SUMMARY:

• With 9 yrs. experience working as Business / System Analysis in Healthcare and Medicare Sector.
• Strong knowledge of SDLC methodologies like RUP (Rational Unified Process), RAD (Rapid Application Development) and Agile. Extensive knowledge using Unified Modeling Language (UML) diagrams (use case, activity, sequence) using Rational Rose and MS Visio.
• A solid base in gathering and documenting user and business requirement. Expert in writing complex queries using SQL.
• Expertise in the EPIC Medical software application (EMR, HER) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• Knowledge of healthcare standard Health Level Seven (HL7).
• Strong Healthcare solution Architect - Payer in the areas of Claims, Provider, Member, Customer Service and Utilization Management.
• Extensive hands-on and HealthCare management experience in a variety of projects involving the customization, design, development, implementation, and testing of automated systems to support the Medical Management Information System (MMIS) as well as day-to-day business operations.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Analyzed and synthesized results from Joint Application Development (JAD), proposed alternative tasks and transformed those into Business Requirement Document (BRD).
• Extensive knowledge on FACETS Claim Processing, Pricing and Billing Processing between provider and payer
• Proficient in transforming business requirements into user requirement specification, Functional Requirement Specifications Document (FRD) and Use Case Narratives.
• Excellent knowledge of Health Insurance Portability & Accountability Act ( Confidential ) standards, Electronic Data Interchange (EDI), HL7 and ICD-9 to ICD-10 coding.
• Experience working in a team-oriented environment and contributed effectively as a problem-solver. Attention to details and ability to prioritize tasks along with excellent communication, project management and problem solving skills. Analytical, methodical, and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial, and system requirements.

TECHNICAL SKILLS:

Business Methodologies: RUP, Agile, JAD, GAP Analysis, SWOT Analysis

Business Modeling Tools: UML, Rational Rose, MS Visio 2010, Brio

Requirement Analysis: Rational Requisite Pro, Test Director, Quality Centre

Databases/ languages: Oracle, SQL Server, XML

Operating Systems and Languages: Linux, Unix, Windows XP

Others: Facets, MS Office Suite, MS Project, Toad

PROFESSIONAL EXPERIENCE:

Confidential, Bismarck, ND

Sr. Technical Business Analyst

Responsibilities:

• Studied business requirements and conduced User Interviews to identify and document the data discrepancies and their sources as related to Government Contract Compliance (GCC), Government Disclosures, Government Pricing, Customers, Products, Product pricing.
• Involved in performance testing of Medicaid client server claims processing system, Medicaid MCC / MCO and Medicaid Management Information System (MMIS)
• From payers perspective (MMIS) all transactions are made compliant to ANSI ASC 4010A1 X12N standards to talk with various Legacy system.
• Analyzed CMS comparison documentation highlighting changes of 5010 format and ICD10 diagnosis and procedure codes.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Evaluated, identified and implemented effective revenue cycle approaches through business intelligence tools to deliver canned reports and ad-hoc reports.
• Responsibility included modifications to a customer’s mainframe system to support new product features or regulatory requirements and, in some cases, involved a system upgrade
• Converted Business Requirements to the Functional Specification and Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Documented workflows and executed comprehensive testing and training plans to ensure the new acknowledgement results demonstrated in the 999 and 277CA were properly interpreted and managed to ensure Payer acceptance of the 837 files.
• Tracked all required resolutions required that were identified as needed from Vendors or Payers based on testing results.
• Enhanced test cases using GUI checkpoints, Database Checkpoints, Text checkpoints and Bitmap checkpoints
• Develop Conceptual Data Model & Logical Data Model in alignment with MITA Information Architecture.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Validated ETL healthcare data to create weekly and monthly logs used for healthcare auditing and data warehouse loads.
• Assist in the set-up of the new hospital web portal and document new business processes to support training roll out.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
• Played key role in defining test automation procedure and standards, creating Win Runner and Quick Test Professional scripts for all the modules, which reduced the regression cycle drastically and improved the testing efforts for daily builds.
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Evaluate data modeling with Oracle and Informatica in building efficient and accurate data warehousing solutions.
• Develop MITA Maturity Model (MMM) & Business Capability Matrix (BCM) to identify the maturity level of SD Medicaid Enterprise.
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• Used the DataStage Designer to develop processes for extracting, cleansinfg, transforms, integrating and loading data into data warehouse database.
• Conducting requirement sessions and successfully translating of those requirements into Use Cases and GUI wireframes.
• Planned and defined system requirements to Wire Frames with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• Involved in setting up different configuration environment for compatibility testing and manual testing.
• Used MS Sharepoint for the purpose of managing documents and for hosting websites which was used to access shared work spaces and documents.

