- 5 years of experience in the Healthcare, Manufacturing and Operations; Business consulting experience in all the stages of SDLC including Requirements Gathering, Analysis, Design, Architecture, Development, Integration, Implementation, Administration, Enhancement, Testing, Production Support and Customer Liaison and Training
- Excellent knowledge of Patient Protection and Affordability Care Act (PPACA), HL7, Health Insurance Exchange (HIX), EMR/EHR
- Solid expertise to analyze and synthesize results from Joint Application Development (JAD) and in Rapid Application Development (RAD), design solutions that are acceptable to the customer and feasible for the developers
- Experience in using methodologies such as UML (Unified Modelling Language), OOAD (Object Oriented Analysis and Design) and APM (Agile Project Management)
- Supported Scrum Master in prioritizing requirements for each scheduled sprint
- Expertise in Rational Unified Process (RUP), Rational Requisite Pro, Rational Clear Quest, Microsoft Project, Rational Rose and MS Visio for business process modelling and designing data flow diagrams (DFD)
- Proven skills in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost Benefit analysis, ROI Analysis, Requirement Traceability Matrix (RTM), Rational Unified Process (RUP) and SCRUM methodology
- Preparing graphical depictions of use cases including State Diagrams, Activity Diagrams, Sequence Diagrams, Use Case Diagrams, and Component - Based Diagrams, Collateral Diagrams, including the Business Workflow Chart
- Very good understanding of Relational Database, Object Oriented Programming, Data Modelling, Data Mapping and Data-warehousing; Excellent skills in data analysis, impact analysis, risks analysis
- Creating Functional specification Documents (FSD), AS-IS and TO-BE workflows, Test Plans and Test Cases
- Experience in transformation of HIPAA 4010 to HIPAA 5010 in the existing claims processing integrated system; Medicare and Medicaid projects; Changing to and testing of new MMIS;
- Excellent knowledge of HIPAA X12 EDI transaction codes such as 270/271 (Inquiry/Response Healthcare Benefits), 276/277 (Claim status), 834 (Benefit enrollment), 835 (Payment/remittance advice/ Explanation of benefits), 837 (Health care claim)
- Knowledge of ICD-9-CM and ICD -10-CM coding and claims processing; Managing Test Director for the test team, SQL, Oracle EBS R12, Supply chain analysis
- Worked extensively on B2B applications and B2C applications in transaction processing and E-commerce applications
- Experience in handling Change Management and Release Management.
- Extensive Experience in UML and Process modeling using Use Case Diagrams, Activity Diagrams and Sequence Diagrams.
- Knowledge of all modules and functional areas of Facets.
- Excellent Analytical, Interpersonal, Communication and Presentation skills
- Developed the stakeholder list, created a stakeholder assessment matrix, and gathered requirements from stakeholders for provider management and member management
- Identified and validated business rules and data elements; Developed and maintained a requirements work plan and assessed the performance metrics of the team members
- Modeled the ‘AS-IS’ and the ‘TO-BE’ process flow and analyzed the gap; Developed and initiated the action plan steps to fill in the gaps
- Conducted Risk analysis and developed mitigation plans; Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS)
- Developed FRD (Functional Requirement Document) to accurately specify the functions that a system or component must perform
- Created different data flow diagrams and UML diagrams to describe the overall EDI transaction sets for different claims
- Created Underwriting, Claims and Administrative reports in Excel using SQL queries.
- Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process
- Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem
- Designed Functional Specifications for the target physical database.
- Facilitated JAD sessions for Requirement Validation with Dept. of Health & Human Services (DHHS) to gather requirements for the new MMIS
- Developed UAT test cases associated with the functional requirements.
- Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS
- Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system
- Participated in developing test plan, test scripts, and test scenarios and designed user documentation
- Worked with legacy team in developing BRD for multiple system change requests and participated in system testing using HP Load Runner
- Used Microsoft SharePoint as the version-tracking tool for managing the requirements documentation
- Create monthly/weekly status reports to update the project schedules & deliverable plan.
