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system configuration analyst ii resume example with 12+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Summary

A result-oriented professional with extensive experience in medical claims administration, business system analyst and configuration of various healthcare systems. Able to multi-tasked with highly developed organizational skills, and accepts challenges with enthusiasm. Proactive leader and motivator, critical thinker with the ability to create measurable project plans, provide focus and control to meet deadlines from inception to completion.

Skills

• PC proficient, including Microsoft Office 2000 applications, Visio, Power Point, Outlook, Access, medical and dental terminology.

• Commercial, Point of Service, Medicare and Medical knowledge.

• ICD-9, ICD-10, Revenue and CPT codes

• Data Entry and 10 keys by touch.

• SDLC (System Development Life Cycle)

• Claims Processing (Professional and Facility)

• Builds strong relationships, collaboration and decision making.

• Excellent attention to detail, which includes problem solving, analytical, technical, verbal and written communication skills.

• Able to lead and configure various projects simultaneously; i.e Care Management, Managed Long Term Support and Services, and Utilization Management letter projects.

• Project Server; updating and adding users to various tasks and adding various tasks to the application.

Education and Training
University of Phoenix Tempe, AZ Expected in 08/2019 Bachelor of Science : Health Administration W/concentration in Informati - GPA :
Experience
L.A Care Health Plan - System Configuration Analyst II
City, STATE, 11/2018 - Current

• Participate in peer review processes within the team as an internal effort to assure quality of configuration prior to migrating changes to QA (Quality Assurance), UAT (User Acceptance Testing) and Production environments.

• Work with technical and reporting teams to provide feedback related to configuration items that will integrate with reports and technical settings.

• Collaborates closely with peers and management within and outside of the department to ensure that the most complex surround systems codes are monitored, analyzed and updated for Process Communication Tracker (PCT).

• Configure Clinical Care Advance (CCA) system settings related to Concepts, Assessments, Forms, and Letters

• Configure Process Communication Tracking System, code classifications, adding users, teams, roles, round robins, letters, attachments and user interface access.

• Collaborate with business partners (i.e. Health Services and Appeals and Grievance) on documentation of system and build requirements for current/new projects.

• Create design documents that outline the configuration elements of the approved and finalized system and build requirements document.

• Complete pre and post production configuration to facilitate collaborations with stakeholders and implementations of new/enhanced configuration.

• Create, demonstrate, and maintain case classification mapping documents for appeals and grievances to assist with the appropriate select in the type of classification for a case.

• Create release notes report and send to various departments that provide information on tasks that are in progress or have been completed by the Surround Systems Configuration unit.

• Monitor the Surround Systems email inbox and create intake tickets to assign the request from various departments.

L.A. Care Health Plan - Senior Quality Configuration Analyst
City, STATE, 11/2016 - 11/2018

• Interface actively with the customer community regarding configuration issues and status.

• Escalate issues that lie outside of the required completion dates to appropriate levels.

• Perform routine testing, validation, and quality assurance of business requirements for the configuration of QNXT.

• Collaborates closely with peers and management within the department and throughout the organization.

• Prepare summary documents, test plans, test strategy documents, perform root analysis and analyze provider contracts to support testing and findings

• Provide thought-out recommendation to decrease the volume of claims pending in QNXT

HealthCare Partners Medical Group - Business Analyst (Lead)
City, STATE, 04/2009 - 11/2016

Perform routine testing and updates to system applications functions, which includes, testing updates to provider contracts, Medicare fee schedules and member benefit plans to ensure proper system adjudication.

• Review and report provider adjudication discrepancies and provider fraud.

• Interface actively with the customer community regarding configuration issues and status.

• Escalate issues that lie outside of the required completion dates to appropriate levels of management.

• Quality control contracts that have been implemented and tested by colleagues.

• Prepare documents, create reports for DMHC and KPMG auditing.

• Review and report discrepancies in system design or system set-up, including referral matching.

• Develops specific and moderately complex reports for users based on request or identified needs using available reporting tools such as MS Access and Claims Operation Download.

• Analyze and define requirements through functional research, needs assessment and data gathering to assure auto release claims are adjudicating accurately.

• Provided feedback to the Manager and/or Director of staff performance. Collaborated with Manager of hiring, training and coaching of staff. Assess and oversee the quality and timeliness of the work and assist staff with complex issues.

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Resume Overview

School Attended

  • University of Phoenix

Job Titles Held:

  • System Configuration Analyst II
  • Senior Quality Configuration Analyst
  • Business Analyst (Lead)

Degrees

  • Bachelor of Science

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