Experienced Senior Business Analyst highly organized, methodical and skilled at overseeing daily milestones along with meeting stringent deadlines to promote corporate initiatives. Ability to multi task from successfully taking a project from the initial stages to completion. Comprehensive experience in identifying and analyzing areas of potential risk including, but not limited to identifying unusual variations and assessing the impact of changes; Excellent quantitative and critical thinking abilities paired with basic knowledge of rational database to effectively synthesize data from multiple sources into sound business decisions with accuracy; Can work independently with limited or no supervision. Strong work ethics and leadership skills in relationship building and project management, foster a working environment that is accountable and transparent through communication. Ability to leverage technology
MS-Excel and rational databases/SQL Server, MS-Access, Business Objects, GeoNetwork, Siebel, InfoMaker, and other MS Software, CPT-4/ICD-9/HCPCS, Health Connect (Network Comparison), NDB, Diamond, Orbit, Health Care Economics (Cognos), Yoda/Pulse, Lotus Notes, Examiner, Phycon, Emptoris, MCO, PHIL (AlphaCare Creation), Care Compass, Cactus, Mosaic, Facets, PUMA, Integrated Provider Database (IPD)
Working within a high degree of independence, having strong technical capabilities in production data loading, querying and monitoring, oversee its validation and organization in support of Network Management and Operations. Continuously support quality improvement, network adequacy standard, and compliance with regulatory requirement for NYSDOH, CMS, ACHA, DMAS and other reporting for Network Adequacy Standards for SOX and HEDIS). Process improvement, P&P and desktop guidelines development
Maintained approximately 15 large delegated NY hospitals delegated and non-delegated provider groups to tracked information and compiled data to improve efficiency and ensuring accurate provider linkage, and contract configuration. Developed and fostered strong business relationships to promote positive working relationship through communications with all groups via phone and/or email, bi/weekly/monthly meeting, which include group tracker of all submissions, external and inter-departmental inquiries and/or request.
Developed operational methods to and grow competitive, stable physician network that achieved unit cost and trend management in an effort to provide affordable products to customers and business partners by fostering strong working relationship with vendors to promote positive working environment. Interpreted needs, utilizing effective communication and identifying solutions by analyzing problems problems and developing appropriate course of actions in project cost while meeting key milestones
Created queries, analyzed and interpreted statistical data to conduct analytic projects; maintained network provider count by region for all lines of business, performed disruption analysis and network accessibility analysis and mapping as requested by Sales to support RFP; Created representative fee schedule for physician and hospital contracting, and managed provider deficiency based on DOH guidelines
Prepared and maintain inventory cycle time report and production statistics; Created departmental operational guidelines and initiating coaching and feedback training program to facilitate production accuracy; Developed functional specification on system enhancement specification for system enhancements such as customer service intake system to standardize communication to providers and subscriber as well as inter-departmental stakeholders
Perform regulatory and compliance audit for internal departments and vendors, prepared root cause analysis and created workable corrective action plan for training and quality assurance
The Six Sigma Green Belt operates in support of or under the supervision of a Six Sigma Black Belt, analyzes and solves quality problems and is involved in quality improvement projects
Completed professional development in Windows, Lotus 1-2-3, Excel, WordPerfect6.1, Word6
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