Environment: Windows 98/2000, Window2003, Window NT, Linux, Mainframe, Solaris IBM Web sphere, Apache Tomcat, IIS 6.0, Web Logic, Java, SAS, Cognos, SharePoint, MS Office, Quick Test Pro 8.2, Mercury Quality Center 9.0, Load Runner 8.2, Sun Java, MSJVM, Oracle 8i/9i/10g, SQL Server 2000, DB2, Toad, MS-Project 2000/2003.

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Assists with the transition of new application system to support ensuring that any unique requirements are incorporated into the ICD-10 program.
• Conduct client meetings, analyze documents and other sources of information, map out requirements and develop business processes using task-flow analysis and work-flow analysis.
• Organizes the coordination of the planning, Testing and Implementation activities for the ICD-10 System Compliance for Division 5 of Confidential facilities (approx 22 facilities).
• Deliver results after thorough research of functional needs by collaborationg and communicating between various users.
• Lead analyst for identifying and developing Viso workflows associated with the ICD-10 compliant version for several applications.
• Acts as liaison between vendor, Revenue Cycle and business management and department end-users
• Work closely with the customer to detail and convert business requirements into system and operations requirements while working with external partners to complete the design, development and implementation of the requirements.
• Developed of ICD-10 test plan template that is distributed to those facilities that may not have a test plan in place.
• Engages in resolution of application system incidents, root cause analysis, impact analysis, and planning of proposed system upgrades and patches related to ICD-10 upgrade.
• Responsible for reporting back results/issues and/or solutions determined from Integrated testing of all ICD-10 impacted applications from Patient Registration to bill being generated for payment from payor.
• Acted as a liaison between the business users and the development team and worked closely with the development team to clarify/understand functionality to that the developers clearly understood the business requirements that the system was designed to fulfill.
• Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio. Involved in large scale Enterprise Implementation experience varying from Payer.
• Validated ETL healthcare data to create weekly and monthly logs used for healthcare auditing and data warehouse loads.
• Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintenance), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/Advice).
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Used Data warehousing for Data Profiling to examine the data available in an existing database.
• Implemented RUP methodology for iterative and incremental development of the system.
• Proven methodology to conduct JAD sessions and design review for successful implementation of 5010/ICD10.
• Identified all system interfaces and modifications needed for those systems to function with 5010 and ICD 10 changes
• Implementing and expertise in ICD-9/ICD-10 and CPT related products (i.e. DSM IV-TR, DRG, APG, APC and HCC).
• Performed gap analysis and impact assessments to identify, capture and categorize all changes and differences between version 4010 and 5010 and ICD 9 to ICD 10 in connection to Health Care Exchange.
• Coordinated with Business Owner, Application Vendor, Business Project Teams, Payers and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the 5010-compliancy requirements.
• Involved in Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Worked with ICD-9/ICD-10 and CPT related products (i.e. DSM IV-TR, DRG, APG, APC and HCC).
• Performed Gap analysis for better understanding of transition from Confidential 4010 to Confidential 5010.
• Analyzed Confidential 5010 related to 835, 837, 270, 271, 276 and 277 transactions (both inbound and outbound) and performed gap analysis between the 4010 and 5010.
• Lead Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams.
• Researched and understood the software interfaces, coding changes and overall impact on claims adjudication and reimbursement systems due to IC-9 to ICD10 transformation.
• Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Worked into Health Care Industry with exposure to Electronic Medical and Health Records (EMR & EHR)/Automated Health Care Systems, ICD-10 conversion, Confidential and other HIT standards
• Performed GAP analysis to identify AS-IS a process EDI transaction set 834,837 and 835 of 4010A and TO-BE processes of 5010 standard and based on that developed Business Requirement Documents.
• Evaluate data modeling with Oracle and Informatica in building efficient and accurate data warehousing solutions.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle database tables.
• Designed robust 5010 testing and 4010 regression SIT and UAT Testing Scripts for the 5010 Project. Scripts were written on an application level and subset by payer resulting in over 600 combined scripts with a maximum of 70 testing scripts steps per script.
• Maintained and submitted periodic/monthly status reports to the Program Manager to serve as the team’s assessment of the project and its schedule.
• Reported progress against Development/Action Plan routinely to the Program Manager with recommendations for corrective actions, where necessary.

