We provide IT Staff Augmentation Services!

Business Analyst Resume

VirginiA

SUMMARY:

  • BUSINESS ANALYST with 7 years of hands on experience in business consulting and application development with excellent skills in client interfacing, requirement gathering, user support, problem solving, and documentation.
  • Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them.
  • Knowledge of Health exchanges: off marketplace exchange and on marketplace exchange. Federally Facilitated marketplace, state partnership Marketplace, State based marketplace.
  • Proficient in identifying, documenting and analyzing Business Requirements Specifications (BRS), System Design Specifications (SDS) and Software Requirement Specification (SRS).
  • Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR).
  • Specialized experience in healthcare insurance domain including Medicare and Medicaid. Profound experience with HIPPA X12 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim - status), 834(Benefit-enrollment), 835(Payment/remittance advice), 837(Health care claim).
  • Experienced in gathering requirements for HIPAA EDI Transactions (837,834, 835,270,271) in various phases of implementation.
  • Experience in conversion and mapping of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes.
  • Strong knowledge of FACETS and actively involved in end-to-end implementation of FACETS Billing, Enrollment, Claim Processing and Subscriber/Member module.
  • Proficient in Requirement Engineering Process, including gathering, analyzing, detailing and tracking requirements
  • Experience in interacting with stakeholders like business clients, end users, vendors, SDLC team, configuration manager and production team to identify information needs and initiate process change.
  • Expertise in creating various artifacts like BRDs, Functional Specs, Used Cases, UML Diagrams, Data Mapping Documents, Test Plans and Test Strategies, pre and post RTMs and Status Weekly Reports etc.
  • Strong visual modeling and business process modeling skills using Rational Unified Process (RUP) with tools like Rational Rose, and MS Visio.
  • Expertise in using various tools like RequisitePro and Ms Office for requirement gathering, Quality Centre and Clear Quest for Defect Management/Defect Tracking, MS-Visio for UML Diagrams, Ms Outlook, IBM Lotus Notes and SharePoint for information sharing.
  • Effectively used various elicitation techniques to gather requirements like JAD sessions, brainstorming, prototyping, one and one sessions, workshops, surveys, interviews and conferences.
  • Hands on experience in the complete Quality Assurance (QA) life cycle from Requirements Gathering and Documentations to developing Test Plan, Test Cases, Traceability matrices and conducting User Acceptance Testing (UAT) for QA Testing.
  • Experienced in writing SQL queries to extract data using complex inner joins, outer joins, constraints etc.
  • Worked with PMO to review time line and schedule for the implementation and discussing the milestone.
  • Excellent analytical, organizational, communication and documentation skills along with good process management skill to gather requirements to bring out the quality product.
  • Motivated self-starter, good team member with exceptional team building, leadership, and interpersonal skills to resolve issues.

TECHNICAL SKILLS:

Project Methodologies: Rational Unified Process (RUP), Waterfall, Agile, Spiral, SCRUM

Business Modeling Tools: Rational Rose, MS Visio, Rational Clear Case

Requirement Management Tools: Rational Requisite Pro

Defect Tracking Tools: Rational Clear Quest, Quick Test Professional, Quality Center

RDBMS: Oracle, SQL Server, IBM DB2

Languages: Visual Basic, XML

Business Applications: FACETS, MS Access, Excel, Outlook, PowerPoint, Visio and SharePoint

Version Control Systems: Rational Clear Case

Operating System: Windows, UNIX/Linux

PROFESSIONAL EXPERIENCE:

Confidential, Virginia

Business Analyst

Responsibilities:

