SUMMARY:

• Business Analyst with 4+ years’ experience in Healthcare domain.
• Conducted Root Cause Analysis, Time studies, Process Mapping exercises, performance and risk matrices etc. using various tool sets.
• Designed and reviewed various documents including the System Requirement Specifications (SRS), Business requirements document (BRD), Use Cases, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Document and communicate changes throughout the user organization, supporting Information System Change Management (ISCM) and compliance
• Good understanding of Healthcare Industry standards, Electronic Data Interchange (EDI), HIPAA Code Sets, Regulatory changes including ICD9 - ICD10 conversions
• Experienced in facilitating Joint Application Development (JAD) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development teams
• Extensive Knowledge of Medicare, Medicaid, procedural and diagnostic codes
• Experience in System Integration and Retirement projects following mergers and acquisitions
• Experience in Risk and Regulatory Compliance associated with archival and disposal of data
• Facilitated project meetings, reviews, walkthroughs, and customer interviews to gather requirements and relevant information for Business analysis
• Experienced in handling Change Management, writing Test Plans and executing Test Cases
• Experienced as BA analyst in Defect Tracking and extensively involved in User Acceptance Testing
• Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations\
• Experience in ticketing system through Salesforce and building CRM processes
• Experienced with project management, planning, Issue/Risk management, budget and resource management, Executive reporting
• Knowledge of Medical and Pharmacy Claims Processing, and HIPAA regulations
• Experience with writing ad-hoc SQL queries as well as designing Business Object reports
• Extensive Knowledge of Medicare, Medicaid, procedural and diagnostic codes

TECHNICAL SKILLS:

Domain: Project Management, Healthcare Management, Pharmacy Benefit Management, ICD 9-10 conversions, HIE, HL7

SDLC: PEGA BPM, Agile (SCRUM), Waterfall, RUP

Tools: MS Project, MS VISIO (UML), SharePoint, JIRA, SAP R/3, PRPC, OPTIM (IBM)

Testing Tools: QTP (Quick Test Pro), Quality Center (QC), JIRA (Defect Tracking)

PROFESSIONAL EXPERIENCE:

Confidential, Princeton, NJ

Business Analyst

Responsibilities:

• Elicited and gathered user and business requirements through open ended discussions, brainstorming and prototyping.
• Worked on preparing new products and services in line with Healthcare regulations
• Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
• Performed GAP analysis to compare the existing system with the proposed system and documented new requirements and features.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Worked on HIPAA 4010 and 5010 / ICD 9, version for all EDI transactions.
• Created specifications for EDI HL7 (A28, A31, ADT) and X12 (837/835) transactions that were transmitted between Claims Editor and Legacy Billing application and external Payers
• Involved with the coders in evaluation of CPT and ICD-9 codes to ensure that the diagnosis meets medical necessity for the specific CPT code.
• Developed Business Requirement Document and Use Case Specification Document for Use Cases
• Responsible for converting the business requirements into functional and non-functional requirements.
• Conducted JAD sessions for communicating with all project directors and stakeholders and created process workflows, functional specifications and project initiation artifacts.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose per UML methodology thus defining the Data Process Models.
• Developed straightforward DBMS queries, with knowledge of HL7 and XML interface messaging.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Extensive analysis on claim processing system allowing the user to inexpensively capture information regarding patient, summary of medical history, symptoms (ICD-9 codes), and treatment (CPT).
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Involved in Service Oriented Architecture (SOA) of the claims processing system
• Understand the As Is system and develop the To Be concept and prepare the System Process Maps.
• Performed extensive requirement analysis including Data analysis and Gap analysis.
• Defined Functional Test Cases, documented, Executed test scripts
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear picture of the project.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Coordinated QA activities across Functional QA and Performance QA teams
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational BPM.
• Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
• Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Requisite Pro, Rational BPM, Agile, HL7Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, Rational Clear Quest, Rational Clear Case, UML, RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Confidential

Business Analyst

Responsibilities:

• Analyzed existing reports and defined systems requirements and process workflows
• Analyzed current processes and did Gap Analysis for gathering requirements for new Healthcare reforms and standards
• Conducted JAD sessions with PM, SMEs; facilitated interviews with end users and hospital administrators to collect systems requirements
• Used the HL7 messaging protocol to send and receive healthcare data, including patient information and various lab reports information in a standardized format to ensure that the data was universally understood and organized
• Created Project management plans for managing on time delivery using MS Project along with writing test cases, and systems integration test plans in Test Director.
• Built a business process model using Rational Rose and Visio.
• Responsible for gathering requirements, creating artifacts for Rational Unified Process (RUP) - use cases, systems architecture document, supplemental requirements document, architecture diagrams; verifying technical production infrastructure; designing and executing performance tests; and documentation.
• Create Functional Requirement Specification for the Data Warehouse and different functionality which were being designed into the Data Warehouse.
• Developed test scripts and test cases with different scenarios and organized them per the Functional Requirements Specifications.
• Performed requirement analysis, went through use cases per the flow of patient data and rules of security sharing.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
• Wrote Test Cases in Mercury Quality center that would test various Test scenarios.
• Assisted in data mart design and prototyping
• Assisted in designing and validating source target mappings and transformation logical data model required to support information requirements.
• Assisted the project manager in preparing the project schedules, milestone tracking, resource allocation using Microsoft project.

Environment: Windows XP professional, MS Office suite, Load Runner, XML, MS Visio, Mercury Quality Center.

Confidential

Business Analyst

Responsibilities:

• Capture business rules for routing of workflow items based on key business data elements
• Created RACI matrix for common suspension issues and related resolution resources
• Support Pega Development teams in creating iterative code packages and testing
• Capture requirements for Management Reporting for workflow and productivity
• Create Use Cases for Claim Adjuster actors to run reports and process workflow items
• Support development of a Security Rule Base to define Roles within the new system
• Coordinate between Technical, Business and QA teams for verification of information and facilitate communication

Environment: Pega PRPC, Rational Req Pro, MS Word, MS Excel, MS Visio