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Business Analyst Resume

Tampa, FL

SUMMARY:

  • A Business/System Analyst with a thorough knowledge of Software Development Life Cycle (SDLC) and RUP including requirement capture, analysis, design and development. In - depth knowledge of business processes in Healthcare industries. Experienced in Business Requirements gathering and managing, Risk Analysis, Gap Analysis, Feasibility Studies, and UML Modeling. A result oriented enthusiast, with highly developed planning, analytical, technical communication, decision-making and leadership skills, driven with the ability to multitask and deliver effectively, in a fast paced environment.
  • Served as Product Owner developing and prioritizing User Stories in SCRUM.
  • Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
  • Six Sigma Green Belt Certified (SSGBC).
  • Managed Product Backlog and provided guidance and information as required for completion of Sprints, and jointly managed Burn down Charts with SCRUM Master.
  • Coordinated and documented SCRUM Reviews and Retrospectives.
  • 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, LO INC and SNOMED Mapping, HL7 Message Validation, ICD 9, Electronic Health Records, Electronic Medical Records.
  • Extensive experience in GAP analysis of 4010-5010 conversion using implementation guides and companion guides.
  • Extensive experience in identifying core business process, identifying risks, creating systems requirements specifications. Ability to comprehend and document business process in models and documents using Rational Tool Suite and other documentation/modeling tools.
  • Strong knowledge of Data Warehousing tools like SSIS, SSRS, Informatica and Cognos.
  • In depth knowledge of ICD-9-CM, ICD-10-CM/PCS structures and format and the differences between them.
  • Involved in JAD, walkthroughs and various meetings with the stakeholders of the project including technical users in order to design complete and detailed documents such as Business Requirement Documents, Functional Requirement Documents, Use Case Diagrams and Activity Diagrams.
  • Experience in Extracting, Transforming and Loading (ETL) data from Excel, Flat file, Oracle to MS SQL Server by using BCP utility, DTS and SSIS services.
  • Evaluated and analyzed the current business models of a company; performed GAP Analysis; generated “AS IS” and “TO BE” process flows.
  • Clear understanding of testing concepts and hands on experience writing test cases, test plans and planning test strategy using testing tools like Quality Center.
  • Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI) in 4010 and 5010 formats.
  • Involved in claims submission and payment (remittance) retrievals and used HIPAA X12N 820 for the inbound premium payments.
  • 837 - Claims and Encounters
  • 834,820,864 - Benefit Enrollment and Maintenance-Payment and Level Error 2.
  • 835 - Claim Payment/Advice
  • 270/271 - Eligibility Benefit Inquiry and Response
  • 276/277 - Claim Status Request / Response
  • Expertise in creating SQL Queries for business analysis.
  • Experience in using requirement management tools, such as IBM Requisite Pro, HP Quality Center.
  • Excellent communication and analytical skills with strong problem solving capabilities to interface with end users, business representatives and development teams.

TECHNICAL SKILLS:

Requirement Management Tools: Test Director (Quality Center), Requisite Pro

Business Modeling Tools: Rational Rose, MS Visio

Programming languages: C, SQL, UNIX shell scripting, VB Script

RDBMS/Data base: ORACLE 9i/10g, MS Access

Operating Systems: Windows 2000/XP/ME/VISTA

Management skill: Risk management, SDLC, UML

PROFESSIONAL EXPERIENCE:

Confidential, Tampa, FL

Business Analyst

Roles and Responsibilities

  • Working on two state base exchanges that are Kentucky and Idaho. For KY I am the point of contact from Confidential .
  • Managing membership with these two states.
  • Wrote requirement documents like BRDs, FSDs, process flow, and inbound/outbound 834,820 and 864 and Gorman mapping.
  • Research Confidential system, inbound/outbound 834,820,864 EDI files in case of any issue/discrepancy with one or multiple members.
  • Touch base with state point of contacts if we need any information/confirmation from State Exchange.
  • Working on recon process for membership from state exchanges of KY and ID.
  • Experience with Trizetto QNXT System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPAA 834 and proprietary format files and Reports development.
  • Worked on HIPAA Transactions 270, 271, 276, 277,834, 835 and 997
  • Worked with (ACS) X12 5010 and (ASC) X12 4010A including the various Claims Transactions such as: 837 (submit medical claims), 835 (medical claim payments), 270 (benefit/eligibility inquiry), 271 (benefit/eligibility response), 276 (claim status request), 277 (claim status notification), 820 (premium payments), and 834 (enrollment).

