Sample Template Example of Beautiful Excellent Professional Curriculum Vitae / Resume / CV Format with Career Objective, Job Profile & Work Experience for Freshers & Experienced in Word / Doc / Pdf Free Download
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MARIA
NIELSON
309 Sir Michael Drive~Salt Lake City, utah 84001
phone (801) 328-9876 maria@xmission.com
Summary of cAREeR pROFILE and Qualificaitons
|
Thirteen (13) years
of professional Software and Web Based
Information Technology experience as a Project
Leader/Senior Business Analyst. Over
twenty-five (25) years of diversified experiencein the Healthcare Insurance field
(Medical, Workers’ Compensation and Auto Industry). Extensive experience and proven ability to
play a key role in the following areas: Software
Development Lifecycle, Software Requirements Gathering/Coordination, UAT (Use
Cases), User Guides, Manual Test Cases/Testing, Acceptance Criteria, Release
Notes, Defect Tracking and Resolution, Management, Customer Service and Process
Improvements. This experience substantiates
enhanced skills in business workflows,
team collaboration, communication, technical writing and the firm desire for
quality results.
Personal and Technical Skills
|
Personal
Skills: Detailed Oriented, Perfectionist,
Customer Oriented, Self Motivated, Team Player, Strong Analytical &
Organization Skill, Dependable, Creative, Artistic and Compassionate
Technical
Skills: Team Collaboration,
Communication, Quality Oriented, Software Development Lifecycle, Workflow
Processes, Research/Analysis, GUI Design, Requirements Gathering/Coordination,
Manual/Functional and User Acceptance Testing, Defect Tracking/Resolution,
Technical Writing (including but not limited to, Requirements Specifications,
Functional Specifications, UAT Plans (Use Cases), User Guides, Manual Test
Cases, Acceptance Criteria, Release Notes, Defects, 508 Compliance (user
interface requirements for handicapped and disabled), training manuals, policy
changes/procedures), Document/Publication Proofing, Management, Medical Healthcare
Insurance Background (Medical Records, ClaimReview/Payment, Claims Auditing, 508
Compliance (user interface requirements for the handicapped and disabled), In-house
Implementation and Maintenance of Claims Adjudication System, Claim Appeals, Fraud
Detection and Healthcare Insurance Document Preparation for Court Cases
Technologies/Tools: Internet Explorer, Mozilla FireFox,SharePoint, TOAD, EDI (Electronic Data
Interchange), HIPPA, Annotation Software, GUI Design Studio, Paint Snagit’, Issue Tracking Systems (DevTrak and
TFS), ICD-DX, CPT, HCPCS, CDT and Microsoft Office Tools 2007 (Outlook, Excel,
Word, PowerPoint, Visio and Office Communicator)
Computer
Systems: Windows
Databases:
Oracle, In House
Databases, Government Enterprise Database
Methodologies: SRUM, Agile
Professional Experience – 1974 - 2012
|
Veterans Administration (Robert Half International)– 1 Year
Professional Software Technology Experience
Business Analyst:
o
Resource
Tracking Tool – A web based interface to manage servers and software assets and
usage associations between them
·
Specification
Requirements
·
Functional
Requirements
·
Use
Cases (UAT Plans)
·
User’s
Guide (User Documentation)
·
Acceptance
Criteria
·
Release
Notes
·
508
Compliance
o
VINCI Audit Manger Tool – UI for
auditors to search, review, comment, and set audit status results/conclusions
on VA patient file transfers:
·
Specification
Requirements
·
Functional
Requirements
·
Use
Cases (UAT Plans)
·
User’s
Guide (User Documentation)
·
Acceptance
Criteria
·
Release
Notes
·
508
Compliance
o
Open Source Annotation Software,
Biometric Natural Language Processing (NLP) – Annotation software utilizing
biometric NLP which allows the government to implement gather measure and apply
metrics for a higher level of standard of medical care for patients.
·
Attended meetings and NLP team support
Ingenix –12 Years Professional Software Technology Experience
·
Senior
Business Analyst:
o
Exceeded
defined target goals and milestones for Y2K readiness.
o Determined time estimates for
research/analysis, documentation and testing of system enhancements, issues and
defects.
o Exceeded defined target goals and milestones for the PowerTrak
Legacy and IMBR projects.
o Performed comprehensive analysis,
wrote detailed functional specifications and/or mini-specifications used to
convey business requirements and functionality, including technical details and
GUI design layouts for enhancements and defects.
o
Acted
as a team lead, working closely with development and other team members,
including offshore resources, to improve and enhance system design.
o
Attended
and contributed to daily SCRUM calls.
o Acted as an integral part of a team
in the re-design of PowerTrak; titled IMBR.
o Participated and excelled in the testing
efforts of PowerTrak including EDI, IMBR, and SONAR Web.
o Contributed to the redesign of EORs
(Explanation of Reimbursement) which included state mandates.
o Successfully proofed a variety of
templates and documents; including but not limited to, EORs, technical
documents and application Help files.
o Contributed written documentation
for PowerTrak’s User’s Guide and Help files.
o
Served
as a key resource and provided clear description of software defects.
o
Developed
complex test objectives and performed manual/functional and UAT testing under
rigorous standards to ensure overall quality of software delivered.
o
Createda
test objective document to improve the manual testing process;define testing
steps and optimize testing accuracy and efficiency related to
enhancements/issues/defects.
o
Identified
and documented software defects to management for resolution.
o
Anticipated
customer needs and proactively provided solutions.
o
Escalated
quality concerns, along with resolutions, to management.
GemInsurance
–25 Years of Professional Experience in the Healthcare Insurance Industry
·
Successfully/Accurately
processed medical, dental, vision, disability and Medicare ‘A & B’ claims,
including COB (Coordination of Benefits); exceeding department quotas and
goals.
·
Managed the
daily activities of eight (8) customer service representatives and twenty (20)
claims adjudicators.
·
Organized
and facilitated benefit code and claims payment training.
·
Audited health
and accident, dental, Medicare and disabilityclaims to ensure accurate payment
according to policy guidelines for statistical and monetary errors.
·
Implemented
and tested new and modified health plans in existing claims processing system
focusing on the auto-adjudication of claims.
·
Actively participated
in a task force charged with proofing and the publication of healthcare
brochures, policy booklets and amendments.
·
Wrote departmental
training materials and policy changes/ procedures.
·
Reviewed/Researched/Responded
to claims appeal letters.
·
Provided support
and thorough documentation to the Legal Department in preparation ofcourt
cases.
·
Actively
involved in insurance fraud detection with the Utah State Insurance Department by
reviewing claims submission from claimants and healthcare providers by
reviewing claim details; diagnoses, services rendered, submitted charges and a
variety of medical records/notes/charts.
·
Coordinated/Oversaw
meetings held with medical consultants and actively participated in the review
of medical records, operative reports, lab/path reports, physician notes,
dental records/charts/x-rays for billing conflicts, pre-existing conditions,
length of stay, medical necessity and fraud.
pResentations, awards and education
·
Thirty-eight
(38) combined years of hands on professional experience in the Software
Information Technology AND Medical Healthcare Insurance Industries.
·
Medical
Terminology and Business Analysis Fundamentals training/certification.
·
Attended
extended business skill development and educationalclasses.
·
Attended/Participated
in learning sessions and round table discussions provided by the ‘International
Claims Association’ and ‘Rocky Mountain Claims Association’ where upcoming insurance
trends, fraud detection, experimental treatments and advancements in the
medical industry and many other medical insurance related topics were
addressed.
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