Environment: MS Office, SQL Server, Agile, SDLC, SAS, JAVA, DB2, Mainframes, MS Project, MS FrontPage 2003, MS Access, Web Logic, EDI, Rational Clear Quest, Rational Clear Case, HP Quality Center, Rational Requisite Pro, Rational Rose, UML,RUP, Microsoft Excel, Microsoft Word.

Confidential, Minneapolis, MN

Business Analyst

Responsibilities:

• Gather requirements by conducting meetings and brainstorming sessions with end users and SME and document them using Requisite Pro - the documentation tool offered by Rational.
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, MicroStrategy Data Warehouse Data Modeling and Design.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Perform Gap Analysis of the processes to identify and validate requirements.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Conducted meetings and understood the requirements of the sales and marketing team
• Organize requirements into high level Use Cases and low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using Rational Rose and MS Visio.
• Apply UML notations and methodology in developing models that accurately represent the business process and workflows and clearly communicate them to the stakeholders.
• Worked with various users including insurance brokers
• Facilitate JAD sessions involving the management, development and user teams for clarifying requirements and facilitating better communication.
• Coordinate and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines
• Assure that all Artifacts are in compliance with corporate SDLC Policies and guidelines.
• Review the Test Plan developed by the testing team for testing the application.
• Assist the QA personnel in the creation of Test Cases using Rational Test Manager.
• Involved in performing version control and defect tracking activities using Rational ClearCase and Rational ClearQuest.

Environment: PL/SQL, SQL Server, XML, Windows 95/98/2000, ODBC, Internet Explorer and Netscape, Web Logic, UNIX, Rational Req. pro, clear case, Rational Rose, Clear Quest, UML, Ms Visio, and Ms Project

Confidential, Baltimore, MD

Business Analyst

Responsibilities:

• Designed the business requirement collection approach based on the project scope and SDLC methodology.
• Gathered requirements from business users and tracked them using Rational Requisite Pro.
• Assist in the set-up of the new hospital web portal and document new business processes to support training roll out.
• Wrote Test Cases in MS Excel for user registration, access to training material, and activity log-in, reviewed the test cases and finalized
• Worked into the EPIC Medical software application (EMR, HER) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• Worked to establish departmental data management approaches for genomic biomarkers/data and biosample coding categories with regard to EMR records.
• Created workflow scenarios, designed new process flows and documented the Business Process and various Business Scenarios and activities of the Business from the conceptual to procedural level.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Helped the business to articulate and prioritize their ideas, while using the Rational Unified Process (RUP) and writing UML-based feasibility studies and Use Case Models to communicate those ideas to the developers.
• Responsible for assuring integrity of rewards system by developing and executing test specifications and test plans by working with testing team to improve quality processes.
• Wrote test scripts for User Acceptance Testing (UAT).
• Enhanced project planning by conducting interviews, feasibility studies to identify and eliminate high risk areas of the application
• Conducted a budget planning of the project through walkthroughs and meetings involving various leads from Development, QAs and Technical Support teams.
• Analyze business requirements and segregated them into Use Cases diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.

Environment: - MS Office, Test Director, MS Project, MS Visio, Unix, Oracle, Toad, Rational Requisite Pro, Rational Rose