Professional BackgroundHighly motivated professional seeking opportunity to obtain a challenging position with Florida Blue that will fully allow me to utilize my education, skills, loyalty and work ethics where initiative and accomplishments will be the basis for professional advancement and mutual growth. Technical SkillsMicrosoft Windows 8, Microsoft Word, Excel, Outlook, PowerPoint, Access.Provider Information Platform (PIP), Diamond DFS, Diamond Maintenance Tool PROD DFS (DMT), PFE, IMS, EVerify, FedEx shipping and tracking, UPS shipping and tracking.Siebel queue inventory management, and Client Letter.Experience in building and Maintaining strong business relationships.Experience with health care industry, business related process and delivery system.Strong written and verbal communication.speak and write both French and Creole.Critical thinking Education and TrainingBachelor of Science Health Service Administration,Expected in2014toUniversity of Central Florida-Orlando,FLGPA Health Service Administration Professional ExperienceProvider Data Service Analyst II,04 2010to09 2015National Vision Grand Rapids,MI,Duties include preparation and execution of provider contracts, loading contracts fee schedules and benchmarks, maintaining provider data such as demographic information.Problem solving to ensure contract arrangements enable the accurate adjudication of claims payments and assistance in contract administration.Identify trends and problems through an assessment of practices, and develop new processes and activities and build a business case for execution, incorporation or adaptation.Participation in the creation of, and compliance with, provider policies and procedures dealing directly with dedicated provider groups.Ensure appropriate investigation and issue resolution, loading and maintenance of contracting arrangements containing several lines of business for provider contracts and provider demographic data in multiple claims administration systems, including but not limited to PIP (Provider Information Platform) and Diamond DFS.Configures provider payment arrangements through integration of provider contractual arrangements, product benefit standards, in order to facilitate accurate claims payment.Coordinate with operational areas and other departments within the delivery system such as network management for due diligence.Resolves provider data and payment discrepancies by interpreting contract language and apply appropriate pricing methodologies and contractual arrangements to facilitate accurate and timely resolution of provider claims payment issues.Build and maintain strong relationship business relationship whether internal or external.Provide dedicated management of provider demographic data and contract arrangements for Minute Clinic, Take Care Health, and CareSpot.Ensure integration and coordination with all Florida Blue Operational areas.Consultant on development of business requirements for provider maintenance and contracting under new Provider Information Management System (PIMS).(Analyst II) Contractor,04 2010to01 2012Blue Cross Blue Shield Of Florida City,STATE,Duties include coordination of contract loads and maintenance of provider data files.Experience in collaborating and building strong relationships with internal and external business partners promoting positive results.Negotiating with external business partners to achieve and influence customer outcomes and meet the targeted set leadership goals.Coordinate activities for continuous improvement efforts.Perform special projects tied to managing territories targeted for Network expansion and associated priorities, action plans and tasks set to meeting targeted outcomes.Perform and lead special initiatives by identifying, developing, recommending, and implementing process, procedure and product.Proficiency in interpreting provider reimbursement methodologies.Coordination with business partners and network management on fee schedule builds that apply to contract reimbursement.In depth knowledge of provider payment programs and billing practices such as coding, subject matter, expert tools (PIP, Diamond, Siebel, DMT, Online Provider Directory and other delivery system tools) and processes to support temporary resource projects.Responsible for following all process and procedures for the four core PPDO business processes, of which include Contracting, Registration, Maintenance and Termination.Confirming that information loaded to provider s files interface to all systems and loading necessary fee schedule history of HMO, MM, NWB, NWMBA, PPC, PPS, MDS, MDB, BSC and PFS lines of business.Assistant Manager,11 2006to07 2009Seven-Eleven City,STATE,Prepared and presented training materials to new employees.Ensured that the store met CDC regulations by regularly performing inventory reports.Monitor, evaluate, and take action to improve individual and team target goals.Planned and established work schedules (e.g., vacations, work shift, coverage for absent team members.)Provided motivation, inspiration, and developmental support to staff through coaching, providing feedback, reward and recognition. Skillsbilling, BSC, business case, business processes, cashiering, coach, coaching, Consultant, continuous improvement, contract administration, contracts, Client, excellent customer service, delivery, due diligence, French, health care industry, IMS, inspiration, Internet Explorer, inventory management, inventory, team building, leadership, leadership skills, managing, Microsoft Access, Microsoft Excel, Microsoft Outlook, Microsoft PowerPoint, Microsoft Windows 7, Microsoft Word, Negotiating, network management, Network, organizational skills, performance appraisals, policies, presenting, pricing, Problem solving, processes, producing, coding, project management, shipping, Siebel, training materials, verbal communication skills, written  SEP  Cloud and Things is a leading provider of IT solutions in the public sector. We are dedicated to delivering results and solving complex challenges for our clients. We are looking for individuals who are passionate about making a difference in the world, who are driven by a sense of purpose, and who are committed to excellence. Our team thrives on collaboration, innovation, and delivering high-quality projects that have a significant impact on the public sector s IT landscape. We are seeking experienced Business Analysts for Level III positions with a strong background in leading complex projects and a focus on system requirements analysis. As a Business Analyst, you will play a crucial role in understanding business needs, gathering requirements, and contributing to the successful implementation of projects. You will collaborate closely with cross-functional teams and assume a leadership role to ensure that project planning, design, and delivery align with business objectives. DutiesLead and participate in requirements gathering sessions, facilitating discussions to capture client-focused needs.Analyze gathered requirements to identify key insights and prioritize system requirements for continuous integration and deployment.Utilize your expertise to validate and document system requirements that align with best-fit technology solutions.Manage and identify system requirements with a focus on areas such as eligibility, enrollment, case management, payment, claims, and recoupments.Document system requirements for mainframe modernization projects across multiple complex functional domains.Conduct thorough business process analysis and optimization within technology environments, documenting current As Is states and proposing innovative To Be states.Develop comprehensive requirements documentation, including use cases, screen prototypes, and specifications, adhering to established templates and using tools like Blueprint Storyteller.Facilitate meetings and workgroups to foster collaboration and ensure a comprehensive understanding of requirements. Basic QualificationsAt least 7 years of experience on complex projects, with a minimum of two (2) years in a leadership role as a Business Analyst.At least 7 years of client-focused business and requirements analysis experience, including leading requirements gathering sessions and preparing technology proposals based on elicited requirements. Preferred SkillsProfound experience in managing, identifying, documenting, and validating system requirements in areas like eligibility, enrollment, case management, payment, claims, and recoupments.Expertise in identifying, documenting, and validating system requirements within mainframe modernization projects encompassing multiple intricate functional domains.Strong aptitude for business process analysis and optimization in technology environments, with an ability to document As Is and To Be states.Extensive proficiency in creating comprehensive requirements documentation, including use cases, screen prototypes, and specifications, using tools like Blueprint Storyteller.Demonstrated capability in facilitating meetings and workgroups to enhance collaboration and requirement understanding. Cloud and Things complies with all applicable federal, state, and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other category protected by applicable federal, state, or local laws.

ATS compatibility score: 88.7 (Good Fit)