Sr Business Analyst
Resume:
Cindy Morgan
******@*****.***
Career Goal
Talented professional with advanced knowledge who would like to continue my career in a company that promotes innovation in all aspects of their business; which allows me to continue challenging myself while creating cutting edge technology. I am a quality-result oriented professional who over the course of my 30+ years career in Healthcare, has developed a diverse set of skills.
Areas of Expertise
Ingenix/Creating reports/Analysis /Lawsuit Data Flow & Process Mapping
Extensive knowledge in healthcare TOPS system
Testing/Scripting/Documentation Claims Processing/Claim Auditing Data Meer
Microsoft Office Communicator 2005 Gap analysis
Snag- IT Organized
Workflow analysis Multi-tasking
Trained in Six Sigma methodologies Creative
Microsoft Office Suite Business process mapping
Data mapping PPM Optics
SQL and databases Problem solver
Business development Auditor/Trainer
Agile Training Nintex
SharePoint Writing Business and IT Specifications
Data/Business/Systems Analysis Implementation of Business process Improvement Initiatives
Technical & Data Subject Matter Expert/ IT Senior System Analyst/
Senior Business Analyst
Expertise in researching, reporting; including but not limited to Galaxy/Ingenix and SharePoint data, defining, creating, training, analyzing, documenting and implementing business process improvements; with experience in gathering, estimating, defining business and functional requirements; and workflows.
Accomplishments
Produce reports/analysis of those reports using Ingenix/Galaxy for a variety of different lawsuits.
Transitioned over Fair Health Data to new carrier (reasonable & customary process).
Application planner for CQA/Specialty/EAS estimates, along with recommending, documenting and implementing process changes to increase estimate accuracy and turnaround times.
Onboard and train all new employees.
Extensive knowledge of TOPS, and Claims Processing.
Worked hand in hand with the project management teams; assisting with workloads and processes.
Analyze data, process and other factors to implement changes for quality improvement. Work with stakeholders to ensure test case scenarios properly depicted the needs of the business.
Reduced organizational operating costs by streamlining processes.
Designed and implemented an innovative workflow solution.
I have consistently demonstrated my dedication and drive and have been recognized by my co- workers and managers receiving 15 Awards between 2016 and 2019 and consistently exceeding on my annual review with a 5 for 2015, 2016, 2017 and 2018 and 4’s for all previous years.
Key Responsible
Worked on Benefit Template Builder: Work with Business Partners to produce, deployed enhancements and tested enhancements on BTB for Key Accounts, National Account and Community and Services Accounts. Created extracts from BTB for a variety of different departments such as actuary department, business partners and IT partners.
Responsible for automating the Estimation Approval/Completing Process used by the Front Office (which was responsible for over 200 applications) by creating the Estimation SharePoints; learning and creating Nintex workflows; creating New Estimation Templates, documenting and training all estimators/approvers. The Estimation SharePoints is used as a reporting tool used by the Front Office/P&S Management, there was no reporting tool available prior. Responsible for analysis reports from the Estimation SharePoints, creating documentation and presenting my findings to the P&S team to get approval to launch the pre-approvals for certain types of estimates, which saved both time and money. The implementation of the Estimation SharePoints/templates changed the turnaround time for posting estimates, in some cases from weeks to a 2-day turnaround time. Also, created a separate SharePoint; along with a Nintex workflow (automation) for FACETS CSP Dev./ P&S/CQA Teams be used for Ad Hoc Coding approvals.
Responsible for producing, validating, analysis, Galaxy reports which are used in lawsuits, identifying defects, research for new business. Most reports are requests by CEO of United Healthcare, Upper Management, etc. Worked with the Behavioral Team in New Mexico to correct all their reports which are used by the State of New Mexico where funding is provide to them by the government.
Our team took over the estimation process for many applications. My responsibility was to use PROMPT/PPM Optics requesting the PM for allocations for the entire team. Update the SharePoint used by the Front Office with all new estimates, update when an estimate was ready for approval and post estimate that had been approved.
Work Experience
2005 - United HealthCare\ Optum Health, Hartford, CT
IT Senior System Analyst /Technical & Data Subject Matter Expert
Wrote specs, deployed enhancements and tested enhancements on BTB for Key Accounts, National Account and Community and Services Accounts.
Testing enhancements to BTB.
Created SharePoints/using Nintex workflows which automated the approval process for the Front Office, which changed the turnaround time for estimate approvals from weeks to a 2-day turnaround timeframe
Creating documentation and training on all new processes in the Front Office to team members, P&S and P&S team.
Performed analysis using the SharePoints data to create proposals for Pre-approvals on estimates which were presented to the P&S Approver teams. Pre-Approvals estimate saved both time and money. Pre-Approved estimates could be posted ASAP, and didn’t have to wait even the 2-day turnaround time.
A few examples of the Pre-Approvals:
TOPS/COMET (BGE) estimates total estimate hours were less than 3,500 hours were pre-approved.
Claims QA for COSMOS (BGE, test only) estimate, were pre-approved
Analysis only estimates – all applications under the Front Office – pre-approved.
Created New Estimating Templates for the Front Office
Application planner for the Front Office Estimating Team
Requested Allocations for all team members
Support of TNOC (Transaction National Operations Center) related projects which could include subpoenas submitted for possible lawsuits, third auditors performed party by outsider vendors on ASO or Fully Insured clients.
Business/System Analyst support for Regressions Testing which includes understanding detailed functionality of the medical/dental/vision claim payment system. Functionality of front-end logic, manual payment logic, 837/835 logic. Objective was to write scenarios, expected results, provide structure(s) and submit system defects (if and when applicable before regression testing begins) to SOS team.
