Facets configuration analyst

THOMAS OROK

*** *********, ****** ******, ** ****7 678-***-**** *********@*****.***

Business Analyst

Senior analytical experience including discovery, data analysis, forecasting, testing and documentation

Ability to analyze, interpret and configure business requirements based upon stakeholder's design documents

Ability to analyze data and understand relationships

Re-engineering business processes and process mapping

Track record for improving processes

Proven ability to learn new applications across diverse organizational structures

Effective communication skills (written, verbal and listening)

Knowledge of provider contracts (Institutional and Professional)

Knowledge of lines of businesses including (HMO. PPO, Medicaid, Medicare)

BUSINESS ANALYST SKILLS

Amisys

Diamond

Facets

ITS

COGNOS

SQL Queries

Crystal Reports

Requirements Documentation

Implementation and Configuration

Client Interface Experience

Project Management

Payer System Applications

Microsoft SharePoint

Microsoft Excel and Access

Microsoft Visio

Microsoft PowerPoint Attributes Tracking

Data Trending

Report Generation

Report Maintenance

Reporting and Analytics

Ad-hoc Analysis

Excel Reports

Pivot Tables

Data Validation

PROFESSIONAL EXPERIENCE

Tenet Health Care, Newport Beach CA. (June 2009 – January 2012)

Business Analyst

Participate as a project team member assessing, configuring and auditing configuration.

Analyze configuration across commercial and government lines of business.

Benefit package configuration setup and maintenance.

Validate current configuration.

Complete analysis of Facets for benefits and medical definition.

Document benefits and medical definitions in Facets.

Review provider contracts and compare data to validate provider/pricing.

User Acceptance Testing.

PROFESSIONAL EXPERIENCE (CONTINUED)

LEGACY CONSULTING (CDPHP) (August 2005 – February 2009)

Facets Configuration/Business Analyst

Participated as a project team member assessing and validating institutional pricing.

• Provided and recommended solutions, processes and procedures for enhancements and modifications to existing system.

• Complete analysis of Facets for benefits and medical definitions.

• Validated via unit testing and rooted issues with Membership and billing; loading groups, class/plan information, sub-groups, billing information and rates.

• Participated in Claims Configurations; building and testing members.

• Loaded, test and audited provider contracts.

• Documented benefits and medical definitions in Facets.

• Analyzed configuration across Medicare and Medicaid lines of business.

• Assisted with creating and modifying queries and reports.

PEROT SYSTEMS (April 2000- August 2005)

Business Analyst

• Provide application support during conversion from Diamond 7.1 to Facets System 4.31.

Perform frontend configurations for Facets profiles in room type profile configuration build.

Procedure code maintenance, generate modifier rows, procedure codes and CPT Modifier loading.

Provide Administrative lead management to staff and client.

Assimilated product testing and auditing.

Load, test and audit provider contracts.

Load medical definitions.

Document benefits and medical definitions in Facets.

Test benefits and pricing configuration and provide findings along with quantified data results of over/underpayments.

Review, document and report spreadsheet analyst of missing data including primary grouping, secondary grouping and medical definitions.

Review and update fee schedules in pricing configuration.

User Acceptance Testing

EDUCATION

SOUTHERN POLYTECH STATE UNIVERSITY Marietta, GA, 1994

Construction Management (Bs)

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