- 6 years of expertise as a Business Analyst in Healthcare and Insurance industries.
- Strong analytical and technical writing skills with high credibility to communicate within all levels of an organization.
- Knowledge in Software development life cycle (SDLC) methodologies like Waterfall Model, Agile Modeling and Rapid application development (RAD).
- Experience in performing GAP analysis and SWOT analysis.
- Experience in conducting Joint Application Development (JAD) sessions, Project meetings, Reviews and Walk through sessions.
- Excellent business writing skills for Functional Requirement Specifications (FRS), Business Requirements Documents (BRD), Systems Design Specification, Systems Requirement Specification (SRS), Use cases and User Stories.
- Expertise in documenting the User acceptance testing (UAT) criteria, assist business teams in conducting UAT anddocumentation and publishing the training material when required.
- Hand-on experience in creating Validation Change Request (VCRs), maintaining Defect log, Incident log, and Tracking of defects to closure.
- Regular interaction with the business users, development teams, QA teams, and the project management team to track/meet the deadlines of the project milestones.
- Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes
- Excellent Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions to meet short and long term business and system requirements
- Profound experience with HIPPA X12 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim-status), 834(Benefit-enrollment),835(Payment/remittance advice),837(Health care claim)
- Familiar with the current industry improvement standards like the Six Sigma (6σ).
- Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process
- Worked closely in clinical trials environment and accurate knowledge on Adverse Events (AE), Laboratory data, Demographic Data, CDISC SDTM and Regulatory Authorities.
- Knowledge of the current industry methodologies like SEI-Capability Maturity Model (CMM), HIPPA, EDI and Foreign exchange.
- Strong communication skills with proven ability in written and analytical skills.
- Ability to manage (Multiple) project tasks with changing priorities and tight deadlines.
- Ability to work well in a team. Open to Team related tasks, team meetings, team interaction and conference calls.
AREA OF EXPERTISE:
- Business Skills: Business Process Analysis & Design, Gap Analysis, Impact Analysis, Data Modeling, JAD/JRP Sessions Requirement Gathering, Customer Liaison, Requirement Extraction and Documentation, and Use Case Modeling
- Methodologies: SDLC - Agile and Waterfall
- Languages: C, C++, SQL, PL/SQL, HTML and XML
- Database: DB2, MS SQL Server
- Operating Systems: Windows Vista, Windows 95/2000/XP/7, and MS-DOS
- Microsoft tools: MS Office Suite (Word, Excel, Power Point, Outlook), MS SharePoint, MS Visio, and MS Project
Confidential, Charlotte, NC January 2011-Present
Confidential is an organization that enables efficient healthcare system through their best practices and products. The purpose of the project is to identify and solve Agreements and Configuration Issues in Facets 4.61 environment. The project scope also extended to configuring key data into Facets. The second part of the project was enhancing Facets to an upgraded version of 4.71
Worked on Health Insurance Portability and Accountability Act (HIPAA) project (Transactions 270/271,276/277,835,837) which involves analysis of HIPAA Compliance rules and designing the Transactions to be HIPAA Complaint, Improve portability and continuity of health insurance coverage in the group and individual markets and lastly to simplify the administration of health insurance services.
- Thoroughly studied the inherent systems to have a clear understanding of the business processes and associated system workflows.
- Work responsibilities primarily involved understanding the business logic, designing requirements, communicating them to the developers, generating documentation, designing use cases, creating various diagrams like State Diagrams, Sequence Diagrams as part of project.
- Involved in HIPAA implementation and EDI transactions like 837, 835, 276/277, 278, 270/271.
- Involved in gathering requirements and documentation of 276/277 claim status Request and Response.
- Conducted Gap analysis to understand the new business model and the additional functionalities to be incorporated into the new application.
- Conducted JAD sessions for better understanding and refining of the requirements in coordination with the multiple teams involved in the projects.
- Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) simultaneously.
- Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
- Documented the Business Requirements Document (BRD) and the Use Case Specification Documents for the project.
- Involved in claims and facets.
- Worked on UAT and Facets application.
- Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance.
- Identified all use case components including basic, alternate and exception flows.
- Participated in various architectural development sessions to provide technical teams with a better understanding of the business requirements.
- Analyzed Requirements and created Use Cases, Use Case Diagrams, Activity Diagrams using MS Visio.
- Knowledge of industry billing and coding compliance requirements
- Prepared Business Process Models, which included modeling of all activities of the business from conceptual to procedural level.
- Participated in Change control meetings recommending appropriate action after analysis of the new/changing requirements.
- Conducted multiple interviews to clarify requirements in order to identify Use Cases and document Use Case Specifications.
- Responsible for HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing of Medicare a Non Medicare claims.
- Responsible for Documentation and Gathering of Requirements of 276/277 Claim status Request and Response and MCCS Claim search Screens.
- Assisted QA team by Reviewing test cases and clarifying requirements to ensure complete coverage of requirements.
- Hands-on experience with Microsoft SharePoint 2010 to collaborate on documents and manage project tasks by implementing business processes on documents.
- Involved in Affiliate and Regulatory submissions through SharePoint 2010.
- Provided training to users, and involved in conducting UAT sessions.
- Created macros in Excel to merge data between different excel sheets for data migration.
Environment: Windows 2007, MS office suite, MS SQL, MS Visio, UML, Waterfall (SDLC), MS SharePoint 2010.
