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It Analyst  Resume

Cleveland, OH

SUMMARY:

  • Seven years of experience in business process analysis, business requirements modeling and development of Web Based, and Client/Server applications in diverse business domains of Healthcare, Insurance and Service Industry Sectors.
  • Proficient in gathering and converting User Requirements into Business Requirements and Functional Requirement Specifications (FRS) and use Modeling tools like Rational Rose and Microsoft Visio for requirements modeling.
  • Expertise in Business Process Modeling, Business Process Re - design and in designing Process Architecture.
  • Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, HL7 Standards, HIPAA, PPACA(Patient Protection and Affordable Care Act), Compliance issues, Confidential and Confidential Mapping, HL7 Message Validation, ICD 9, Electronic Health Records(EHR), Electronic Medical Record (EMR), Invision to Epic, E-gate Monitoring, Orion Rahposdy.
  • Sound understanding of Gap Analysis, requirement management, risk analysis and project plans.
  • Strong experience with different project methodologies including Agile, Scrum Methodology, SDLC, RUP.
  • Extensive experience in gathering Business and Functional Requirements, Business Scope & Vision Document, developing Business Requirement document, Functional specification document, communication plan, Use Cases, conducting Gap Analysis and Risk Analysis.
  • Worked on FACETS batches like XPF and MMS to upload bulk data into the FACETS system through the HIPAA gateway by generating keyword files to enroll, modify or terminate providers and members
  • 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.
  • Knowledge of 837, 835, 277, 270, 271, NCPDP, 5010 and ICD-10.
  • Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
  • Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
  • Experienced with insurance claims processing using main frame legacy system (on Oracle, MS SQL background) and paper intensive environment and experience in using Trizetto’s Facets e2 and Network X Suite for the membership eligibility, billing, claims processing and claims reporting.
  • Solid understanding of Rational Unified Process (RUP) using Rational Rose, Requisite Pro, Unified Modeling Language (UML), Object Modeling Technique (OMT), Extreme Programming (XP), and Object Oriented Analysis (OOA).
  • Excellent understanding of Data Models and Information Architecture and sound skills in SQL.
  • Excellent understanding of Software Quality Assurance Techniques, CMM, Master Data Management, Six Sigma and ISO Standards and highly acquainted in working in SOX Compliance Environment.
  • Experience in Risk Management process and technology reengineering, Sarbanes Oxley implementation, valuation review process and technology, strategic sourcing, metrics and benchmarking
  • Experienced with BI Reporting Tools like SAS, Databases like SQL, Oracle.
  • Excellent in designing business models using UML diagrams such as use case diagrams, class diagrams, activity diagrams, sequence diagrams and collaboration diagrams using Rational Rose and MS Visio.
  • Experience in conducting Joint Application Development (JAD) sessions and White Board Sessions with end-users, Subject Matter Expert (SMEs) team, Architects and design group development and QA team for project meetings, walkthroughs and customer interviews commensurate with excellent communication skills.
  • Defining Test Cases, analyzing bugs, interaction with team members in fixing errors and User Acceptance Testing (UAT)
  • Creative and aggressive self-starter with integrative thinking skills, capable of communicating creative ideas through graphical analysis charts and statistical data display.

TECHNICAL SKILLS:

Project Management: MS-Project2010, MS-SharePoint Project Methodologies SDLC, Agile, Rational Unified Process (RUP), UML

Business Modeling Tools: Rational Rose, MS Visio

Requirement Management Tools: Rational RequisitePro, Rally

Defect Tracking Tools: Rational Clear Quest, Quality Center, Test Director

Operating Systems: Windows 7/XP/2000, UNIX

Database: Access, Oracle, SQL server, DB2, Teradata

Scripting Languages: HTML, CSS, XHTML,JAVA SCRIPT.

Quality Assurance: Software Application Testing Life Cycle

Business Applications: Microsoft Office Suite, MS VISIO, MS Project, SharePoint

Content Management Systems: Drupal, Joomla, Interwoven.

PROFESSIONAL EXPERIENCE:

Confidential,Cleveland,OH

IT Analyst

Responsibilities:

