For the given job description <<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.>> the resume: <<Professional SummaryPerceptive and logical data analyst with proven ability to communicate with both technical professionals and end-users to identify and translate business requirements. Offering 9+ years of experience driving data accuracy and integrity. Proven ability to build and lead teams of talented professionals to develop valuable process solutions to meet business objectives. As a dedicated and flexible individual, that will bring a charismatic energy, years of developed communication skills, and my ability to work sufficiently with others and individually with strategic project management and organization skills. With time, my experience in customer service, patient care, and health insurance, has helped me to excel within the Health Care and Data Analytic Industry. If given the opportunity, I will continue to grow and learn within your company.
SkillsExcelSQLClients relations and Customer ServiceData managementData MiningMS OfficeBusiness operationsData interpretationAnalyzing trendsOperational improvementSome VBA reading capabilityNegotiations and ContractsMedical AssistanceData AnalysisCreating new Policies and Procedures for workflowsWorkflow OptimizationQuality Assurance and AuditingProject Management and OrganizationMedical Billing and CodingProcess improvementAccounts Payable and Purchasing SupportSoftware programmingProblem resolution
EducationFortis Institute (MedVance)Nashville, TN,Expected in5 2011––Diploma:Medical Assisting-GPA:Graduated with Medical Assisting Diploma with Medical Billing and CodingMiddle Tennessee State UniversityMurfreesboro,TNExpected in––:-GPA:Centennial High SchoolFranklin,TNExpected in2009––High School Diploma:-GPA:
Work HistoryBadger Daylighting-Master Data Management Analyst IForest Lake,MN,04/2018-CurrentAssists master data management team to ensure system data integrity using SQL, Excel and some VBA.Identify areas for data quality improvements to resolve quality issues through error detection, correction, process control, improvement and/or process re-design strategies.Training new and existing employees on building and maintaining items and contracts within Lawson, as well as all other standard everyday workflow.Conduct data cleansing using Excel and SQL to rid the system of old, unused, inaccurate or duplicative data. Upload, sort, and analyze item and contract data to ensure accurate data.Collaborates with subject matter experts and data stewards to define and implement data strategy, policies, controls, and programs to ensure the Global data is accurate, complete, secure, and reliable.Support item/ vendor master maintenance, General Ledger (GL) category maintenance, item agreements, template creation, and Requestor/Location/Par Location setup.Demonstrate an understanding of the data maintenance impact upon clinical and business process operations and use that knowledge for easier daily workflow and department connection.Work with Accounts Payable and Purchasing team members to identify master data related improvement opportunities.Maintain a consistent taxonomy for new item and contracts master data.Developed data tables and databases to create relation between tables, on a intermediate level, to allow efficient data retrieval.Performed data cleaning and data preparation to support high-quality data and catch errors before processing.Evaluated statistical techniques and extracted SQL and Lawson information from research data to provide different ways to assess robustness of research outputs.Created workflow steps for Unit of Measure changes within Excel connection to LawsonMaintain detailed communication with affiliated Hospitals with over 200 service request monthly.Conducted quality checks on data sources to check for inconsistencies and perform data cleaning activities.Evaluated reliability of source information by weighing raw data to make data easier to interpret.Hope Credit Union / Hope Enterprises-Cost Management/Medical Claims AnalystNew Orleans,LA,08/2014-04/2018Provided direct contact to Claims with OON pricing for proper payment of claims.Handle disputes, adjustments, and negotiations for specific networks.Cost management for multiple plans working with Health Scope.Self-managing time to properly work end of week due report, each week.Handling large quantities of data from multiple networks and handle pricing based on specific guidelines provided by each network.Manage and update excel report of over 11,000 medical codes, creating excel spreadsheets to accommodate average pay-outs and generating weekly reports via access into excel to distribute throughout the department.Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.Paid or denied medical claims based upon established claims processing criteria.Managed large volume of medical claims on daily basis.Reviewed provider coding information to report services and verify correctness.Processing and evaluating medical, dental, and vision claims manually according to precise and specific Summary Plan Description.Obtaining information necessary by telephone as well as by hard copy and entering into computer system.Prioritization of individual work flow associated with case assignments, while meeting a set production daily.Reviewing and Auditing each individual claim (Hospitals Outpatient and Inpatient, Physician Offices, Skilled Nursing Facilities, Medical Equipment Rentals, etc.) to ensure proper reimbursements to the assigned plan.Maintaining and assuring accuracy of documentation.Discuss with members, clients and providers of issues relating to claim administration and establishing and maintaining professional rapport with clients and providers (physicians and hospitals).Wood Personnel Services-Collection SpecialistCity,STATE,05/2014-08/2014Monitor insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner.Identify coding or billing problems from EOBs and work to correct the errors in a timely manner, Identify problem accounts and escalate as appropriate.Work with patients and guarantors to secure payment on outstanding account balances.Achieved performance goals on consistent basis.Monitored accounts for compliance with established payment plans and flagged those in violation.Used scripted conversation prompts to convey current account information and obtain payments.Wood Personnel Services-Member Service RepresentativeCity,STATE,10/2013-05/2014Processing inbound calls from State of Tennessee members.Assisted them with their requirements to uphold insurance policy.Problem solving and special projects assigned by management.Completed inbound and outbound calls to member on specific requirements needed for insurance coverage.Completed training and worked effectively under high-pressure client services environments.Evaluated customer information to explore issues, develop potential solutions and maintain high-quality service.Evaluated customer information to explore issues, develop potential solutions and maintain high-quality service.Learned all internal systems and related service role duties to provide skilled team backup in handling customer demands.MedSolutions Inc.-Intake Coordinator/ Communication SpecialistCity,STATE,09/2011-10/2013Processed inbound Calls from physician’s/providers offices regarding prior authorization for radiology/cardiac test.Resolve Customer Service Issues while keeping professional control on the call.Handle confidential information daily in a professional manner.Completing special assigned projects for CMI (fax team), Projects including but not limited to; process outbound calls to providers’ offices for missing information, verification of contact info, and sending awareness of fax processing, Work incoming Intake mail and fax or mail to appropriate recipient, Attach incoming faxes to ISAAC, Problem Solving for missing faxes in ISAAC and Incoming Folder.Maintained current and accurate medical records for over 50+ patients daily.Established and developed highly efficient and dependable administrative team by delivering ongoing coaching and motivation and fostering career advancement.Trained staff, established and monitored goals, conducted flow performance for elite staff reviews.
SkillsExcelSQLClients relations and Customer ServiceData managementData MiningMS OfficeBusiness operationsData interpretationAnalyzing trendsOperational improvementSome VBA reading capabilityNegotiations and ContractsMedical AssistanceData AnalysisCreating new Policies and Procedures for workflowsWorkflow OptimizationQuality Assurance and AuditingProject Management and OrganizationMedical Billing and CodingProcess improvementAccounts Payable and Purchasing SupportSoftware programmingProblem resolution>>. The result is, Good Fit

Fit assessment: Good Fit