jessica claire professional summary 100 montgomery st 10th floor 555 4321000 resumesampleexamplecom 5 years experience business requirements modeling business process analysis data analysis clientserver applications enhancing business processes diverse business domains summary expertise strong analytical aptitude ability structure complex undefined business problems business writing skills creating business requirements document brd usecase specifications systems requirements specification srs high level lowlevel documents hldlld proficiency gathering smart specific measurable attainable realistic timely requirements transforming functional specifications focusing workflow analysis design user interface design experience health care systems qnxt facets medicare part b c medicaid systems validating general equivalency mappings gems technical report type 3 tr3 implementation guide companion guide ensure timely escalation customer problems documenting impact customer assigning appropriate priority resolution target initiate escalation appropriate ensure management awareness problems severe nature exceeding documented targets knowledge edi transactions 837 claims 834 enrollment2701271 eligibility enquiry response experience ansi x12 healthcare edi transaction sets 837 999 277ca 276277 835 proven success eliciting requirement asis tobe analysis gap analysis cost benefit analysis risk assessment swot analysis experience endtoend testing uat user acceptance test user training customers proficiency sdlc life cycle ability gather document business requirements experienced writing use cases used rally tfs updating status test cases test scripts executed testing process data mapping logical data modeling created class diagrams er diagrams using sql queries filter data experience using sql data extraction working knowledge ms office programs word excel power point etc experienced analyzing documenting business rules client needs user stories produce accurate designed feature set reflect business needs working hipaa edi 5010 icd10 analysis compliance experience payers providers exchanges perspective primary focus coordination benefits cob working knowledge icd9 icd10 structures formats experience edi hipaa testing privacy multiple transactions exposure inbound claims 834membership enrollment 837 institutional 837professional 835claim paymentremittance advise 270271eligibility benefit inquiryresponse 276277claim status inquiryresponse transactions apply knowledge business process modelling document processes gather critical information scrum ceremonies various stakeholders producing useful reports worked closely product owners clients technical managerial staff using strong analytical aptitude ability structure complex undefined business problemsunderstanding change management practices using facets various health insurance areas enrollment member products facets related modules experience data extracts reports data validation activities experience data warehousing experienced business analyst 5 years experience healthcare excellent reputation resolving problems improving customer satisfaction skills strategic planning data analysis product development gap analysis webbased reporting tools customer targeting revenue development sql databases business process mapping project management business artifacts documentation competitive analysis conflict resolution release planning quality assurance test case scenarios data mapping business planning technical writing workflow analysis negotiation work history business analyst 022018 current rakuten seattle wa project description scope project implement secure hipaa compliance cloud based application improve enhance healthcare experience allows healthcare professionals send real time text photo video updates family friends patients loved ones roles responsibilities submit gain approval edi encounter transactions state il worked qnxt including claim processing online batch adjudication case management customer service membersubscriber administration provider network management reporting responsible organizing submitting roster vendor file applicable data worthy upload evips system tasked working non par provider edits qxnt system well linking participating providers appropriate payto contract configuration qxnt system based updates received provider specialist ndm within evips platform involved implementation diu altrex evips system worked closely attending weekly meetings coming innovative ideas implemented integration testing system weekly making sure major issues claims impact research update provider npi payto associated logic linking qxnt application applicable worked within configuration support department ensure new existing sponsor provider information entered qxnt system related databases timely accurate manner also ensures sponsor related materials created sent appropriate membership based materials configures appropriate benefits within pcs application works ensure error data integrity various reports processed effectively pertaining system applications used configuration work responsible impact end result health plans well quality claims operations customer care operations cost containment recovery operations strong dedication excellent quality work ensures members providers positive experience pay claims correctly time avoiding fines extra costs process complex claims ensure correct payment authorized claims following established protocols complied department company guidelines including hipaa applicable laws regulations worked claims claim adjudication membership eligibility accumulators responsible system integration testing 837 claim files 834 eligibility files 270271 interface files ensure required interactions met sdlc process validated inbound outbound 837 transactions including limited loading correcting errors process edi inbound outbound files validated outbound 835 transactions including limited vendor qnxt mapping system configuration business process analysisend user educationbusiness requirements documentation validated system configuration including enrollment provider benefits modules creation queries reports assist health plan operations analysis data relating claims members providers planned entire data warehousing initiative requirements gathering analysis design identifying analyzing source systems data quality etl end user data access provided release management strategy checklists change management techniques presented assisted end users education training new system generated reports using sql server reporting services ssrs ms excel spreadsheets involved source data analysis analysis design mappings data extraction also responsible design development ssis packages load data various databases files design deploy maintain various ssrs reports sql server environment qnxt ms visio ms project sql oracle etl sas ms access ms excel ms word business analyst 012017 022018 rakuten san mateo ca project description scope project make enhancements new ai health systems automate revenue cycles recognize vulnerabilities current system creating technology solutions revenue cycle operations risk analytics data management analyze key areas revenue loss seal gaps roles responsibilities process included importing claims facets adjudicated setting quot payquot status payment cycle could run create checks facets defined data maps validate customize claims daily load facets processing transactions reviewed stored procedures reports wrote test sql queries joins unions group functions source system sql server match results actual report data mart oracle 10g implemented sdlc agile scrum methodology developing life cycle followed standards process application elicited requirements business users stakeholders interacting asking detailed questions jad sessions focus groups brainstorming prototyping carefully recording documenting requirements format easily understood reviewed business technical people resolved high volume claims edits lines business evaluated customer service cases related pended claims reviewed validated requests claims review claim documents thorough understanding authorizations benefits contracts enrollment fee schedules worked various departments identified discrepancies fully supported internal audits responded timely resulting action plans quality control implemented data ensured provider entered core processing system within 30 days receipt used jira issue tracking user story management requirement traceability created managed tracked analyzed sprint burn chart product burn chart estimate sprint velocity development teams capacity release planning respectively improve maximize value focusing achieve sprint goal ensured team following coding standards adhering definition done avoidreduce technical debt focused resolving shielding team impediments keep working group flow conducted impact analysis gap analysis derive document requirements web based claim processing system cps identified asis tobe business processes based created business process models defined data maps validate customize claims daily load facets processing transactions reviewed audited eob validate accumulations payment provider checks worked facets tm qnxttm front backend data many proprietary subrogation check benefits eob cobssubscriber groupclass benefit levels provider network national drug coded ndc ncpdp codes exclusions prior authorizationutilization clinical editing accumulators determine payment levels determine coordination benefits environment agile methodology jira 50 java ms visio 2013 uml oracle tableau 90 ms outlook 2013 ms office suite excel word power point business analyst 082016 012017 rakuten san francisco ca project description scope project implement online platform connect prescription cards mobile app using barcode scanner pharmacy get coupons discounts roles responsibilities reviewed processed adjusted managed care claims including pcp capitation using qcare assisted coworkers medical policy coding issues processed facility claims validated pricing national account grievances appeals medical director review approvals adjust claims monitored claims paid according contract limits ensured deductible pockets expenses calculated accurately claims processing appeals claim denials claim adjustments performed configuration corrected updated facilitated stakeholder meetings jad sessions gathering writing requirements technical design review tdr walkthroughs included 837 mapping successfully met deadlines updates requested incident management tracking ensure defect triaged correctly resolved timely education bachelors computer science college digital sciences