  • Exclusively worked on Bridges Regional Error Correction Application for Error Correction process in EPIC
  • Manually tested the BREC application in TEST environment and worked in Production environment. Worked on errors made by doctors in hospitals on Orders, H & P, Notes
  • Bridges is an EPIC Interface application. Bridges is the Interface that allow HL7 messages to be sent out and to be accepted by EPIC
  • Strong understanding of FACETS and Facets Data Model working on data model and data extracts.
  • Experienced working in Facets online modules such as Billing, Provider, Claims and Membership modules.
  • Monitore all EM componenets throught E-Gate monitore where all components interfaces connectected to central e-gate tool. Monitore all coponents ORM, ORD, Contex based ADT, Bridges Tables, ambulatory clinical work flows through system, Results of lab, Syngo Dynamics, Radiology, Muse Holter, Agfa, Sunquest Lab Results etc manage through In Bound and Out Bound Epic. Make sure EHR & EMR, ADT, PID, OBR, OBX, Providers ID (Varified through NPI Lookup) are correct.
  • Extensively worked with other Business Team / Units to resolve issues. Coordinated with other team members on issues as-needed
  • Worked on error of different regions like East, West, and Central regions. Central comprise of Medina and Ashtabula county hospitals. East comprise of Euclid, Lakewood, Marymount Hospitals. West comprise Fairview, Lakewood, Lutheran, Marymount Hospitals
  • Extensively worked on EPIC interface engine for Orders from EPIC and Results from LAB System, Radiology System, Pharmacy System
  • Errors get loaded to the EPIC system, BREC team resolves the errors and corrects the errors in EPIC
  • ADT, ORU Delete and Process Reports were tested in all regions. MED Image Reports were also tested in all regions
  • Worked exclusively on Reconcile Reports to match the data in both systems (In EPIC and Invision systems)
  • Logged issues in EPIC defect tracking system called Sherlock and discussed the issues in daily and weekly status meeting

Confidential,Jefferson City,MO

Business Analyst

Responsibilities:
  • Participated in the analyzing and understanding the business requirements. Worked with the Business Users to understand the existing process.
  • Developed the Uses cases by analyzing the various scenarios and documented the Use case Document.
  • Worked on the GUI, user profile, created workflow processes documentation & charts.
  • Developed the test plan and designed the test strategy.
  • Implemented the Agile Software Development Life Cycle throughout the Project.
  • Created LOINC/ Confidential Vocabulary Mapping based on Missouri Reportable Conditions.
  • Created the data mappings for the digital pathology Confidential Codes
  • Tested the HL7 ORU R01 Version 2.5.1 to receive messages from HL7 ORU R01 version 2.3.1.
  • Gathered the Requirements for Enhancement of Electronic Lab Reporting Dashboard and implemented the timely status/error messages in the Dashboard
  • Designed a Document of Identifying and marking outbound laboratory results to public health entity to be accommodated on the Websurv.
  • Testing of HL7 Message Validation and sending of ADT Messages like ADT A01, ADT A04 and ADT A08.
  • Created a Data Dictionary Mapping the Reportable Health Conditions with LOINC/ Confidential codes and Master Data Management Documents.
  • Participated in JAD Sessions with SME’s and Business Users for gathering the requirements.
  • Created error/ defect reports and communicated with developers and application owners for application defect tracking & resolution
  • Support the Business Configuration Team (BCT) for creation of FACETS Group, Subgroup and class for Individual HMO On/ Off Exchange and Individual PPO On/Off Exchange for HCR in Facets Front end.
  • Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintainace), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/Advice).
  • Document APTC Configuration Process including Exchange Rules, Delinquency Definition and APTC Eligible Indicator.
  • Developed test scripts and test cases to test the eligibility as well as provider side of the delinquency implementation.
  • Worked on developing the business requirements and use cases for FACETS batch processes; automating the billing entity and commission process
  • Setting up Fee Definition and Fee Calculation in FACETS for QHP Individuals, Grandfathered/ Transitional Small Group, QHP Small Group and Large Groups
  • Involved in Testing of the various results generated by the reports against the data present in the database tables and used UAT on that data involving the users.
  • Work with the Cross-Functional teams to proactively automate the applications. Maintained the Requirements Traceability Matrix and also conducted the Gap Analysis to and also maintain and review test metrics/results/KPIs for analysis and audit purpose.
  • Provided functional inputs to the software development team, to enable them understand the role of the software in the business process of the client.
  • Wrote SQL Queries to extract data from the SQL Server Databases.
  • Designed and implemented basic SQL queries for QA testing and report / data validation.
  • Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance Testing.
  • Involved in manual testing and UAT with the development team and QA team.
  • Assisted the Test lead with estimations and also got the opportunity to work with the project manager in preparing the project schedules, milestone tracking, and resource allocation

Environment: MS Windows, Quality Center, Rhapsody version 2.3.1, 2.5.1,HL7, SQL, MS Visio, MS Project, MS Office (PowerPoint, MS Word, MS EXCEL), Web 2.0, SQL, Oracle, SDLC, Agile, MS-Project2010.

