Summary
Overview
Work History
Education
Skills
Education
Careerstrengths
Timeline
Generic

Albert Barrera

Summary

Diligent Analyst/Consultant with in-depth and extensive knowledge of Claims; Provider Pricing; Claims Overpayments; Claims Adjustment and User Acceptance Testing (UAT). I possess an array of solid experience ranging from business analysis, data research, reporting. I also have a strong skillset ranging from analytical, organizational, planning, problem solving and detail‐oriented with the ability to multi‐task and commit to deliverables and maintain timely turn-around times. Additionally, I possess an extensive knowledge of many business processes and systems capabilities such as but not limited to Claims, Adjudication, Medicare, Medicaid, Coordination of Benefits, Provider Pricing, Member’s Benefits and Eligibility. I also bring a strong stakeholder approach in my work and I am dedicated in maintaining positive relations through collaborations. I can independently jump into the unknown and help pick up the pieces in any given situation.

Overview

16
16
years of professional experience

Work History

Business Info Consultant

Anthem / Elevance Health
10.2023 - Current
  • QA audit for West Pricing configuration
  • QA audits for FSMU & CRF
  • Developed the UAT testing for a new application tool: UIX-User Interface Extension and Pricing Automation for our Enterprise Market: VA-CPMF and GA-QCARE
  • Tested the various screens of the UIX-User Interface Extension application: Fallout Reports; Creations for Worksheets-Networks; Pricing Assignment Module-(PAM); Pricing Rules Creations and the Lookup Table
  • Conducted walkthrough with our business partners of the new enhancement/markets of the new UIX application tool
  • Reviewed business requirements with the requirement BA (Business Analyst)
  • Supported business/production checkout for each implementation
  • Reviewed and provided feedback on provider issue from the providers rooster automation template
  • Reviewed and provided status and provided feedback on claims error report and on DOFR claims

PROVIDER EXPERIENCE CONSULTANT/PROVIDER OPERATION CONSULTANT

Anthem / Elevance Health
11.2019 - 10.2023
  • Helped develop the UAT testing strategy for a new application tool: UIX-User Interface Extension for our Enterprise Market: Central-FACETS, NY-CPF, WEST-R6
  • Developed the UAT testing Summary for each release
  • Meet with our business partners for review and sign off of UAT testing Summary for each release
  • Conducted walkthrough with our business partners of the new application tool
  • Supported business/production checkout for each implementation
  • Supported Claims validation and feedback during testing for the SPS (Strategic Provider System) migration for our Central Market
  • Participated in the Business Validation for DOFER testing and Production implementation for the West and GBD FACETS
  • Consulted in the ‘Machine-Readable Files’ federal mandate project
  • Possessed Strong Knowledge & Understanding of Provider Pricing and Claims
  • Analyzed and documented Business Validation of UAT Automation Testing results for Claims and Pricing; identified any testing issues, and communicated them to the Project Manager
  • Strong knowledge of: Pricing, Pricing Configuration and Claims Operations Process
  • Coordinated Pre and Post Implementation of Claims and Pricing Validations
  • Consulted in Projects and Workshops as a SME for Pricing Configuration and claims; provided input into Business Requirements
  • Excellent time management skills to support multiple priorities projects including critical/urgent Projects
  • Monitor initiative impact to Provider Experience Key Performance Indicators and identified improvement opportunities
  • Provide Subject Matter Expert Training to support the needs of the project teams
  • Experience in analysis and reviewing of Business requirements to ensure correct positive and negative Test Cases are being created by UAT
  • Participate in targeted continuous improvement activities
  • Assisted in development; training and transition to our External Contractor partners for the NASCO Migration to WGS

Business Analyst II

Magellan Healthcare
07.2019 - 09.2019
  • Develop and document workflow, system Impact analysis, systems design and process analysis
  • Develop system Business Requirements
  • Developed test cases scenarios, used test cases and test scripts for different testing phases, functional, User Acceptance (UAT), Regression, End-to-end testing & validation
  • Identifies impact of solutions on existing and future systems
  • Perform operational activities
  • Create and maintain standard related reports to support operational and development needs
  • Conduct root cause analysis, gather data to pinpoint problem areas on which to focus, validate that the analysis is data driven, recommend and implement solutions and evaluate those results and implement controls to monitor consistent use of the solution
  • Participate in design plans for implementation, produce user documentation
  • Provide status reports that give a detailed description of the current project's progress and indicate time devoted to each task of the project
  • Lead status meetings, create agendas and document meeting minutes as needed
  • Identify reporting needs based on system configuration and workflows and document reporting requirements and testing of new reports in development prior to implementation to Production
  • Participate in initiatives or projects that support process improvements, leveraging new system capabilities or the integration of data/other applications into existing systems
  • Review functional design documents

IT Quality Analyst Sr.

Anthem / Elevance Health
07.2014 - 04.2019
  • Lead & Conducted UAT-User Acceptance to ensure that functionality, usability, performance of IT solutions are consistent with user stores/business requirements and established acceptance criteria
  • Collaborated closely with Project Oversight Stakeholders, SME’s and staff to understand the user stories/business requirements and specifications for systems changes
  • Ensured that test environment reflects user stories/business requirements for test execution
  • Developed detailed test plan and test cases to cover all the user stories/business requirements
  • Reviewed and edited of test cases
  • Experience in Migration Projects: CS90, FACETS, GA/VA Conversion for claims and Provider Pricing
  • Coordinated test schedules, work and resource plans, and managed progress of testing activities against Test Plan
  • Established testing entrance and exit criteria, identified and managed the critical path of testing
  • Report and managed defects to ensure that all issues are resolved according to established guideline and expectations
  • Experience in the analysis and design activities, including data profiling, to ensure completeness of business requirements/user stories
  • Analyzed and documented overall test status and results, identified test issues, performed risk analysis and communicated to Project Management
  • Mentored, coached and trained Peers on JIRA Enterprise for Business, claims processing, provider pricing, test execution reporting, requirement traceability, benefits and claims billing
  • Develop/create Test Evaluations Summary Document (TESD) and send out for appropriate sign-offs from stakeholders
  • Experience on Agile projects

