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Yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000

Phone: (xxx-xxx-xxxx

abc@xyz.com

 

Dedicated and incisive Business Analyst with solid background in healthcare technology eager to contribute exceptional account management, relationship-building, and analytical talents toward supporting a dynamic organization in optimizing performance and productivity.

 

Qualifications Profile

 

         Adeptly project-managed design, development and implementation of Electronic Data Interchange (EDI) networks and coordinated cross-functional team efforts throughout all project phases. 

         Proven ability to interface with all levels of management, peers, clients and technical specialists.   

         Ability to clearly articulate business value to gain commitment and support.

         Exceptional blend of analysis, research, problem solving, planning and multi-tasking expertise.

         Advanced knowledge of healthcare payer processing and HIPAA requirements.

 

Professional Experience

 

Capario, Santa Ana, CA 2007 to Present

Project Manager           (2010 to Present)

Payer Account Manager           (2007 to 2010)

         Project-manage HIPAA 5010 conversion with full accountability for project budget, schedule, risk management, issue resolution, resources allocation, and vendor relations.

         Direct ICD-10 conversion project, providing adept leadership, guidance, influence and mentoring to team members.

         Seamlessly expedite and facilitate deliverables such as project plans, budgets, WBSs, project task schedules, business requirements, technical/functional requirements, training materials, roll-out documentation, stakeholder communications, and support plans.

         Actively participate in PMO planning and forecasting processes.

         Exceeded targets each quarter of 2008 by 116%, 110%, 119%, and 139% respectively.

         Championed efforts to surpass 2008 revenue forecast by $246K.

         Coordinated TriWest redirect initiative to capture an additional $160K per year.

         Contributed to driving revenue growth and client satisfaction by expeditiously steering 11 new implementations, 12 payer portal demos and/or follow-ups, and one signed portal contract valued at $9K annually.

         Delivered informative and persuasive presentations to up-sell new services and products resulting in an additional $250K in annual revenue.

         Consistently exceeded revenue goals by an average of 45% through creative sales approaches, proficiency in winning repeat business, contract negotiation expertise, and strong follow-up practices.

 

Continued ►

 

 

 

Yyyyyy x. yyyyyy ~ Page 2 of 2

 

Professional Experience continued

 

EMDEON Business Services, Nashville TN, 1998 to 2007

Senior Business / Implementation Analyst

  • Awarded promotion as a result of outstanding experience in managing Veteran s Administration (VA) account.
  • Supported approximately 14 million transactions annually by swiftly responding to and rectifying programming and mapping issues, processing payer and provider enrollment, and handling payer and clearinghouse rejections for VA Hospitals nationwide.
  • Led cross-functional team in seamless implementation of EDI networks nationwide to BlueCross, BlueShield, Medicaid, and Medicare plans resulting in an additional $2.5M in annual revenue. 
  • Spearheaded VA Electronic Remittance Advice (ERA) enrollment project, enabling receipt capability for remits from several designated Government and Commercial payers.  
  • Piloted Coordination of Benefits project including testing and implementation of EDI secondary 837 transactions for Blue Cross/Blue Shield plans throughout the U.S., directly increasing electronic secondary claim volume by 36%.
  • Facilitated conversion of more than 50 Medicare, Medicaid, and Blue Cross/Blue Shield payers from legacy electronic formats to HIPAA compliant 837I format. 
  • Scrutinized payer companion documentation to develop complex logic and mapping structure for coding of compliant transaction sets.
  • Resourcefully designed Excel tool detailing and maintaining payer demographics and EDI requirements for Medicaid, Medicare and Blue Cross/Blue Shield payers facilitating electronic claim submission approvals.

 

Education & Training

 

Volunteer State Community College, graduated 2005 with Honors ~ GPA 3.7

A.A.S, Business Management, Emphasis in Computer Information Systems

 

ICD-10 Medical Coding Certifications:

Preparation and Instruction for Implementation

 

Training:

Supervision Principles                           Project Management

Human Resource Management               Time Management

Business Communication                       Spreadsheets and Databases

 

Computer Skills

 

Microsoft Office  (Word, Excel, Access, Project), UNIX, DOS, Siebel, SalesForce and Oracle databases

 

Memberships

 

Project Management Institute (PMI);  Phi Theta Kappa Honor Society

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