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Business Analyst Resume

Barrington, IL

SUMMARY:

  • Business Analyst with 8+ years of diverse experience in Business Modeling, Document Processing, EDI, Mapping, HIPAA Regulatory changes and Application Integration in healthcare domain. Have experience with analysis and review of software, prepare Business Requirements Document (BRD) and Functional Requirements Document (FRD). Experienced in gathering business requirements, JAD Sessions, Gap Analysis, UML diagrams, Process Flows, Business Documentation, Claims Processing & Testing and Claims Adjudication for Medicare and Medicaid, Data Mapping/Modeling, Trizetto Facets and Medical Billing. Worked in all types of software development methodologies mostly Agile (Scrum), RUP and Waterfall. Highly motivated self - starter and capable of working independently.
  • Specialized in Healthcare, Risk and Compliance and Document Management.
  • Verified and documented HIPAA regulator changes found when moving from 4010 to 5010.
  • Experienced with TriZetto Facets and HIPAA Gateway - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
  • Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Enrollment, Provider, Commissions and Billing Modules of Facets.
  • Experienced with Trizetto’s Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, and Utilization Management.
  • Worked on EDI files 837 (RA), 835 (Institutional, Professional and Dental), 834 (Membership enrollment) and 820 (Payment Order/Remittance Advice)
  • Worked on Mobile apps for different operating system like IOS and Andriod devices.
  • Experienced in GAP analysis, MoSCow Analysis and SWOT Analysis of HIPAA 4010 to 5010 with particular attention to qualifier, length and required field and situational rules and professional knowledge of HL7 standards.
  • Worked on Facets to help payers efficiently execute core administrative functions, including claims processing, premium billing and customer service.
  • Revitalized requirement elicitation techniques, conducted user Interviews and JAD Sessions and managed the requirements using Rational RequisitePro and Use Case Diagrams with all phases of SDLC.
  • Technical expertise in EDIANSI X12, HIPAA & EDIFACT Standards, Sterling’s GIS, Gentran Server on UNIX/Windows Platform and support for various transactions for both inbound and outbound mapping using EDI ANSI X12 standards.
  • Demonstrated proficiency in EDI ANSI X12 and EDIFACT standards.
  • 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
  • Experienced in EDI, Type Trees,Mapping, ANSI X12, EDIFACT, Mercator,Gentran for Windows NT, Unix
  • Conducted Impact Analysis, SWOT Analysis, Risk analysis, Sensitivity Analysis and Risk Mitigation.
  • Designed Graphical User Interface (GUI) using Adobe Photoshop. Knowledge of DB2, SQL queries using MS Access, VB script and Oracle.
  • Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835, 837 270/271 transactions.
  • Perceived ITIL Framework and the various areas of IT service delivery and support including Configuration Management, Vendor Management, and Incident Management, Customer Relationship Management, Infrastructure Management and Portfolio/Project management.
  • Substantiated Object Oriented Analysis and Design representation techniques in UML using Rational Rose, Dataflow Process Modeling and Analysis & Design with Interaction and Class Diagrams.
  • Executed SQL queries to verify data integrity of the databases.
  • Conducted User Acceptance Testing (UAT)

TECHNICAL SKILLS:

Project Methodologies: Rational Unified Process (RUP), UML, Agile

Business Modeling Tools: Rational Rose, MS Visio

Requirement Management Tools: DOORS, Rational Requisite Pro

Defect Tracking Tools: Rational ClearQuest, Test Director

Operating Systems: Windows XP/Vista/7, UNIX

Databases: SQL Server, MS Access, DB2, COBOL.

Languages: C, SQL, HTML, XML

Quality Assurance: Software Application Testing Life Cycle

Business Applications: Microsoft Office Suite- MS Word, Excel, Outlook, PowerPoint

Design Tools & Languages: Microsoft Visio, C, C++, HTML

PROFESSIONAL EXPERIENCE:

Confidential,Barrington, IL

Business Analyst

Responsibilities:
  • Worked on EDI files 837 (Claims), 835 (Institutional, Professional and Dental) and 820 (Premium)
  • Gather requirements from the Business users; interact with the business users on constant basis.
  • Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system)
  • Testing of EDI file 834 (Enrollment) with vendor benefit Focus, upgrade to 5010 from 4010.
  • EDI X12 Transaction sets for the mandates for the upgrade.
  • Interacted with the Business Team on continues basis, coordinated meetings with the vendor
  • Data mapping for the 834 EDI membership enrollment files and member records
  • Worked on Business Requirement Document, & Schedules. Provided project life cycle Artifacts.
  • Interacted with the Business Team on continues basis, coordinated meetings with the vendor
  • Provided Daily Status reports to the Business owner, Project executives & Team,
  • Monitor and control the project without schedule slippage
  • Analyzed requirements of the existing systems and suggested the improvised business process model.
  • Worked on Mobile Application for member enrollment for various different groups on different operating system like Android and IOS.
  • Responsible for creating GUI mock screens for Mobile App in IOS system using Ipad and Iphone.
  • Assigned work efforts of different tracks to the team member, Mentoring the teams and resolving day to day issues.
  • Involved in doing end to end testing for various functionality for Mobile Applications with IOS and Android devices like IPhone, IPAD, and Samsung.
  • Worked closely with the project Managers and assisted in creating project timeline with MS Project.
  • Perform Extensive EDI testing on X12/4010 837,835, 270 etc., worked with state vendor to validate inbound /outbound EDI transactions to Facets.
  • Designed, analyzed and performed integration and wrote system requirements on FACETS.
  • Set claims processing data for different FACETS Module.
  • Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions
  • Extensively worked with Member/Subscriber and HIPAA Privacy Facets application groups.
  • Involved in creating documents and diagrams for Membership Enrollment according to the HIPAA 834 Compliance Standards for Membership Enrollment.
  • Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Enrollment, Claim Processing and Subscriber/Member module.
  • Set claim processing data for different Facets Module.
  • Gathered requirements and developed process flows diagrams in accordance with Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluated the impact of proposed changes.
  • Worked on Data Mapping to map Facets data to outbound eligibility extracts
  • Conducted Gap Analysis of requirements, generated workflow process, flow charts
  • Defined and documented the vision and scope of the project.
  • Conducted one on one interviews with high level management team and participated in the JAD Session with the SMEs.
  • Participated in weekly status meetings to present status and in corporate any digressions from the original scope.
  • Carried out a thorough target organization assessment and risk and impact analysis
  • Analyzed “As is” and “To be” system state to show the current and proposed functionalities of the system using MS Visio.
  • Worked with the clients on the final signing process in the User Acceptance stage

Environment: s: HP Quality Center, MS Visio, Mercator, HIPAA validator, Instream, BizTalk, MS office, Serena Business Mashups (Defect Management Tool), SQL, VB script.

Confidential,East Brunswick,NJ

Strategic Business Analyst

Responsibilities:

  • Analyze Organizational Contract Labor spend, Overtime Spend, Vacancy and Turn-over rate. Evaluate the productivity of current per-diem contingent workforce.
  • Prepare optimal workforce solution based on current findings to create an additional layer of support and reduce the Contract labor spend and overtime spend.
  • Prepare ROI (Return of Investment) based on the data findings during the client interviews and present it to the steering committee for approval.
  • Facilitate business requirement gathering sessions by holding interviews, document analysis, business process descriptions, business analysis, and workflow analysis.
  • Research, analyze, and consolidate information gathered from multiple applicable sources to document business process requirements appropriately.
  • Evaluating data captured through task analysis, application walk through, and business process reviews.
  • Ensure requirements specifications are formatted for ease of consumption by project stakeholder and technical teams.
  • Analyze System Requirements and in developing test plans and test strategies
  • Involved in preparing Project Life Cycle Test Document and conducted Quality Reviews on project artifacts.
  • Performed Gap Analysis to compare all elements of existing "as is" with desired "to be" processes. Re-engineered the user interface of the application
  • Serve as a liaison between project manager, project stakeholder teams (Business Unit, Disciplines, and Operations) and technical teams.
  • Gather and analyze information and provide recommendations to address and resolve root causes. Evaluate/research business problems and their relationship to technology
  • Design the business analysis reports during the product implementation.
  • Interact with end users and developers to analyze and understand the updates in the application functionalities and to gather feedback on application usability
  • Interact with the developers regularly to analyze and understand the updates in the application functionalities and develop detailed weekly and monthly status reports to communicate status and issues to the stake holders.
  • Involved in Design, Modifications, development, installation and maintenance of Application program.
  • Created user-training videos, modules and trained the users on the product functionality.

Environment: Visio, Active Presenter, Camtasia Studio 8, Office 365, MS Office Suite 2016 (word, Excel, PowerPoint, Project), SQL and SharePoint.