Confidential,DE

Business Systems Analyst

Responsibilities:
  • Facilitated requirements gathering sessions with the business unit managers and subject matter experts to document requirements.
  • Documented the work flow using the flow charts for the application to be accessed by different types of Business Users.
  • Provided full life cycle support for company’s Facets enhancement to Facets e2 Workflow and Network Management Suite with Pricing Modeler and Network Modeler application--including Business Requirement gathering, Functional Design, Technical Design, and Production Support documentation for multiple outgoing interfaces.
  • Documented the user Stories, Functional Specifications Documents and also Designed Data Flow Diagrams using MS-Visio.
  • Published detailed guide describing data file content and structure for business partners; created quick reference guide for HIPAA EDI ASC X12 834 transaction set for Medicaid enrollment.
  • Coordinated testing for contract set-up, enrollment and claims processing for four new managed care contracts for Medicaid mental and physical health providers.
  • Involved in intensive system level testing of analyzing the HL7 messages coming out and in of EPIC Bridges.
  • Responsible for the mainframes that receive the HL7 message in pre-approved format from the middleware as disclosed in the documentation.
  • Researched and documented data variances reported by managed care contractors
  • Reverse engineered processes where no documentation for system existed.
  • Studied existing business application and processes, current source system, collected end user requirements and suggested the improvised business process model
  • Assisted Project manager to create project timelines, milestones, resource planning etc.
  • Use HL7 implementation methodology to create specifications, assist with unit testing, and perform integrated testing for messaging between the state Departments of Health and the location office
  • Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS VISIO.
  • Working knowledge of inpatient and outpatient claims processing including ICD-9, ICD 10-CM, ICD-10 and set up system related components to ensure accurate claims adjudication by health systems
  • Designed a claim processing system for the healthcare management client system. It allowed the user to inexpensively capture information regarding patient, summary of medical history, symptoms (ICD-9, ICD-10 codes), and treatment (CPT).
  • Facets Benefit Configuration (Product Configuration) and Testing
  • Strong HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10, analysis & compliance experience from, payers, providers and exchanges perspective, with primary focus on Coordination of benefits
  • Reviewed extensive SQL Queries with complex multi-table joins and nested queries.
  • Involved in reviewing complex SQL queries, views, functions and stored procedures and spotting issues before/during code migration.
  • Rigorously tested SQL’s implementation of existing code.
  • Participated in design of the Master Test Plan Documents, Test Cases, Test Plan.
  • Participated in User Acceptance Testing with Business Users.
  • Co-ordinated with the Development Team and Testing team to track the Defects and Resolution.
  • Participated in Analysis of High Priority issues and risks as part of Risk Assessment.
  • Designed the Test Metrics Documents for tracking the Status and Compliance of the Application.
  • Performed Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
  • Participated in the walkthroughs and meetings specifically for Assessments and The report Generation.
  • Created the report from the databases using Crystal Reports.
  • Coordinate with Development and Business team to develop high level Business and Technical documents.
  • Worked with the clients on the verification process for the requirement phase documents
  • Implemented Agile Framework throughout the software Development Life Cycle (SDLC).

Environment: Java Server Faces, IceFaces, HL7, Seam, UML, MS-Project, MS-Sharepoint, Windows XP, Microsoft visio, XMl, SAS, SPSS, Rational Requisite Pro, SQL, Oracle, Agile.

Confidential

Business Systems Analyst

Responsibilities:

  • Authored business system analysis reports based on state regulations, HIPAA compliance and product business rules.
  • Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
  • Worked with the SMEs (Subject Matter Experts), IT managers, software architects to identify the key changes pertaining to HIPAA, and participated in Health Management to communicate effectively with them.
  • Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
  • Gathered the Requirements for Medicare, Medicaid Systems as part of Patient Protection Affordable Care Act(PPACA).
  • Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
  • Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
  • Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
  • Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
  • Used Query Analyzer, Execution Plan to optimize SQL Queries.
  • Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
  • Planned and documented procedures for data processing and prepared data flow diagrams for the application.
  • Evaluating various open source architecture framework in the architecture framework to come up with the architecture roadmap for the client.
  • Utilize HL7 implementation methodology to develop Electronic Laboratory Reporting interfaces
  • Expertise with supply chain strategies/vendor manufacturing process methods to determine level of procurement and strategic sourcing strategies/plans and worked with vendors/peers to determine lead times, schedules and cycle counts, established requirements needs.
  • Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
  • Prepared and documented System Requirements and workflows for the Content Management Application tool.
  • Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
  • 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 Medicaid Claims.
  • Experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C & D, FACETS 4.5/4.7 system, Claims Processing, Insurance Pricing and Claim Adjudication. Strong Experience in FEP (Federal Employment Program) and CDA (Clinical Development Analytics). Healthcare Domain Knowledge with SQL knowledge (in Oracle environment) and 5010, ICD-10 experience.
  • Participated in 1CD 9 to ICD 10codes mapping sessions as well as status meetings and provided comments and suggestions on challenges. Gathered requirements on Trading Partner Registration and certification. Verified Trading Partner configuration and the profiles.
  • Looked up ICD-9 codes to verify if a code has been changed and entered deposited and updated patients\' demographics using the Medisoft system and ePACES online system to verify a their Medicaid status.
  • Mentored business analysts in methodology for defining ICD-10 mapping processes and documenting business requirements. Developed additional processes specifically designed to handle Benefits Administration.
  • Participated in changing of 4 digit numeric codes of ICD-9 to Alpha-numeric codes in ICD-10.
  • Created an enterprise workflow application based on CRUD rules for Customer Data that would allow for future integration of data infrastructure across various business areas into a single User Interface.
  • 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 the design of the Automation framework.
  • Performed data analysis by using SQL queries
  • Designed the Master Test Plan, Test Plans,Test Cases and also Test Metrics Documents.
  • Performed Unit Testing and User Acceptance Testing and documented detailed defects.
  • Designed and developed project document templates based on SDLC methodology
  • Designed workflows and allocated permissions within SharePoint.
  • Performed Unit Testing and User Acceptance testing (UAT) and documented detailed results.
  • Expertise in BI Reporting for Reporting the data.
  • Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, TOGAF, Rational Requisite Pro, MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0.,UML.