- Examine the system design deliverables & validating it against the Request for Proposal (RFP)
- Worked with developer to create requirements surrounding C# and .Net code for website applications
Environment: SQL Server 2014, MS Office, Quality Center, Facets 4.21, MS Project, Server, MS Visio, Unix, J2ee, Java, .NET, XML, Mainframes and Rational Clear Quest, ClearCase, Windows XP, Jira, Selenium
Lead Business AnalystResponsibilities:
- Created Business Requirement Document (BRD) by aiding in the collection of the User Requirements and Business Requirements; provided appropriate scope of work for the technical team to develop the prototype
- Incorporated and implemented HIPAA standards, Electronic Data Interchange (EDI 835, 837, 270, 271), transaction syntaxes such as ANSI X12, ICD-9, ICD-10 coding and HL-7
- Conducted AS-IS and TO-BE analysis and assisted in developing process models and system integration structure; Conducted business process analysis using GAP analysis
- Extensively involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in designing the EDI transactions using the new HIPAA 5010 version including the ICD-10 codes
- Facilitated Joint Application Development (JAD) sessions to speed up information flow among the stakeholders as well as the project team
- Test cases and test plans preparation according to the test strategies defined in the project guidelines
- Documented in state and out of state claims processing workflows
- Developed a very effective tracking system using Requirement Traceability Matrix (RTM) to track and maintain stakeholder requests for enhancements and changes during the project life cycle
- Identified critical areas of the business risks, modified business processes to manage and reduce risk using Risk Management Process
- Handled the knowledge transfer of EDI format used in electronic documentation to vendors as per the requirements
- Worked with Subject Matter Expert (SME) to ensure the extracts are properly mapped; Used SQL for mapping and querying; Assisted in creating requirement document for ETL - Data Extraction, Data Analysis and Data uploading process
- Involved extensively in various types of Audits in different stages; Gained Compliance Audit experience through exposure to different legal and audit consulting groups
Environment: MS Office, Quality Center, SQL Server 2018 & 2014, Facets 4.21, MS Project, Server, MS Visio, Unix, J2ee, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP
- Facilitating interactive sessions with stakeholders to facilitate a smooth understanding of Project scope and feasibility
- Conducting JAD sessions with members of Business and Technology teams to research and identify the Requirements and investigate their impact
- Develop the Business Requirements Specifications document ensuring consistency with Sarbanes Oxley considerations
- Preparing Use Case Diagrams, Workflow Diagrams and Entity Relationship Diagrams using MS Visio to define the business process
- Identifying the Data elements and Attributes and preparing a Conceptual Data Model
- Preparing Screen Mockups and Demo presentations for the application
- Defining and building prototypes for necessary reports to provide the management a measure of success for each Life Stage/ Value as it pertains to the participant’s experience
- Interacting with the Technical developers and preparing the Functional Specifications document and participating in Technical design walk-throughs to ensure they meet stakeholders’ expectations
- Working closely with Project Manager and Technical Lead to identify, research and drive issues and risks to resolution
- Interfacing effectively with external Vendors to ensure the Technical solution meets the Stakeholders’ expectations
- Interacting with Testing team to create Testing plans and System and Functional tests cases and assisting with executing the same
- Conducting UAT and obtaining Business sign-off
- Developing Training material and Conducting Training session for end users
- Performing Analysis & Estimation of Enhancement requests and implementing effective Change Management strategy
- Communicating frequently with all team members and stakeholders and following up when required to ensure project timelines are met and to ensure project success
Environment: Microsoft Office, Tomcat, JBoss, Windows XP, Business Objects, Toad, MS Visio, Oracle, HTML
Junior Business AnalystResponsibilities:
- Responsible for serving as a liaison between the multiple interdisciplinary teams.
- Provided technical support to large multi-server middleware environment.
- Managed the simplification of the architecture from Phase 2 to Phase 3.
- Creating and managing the lifecycle of a new code.
- Using ticketing agents such as JIRA and CALT to manage and execute changes in the environments.
- Managing the deployment of multiple code releases in to the environment.
- Performing requirement gatherings for functional and technical teams.
- Working closely with the infrastructure team, developers, and technical operation teams to ensure new code is being successfully deployed to the respective environments.
- Performance testing to check functional validation of the client website and services.
- Manage a series of IRS jobs and correlating with IRS teams to ensure jobs are executed as expected.
- Analyzing monitoring tools such Splunk & New Relic to ensure client website is healthy and affective
- Troubleshooting errors and analyzing root cause to ensure a more optimal environment.
- Appointed by manager to Train team members on case analysis and work flow procedure through group presentations and one-on-one sessions in the absence of lead for a month, Monitored work progress and adherence to project directives, Performed quality reviews of team’s work, Communicated new guidelines and directives from project directors.
- Elicit and interpret requirements and specifications from business stakeholders and translate into Functional Specifications
- I was a part of peer review team where my roles included:
- Review work for quality of data mining, correct analysis and proper determination of case, provided individual training sessions to analysts’ still needing assistance, Point of contact for analysis questions regarding data mining, analysis, work flow and complex situations.