MICHELE L. GREEN
Tempe,AZ
Summary
Talented and skilled SR. Business / Systems Analyst looking to receive a challenging role in Operations or IT as a Systems Product Owner or Sr. Business Analyst to provide efficient and effective business and technology solutions that will help the company continue to grow and achieve the best automated solutions in business processes, ultimately increasing productivity. Possess over 30 years' System Configuration experience as a Senior BA in a broad range of Insurance Industries from Life & Annuities, Auto, Pharmacy and Medical (Commercial, Medicaid, Medicare, Dental). Also possess strong collaboration, customer service and interdepartmental team building skills. Have a vast understanding of Operational Life Cycle for claims processing. Consistently broaden scope of job, leadership and system knowledge by establishing core relationships within the organization that, in turn lead to a strong ability to troubleshoot and solve system challenges.
Overview
22
22
years of professional experience
Work History
Alignment Healthcare
Mediant Health Resources
Remote - Orange, CA
02.2023 - Current
- Validates provider contract pricing and fee schedules configuration for accuracy in EZ-CAP and Burgess Pricing tool.
- Performs quality assurance and testing of new and revised claim adjudication logic within health plan configuration system.
- Documents audits and validation results timely and accurately.
- Communicates validation results to Configuration Specialists and provides recommendation for improvements.
- Validates other EZ-CAP claims system configuration as they relate to claims payment processing such as interests.
- Collaborates closely with peers and management within the department and throughout the organization to ensure quality assurance of provider pricing configuration.
- Assists in the research and resolution of pended claims as they relate to provider contract pricing and fee schedules.
- Conducts root cause analysis to help identify process gaps and offers recommendations for improvements.
- Assists the Senior Manager with the development and maintenance of training documents.
- Assists with new employee training and refresher training as needed.
- Prepares performance reports and provides feedback to Management.
- Performs all other related duties as assigned.
Sr. Professional Data Analyst
Gainwell Technologies
Remote - McLean, VA
08.2022 - 02.2023
- Creates accurate mapping documents according to mapping process.
- Works toward delivering first draft solution to ETL for coding, by rapidly understanding which details about mapping can be deferred.
- Presents analysis and design recommendations to lead MITA teams, customer and/or vendors into acceptance of design.
- Supports ETL developers based on mappings created.
- Works closely with configuration team and DBAs to ensure synchronicity of configuration to interfaces and mappings.
- Refines mapping documents, adding more detail and filling out deferred material as questions are resolved.
- Uses SQL, data models, data element dictionary and schema to perform data and business analysis.
- Creates unit test cases for area of responsibility and updates technical specifications and mappings.
- Validates test plan results that satisfy detailed design goals.
- Supports Unit Testing, System Integration Testing, System Testing, and User Acceptance Testing.
Sr. Business Analyst
EMIDS - Contractor: Client Evolent Health
Remote - Chicago, IL
12.2021 - 07.2022
- Provide direction to department members on development of configuration builds, including benefit and payment rules, provider reimbursement and structures, and system parameters that accurately process and pay claims as specified in client contracts.
- Provide recommendations on development and design of new system logic to support legislative activity, medical policy changes, and reimbursement methodology changes for Medicaid and Medicare Advantage plans.
- Performed root-cause analysis on data-related system problems to recommend or execute corrective action.
- Extract data via SQL statements, of existing configuration, format data/configuration changes and utilize data loading tool to load data in most efficient way across all system environments.
- Developed tactical plans to improve processes and systems by analyzing large amounts of data to identify trends and find patterns, signals and hidden stories within data.
- Intergraded Testing/Validation of data loads and configuration builds to ensure accuracy and functionality.
- Acted as contributor to establish and meet short and long-term department goals consistent with company objectives and division strategy.
- Provide clear and consistent expectations to support management and staff.
- Utilized personal subject matter expertise to produce innovative solutions for clients and enterprise.
- Foster trusting and safe environment with emphasis on problem solving and continuous improvement.
Business Analyst IV
Centene
Tempe, AZ
09.2015 - 12.2021
- Configuration Lead for CA, IA and OR Medicaid plans.