Confidential, Milpitas, CA Apr 2009 - Nov 2010
Confidential provides solution in safety & regulatory areas. Over 2,000 facilities have used our Web-based, real-time software solutions to capture, manage, report and analyze relevant quality, safety and compliance data. Regulatory Reporting Management solution helps healthcare organizations capture, aggregate, analyze and manage quality and performance data for submission to state and national healthcare quality initiatives, including The Joint Commission and the Centers for Medicare and Medicaid Services.
- Performed Gap Analysis, conducted walkthrough sessions and acted as a liaison between the business users, stakeholders and the various teams involved in the project to perform requirements, quality and risk analysis.
- Involved extensively in the inception phase of the project for understanding the Scope, feasibility of the implementation and define the risk factors involved.
- Experienced in gathering requirements for clinical trials data using BASE SAS for the developers to establish deliverables and reports for regulatory agencies like NDA, IND, FDA.
- Working with Medicare operational management to monitor, trend, and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
- Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
- Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products.
- Gathered business requirements by interviewing business users and Subject Matter Experts (SME).
- Conducted Joint Application Development (JAD) sessions with IT groups. Identified the Key Changes.
- Analyzed business/system requirements using requirement arbitrage and assigned appropriate priorities.
- Effectively managed the requirements and requirement change requests during various phases of the project life cycle.
- Ensured that all the requirements, enhancements and defects for that particular release have been developed, fixed and tested by creating traceability matrices between all the project artifacts.
- Work with business users to ensure that the user stories are good, has business values and story points.
- Facilitated the story board discussions of the user stories for portal design and usability.
- Providedthe projectmanagerwith regular status updates assisting the overall project management initiative.
- Performed requirement walkthrough sessions with the Dev and QA teams with the aim to develop testing strategies and test plans such that test cases reflect the user needs.
- Worked extensively with MS office suite for preparing status reports
Environment: Windows 2007, SAS, MS Project, Agile, MS Visio, Oracle, MS Office suite.
Confidential, NJ Jul 2007 - Mar 2009
Confidential provides a wide variety of insurances ranging from Auto/Home to commercial; it is one of the leading Property & Casualty insurance companies, which provides various insurance products for personal and commercial lines of business to the customers through independent network of insurance agents. Farmer sells its insurance through a web application known as Point of Sale. This application is used by Farmers Insurance independent agents and Hub users (Farmers Employees). This application supports different lines of businesses like Personal Auto, Homeowners, Commercial Auto, Business owners, Workers Compensation and Claims.
- Determined user, business and functional requirements.
- Created vision, scope, and use case documents; business process models, use case diagrams, activity diagrams, and state chart diagrams.
- Performed GAP and Risk analysis of the existing system and evaluated benefits of the new system.
- Conducted Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
- Validated technical designs created by IT developers against functional specifications.
- Worked with QA team to design test plan and test cases for User Acceptance Testing (UAT).
- Coordinated work plans between project manager and client using MS Project.
- Created documentation for training and Help Desk teams.
- Created logical data models to define business and project requirements of customer management and pipe sales quoting system.
- Gathered, analyzed, documented and communicated requirements for logical data modeling in the system including narratives, data flow diagrams and functional decomposition diagrams.
- Created requirements matrix and tracked solution validation for the requirements matrix.
- Organized requirements for customer statement, invoice and ticket system with use cases and UML diagrams.
- Developed feasibility analysis and project risk analysis and documented use case description.
- Used interview process with key stakeholders to deliver high level business requirements documentation.
- Facilitated JAD sessions with participation from stakeholders, multiple teams involved in the project.
- Identified stakeholders and facilitated JAD for Web Time Entry system for 260 plants in US and Canada.
- Elicited, analyzed, documented and communicated requirements feeding into deliverables including but not limited to scope, cost, schedule and risk management for the upgrade and maintenance of the system.
Environment: MS Visio, UML, MS Office suite, Quick Base, SDLC Waterfall, XML, SQL Server.
Confidential, Bloomfield, CT Nov 2006 - Jun 2007
The goal of this project was to develop a Benefits Management Workbench (BMW) that supports the creation, search/inquiry and update of products, features, benefits, availabilities within the Product Catalog and additionally provide reporting capabilities. The Product Book of Record (Product Repository) will provide CIGNA with a "single point of truth" for products across the organization to ensure that products made available are in compliance and equivalent to the products sold, installed and serviced.
- Formulate and define the scope (requirements) and objective of the project based on the user needs and thorough understanding of the business processes.
- Helped manage risk analysis and mitigation plans, status reports, and client presentations.
- Prepared business process models, defined milestone deliverables, and established critical success factors.
- Gathered requirements during inception phase, documented and delivered functional specification documents, and assisted architecture analysis and design using UML.
- Work with the business and technical teams to devise effective user stories.
- Translate business needs into value, breaking down value-based requirements into detailed functional requirements that can be delivered in an iterative project environment.
- Dialogue and negotiate with all levels of stakeholders.
- Organize and present ideas in a convincing and compelling manner.
- Possess excellent communication, presentation, and interpersonal skills with the ability to demonstrate tact and professionalism in a fast-paced, sometimes ambiguous environment.
- Assisted in designing test plans, test scenarios and test case for integration, regression and user acceptance testing (UAT) to improve overall quality of the application.
Environment: MS Visio, Agile, Oracle 9i, SQL Server 2003, Windows XP.