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Healthcare Business Analyst Resume Samples
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6-10 years of experience
Analyzed and collected national account benefit benefit package information regarding subscriber liability and covered services such as cost-share and visit or dollar maximums on a ICD- 9 code level of detail and built requirements using custom applications such as Benefit Explainer and Benefit Editor
- Performed ongoing quality assurance to ensure accuracy and consistency of output in the system
- Acted as project team member on [company name] Blue Shield of Michigan's initiative to combine a local and national claims processing system into one single platform
- Conducted user acceptance testing and data validation of web applications used to present benefit information
- Loaded and maintained Health Care Certificates and Riders in Document Database
- Wrote and entered SQL language in Benefits at a glance (BAAGS) chart templates
- Generated reports and performed data validation in SMART ([company name] Blue Shield Custom App.)
- Implemented and maintained account benefit updates in system as part of National Health Care Reform mandates.
0-5 years of experience
Worked closely with IT personnel and business partners to identify and maximize opportunities to improve products services and program business processes.
- Reviewed, analyzed and created detailed documentation of business systems and user needs, including workflow, program functions and steps required to develop or modify application programs.
- Assisted in developing and maintaining business & financial reports and IT work/databases which was required to support the various lines of business and specific projects.
- Consulted with IT Personnel to determine business, functional and technical requirements for specified applications.
- Developed effective reporting tools for the business unit and completed existing projects from original concept through final implementation
- Organized chart-holding facilities and assisted in training staff. Assisted various projects from start to finish through the SDLC process.
- Participated in Code Reviews, System Testing and UAT followed by production verification, post production testing and support
- Performed internal & external reporting, cash management, cost reduction & efficiency
0-5 years of experience
- Gathered and documented existing client processes and data using Microsoft Excel in order to perform gap analysis between client’s system and McKesson’s system in order to access client’s readiness.
- Identified specifications for billing and accounts receivable requirements, performed gap analysis and presented information to technical team to identify system requirements.
- Facilitated strategic meetings between Perot technical team and hospital administrators resulting in identifying key differences in clinical systems.
- Created and designed SharePoint website to be used as project data repository for project.
- Created new processes/procedures/guidelines to leverage data.
- Trained all new associates which were on-boarding on how to use SharePoint website.
0-5 years of experience
Was the resident subject matter expert for all health-related projects. Trained as business analyst using e-
[company name]. Awarded more than $1M by DARPA over 3 consecutive years to develop a
healthcare modeling application. Won Cleveland Clinic bid to develop EMR.
- Developed algorithm for healthcare simulation model.
- Gathered functional, business and technical requirements using individual and group meetings.
- Documented system functional and technical requirements.
0-5 years of experience
Managed Data Aggregation project for BCBSIL medical groups keeping project on schedule and on budget
- Jr. Project Manager for IMH, HEDIS and CCM projects
- Developed project proposal for BCBSIL HIE project to increase company revenue and capabilities
- Developed website and marketing materials for company and client outreach
- Developed operational processes for increase company organization, productivity and performance
0-5 years of experience
- Researched, defined and analyzed changes to both state and federal laws affecting the Medicaid Management Information System (MMIS) for Texas Medicaid account.
- Served as a project management analyst on multiple initiatives involving maintenance and systems changes for HIPAA implementation.
- Researched and gathered detailed requirements and translated it into proposed systems system enhancements.
- Completed system documentation, researched system requirements, participated in system testing and verification for HIPAA implementation.
0-5 years of experience
Served as business analyst implementing McKesson Healthcare software.
- Gathered and documented existing client processes and data in order to perform gap analysis between client's system and McKesson's system in order to access client's readiness.
- Identified specifications for billing and accounts receivable requirements, performed gap analysis and presented information to technical team to identify system requirements.
- Facilitated strategic meetings between Perot technical team and hospital administrators resulting in identifying key differences in clinical systems.
- Defined, designed and created initial specifications for SharePoint website to be used as project data repository for project.
- Created and designed custom webpages on SharePoint to maximize storage on SharePoint website.
- Created new processes/procedures/guidelines to leverage data.
- Trained all new associates on SharePoint website.
- Completed Perot's Project Management class. Utilized Project Management Institute (PMI) methodology.
6-10 years of experience
Analyzes Medicare business processes and translates to business requirements for users within Medicare Operations.
- Works closely with business users to define requirements, prioritize issues, and address production support issues.
- Coordinates and facilitates work sessions with Medicare Operations users and IT development to define projects' scope and requirements and manage project expectations.
- Acts as liaison between the users and the IT development team to determine and deliver the most effective solution for development and implementation including preparing detailed business requirements documents.
- Develops implementation and testing plans and assists in coordinating testing.
- Performs user acceptance testing to ensure system integrity before release to production
- Participates in driving the success of the software design, implementation, testing, production deployment and post-production phases of the Medicare tool.
0-5 years of experience
- Served as the Applications developer developing the solutions agreed upon by Business.
- Performed Vulnerability Analysis and Deep Dive analysis of the application to find out vulnerable areas and to strengthen them by offering solutions.
- Provided post implementation support and performed root cause analysis and fixed post implementation issues.
- Participated in IT Audits and made sure all the project artifacts were available whenever required to produce them.
0-5 years of experience
- Reported to and worked directly with the CIO.
- Researched the progression of the national Beacon Project, in regards to the adoption of Health Information Exchanges for San Diego and Riverside County area medical facilities.
- Assessed how Planned Parenthood Southwest could benefit in partnering with this program.
0-5 years of experience
Develop business process models for projects and demonstrations at the Centers for Medicare and
Medicaid (CMS) using business process model notation and enterprise architecture
- Facilitate and lead project meetings with various CMS stakeholders to elicit project information and resolve project issues
- Analyze government furnished information to develop business artifacts, models, and interaction
- Create business process detailed description documents for projects under the Affordable Care
- Prepare and track projects through weekly reports and deliverables
- Collaborate with client to develop Standard Operating Procedures for CMS IT Systems Inventory
0-5 years of experience
Participates in the analysis of existing business process and systems to recommend process and system enhancements to improve business performance and maximize the effectiveness of available technology.
- Participates in the design and implementation of new systems initiatives.
- Performs business support responsibilities, including production monitoring, file maintenance, and ad-hoc reporting.
- Provides ongoing internal and external customer support for system questions and problems.
- Analyzes and researches system problems, coordinating with the necessary parties to track them to resolution.
- Develops or assists in the development of user documentation and training.
0-5 years of experience
Responsible for implementing payers onto the Health Care Exchange (HIX) for the Affordable Care Act.
- Document requirements, system analysis and project documentation such as BRD, Business Process Mapping and functional workflows
- Facilitate communication between clients, consultant teams, and solution developers
- Strong working knowledge of the 820, 835 & 834 EDI Healthcare files and Transactions
0-5 years of experience
Lead the analysis process from concept to development for clinical applications. Act as the subject matter expert post-development.
- Gather, assess, and interpret business need and translate into written system requirements. Organize and facilitate meetings with key internal stakeholders.
- Author and champion system requirement documents in order to solicit approval.
- Conduct focus group meetings with external senior managers.
- Subject matter expert for Computerized Physician Order Entry and Zynx
0-5 years of experience
- Gather and document functional requirements for the integration of a $5 million dollar long term care EMR system.
- Communicate with the business owners to identify clinical and operational reporting metric requirements.
- Collaborate with stakeholders and IT teams to align ETL transformation rules with Cognos reporting.
- Data Mapping to integrate vendor external systems with a major insurance company.
- Experience with the Waterfall systems development life cycle model.
- Experience with Primavera (financial management solution tool).
