SUMMARY:

• 7+ years of experience acting as a liaison between clients and development teams providing business/functional requirements.
• Strong understanding of project life cycle and SDLC methodologies including Waterfall, Agile Scrum and SAFe Agile.
• Experienced in translating business requirements and user expectations into detailed specifications using Agile methodology.
• Efficient in conducting many workshops and JAD/JAR sessions involving company employees and end users.
• Experience in developing Use Cases, creating Screen Mockups, conducting Gap Analysis.
• Excellent work experience in creating Project Plans, Business Requirement Documents, Functional Requirement Documents, Use Cases, Activity Diagram, Sequence Diagram, Requirement Traceability Matrix and Test Plans.
• Experience in conducting User Acceptance Testing, SWOT Analysis, Cost Benefit and ROI analysis
• Skilled in Requirement Analysis, Use Case development, UML/BPMN Modeling with Sequence Diagrams, Activity Diagrams, Data flow, Context diagram, and Process Flow diagrams using MS Visio.
• In depth knowledge of health care basics including Medicare/Medicaid, HIPAA 4010 - 5010, ICD9 and ICD10, and EDI Transactions.
• Experience in HIPAA 4010 and 5010 EDI healthcare transactions like 837, 835, 834, 820, 270, 271, 276, 277, and 278 along with ICD-9/10.
• Extensive knowledge on the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO, HMO, Dental claim and POS, Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), HL7, PBM.

TECHNICAL SKILLS:

Business Planning & Work Flow Tools: UML, MS Visio, Rational Rose, MS Project, Rational Requisite Pro, MS Office, Word Perfect, BPMN 2.0

Processes: RUP, RAD, Agile, Spiral JAD, Waterfall SDLC models

Databases: MS Access, MS SQL Server, ORACLE, DB2

Testing/Defect Tools: Rational Test Manager, JIRA, Quality Center, Clear Quest, QTP

Operating Systems: Windows, Unix, Linux

Management Tools: Microsoft Project, MS Office, MS Outlook, VersionOne, Confluence, Rally

PROFESSIONAL EXPERIENCE:

Confidential, Baskin Ridge, NJ

Business Systems Analyst

Responsibilities:

• Evaluated requirements and prepare detailed user stories in CA Rally Tool for Developers.
• Created new and maintain existing documentation related to web processes and functionality and servers.
• Reviewed recommendations on existing implementations with developers and application architects.
• Collaborated with QA team to ensure testing efforts align with system deliveries and business processes.
• Performed As-Is and To-be analysis and GAP Analysis to verify the required information on the existing system and created the business process workflows based on Business Process Modeling and Notation (BPMN).
• Designed and implement product features in collaboration with business and IT stakeholders
• Participated in strategic decisions regarding enterprise architecture for technology domains.
• Conducted technical analysis within requirements context, diagrams and documents formats.
• Worked closely with executives and subject matter experts to establish portfolio architecture strategy.
• Developed detailed source to target data mapping and data transformation rules for data modeling.
• Used SQL knowledge to retrieve and understand data from relational database warehouse to make recommendations to product team.
• Host JAD sessions with co-workers from other functional areas to create solutions.
• Write documents for solutions, such as, Solution Summary Document, High Level Documents, Requirement Traceability Matrix, etc.
• Understand user stories and define which user stories were technical and acceptable, create a solution for the user story, and review code and test results with the developers and CQA.
• Use of CA Rally to report daily progress on solutions and user acceptance testing.

Confidential, Richardson, TX

Business Systems Analyst

Responsibilities:

• Working on master documents of Business and Technical Architecture for end to end enrollment.
• Developing capabilities for current state of End to End Enrollment per stakeholder’s requirements.
• Conducting requirement gathering sessions to define the project and to reduce the time frame required to complete deliverables.
• Monitored and supervised submission of monthly Medicaid encounters to MDCH for timely processing per State compliance.
• Responsible for business analysis, requirement specifications, risk analysis, project planning and identifying the resources and implementation of the project.
• Coordinated quality management factors, clinical documentation, risk management analysis, clinical workflow review, and provide analytical support and document performance improvement processes.
• Coordinated project tasks relating to the use of Health Information Technology to improve clinical care.
• Involved in EDI transactions Analysis, Design, Implementation and Documentation.
• Conducted Functional meetings with the Project Manager to align and analyze resource capacity for planning the demands of the project.
• Provided Technical inputs from Facets perspective in the BTRD completion process for satisfying the downstream system needs especially to PBM.

Confidential, Fargo, ND

Business Analyst/ Data Analyst

Responsibilities:

• Analyzed the current software used to manage health claims..
• Responsible for business analysis, requirement specifications, risk analysis, project planning and identifying the resources and implementation of the project.
• Performed Gap analysis pertaining to HIPAA 4010 - 5010 conversion to accommodate the ICD-10-CM and ICD-10-PCS code sets.
• Assisted with building the EDI 837, 835, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading Partners to the translator.
• Facilitated review of Enrollment, Claims, Commissions, and membership port designs with architects and developers to ensure that the goals of the portal requirements were satisfied.
• Communicated with business, technology leadership for overall project/program office milestones.

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Responsible for developing and reviewing business requirements, functional specifications, project schedules, documentation and test plans.
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System-Related to the HIPAA.
• Coordinated with Project Managers to resolve risk issues and ensure compliance with HIPAA standards.
• Managed and developed EDI specification, gap analysis and applications structures for data feeds and mappings for integration between various systems to follow ANSI X12 4010 formats including:
• Eligibility/Benefit Inquiry and Information.
• Claim Status Request and Response.
• Benefit Enrollments.
• Remittance Advice.
• Claims and Encounter.
• File Transmission Acknowledgement to meet and exceed HIPAA requirements set forth by the federal government.
• Developed use cases, and traceability matrices to better assist software development.

Confidential, Mountain View, CA

Business Analyst/ Content Engineer

Responsibilities:

• Maintain data accuracy and identify patterns in data for Confidential Maps.
• Making outbound calls in needed language to verify and correct information on Confidential database.
• Compare between multiple sources of information with strong attention to detail in order to ensure all data reflected on Confidential Maps is accurate, user friendly and in accordance with Confidential ’s policy.
• Experience in Software Development Life Cycle (SDLC) methodologies
• Led requirement gathering sessions (RGS) and joint application development (JAD) sessions.
• Assisted in deriving functional requirement specifications (FRS) based on user requirement specifications (URS).
• Knowledge in documenting Unified Modeling Language (UML) diagrams like Use Case Diagrams, Activity Diagrams, Sequence Diagrams, Data Flow diagram, Business process modeling and Business Flow Diagrams using MS Visio.