Environment: Quality Center, MS Office, Windows, HTML, Internet Explorer, TAZ, Sharepoint, Firefox.

Confidential, Auburn Hills, MI

Systems /Business Analyst

Roles and Responsibilities

  • Analyzed and optimized the process. Converted Business Requirements into Functional Specifications and Technical Specifications using Rational Requisite Pro.
  • Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
  • Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA 5010 code sets, ICD-9, ICD 10 coding and HL7.
  • Understanding of Trizetto’s core Facets product and knowledge of using Facets Data Dictionary.
  • Understood the business processes and helped select the most appropriate functional requirements specification and business processes.
  • Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD) and the Functional Requirement Document (FRD) using Rational Requisite Pro.
  • Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets
  • Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets
  • Involved in preparation of Test Data to test the functionality of ETLSources Mappings and Targets.
  • Created a performance model for defining the non-functional requirements across the ACA Program.
  • Managed software system development and integration projects through all phases of project life cycle - analysis, design, development, testing, implementation, and post-production support.
  • Created UML Diagrams like Use Case, Activity and data flow diagrams using Rational Rose and MS-Visio.
  • Effectively used rational tools for Requirements Management Practices. Documented user requirement specifications in Rational Requisite Pro.
  • Communicated extensively with the Subject Matter Experts (SME) to gain further knowledge in completing user requirements.

Environment: MS Visio, Agile/Scrum Methodology, .Net, Microsoft Office suite,XML, SharePoint 2010, SQL OBIEE, JAVA/J2EE, JSP, Windows Vista/7, VBScript, Test Director, HP Quality Center.

Confidential, Tampa, FL

Systems /Business Analyst

Roles and Responsibilities

  • Data mapping on Enrollment Module (EDI 834) of FACETS .
  • Strong knowledge of Affordable Care Act (ACA) and Detail understanding of ICD 9/ANSI/HL7 to ICD 10/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare industry
  • Verifying, validating and routing the X12 834, 5010 enrollments, confirmation/effectuation, cancellation, and termination information from the enrollment systems to the exchanges in the format required by the recipient system.
  • Gathered the Requirements for Medicare, Medicaid Systems as part of Patient Protection Affordable Care Act (PPACA).
  • Worked with different lines of business to understand the ACA and HIX policies and developed a process to implement them from IT perspective by developing necessary artifacts.
  • Expertise in iterative approach of AGILE development with all the teams members
  • Involved in all phases of Software development life cycle (SDLC) using Agile Scrum methodology.
  • Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users, and the errors discovered were fixed and then verified via regression testing.
  • Cancellation and termination for On-Exchange and Off-Exchange using Edifecs Transaction Manager.
  • Validated EDI X12 files for Connecture (CNX) and Center for Medicare System (CMS) using Ingenix Claredi and manually edited and fixed the errors to make it error free and ready for processing.
  • Thoroughly analyzed EDI raw data for transactions (834) in the 5010 format to verify the changes as per the 5010 format.

Environment: Edifect, Facets, Agile method, Sharepoint, Contact center, Quality Center, MS-Office Suite, Microsoft Visio, SQL/PLSQL,SQL Server 2008.

Confidential, Grand Forks, ND

Systems /Business Analyst

Roles and Responsibilities

  • Facilitated requirement-eliciting sessions (JAD sessions) with Subject Matter Experts and other Key Users and documented the requirements in an easy to understand format by both the business and technical personnel
  • Experienced with the HL7 data transactions.
  • Worked on outsourcing and delegation of EDI claim 837, NASCO,QBLUE claim processing tools.
  • Expertise in writing SQL Queries using Oracle, SQL Server .
  • Adequate knowledge in Health Administration - Health Information Exchange HIE, Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI (Electronic data interchange), Medicare, Medicaid, CDHP (consumer driven health plans)
  • Establish documentation for agile methodology for implementation with a very water-fall-centric development team.
  • Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
  • Coordinated daily activities with the IT Developers, QA and Product teams along with the project management group.
  • Assisted quality assurance team to functional-test the new HL7 interfaces always keeping in mind HL7 and HIPAA guidelines, and coordinated user acceptance testing using derived test data
  • Generated test data using X12 generator for transactions 277/288, 834, 835, 837P/I/D. Conducted Gap Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards.
  • Created Online User Guide comprising different scenarios, screenshots, and troubleshooting procedures
  • Assisted in the Project manager in creating and updating the Vision Document, Business case, and the Project Plan to define Objective, Scope and Risks. Also assisted in creating RUP iteration plans and phase plans
  • Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes
  • Elicited requirements, and managed Change Configuration to maintain an orderly procedure for managing requirement changes after sign off
  • Used the Agile methodology to build the different phases of Software development life cycle.(SDLC)
  • Followed AGILE methodology viz. Scrum throughout the project.