- Help support other BA leads with AZ, NV, NC, SC, NE, WA.
- Lead and Mentor up to 20 Configuration BA's in Change Request configuration and claims flows.
- Manage new configuration requests and changes to existing configuration ensuring accuracy and timely delivery.
- Collaborate with plan CIAs on claim workflows, educating on system functionality and claims reporting.
- Assign tasks to Configuration BA's, staffed projects and updated involved parties to enhance optimal business flow.
- Lead and support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of AMISYS and DST configuration.
- Improved business direction by prioritizing customers and implementing changes based on collected feedback.
- Applied honed problem-solving skills to analyze and resolve issues impacting business operations and goal achievement.
- Resolve issues and identify opportunities for process redesign and improvement.
- Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to existing business processes and requirements.
- Evaluate risks and concerns and communicate to management.
- Coordinate with various business units and departments in development and delivery of training programs.
- Develop, share, and incorporate organizational best practices into business applications.
- Oversee changes to departmental policies and procedures, including communicating and implementing changes.
- Serve as subject matter expert on assigned function product to ensure operational excellence.
- Bridged gaps between CIAs and other Operational areas with excellent customer service, opening communication lines with multiple parties.
Sr. Business Analyst
Concentrix Insurance Solutions
Tempe, AZ
08.2014 - 08.2015
- Identify and document functional and non-functional business requirements through various techniques including research, analysis, user interviews and facilitated requirement sessions.
- Design and Analysis of current systems to assist in writing of Business Requirements and Business Designs for high profile project.
- Interacted with internal customers to understand business needs and translate into requirements and project scope.
- Subject Matter Expert on GENELCO products.
- QA Testing for System Modifications based on Client needs.
- QA tester for new Portal interface development working internationally bridging gaps between requirements and developers.
- QA tester for system modifications for high profile project for new web based portal to GENELCO system.
Sr. Business Analyst
Randstad Technologies, LLC
Tempe, AZ
03.2014 - 06.2014
- Contracted to Client CVS to assist in UI screen for Provider onboarding process.
- Identify and document functional and non-functional business requirements through various techniques including research, analysis, user interviews and facilitated requirement sessions.
- Work with Developer on development of UI screens for new internal application to assist in Provider Client Implementation.
- Worked with client and internal business partners to capture and translate business needs into business process and technology requirement.
- Team Member for Client Implementation process for their Clients.
Solution Analyst
Solu Technology Partners
Tempe, AZ
06.2013 - 03.2014
- Contracted to Client Scottsdale Insurance Company to assist in multiple projects and develop Agile process knowledge.
- Collaborate with business stakeholders to clearly define scope of business problem and document business objectives for IT projects.
- Perform business process modeling to concisely communicate “as is” and “to be” business processes to be supported by technology solutions.
- Identify and document functional and non-functional business requirements through various techniques including research, analysis, user interviews and facilitated requirement sessions.
- Prepare required deliverable for Projects.
- Lead Solution Analyst for new file transfer process for their Agents.
- Developing sound knowledge of requirement development methodologies such as Agile and Waterfall and how to apply process to current project.
- Data Mapping Team Member Data Warehouse.
- Lead Solution for rating application system.
ETS Production Support Analyst
KForce
Phoenix, AZ
05.2012 - 06.2013
- Contracted to Blue Cross Blue Shield of Arizona to assist in Production Support of EDI transmission files.
- Lead projects in development and review of documentation used to support associated systems and process.
- Research, respond to, and finalize questions or requests for research received from internal customers.
- Lead all aspects of System Development Life Cycle.
- Develop, execute and analyze test data, test scripts and results as it pertains to Foresight Claims Software.
- Create ad-hoc reports for internal customers reporting EDI performance times or other errors detected.
- Troubleshot incidents reported by end-users to schedule system changes and identify permanent solutions.
- Communicated and explained business requirements to team members to understand and implement functional demands.
Sr. Business Systems Analyst
Oxford Life Insurance Company
Phoenix, AZ
11.2006 - 05.2012
- Support and Lead all areas of Company Operations in regards to improving processes and procedures through technology by understanding, teaching and communicating system functionality.