Confidential,Dallas,TX

Business Analyst

Responsibilities:
  • Constantly interacted with the Product Director at Telnet for the enhancements and discussion on the changes.
  • Extensively worked on their 835 Institutional, 835 Professional, 835 Dental, 820 premium
  • Analysis on the EDI file structure, for Telnet, for 835 and 820 EDI transactions.
  • Constantly interacted with the Product Director at Telnet for the enhancements and discussion on the changes.
  • Analysis on EDI files 820 for the Telnet clearing house, which had various clients
  • Created a Gap analysis on Web Native Institutional (WIN), Web Native Professional (WIP), Denial Manager, and recommended changes for the goal of providing the customers with GUI interface and customer satisfaction,
  • Interacted with one of their important Client, provider Yale for the usability and current challenges that are faced usability point of view.
  • Documented as is and to be, using screenshots
  • Worked on 837, 270, 271, 835 Transactions
  • Documented all the changes for the enhancements and recommended changes.
  • Worked on the Institutional and Professional Claims, Design of the real time transaction
  • Created screen mockups and wire frames for prototypes for the applications of the different products.
  • Analyzed the current state and provided recommendations for the future state of the products.
  • Documented the Screen inventory of the products and analyzed the best go forward approach
  • Created Visio Diagrams for the entire architecture

Environment: MS Office Tools, Windows XP, MS Project, Quick Test Pro, RequisitePro, MS Visio, ClearCase, Visual Studio, MS-SharePoint

Confidential,Minneapolis,MN

Business Analyst

Responsibilities:
  • Responsibility includes reviewing the business process and possible improvements based on user requirement to implement system testing.
  • Gathered requirements, interacting with users and created requirement about shipment specification artifact.
  • EDI X12 Transactions for the Disability claims processing with Beth Israel Deaconess Medical Center
  • Followed the X12 Transaction formats for the EDI files processing through Web Services
  • Interviewing business area experts, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business people and technical people.
  • Conducted JAD Sessions with stakeholders and System Users.
  • Participated in all the phases of SDLC including Client interaction, Requirement gathering/analysis, Design/Testing and the Documentation.
  • Participated in all the HIT/NHIN Client and meetings for requirements gathering/analysis desired by the client. Brainstorming with the team to extrapolate the requirements that are not stated. One of the main responsibilities was to understand and analyze the requirements and write down the documentation accordingly.
  • Created and managed project templates, use case project templates, requirement types and traceability relationships in Requisite Pro
  • Involved in detailing project mission, Data Process Flow Diagrams and timelines.
  • Formed a bridge between the Project Manager and different teams with effective presentations.
  • Created and documented the Test Plans and Test Cases for the project.
  • Formed a bridge between the Project Manager and different teams with effective presentations.
  • Participated in weekly review meetings to report the documented test metrics & defect found in the system.

Environment: UML, RUP, Java, Web Services, MKS Client, MS Vision, MS office tools, MTOM, SQL

Confidential,Bloomington, IL

Jr. Business Analyst

Responsibilities:
  • Extensive requirement gathering experience which includes interacting with Stakeholders, Conducting one-on-one interviews, questionnaires/survey, JAD Sessions, Creating & Maintaining Use Cases, Conducting Requirement Refresh Sessions.
  • Also vast experience in Code reviews, Reviewing Test Cases and suggesting changes, Providing business knowledge to Developers and Test teams, Helping Data Stewards with Test Data creation, Analyzing defects that arise during Test execution.
  • Working on Personal Lines of Business (Auto and homeowner) & Commercial Lines (Commercial Auto, Workers Compensation, and Commercial Property).
  • Provided detailed analysis on two important and most complex functionalities of Insurance: Bill Management and Financials.
  • Involved in working with Cause of Loss, Rental Management, Auto Estimates, Subrogation, Salvage, Performer, Recoveries, Background Processing and Payments.
  • Documenting & maintaining business related documents like Business Requirements Document (BRD), Functional Requirements Document (FRD), Test Plans, and Use Cases.
  • Primary point of contact between Subject Matter Experts (SMEs) and other Business representatives, using knowledge of Insurance practices and methods to ensure accurate documentation of business requirements
  • Providing business knowledge and Insurance domain knowledge extensively to Development teams, Testing teams and other Business representatives
  • Investigates, analyzes, and recommends cost effective solutions for business issues.
  • Breaking down requirements of Business partners into functional requirements and documenting those requirements
  • Create detailed test plans to conduct detailed testing. Attend test conditions & test cases review meetings organized by the testing teams
  • Extensive use of Database (IBM DB2), understanding of UI specifications, Data Dictionary and Data Modeling.
  • Tracking issues/defects resulting from testing and making appropriate recommendations for resolutions and risk management
  • Analyze impacts on test cases due to Data Model Change Requests (DMCR) applied to the database, change in code resulting from defects
  • Support the Project Manager and Technical Team leads so that project deliverables are completed in a timely and professional manner
  • Designing Requirements based on Requirement gathering. Assisted in Test Case Execution by supplying insurance business knowledge to testing teams.

Environment: MS SQL Server, UML, Rational Clear Quest, Rational Rose, MS office, MS Visio

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