- Over 7 years of comprehensive experience as a Business Analyst in the Healthcare Domain.
- Experience with various modules like membership management, premium billing, enrollment, claims processing & adjudication, benefits administration within Healthcare industry.
- Strong understanding of Healthcare terms and experience of Claims management process.
- Good experience working with Claims Processing Enrollment, Billing, Finance, Fulfillment and Reporting.
- Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
- Worked with ANSI X12 5010 and ANSI X12 4010 standards for transactions like 837 (medical claims), 835 (Payments & Remittance advice), 270 (eligibility inquiry) and 271 (eligibility response)
- Experience in developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams.
- Knowledge in Healthcare operations, Interfaces, Reports, Letters and system Migrations, Health Administration - Claims processing (auto adjudication), Claims pricing and testing, HIPAA, enrollment, Medicare, Medicaid, CDHIP.
- Expertise in the design and development of Tableau visualization and dashboard solutions using Tableau Desktop and publishing the same on Tableau Server/ Public/ Reader and external websites.
- Experience facilitating JAD (Joint Application Design) sessions and maintenance of Test Matrix and Requirements Traceability Matrix.
- Conducted User Acceptance Testing (UAT).
- Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
- Excessive use of documentation to avoid any form of miscommunication or misinterpretation during the entire software development process. Prepared Systems Proposal Reports, Change Request Forms and Business Plans.
- Experience transforming complex business requirements into rich data visualizations using Tableau.
- Creative and aggressive self-starter with integrative thinking skills, capable of forming and maintaining positive and productive working relationships in internal, external, independent, and team environments
Project Methodologies: SDLC, Agile, Rational Unified Process (RUP), UML, RAD, JAD/JAR
Business Modeling Tools: MS Visio, UML, Tableau, Pega
Operating Systems: Windows, UNIX
Standard and Codes: HIPAA, ICD-10, ICD-9, ANSI X12
Database: SQL server, DB2, Oracle
Reporting Tools: Business Objects and Tableau
Business Applications: Microsoft Office Suite, MS VISIO, MS Share Point, Outlook, Clear Quest
Confidential, Southfield, MI
Sr. Business Analyst
- Studied existing business application and processes, collected end user requirements and suggested the improvised business process model.
- Reviewed new and modified program, including documentation, diagram, and flow chart, to determine if program performed according to user request and conform to guidelines.
- Analyzed the changes made to different EDI ANSI X12 transactions (837 I and P, 278, 270 and 271) under HIPAA 5010.
- Owned weekly resource allocation reports in Excel and Tableau for headcount tracking (extensive vlookup use) which results in a leveling of human capital allocation through real business cycles (i.e., Open Enrollment)
- Conducted project in an Agile framework using scrum methodology
- Involved in project planning, coordination and QA methodology in the implementation of the Facets in the EDI transaction of the claims module.
- Attended week-long Tableau training (Fundamentals and Advanced) to uplift team’s dash boarding and reporting capabilities
- Coordinated and worked with Project Manager to prepare Project Plan in MS Project for Process Claim Domain.
- Analyzed the mainframe Reports for Member/Eligibility/Claims and mapped the fields with Facets batch jobs and reports.
- Experience with HIPPA X12 EDI ANSI transaction code 834(Benefit enrollment), 820 (Premium Payment)
Followed structured approach of gathering and formalizing business requirements expressed by managers, process owners and operational users of the information system.
- Attend Agile Scrum meetings to discuss project progress and plan
- Wrote SQL queries to retrieve data from databases after data migration.
- SQL queries and creating visually impactful dashboards in Tableau.
- Utilized MS Visio to draw Use Case diagrams and Process flow mapping to capture the requirements so that the development team and stake holders can understand the business process.
- Created detailed guide describing data file content and structure for business partners; created quick reference guide for HIPAA EDI ASC X12 834 transaction set for HCR enrollment.
- Used Agile methodology to manage the development life cycle of the projects.
- Done claims processing, benefits, provider reimbursement, provider set, billing and accounts receivable.
- Evaluated data models to design Tableau solutions.
- Worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets.
- Analyzed existing Business units, Business process, System Application and there Interfaces with their capability through open-ended discussions, brainstorming sessions, and prototyping, prioritizing them and converting them as system requirements that must be included while developing the software.
- Worked on EDI transactions: X12, 835, and 837 (P.I) to identify data set elements for designated record set.
- Gathered Business requirements. Interacted with the End users, Designers and Developers, Project Manager to get a better understanding of the Business Processes.
Environment: UML, M.S. Visio, M.S. Project, Tableau, SQL, MS Office, MS Visio, Agile, Pega, Rational Tools, UAT, HIPAA, EDI, MS-SQL, XML, DTD, .NET
Confidential- Boston, MA
- Work closely with Business Partners, User Experience (UX) Designers, Project Architects, Security Analysts, Service Providers and Technical Delivery Managers to gather and document the system and UI requirements.