- Responsible for configuration of processing system, such as company level configuration, benefit plan building, new business data entry processes, premium accounting processes and claims processes.
- Responsible for acting as system user process expert to gather, analyze, validate, manage and document business requirements from business users and translate into technical terms for Information Technology Department.
- Test, implement and manage solutions required for Teams throughout organization to fully utilize processing systems in daily production flow.
- Responsible for monthly Operational reports, demonstrating operational effectiveness and efficiencies, milestones and commitments
- Supervisor for Premium Accounting Team (2 Years)
Business Systems Analyst
Star HRG
Phoenix, AZ
06.2001 - 06.2006
- Extracted, analyzed, validated and documented end-user requirements for business system and reporting needs.
- Worked with client and internal business partners to capture and translate business needs into business process and technology requirements.
- Developed use case models from business process models.
- Focus was on web, financial, claims processing, enrollment, call center, and process improvement initiatives.
- Supported software development life cycle by effectively articulating client requirements to developers.
- Business analyst for legacy system data integration as part of creation of new data warehouse environment.
- Created streamline process between business areas to communicate announcements to affected departments.
- Created processes and procedures to avoid additional costs in vendor modifications to existing systems.
Education
Certified By National Board of Pharmacy - Pharmacy
Board of Pharmacy AZ
Phoenix, AZFMLI Level I Designation - ASC Associate -
LOMA Life Office Management Association
High School Diploma -
Dobson High School
Skills
- Forward and creative thinker for business and automation solutions
- Customer Centric
- Motivated
- Proven Leader
- Business Analysis
- Project Management
- Data Analysis/Reporting
- Strategic planning
- Healthcare Administration - Highlighting Medicaid, Medicare and Commercial type plans
- Pharmaceutical Administration
- Electronic Data Interchange (EDI)
- Claims Systems Configuration - Pricing / Benefits - ALL
- Agile and Waterfall Methodology
- Business Artifacts Documentation
- Health Claims Procedure and Diagnosis Coding; Pharmacy Coding
- Business Process Mapping
- Data Mapping
- Web-Based Reporting Tools
- Conflict Resolution
- Workflow Analysis
- SQL and databases
- Operations management
Accomplishments
- Currently, Mentor and Lead multiple Configuration BA's to be well trained in healthcare administration, system configuration, automation of claims processes and workflows.
- Key Team Member for multiple Client Medicare Implementations
- In multiple companies, bridged gaps between offices with excellent customer service, opening communication lines with multiple parties.
- Configured and Implemented non-standard Medicare claims processing on claims payment system. Working with an IPA to accept claims and transmit claims via EDI file processing to their systems for pricing then in turn returning the claim for us to process and pay from their designated system banking account.
- Successful process implementation of 834 Benefit Enrollment and Maintenance on Group Portal to automate Client Enrollment data and communication of their Employees changes.
- Business analyst for legacy system data integration as part of the creation of a new data warehouse environment
- Created streamline process between business areas to communicate announcements to affected departments
- Created processes and procedures to avoid additional costs in vendor modifications to existing systems
Timeline
Alignment Healthcare
Mediant Health Resources
02.2023 - Current
Sr. Professional Data Analyst
Gainwell Technologies
08.2022 - 02.2023
Sr. Business Analyst
EMIDS - Contractor: Client Evolent Health
12.2021 - 07.2022
Business Analyst IV
Centene
09.2015 - 12.2021
Sr. Business Analyst
Concentrix Insurance Solutions
08.2014 - 08.2015
Sr. Business Analyst
Randstad Technologies, LLC
03.2014 - 06.2014
Solution Analyst
Solu Technology Partners
06.2013 - 03.2014
ETS Production Support Analyst
KForce
05.2012 - 06.2013
Sr. Business Systems Analyst
Oxford Life Insurance Company
11.2006 - 05.2012
Business Systems Analyst
Star HRG
06.2001 - 06.2006
Certified By National Board of Pharmacy - Pharmacy
Board of Pharmacy AZ
FMLI Level I Designation - ASC Associate -
LOMA Life Office Management Association
High School Diploma -
Dobson High School
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