*******@*****.*** 818-***-**** LOS ANGELES, CA

Summary

Healthcare professional with a wide range of health care Knowledge within HMO, MSO & Medical Management. Experience includes Claims Adjudication, Contract Configuration, PMO Compliance and Business Analysis. Dedicated team player with unique ability to collaborate with stakeholders to identify and document quality user business requirements. Adept in executing System, Integration, E2E & UAT testing and the ability to effectively manage and achieve project goals.

Skills

Requirement gathering, Workshop, Interviews

Project Management

Conflict Resolution

MS Word, Excel, PowerPoint

Visio

UML Diagram

Reporting

Reports, Documentation & Reconciliation

Experience

Billing Supervisor

CodeMax Medical Billing 2023

Supervising a small group of seven (7) medical billers.

Provided input regarding selecting, hiring, and training of staff.

Overseeing claims reports & ensuring billing operations and audits are performed in an accurate and timely manner.

Evaluating billing processes and procedures and assisting management in developing revisions.

Claims Examiner/Specialist

Caring 4 Healthcare LLC/ Clinicas Del Camino Real, Claims Unit 2019-2021

Worked to support team with claims analysis and claim processing of medical institutional and professional claims.

Reviewing and auditing reports to ensure claims are billed and paid with the correct codes, copays, providers, as well as the unbundling of CPT codes, minimizing overpayments to vendors.

Reviewing insurance claims for accuracy, including reviewing medical records for documentation of services rendered and items supplied.

Compliance Auditor,

Centene/HealthNet, Woodland Hills 2015-2018

Demonstrated ability to examine and evaluate potential risks within PMO to eliminate issues with Industry standard regulatory compliance and ensuring project teams were meeting and complying with all principles and rules set by the company guidelines by developing effective lines of communication.

Work to maintain quality assurance by recommending new policies & procedures, communicating audit findings via final report.

Business Analyst,

HealthNet, Woodland Hills 2006-2015

Experience in writing Business Requirement Documents for numerous projects, ensuring that quality requirements are gathered, detailed & defined for transparency of business needs, decreasing oversite for higher quality IT product development.

Proficient in developing and executing Test Plans, Test Case, Test Scenarios and Use cases while leading

the UAT team, ensuring software/products are tested and validated according to functional specifications.

Proficient in Developing of Traceability Matrix by cross-referencing system testing with Business Requirements.

In depth knowledge of SDLC framework (i.e., Waterfall, Iterative & Agile methodologies).

Claims Examiner,

Care America, Meridian IPA Management, Woodland Hills 2000-2006

Adjudication and Audit of Foreign & domestic medical, Institutional and Professional claims with knowledge of Membership, Billing & Claims payment systems. Experience with Provider Disputes Resolution, working with IPA’s, providers, hospitals, and patients.

Assisting patients with filing appeals or grievances with their insurance companies regarding coverage or payment issues.

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