- Used MS Project to document the project progress and manage the project resources
- Analyzed business requirements and segregated them into Use Cases. Created Use case diagrams using MS Visio according to UML methodology
- Followed the Scrum methodology (Agile) and was extensively involved
- Coordinate with MD's of different applications on daily basis to notify them on the risk involved into their application settings
- Build and publish Tableau reports utilizing complex calculated fields, table calculations, filters, parameters.
- Gather, Analyze and document requirements from different user groups and communicate those with the developers, QA and PM
- Preparation of Requirements Document, AGILE Story cards
- Successfully conducted JAD Sessions with SME's and Business Users to gather requirements.
- Accurately identified the various groups and created pivot tables for further classification and thus, created a better understanding of the groups.
- Interacted with various department heads and senior management to conduct interviews and requirement gathering workshops
- Solved business problems with proposed multiple solutions and pros and cons of each solution.
- Worked with Tableau to design, develop and support interactive Tableau and Excel based dashboards and workbook.
- Interacted with application developers and communicated user needs and requirements.
- Created Screen mock up to illustrate new requirements and alignment around project scope using MS Visio.
- Defined testing objectives and verify requirements are testable
- Utilized Agile Software Development Methodology.
- Responsible for managing the documented System Requirements and Requirements Traceability Matrix using MS Excel
- Wrote and executed SQL queries to verify data in the reporting system and used Tableau to generate reports for upper Management.
- Responsible for creating the System Requirements Specification (SRS) document, detailing the functional and non-functional system requirements and Web Services necessary to interface with each service provider.
- Created Use Case Diagrams, Activity Diagrams, and Sequence Diagrams in MS Visio.
- Work closely with Test Analysts/Managers to ensure their understanding of the requirements, review test cases to ensure completeness and provide consultation during test execution.
Environment: Microsoft SharePoint, .Net, Tableau, MS Visio, MS Office, MS Exchange, Pega, Clarity, Microsoft Project, SQL, UML, Agile.
Confidential, Buffalo, NY
Sr. Business Analyst
- Gather Business Requirements from the Business users, Subject Matter Experts (SMEs) and document the requirements in the BRD.
- Involved in gathering, documenting and verifying business requirements.
- Organized JAD Sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
- Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the BRD.
- Worked on documentation for various Care Management Case Referral Reasons including, Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Physician referral, Primary Care Provider (PCP) referral, internal patient profiling and ICD screening.
- Develop, coordinate and support Information Technology Division on all operational requirements of FACETS claims processing system and production management.
- Develop, design & implement department plan to operationalize new FACETS integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
- Involved in HIPAA lifecycle with traceability analysis, mapping, implementation, & also worked on different EDI X12 transactions.
- Identified end to end requirements for all systems and business units that may be impacted by the project.
- Developed requirements integrating Use Case diagrams and designed the testing process flows.
- Established and maintained traceability matrix until business requirements were signed off.
- Conducted walkthrough and lead work sessions.
- Using MS-Visio analyzed business requirements and process through Use Cases, Class, Sequence, and Activity diagrams, and adapted UML standards to define modularized Data Process Models.
- Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
- Developed a Business Acceptance testing strategy and plan.
- Created test files and analyzed test results using MS-Excel.
- Involved in Claim Processing from End to End and major work was involved with 837 P/I Claims Processing systems.
- Worked as system analyst on System Support, data migration and data, meta-data validation.
- Worked on Claims Processing and Claims Accumulation and Adjudication in FACETS.
- Involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
- Set claim processing data to test different Prior Authorization to use in the claims.
- Worked with Defects and involved in Defect Triage and prioritization.
Environment: Facets, Windows, XML, Tableau, SQL, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio)
Confidential, El Segundo, CA
- Organized and conducted extensive JAD sessions with users to identify, understand and document requirements.
- Provided key project inputs by working with users in defining the project and system requirements.
- Reviewed business process and functional requirements.
- Worked on Pharmaceutical data processing for improving database for storing user files.
- Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision.
- Involved in detailing project mission, data process flow diagrams, and timelines.
- Assisted in building a business analysis process model using Requisite Req Pro and MS Visio.
- Dealt with data mapping issues between various source systems and staging area and data-marts
- Produced functional specifications and led weekly meetings with developers and business units to discuss outstanding technical issues and deadlines that had to be met.
- Identified Actors, Activities, Artifacts and Workflows and developed use case diagram using Rational Rose.
- Participated in Automated regression and Non-Functional test plans.
- Mapped the collected data with the existing data provided by the hospital departments.
- Used Word, Excel and Visio as a working tool.
- Established a Business Analysis methodology around the Rational Unified Process.
- Researched the various steps in the lifecycle and then constructed the system in a way that the high risk customers would be easily identified and monitored.
- Streamlined clerical work processes and mapped then into the new system.
- Developed project plans and managed project scope.
Environment: SDLC, UML, Windows, MS Visio, Agile, MS Project, SQL, Oracle, Rational Clear Case, RUP, UML, HTML, MS Project.