Corporate Business Analyst
PRO Behavioral Health
ØWorked on multiple projects involving the transition of business operations from several legacy systems to an integrated provider network and medical management system.The new system (a software package named PRO) allowed vendor’s to integrate provider network administration, claims processing, medical case review, and customer service functions.Performed analysis for writing business requirements and functional design documents for the following projects: data conversions from the legacy systems to PRO; medical management reports for the vendor’s clients; an automated process for generating and mailing medical management letters to providers and members; producing a medical claims interface for the vendor’s clients.
ØAnalyzed the workflow for receiving and tracking customer requests for vendor’s product information or customer requests for changes to a provider’s profile.The analysis involved documenting the workflow for thirteen regional centers for the purpose of understanding the similarities and differences among the regions and to identify areas where automated solutions could be provided to standardize the workflow and improve worker productivity.
ØDemonstrated depth of knowledge of common corporate business functions, (financials, operations, customer relationship management, etc).Provided business functions relevant to insurance, (claims, financial management, billable, heath management organizations.Competent in identifying risk areas and proactively determining appropriate mitigation strategies.Experienced working with internal and external auditors and regulatory examiners.
ØResponsible for performing the complete range of duties involved in the budget examination, formulation, presentation, and execution process; performing revenue and rate analysis; comprehensive program review involving multi-faceted elements extending over a long-range period; development of program definitions, goals and quantifiable measuring devices.
ØApplied advanced principles of fiscal analysis to the study of various health care revenues, particularly rate structures and related fiscal problems.Work involves developing and conducting rate studies; monitoring and long-range projections for health funds.
ØExecuted special projects with limited supervision, including shareholder value analysis, expense allocations, market analyst questions, benchmarking, etc.