Micheal C.

About Micheal C.

I’m a Business Systems Analyst with 6+ years of experience in healthcare, helping organizations optimize payer operations, streamline EDI workflows, and drive data-backed decision-making. I’ve worked with Medicaid, Medicare, and commercial lines of business, translating complex business needs into clear technical requirements. I specialize in EDI transactions (837, 835, 834, 278, 270/271), HEDIS reporting, claims workflows, and enrollment systems. I’m also skilled in tools like SQL, Power BI, Tableau, Excel (including VBA), and ServiceNow to build custom dashboards, automate reporting processes, and support end-to-end analysis. My background spans Agile (Scrum, SAFe) and Waterfall environments, and I thrive as a bridge between stakeholders, developers, and QA teams—facilitating workshops, leading requirement sessions, and supporting testing (UAT, regression, validation). If you’re looking for someone who’s technical but business-savvy, and can deliver both the “what” and the “how” of system solutions in healthcare, let’s connect.

Experience

1. Business Systems Analyst

   CareSource

   Apr 2024 — Present · Dayton, OH, US

   At CareSource, I supported Medicaid and Medicare programs by translating business needs into technical requirements for EDI transactions, care coordination tools, and reporting dashboards. I worked cross-functionally with internal teams, healthcare providers, and state agencies to streamline workflows and enhance data visibility across the revenue cycle.Key Highlights:• Gathered and documented requirements for 834, 837, 835, and 278 EDI transactions and implemented improvements to prior authorization and claims processes• Built interactive Power BI and Tableau dashboards to track HEDIS compliance, claim turnaround time, and UM operations• Automated TAT reporting and reconciliation processes using Excel VBA, improving efficiency by 70%• Conducted revenue cycle analysis (registration to collections) and supported finance with SQL-based data extracts for provider reimbursement• Led workshops to map As-Is and To-Be workflows; supported UAT planning and defect resolution in Azure DevOps.•Managed ticket queues using ServiceNow, ensuring proper assignment and timely follow-up across business teams

Education

• Estam University

  Bachelor's degree