Senior Business Analyst offering twenty plus years of experience delivering HIPAA compliant software, high performance technology solutions to meet shifting organizational demands.
Provided DMLSS DT&E testing with detailed oriented analytical and communications skills. Developed technically adept and test scenarios and quality assurance. Only non military personnel on project. Quickly learned the software and updated documentation.
Subject Matter Expert for Commercial Clearinghouses, Medicaid, Medicare, Home Health and Hospice billing formats. Assisted stakeholders in understanding regulatory requirements to implement mandated initiatives into detailed user stories for development team. Product owner for state Medicaid Electronic Data Interchange (EDI) billing changes. Participated in all regulatory sprints and presented Concept Reviews to Homecare team. Responsible for all Medicaid electronic billing formats and issues related to claims processing. Utilized HIPAA Billing Tool for the utilization of the 837 ANSI Transactions Set. Created informative concept reviews on complex billing regulations for team members and sales executives. Responsible in the completion of Payer validation requests. Created monthly vendor reports for Emdeon Clearinghouse. Ensured that the Home Health and Hospice software is compliant with Medicare and Medicaid guidelines. Coordinated claim and Issue Cases with the both Emdeon and Payerpath. Developed billing templates and created test scenarios. Monitored and tested business applications to verify that all client requirements are incorporated into the system design. Provided input into developing and modifying the application to meet client needs and regulatory requirement specifications to support these modifications. Coordinates and facilitates meetings with clients and payers to gather and document requirements and explore potential solutions. Provided leadership and guidance to less experienced personnel. Prioritized and resolved forty one percent of case backlog for Regulatory team of three. Resolved 63 SFDC cases within 10 month period.
Claims Processing, Medicare, Electronic Data Interchange (EDI), Testing, ANSI, Sales Validation, Issue Case Resolution, Client Focused, HIPAA, Subject Matter Expert, Billing, Medicaid, Regulatory Compliance, Test Case, User Stories, Project Management, Project Manager, Training, CMS, Health Maintenance Organization (HMO), Business Requirements, Test Plans, Mapping, Quantitative, Work Flow, Amisys Configuration, Documentation, Medicare Part B, Team Lead, Administrative Assistant with American Red Cross and UPS.
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