Cymyera Hart
Lakeland,FL
Summary
Experienced Business Analyst with over 18 Years experience with strong research analytical skills, excellent communication skills, and results driven person. Mastering time management, organizing and prioritizing the importance of duties assigned to meet deadlines. Seeking a role where skills can be upgraded to contribute to the organization's growth.
Overview
16
16
years of professional experience
Work History
Business Analyst III
Blue Cross Blue Shield of South Carolina
08.2022 - Current
- Reviews system enhancements/changes and identifies issues to standard system and other processing components.
- Acts as facilitator for business/contract mandates and moderates large projects.
- Attend daily and weekly workgroup calls.
- Objectively evaluates activities and systems within specific area for process evaluation and makes recommendations for simplification.
- Writes procedures and documents customer requirements.
- Guides coworkers in problem resolution related to documented procedures as well as various systems.
- Prepare verbal and written communication regarding changes, procedures, projects, implementations, etc.
- Designs user training as related to operations system changes.
Business Testing Analyst II
Blue Cross Blue Shield of South Carolina Columbia
10.2015 - 08.2022
- Analyze system function for claim processes including daily reports with testing results or production issues.
- Identify, analyze, and document business requirements and deliver work products throughout project life cycle.
- Translate business requirements to system functional requirements.
- Conduct process improvement meetings to better facilitate work progress.
- Review and complete testing data for change sheets, test matrices, and annual releases.
- Utilize internal and external software to support testing. (TI Tool, DB2, Microsoft Office Tools, Quality Center)
- Attend Scope, Design, and Test Plan walkthrough for major system projects.
- Evaluates quality assurance metrics not limited to defects and defect counts.
- Creates test matrices, trains, and provides supporting documentation.
- Monitors software/programs implemented to verify that changes to system's operational process have desired effect.
- Identifies and documents systems problems and works with Information Systems and production areas on short per and long-term solutions.
- Key claims utilizing ICD-9/ICD-10, CPT, and HCPCS coding. Initiate complex claims adjustments.
- Applied honed problem-solving skills to analyze and resolve issues impacting business operations and goal achievement.
- Updated scripts and developed queries to extract and analyze data from multiple sources.
Guardian Ad Litem Volunteer
CASA Crt Appointed Spcl Advoc
09.2017 - 09.2018
- Coordinated and managed volunteer activities for community service projects.
- Led group discussions and activities to meet different community needs.
- Approached issues proactively to best meet current and future community needs.
- Facilitated community outreach to expand participation and support.
- Built partnerships with related organizations to develop support and gain greater attention for important issues.
- Tracked service activities and outcomes against outlined plans and goals.
- Kept case files updated, accurate and aligned with requirements.
- Intervened in crisis situations to obtain support for clients and reduce escalation or recurrence risks.
Claims Customer Service Advocate I-III
Blue Cross Blue Shield of South Carolina Columbia
10.2007 - 10.2015
- Handled complex telephone correspondence and written inquiries ensuring quality and timeliness, pertaining to claims and appeals.
- Provide education to providers on need for accurate and complete documentation for health records, appropriate code selection of Evaluation and Management (E/M), Current Procedural
- Terminology (CPT) and ICD-10 diagnosis codes, and ensuring documentation supports codes selected to highest degree of specificity.
- Trained claims customer service advocates and provide feedback to management to improve quality standards.
- Forward claims for medical review, pre-authorization review, and further review by group management
- Analyze and resolve claims issues regarding member benefits and ensuring contract standards are met.
- Analyze medical records to determine if compensation, hospital treatment, prosthetic appliances, should be paid per contract benefits.
- Maximize HIPAA compliant guidelines regarding member and provider rights, privacy, and contract information.
- Handled confidential and sensitive information with discretion identifying and reporting potential fraud and abuse situations.
- Requested medical records via web and hardcopy avenues to complete claim reviews and or claims processing.
- Supported call center associates by taking on escalated calls, handling complex concerns and achieving customer satisfaction targets.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Provided primary customer support to internal and external customers
- Utilized customer service software to manage interactions and track customer satisfaction
- Analyzed customer service trends to discover areas of opportunity and provide feedback to management
Education
Bachelor's Degree - Leadership and Professional Communication
Columbia College
Columbia, SC12.2017
Associate of Arts Degree - Business Commerce
Midlands Technical College
Columbia, SC06.2013
Skills
- Staff Training
- Google Workspace
- Citrix
- Business Processes and Procedures
- Data and Analytics
- Insurance industry experience
- Insurance coverage verification
- Proficient in Microsoft Office Suite (Excel, PowerPoint, Teams SharePoint, Azure)
- Training and Development
Timeline
Business Analyst III
Blue Cross Blue Shield of South Carolina
08.2022 - Current
Guardian Ad Litem Volunteer
CASA Crt Appointed Spcl Advoc
09.2017 - 09.2018
Business Testing Analyst II
Blue Cross Blue Shield of South Carolina Columbia
10.2015 - 08.2022
Claims Customer Service Advocate I-III
Blue Cross Blue Shield of South Carolina Columbia
10.2007 - 10.2015
Bachelor's Degree - Leadership and Professional Communication
Columbia College
Associate of Arts Degree - Business Commerce
Midlands Technical College
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