Confidential,Huntsville, AL

Business Systems Analyst

Responsibilities:
  • Gathered legacy system requirements by shadowing Customer Service Representatives (CSRs), Customer Relationship Representatives (CRRs), preparing questionnaires, to identify limitations in the current system and GAPS in the proposed system.
  • Created an enterprise workflow application based on CRUD rules for Customer Data that would allow for future integration of data infrastructure across various business areas into a single UI.
  • Prepared logical data model in the form of Business Context diagram to include various entities and attributes in order to facilitate the design of Data model in the form of ER Diagrams. Studied current information structures and data models of the current databases to better understand the design of target data source.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid 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.
  • Co-ordinated with enhancement of AMISYS(Accounting and Management Systems) responsible for Billing of Claims.
  • Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • Performed custom data conversions and developed custom software for risk management applications including general claims, vehicle accident and administrative tracking. Performed all data field mappings.
  • Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
  • Used Rational Clear Quest to track required changes and Rational Clear Case to maintain different versions of the project documentation
  • Involved in integration of various Customer Data Sources and provided Data Mapping from various sources like CCD, LPCD, DCD into the target centralized customer data source.
  • Modeled Business requirements into workflows to depict various scenarios of system to request RFI and RFP responses from major vendors.
  • Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
  • Intricately involved in Business Process Flow development, Business Process Modeling, and ad hoc Analysis
  • Performed detailed comparative analysis of response to RFPs of vendors and Graphically Represented the recommended solutions in PowerPoint to Senior Management
  • Prepared Business Context Diagram, Use Case diagrams and corresponding Activity Diagrams using Rational Rose to depict the workflows to be incorporated into the development of Pega Business Process Management (BPM) tool.
  • Conducted Requirements walk- through with the Business Team to ensure that all their needs are met and gathered sign off on the requirements for SOX compliance after the requirements were base lined.
  • Prepared and maintain Business Rules Spreadsheets (BRS) identifying Rules, Triggers and corresponding data fields from Legacy to target CRM application.
  • Involved in testing of claims processed through Claim Processing Engines like Facets.
  • Followed a methodical Change Management Process and documented any Change Requests into Clear Case for any changes in the requirements after the requirements were base lined.
  • Conducted Architectural Discussions to prepare the Proposed Architecture and provided insight in the Business Case to the Architecture Review Board (ARB).
  • Lead the effort of Data Migration from disparate data sources into normalized data to eliminate redundant information and organizing the tables to easily maintain the table structures.
  • Prepared Test Cases based on base-lined Requirements Document, prepared Requirements Traceability Matrix and provided Performance Testing Requirements. Worked very closely with the Test team to Test all iterations during the Testing Phase and documented all the defects.
  • Facilitated the User Acceptance Testing (UAT) with Pega System Administrators and Business Users, documented any issues or defects and eventually got sign off from the right parties.
  • Prepared training materials in the form of User manuals by preparing step-by-step guide to all screen flows in CMS.
  • Assisted in development of User Interfaces and prepared screenshots to get business’s buy-in on the requirements.
  • Worked on BI Reporting Tool to retrieve, analyze and report data.
  • Worked with Siebel trainer to prepare training materials and conducted on-site training with Siebel to train the various types of audience like Customer Relationship Representatives (CRRs), administrators and Account Managers (AMs).

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