Galaxy reporting requests which includes running, validating data returned by Ingenix. Information requested can be any information used to process/deny/reject a claim, which includes payments to providers, states, and employee’s, etc. Export, format and send reports to requestor.
Six Sigma
Senior System Analyst:
Main Responsible: Business Partners request for System Analyst for system enhancements or new processes to be performed on the main processing system which is called TOPS. Perform assembly testing for changes made to the High and Detail Level System Specifications which will be affect the TOPS system.
Work with matrix partners to determine impacts on other departments or applicable used by TOPS.
Internal walk through with departments that are directed effected by any changes or enhancements due to the High and Detail System Specifications.
External walk through with managers and departments that are directly affected by any changes or enhancements due to the High and Detail System Specifications.
Analysis only projects requested by business partners to determine whether the process can be performed in the TOPS and/or other systems. Responsibility is to determine time and effort needed in order to accomplish request and send analysis back to Business partners.
Weekly status reports.
2002 - DEC 2005 ~ CIGNA HEALTHCARE, Bloomfield, CT
Senior Business Analyst:
Team-site-importing and deploying files for mycignaplans.com and Sales tool Box-mycignaplans.com award winning website
Loading website for mycignaplan.com, which is used for pre-enrollment of clients? Loaded benefits which are used for plan and cost compare by WebMD, a third-party vendor - HRA and HSA plans
Assisting in the writing Business Requirements including enhancements to Account Activation, Secure emails, and Vetting letter for Secure emails
Account Activation - Providing employers with online applications available through CIGNA within a 5 to 10 business day turnaround, and updating Standard Operation Practice manual for training purposing.
Updating Team-site for employee(s) and employer(s)
Designing Business System Design manual for the Kaiser lawsuit
Tracking new application for Account Activation
Training teammates on Secure Email and loading Account Activation for Internal and External Customers.
Audit Account Activation for updated information, verifying that Personal Health Information level and the Primary Administrator are correct and that it is eligible for the applications the client manager has applied for.
Business Analyst/HIPAA:
Business lead in the testing
Provided status reports
Obtained data from all source systems
Attended all meeting regarding testing
Maintained deadlines appropriate for testing
Taught teammates to read claim history in order to validate test scripts
Provided Provider ID’s obtain from CPF for the Provider Registration process
Composed grids to PSS, identifying what each source system can supply in order for the Hospitals to utilize PSS effectively
Identified government rules and regulations regarding HIPAA.
Designed Business System Design manuals enabling CIGNA to follow guidelines to be HIPAA compliant for the interactive transition, eligibility and benefit transition.
1997 - 2002 ~ CIGNA HEALTHCARE, Bristol, CT
Field Claim Examiner
Processed various types of HealthCare claims in all lines of PPO and Indemnity business.
Identified system improvements within the Proclaim and Medicom system. Addressed the details of the problem to our internal service partner for review and resolution: Found numerous structure errors on the Viper system for accounts, such as Paine and Webber, multiple surgeries paying incorrectly, not linking to correct PPA link (structure not completed for some accounts) therefore wouldn’t pay correctly.
Processed various types of HealthCare claims in multiple lines of business, including Preferred Provider Organization (PPO), Dental, Vision, Medicaid, Medicare, No Fault, Workmen’s Compensation, Indemnity, and PPA.
Investigated customer service inquires regarding any claim adjustments that are needed on member files. Identified, researched and made the necessary adjustments. Processed PSU.
Trained for all levels of tiered processing for Proclaim. First person in the Bristol office to process claims for Tier 2 mail.
JUL 1996 - JAN 1997 ~ CIGNA HEALTHCARE, Charlotte, NC
Facilitator
Responsible for daily management of the claim production team, to include all aspects of performance management based on quality and production results.
Maintained productivity to ensure timely claim productivity in keeping with claim office standards.
Provided daily, monthly, quarterly and annual feedback relative to performance, attendance, etc. to the staff, both in written and oral format, setting goals and ensuring that everything possible is provided to help the employees reach their goals.
1981 - JUL 1996 ~ CIGNA HEALTHCARE, Bristol, CT
Field Claim Examiner (Part-time status) (1995 - Jul 1996)
Processed various types of HealthCare claims in all lines of Managed Care and Indemnity business.
Identified system improvements within Medicom system. Addressed the details of the problem to our internal service partner for review and resolution.
Processed various types of HealthCare claims in multiple lines of business, including Preferred Provider Organization (PPO), Dental, Vision, Medicaid, Medicare, No Fault, Workmen’s Compensation, Indemnity, and PPA.
Investigated customer service inquires regarding any claim adjustments that are needed on member files. Identified, researched and made the necessary adjustments.
Trainer/Auditor (1993 - 1995)
Performed ongoing pre and post payment audits as specified by the customer.
Maintained all quality results and reported these results to management, identifying areas of improvement opportunities, as well as ongoing trends and training needs.
Participated in third party audits, performing the audit, as well as responding to challenges, including assisting the Third-Party Auditors in benefits clarification, claim payments and as a technical support when needed.
Benefit Analyst (1981 - 1993)
Processed HealthCare claims for the PPO and Indemnity business.
Identified system improvements within Medicom system. Addressed the details of the problem to our internal service partner for review and resolution.
Processed various types of HealthCare claims in multiple lines of business, including Preferred Provider Organization (PPO), Dental, Vision, Medicaid, Medicare, No Fault, Workmen’s Compensation, and Indemnity.
Investigated customer service inquires regarding any claim adjustments that are needed on member files. Identified, researched and made the necessary adjustments.
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