  • Understood and Implemented Form 1095-A Data elements Deep Dive document (BRD) that explains the project scope, project deliverable, common reasons for known data errors on form 1095-A and limitations of the 1095-A project for coverage 2014.
  • Recognized the reference materials like FFM Marketplace Issuer Data Extract File layout (Mapping document) created for Issuer Pre-Audit Enrollment file to analyze the data elements of Pre-audit Data file for case resolution.
  • Realized and followed the Form 1095-A Issue workflow processes to better understand analyst roles and responsibilities within the project.
  • Being able to adapt and work efficiently in an agile environment where the cumulative Standard Operative Procedure (CSOP) and Policy directives and decision Matrix documents were in process and unstable during the initial phase of the project.
  • Attended and participated in daily Team call and Managerial Meeting to update the Case status of various Case types and gave walkthrough on complex cases during Peer Review session with Peer Review Team and escalated the cases through Team manager regarding Policy directive and guidance for case resolution.
  • Followed and adhered to the standard policy directive to research and request MIDAS, EDBO and Pre-Audit Data files which contain PHI of consumers to resolve the issue on 1095-A forms.
  • Worked as a Subject Matter Expert (SME) and Mentor to other Analysts to identify and analyze the real issues on consumer’s 1095-A form and helped them in case resolution following CSOP.
  • Communicated effectively with different roles: Data miners issuer, Outreach team and Consumer Outreach Team and special project Team members in the process of case resolution and case escalation throughout the project.
  • Implemented and used OneNote (MS office product) effectively within our Team as a cross- platform for daily updates of work load priority, changes in Policy directive and team collaboration to resolve any issues with complex cases among Team members before any issues were escalated to RO (regional Office of CMS) and upper management for guidance.
  • Adhered to the latest Decision Matrix versions as it gets reviewed and updated for the Case Status and Case disposition within the Case Life Cycle.
  • Worked as QA as part of the Quality checking and auditing of cases to review the case analysis before they were moved to Consumer Outreach Team for further processing.
  • Also verified the test scripts before manual execution if they cover all the aspects of rate and quote details according to State Medicaid and Medicare Policy coverage selection
  • Updated the Analyst notes consistently in 1095 Issue Tracking Page of Share Point of Cognosante according to case analysis in Workbook and customized the view of Share Point for ease access of Case tracking and Daily Report.
  • Researched on HICS (Health Insurance Casework system) portal for additional correlated cases or additional related cases to get additional information like Marketplace Model and case resolution details from issuers (QHPP) and CMS (center for Medicare and Medicaid).
  • Researched on EDBO (CMS Medicare Beneficiary entitlement record or Research file sent by Opera to Cognosante), which is a Macro-enabled heavy Excel file, with certain search criteria or query to extract the rows of valid records of consumers necessary for Case analysis or consumer dispute determination in the workbook.
  • Ensure system configuration and functionality adheres to HIPAA 5010, Medicare, Medicaid other market-specific regulations and business rules.
  • Updated the BUU templates accordingly (Batch Update Utility) to case types to correct the data elements in 1095-A form and exported the workbook to Outbound Excel directory located in shared drive (VPN) for Opera.
  • Used FileZilla as a cross platform FTP application to transfer the encrypted files to the shared drive (remote server) of Cognosante.
  • Prepared Daily Status Report and took minutes of Meeting (MOM) during team meeting for any policy updates.

Environment: Rational Rose, Rational Requisite Pro, MS Word, Rational Clear Quest, MS Visio, MS Project, Java, HTML, Windows XP, Oracle

Confidential, San Diego, CA

Business Analyst

Responsibilities:

  • Acted as a primary contact in all the phases of Software Development Life Cycle SDLC, including Quality Assurance Testing, Performance & User Acceptance testing.
  • Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/ Medicaid claims processing.
  • Performed GAP analysis for ICD-9 and ICD-10 and EDI 5010 X12 Message Structure with the 4010 Structure. Developed End-to-End Business Process Flows for HIPAA 5010 EDI transactions including 834 (Benefit Enrollment and Maintenance), 835 (ERN-Electronic Remittance Notification) and 837 (Claims Submission) Transactions.
  • Worked in the analysis of the ICD 9 - ICD 10 codes conversion Project using GEM (general Equivalence mapping) processes and concepts. Worked in a project involving Miami Systems to create Drug Cards and created Test files to be sent to drug card vendors for approval.
  • Involved in end-to-end testing of Facets Billing, Claim Processing and Subscriber/Member module.
  • Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations
  • Contributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management.
  • Worked on a Paid without prejudice project for various States. Performed UAT tests using the (MORAE) Usability Testing Tool using the Observer and the Manager Mode.
  • Experience in writing SQL queries, Stored Procedures and Triggers.
  • Worked extensively with Tableau and MS Excel for the generating of reports.
  • Responsible for architecting integrated HIPAA, Medicare solutions, and Facets EDI 834.
  • Worked with FACETS, eBilling and EDI HIPAA Claims (837/835/834) processing.
  • Developed test Scripts using Test Director/Quality Center and coordinated with developers to quickly resolve the defects associated with them.
  • Conducted JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications. Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test Conditions to test the performance of the application from various dimensions.
  • Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams. Assisted in creation of the Functional Design Document from the Business Requirements Document, which was used as the reference by the development team while preparing the design and held the responsibility of the required data setup for unit testing.
  • Worked extensively in the executing of SQL queries on the database to verify data integrity.

Environment: IDX, MS Visio, Word, Excel, PowerPoint, CMMI, Rational Rose, Requisite Pro, Clear Case, Clear QuestSQL, Oracle, J2EE technology.

Confidential, Bronx, NY

Business Analyst

Responsibilities:

  • Performed GAP analysis as pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process
  • Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation & Verification process.
  • Created Process Work Flows and responsible for preparing Functional Requirement Specifications Involved in gathering and prioritizing requirements using 1 to 1 interviews, job shadowing, brainstorming & developing questionnaires
  • Develop, design & implement department plan to configure new Facets integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
  • Translated business requirements into functional specifications and documented the work processes and information flows of the organization
  • Used HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions
  • Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I, P, Dental) and 820) standards
  • Contributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management
  • Involved in Up-gradation of HIPAA X12 4010 transactions to HIPAA X12 5010 and ICD-9-CM to ICD-10.
  • Participated in changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
  • Involved in identifying and studying the ACES and Facets system data and field-by-field analysis of Facets system for the attribute mapping purpose.
  • Analyzed the data in the Facets source system to map into the correct field and attribute in the target storage
  • Owner of the business rules document, which documented the business rules across different systems.
  • Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases
  • Created detailed use cases, use case diagrams, and activity diagrams using MS Visio.
  • Led and managed the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that the HIPAA regulation are met across all the modules
  • Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan.
  • Involved in the development of Test Plans, Test Cases and Expected Results, and coordinated the tests with the QA team to verify implementation of new features and enhancements.
  • Conducted user training pertaining to old and new Affinity Provider ID appearing on documents providers receive from Affinity (mainly occur with EOPs, capitation rosters, PCP membership rosters, provider directory listings and some system generated letters)

Environment: MS-Project, Visio, MS Word, Rational Rose, clear case, Requisite Pro, Clear Quest, Test Director, HP QTP, Oracle, EC Map, Facets, HIPAA.

Confidential, Seattle, WA

Business Analyst

Responsibilities:

  • Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
  • Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
  • Manage the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios. Modeling of the business and application using Rational Unified Processing (RUP) and Unified Modeling Language (UML).
  • Performed Gap analysis and assessed risks of the project.
  • Gathered Requirements through interviews and JAD sessions with business owners.
  • Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically with 837, 835, 834, 270/271, and 276/277.
  • Observed extensive troubleshooting for the failures in mapping systems for outbound claim payment transactions (835).
  • Ensured that application was created and maintained in a manner that supports the departmental, user and overall business objectives in coordination with other system vendor products.
  • Performed System Integration and Regression Testing for the Microsoft BizTalk 2002 applications. These are developed to perform EDI translation from ANSI ASC X12 layout to MMIS (Medicaid Management Information Systems) fixed-width record format.
  • Worked as liaison between software developers and users of EMR systems to create better electronic medical record systems.
  • Created test scenarios for EMR systems executed those tests cases and evaluated the results.
  • Experience in working and conducting requirement engineering process and Business process Analysis.
  • Translated and transferred requirements from Business Requirements Document (BRD) to Functional Requirement Document (FRD).
  • Designed Activity, Sequence and Process Flow Diagrams using MS Visio to simplify and elaborate certain selection criteria and filter conditions.
  • Extensively worked with HIPAA Privacy Facets application groups.
  • Enabled successful implementation and usage of the FTP for the extract submission to the corresponding vendor.
  • Was involved in User Acceptance Test using the test cases given by the client before releasing the application.
  • Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.

Environment: J2EE, Java, UNIX, SQL, MS Word, Siebel 7.7, Windows XP, MS Project, RUP, Rational ROSE, RequisitePro, Rational Clear Case, UML, MS Visio.

Confidential, Sterling, VA

Business Analyst

Responsibilities:

  • Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
  • Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
  • Manage the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios. Modeling of the business and application using Rational Unified Processing (RUP) and Unified Modeling Language (UML).
  • Implemented automated COB processing of Medicare claims into Facets
  • Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation & Verification process.
  • Created Process Work Flows and responsible for preparing Functional Requirement Specifications
  • Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the proposed system.
  • Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals.
  • Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions
  • Involved in creating test scripts and test data files for the HIPAA transaction based on the ANSI X12N HIPAA standards.
  • Followed up with the SME in every module to ensure that HIPPA guidelines are being followed.
  • Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets.
  • Worked with the development team to make sure that they understood the user requirements and that the system developed met those requirements.
  • Participated in developing test plans and test procedure templates and guidelines to be used by the project team with detailed screen layouts with regards to various types of corporate actions.
  • Was involved in User Acceptance Test using the test cases given by the client before releasing the application.
  • Involved in the development of Test Plans, Test Cases and Expected Results, and coordinated the tests with the QA team to verify implementation of new features and enhancements.
  • Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.

Environment: Windows XP, SQL, MS-Visio, MS Word, Rational Rose, HTML, HIPPA, JSP, Oracle, Requisite Pro.

Confidential, Baltimore, MD

Business Analyst

Responsibilities:

  • Involved in business analysis and project management, coordinating between the team members, addressing budget issues and creating test plans according to the business requirements.
  • Worked with the project manager for planning and organizing the project activities, and in communicating with other business center mangers and stakeholders of the project.
  • Involved with the business partners to define requirements, determine solution alternatives, and develop high-level designs and estimates.
  • Defined and documented the vision and scope of the project.
  • Met with various groups, including business owners, SMEs (subject matter experts) and marketing team, for requirements gathering in definition Stage.
  • Gathered requirements, developed Process Model and detailed Business Policies.
  • Designed Use Cases using UML and managed the entire functional requirements life cycle using RUP.
  • Managed multiple vendors in the project (Issue & Risk management and timely project deliverables).
  • Followed the RUP methodology for the entire SDLC.
  • Involved in writing and implementation of the test plan, and various test cases.
  • Initiated, proposed and implemented critical analytical and technical turnkey solutions extensively increasing the quantitative and qualitative value of the application.
  • Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
  • Build and managed a cohesive team to meet deliverables per project / track assigned.
  • Provided customer support as required to meet service level agreements.
  • Prepared the Business Workflow using MS-Visio with input, output, Pre and Post conditions.
  • Enhanced test cases and scripts by adding the required functionality as per the new business requirements.
  • Defect Tracking and Bug Reporting was performed using Test Director.
  • Worked with the clients on the final signing process in the User Acceptance stages.

Environment: Rational Rose, Rational Requisite Pro, MS Word, Rational Clear Quest, MS Visio, MS Project, Java, HTML, Windows XP, Oracle

Hire Now