Environment: HTML, XML, MS-Project, load runner, Agile method, Sharepoint, Contact center, Facets, MS-Office Suite, Rational Suite, Doors, RequisitePro, RequisiteWeb, UML, IBM WebSphere, Microsoft Visio, SQL/PLSQL,SQL Server 2005, Rational tool

Confidential, NYC, NY

Systems Analyst

Roles and Responsibilities:

  • Created ETL metadata reports using SSRS, reports include like execution times for the SSIS packages, Failure reports with error description .
  • Worked with Business Analysts understanding and analysis of design specifications for conversion and ETL of Coverage Administration Module for CNO & SHIP carriers.
  • Maintained daily SQL (SSIS, SSRS) reporting, ad-hoc reporting
  • Involved in gap analysis and implementation of HIPAA 5010, ICD10 and Claim Validations
  • Experienced in testing EDI and HIPAA Transactions 837, 835, 820, 276, 277, 278,270.271 code sets testing in Health Insurance.
  • Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
  • Analysis of ETL Mappings based on Facts & Dimensions from Source to target tables for directs moves and indirect moves based on transformation rules & lookup tables.
  • Configured FACETS.to adhere to customers work flow for claims processing, claims automation and group administration
  • Used FACETS to provide seamless transactions between the provider, members and the plan and used FACETS Workflow to route the claims according to the priority.
  • Created SSIS packages to extract data from OLTP to OLAP systems and Scheduled Jobs to call the packages and Stored Procedures.
  • Worked on Value added routines in Facets and provider and subscriber modules
  • Experience with BlueCross, Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12, 4010 and 5010 ICD9 and ICD-10 implementation guidelines & electronic formats including 270/271, 276/277, 700, 701, 810, 820, 834, 835, 837, 997, and NSF formats for interfaces and images to third part vendor applications including NEIC, SSI, ESI, Datatrac, Medtrac, Cube, BlueCross, Medicare, and several others using COBOL, Metafile, Visual Basic, Unix, DOS, Assembler, C, FTP, Windows, Novell, and various other communication packages.
  • Used MS Sql server Management studio for Creating & executing SQL queries for testing the conversion & ETL process .
  • Created Heat map with alert mechanism. Various KPI graphs were drawn. Kept eye on Qlikview best practice
  • Project entailed developing a data model based on MS SQL Server and Tableau Server.
  • Worked as Subject Matter Expert (SME) for various projects. Taught the users to get along with Qlikview.
  • Elicited functional specifications, conducted feasibility analysis, and performed impact analysis
  • Elicited Business Rules and other Non-functional specifications for the new system by interviewing the Subject Matter Experts (Doctors & Nurses) to further understand the business models
  • Analyzed CMS comparison documentation highlighting changes of 5010 format and ICD10 diagnosis and procedure codes.
  • Authored functional specifications for different HL7 system interfaces: ADT (registration), SIU (scheduling), OMG (rad order entry), and ORP/RDS (Rx processing)
  • Designed, developed, and implemented innovative & sustainable Tableau reports. Supported effective rollout of reports, including training collateral
  • Tested, Cleaned and Standardized Data meeting the business standards using Fuzzy /exact lookups using SSIS transformations
  • Responsible for Back-End Testing Using SQL Commands using TOAD.
  • Experience with developing HIPAA Companion Guides for 834 Enrollments, 270/271 Eligibility Inquiry/Response & 820 - Health Plan premium payments for MMIS (Texas, Maryland, Illinois and Virginia).
  • Responsible for positioning and delivering QlikView projects and cross building applications into new and existing customer base
  • Developed gap analysis and risk assessments for the FACETS upgrade project including effects on internally developed extensions and third party software for pricing and contract configuration.
  • Gathered requirements from the clients and developed crosswalks for 277/288, 834, 835, 837 P/I claims
  • Developed test cases based on the crosswalks and compliance guidelines for 277/288, 834, 835, 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response
  • Created Use Case Model using Rational Rose for developers and other stakeholders to understand the business process, depict roles, and procedures

Environment: Rational Suite (Rose, RequisitePro, Requisite Web), Rational Unified Process (RUP), Informatica, facets, Windows XP/2000, Doors, Oracle, IBM WebSphere, SQL, System Architect, MS-Project, MS-Office Suite, MS Visio, MS Word, MS Excel

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