Business Analyst I, II, III

Anthem / Elevance Health
07.2009 - 07.2014
  • Developed test cases scenarios, used test cases and test scripts for different testing phases, functional, User Acceptance (UAT), Regression, End-to-end testing & validation
  • Conduct insightful-and-inspired ad hoc analyses to investigate ongoing or one-time operational issues
  • Prepare technical reports by collecting, analyzing and summarizing information and trends
  • Monitor project progress by tracking activity; resolving problems; publishing progress reports; recommending actions
  • Determine operational objectives by studying business functions; gathering information; evaluating output requirements and formats
  • Develops project plans and identifies and coordinates resources, involving those outside the unit
  • Acted as a resource to users of the software to address questions/issues
  • Reviewed Business Requirements, business needs and projects objectives via feedback sessions and client meetings in collaboration with project teams
  • Interacted with the developers on resolving the reported bugs and various technical issues
  • Participated in UAT testing followed by production verification, post production testing and support
  • Reviewed functional design documents

Education

General Studies - Business Admin

Moorpark College

General Studies - High School Diploma

Moorpark High School

Skills

  • Claims Processing
  • Overpayments
  • Benefits & Provider Pricing
  • Medicare
  • Medicaid
  • Coordination of Benefits
  • Claims Identification
  • Adjudication
  • Provider Pricing Issues
  • Benefits Issues
  • Medical Terminology
  • CPT Codes
  • HCPC Codes
  • Institutional Revenue Codes
  • ICD-9 Codes
  • ICD-10 Codes
  • DRG Codes
  • CA-Mainframe
  • GDB-FACETS
  • Migration/Conversion Projects
  • Jira Enterprise
  • User Acceptance Testing (UAT)
  • Test Execution Reporting
  • Defect Management
  • IT Claims Support
  • IT Pricing Support
  • Requirement Gathering
  • Business Process Improvements
  • Organizational Skills
  • Active Listening Skills
  • Collaborative Abilities
  • Time Management Skills
  • Microsoft Office
  • Quality Assurance
  • Auditing
  • Software Development Life Cycle (SDLC)
  • Waterfall Testing
  • Agile Testing
  • Peer Auditing
  • Training
  • Mentoring
  • SQL
  • Data Research
  • Running Queries
  • Reporting
  • Business Analysis
  • Claims Analysis
  • Claims Automation Testing
  • Membership
  • Inquiry Tracking
  • Spider Benefits Knowledge
  • Business Requirements Analysis
  • Testing Phases
  • Testing Scenarios
  • Testing Scripts
  • Analytical Skills

Education

General Studies with an emphasis on Business Admin, Moorpark College, Some College, General Studies, Moorpark High School, High School Diploma

Careerstrengths

  • In-depth & extensive knowledge of Claims Processing, Overpayments, Benefits & Provider Pricing from point-of-entry to finalization of claim
  • Knowledge of Medicare, Medicaid & Coordination of Benefits
  • Identifying Claims, Adjudication, Provider Pricing & Benefits issue
  • Extensive knowledge of Medical Terminology, CPT Codes, HCPC Codes, Institutional Revenue Codes, ICD-9/ICD-10 Codes & DRG Codes
  • Knowledge of CA-Mainframe
  • Knowledge of GDB-FACETS
  • Participated in Migration/Conversion Projects
  • Experience with Jira Enterprise for Business
  • Extensive & in-depth experience with UAT – User Acceptance Testing
  • Experience in Test Execution Reporting & Defect Management
  • Ability to sense, interpret, evaluate & respond accordingly
  • IT Claims Support
  • IT Pricing Support
  • Participated in Requirement gathering session
  • Participated in Business Process Improvements
  • Strong organizational skills
  • Active listening skills
  • Collaborative abilities/team player
  • Time management skills
  • Able to commit to deliverables & maintain timely turn-around times
  • Intermediate Microsoft Office skills including: Excel, Word, Access, SharePoint, Outlook, PowerPoint, OneNote (also Adobe PDF)
  • Experienced in Quality Assurance/Auditing in both Test & Production environments
  • Knowledge of Software Development Life Cycle Methodologies (SDLC)
  • Experience with Waterfall Testing approach
  • Experience with Agile Testing approach
  • Experienced in Peer Auditing, Training & Mentoring
  • Basic Knowledge of SQL
  • Experience with Data Research, Running Queries & Reporting
  • Participated in the 'Machine-Readable Files' federal mandate project
  • Participated in the Strategic Provider Systems (SPS) Migration

Timeline

Business Info Consultant

Anthem / Elevance Health
10.2023 - Current

PROVIDER EXPERIENCE CONSULTANT/PROVIDER OPERATION CONSULTANT

Anthem / Elevance Health
11.2019 - 10.2023

Business Analyst II

Magellan Healthcare
07.2019 - 09.2019

IT Quality Analyst Sr.

Anthem / Elevance Health
07.2014 - 04.2019

Business Analyst I, II, III

Anthem / Elevance Health
07.2009 - 07.2014

General Studies - High School Diploma

Moorpark High School

General Studies - Business Admin

Moorpark College

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Albert Barrera