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Business Analyst Resume

Hartford, CT

PROFESSIONAL SUMMARY:

  • Over 8+ year’s expertise in Business Analysis, Quality Assurance and Testing with hands on experience in Healthcare and Insurance sectors.
  • Having strong experience with data mapping and SQL skills
  • Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS - Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
  • Having strong experience with Data Mapping, SQL, MS Office Suite, MS Project, Microsoft Team Foundation Server
  • Experienced in data integration, business data, data mapping, risk management and compliance, Cleaning & Mapping, metadata management, ETL, data modeling tool sets
  • Complete Understanding of HIPAA Implementation guides and developing Business Specifications according to Mapping Notes for Transformation tools
  • Strong understanding of data modeling, data warehousing, and ETL concepts
  • Managed and prioritize staffing assignments to meet customer demand for tier 1.5 support of Provider applications
  • Extensive experience in conducting Market Research, Feasibility Studies, Data Analyses, Data Mapping, Data Profiling, Gap Analyses, Risk Identification, Risk Assessment, Risks Analyses, and Risk management.
  • Extensive experience in conducting Market Research, Feasibility Studies, Data Analyses, Data Mapping Gap Analyses, Risk Identification, Risk Assessment, Risks Analyses, and Risk management
  • Extencively worked on Agile Scrum development and Project Management Office (PMO) projects
  • Worked closely with PMO and assisted in monitoring various project deliverables and involved in developing Project Plans, Project charter, project dashboards, Objectives and timelines and maintained the repository for all deliverables
  • Extensive working experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from a Operational Data Store to a Enterprise Data Warehouse
  • Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
  • Directly managed multiple projects involving multiple team sizes. One of the key projects involved Clinical Trial using SCRUM development methodology handling highly sensitive data. Recommendations established new firm wide coding and testing standards
  • Skills include defining Project Scope, Business Process Analysis, Business Process Reengineering, Requirements Gathering, Data and Process Modeling
  • Expert in MS Office
  • Strong knowledge of the Software Development Life Cycle methodologies (phases and gates) like Agile and Waterfall models
  • Working knowledge of implementing software development projects using methodologies such as Waterfall, Rational Unified Process, and Agile/Scrum
  • Experience with Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP), involved in inception, elaboration, construction & transition phases using rational tools like RequisitePro, ClearCase, ClearQuest during various phases of RUP.
  • Extensive experience in Business Requirements gathering and writing skills with expertise in developing and documenting Business Requirement document (BRD), Functional Requirement Document (FRD),Software Requirement Specification (SRS) across the deliverables of a project.
  • Strong Subject Matter expertise(SME) in ARMS Medical Billing Information System, Market Research, Risk Management, Product Development, Banking, Risk Analysis, Asset Management- risks and returns.
  • Effectively used Rational Requisite Pro to organize, track and change requirements of the system.
  • Heavily participated in the design and implementation of extensive healthcare accounts receivable software that transitioned focus from vendor to payer.
  • Expertise of UML in visualizing and documenting the artifacts using Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams, Sequence Diagrams using MS Visio
  • Experienced working on 4010 and 5010 HIPAA implementation guides relate to Claim Testing and Medical Billing
  • Experience in facilitating Joint Application Development (JAD) sessions, Rapid application development (RAD) sessions, conducting user interviews and acting as a liaison between the customers, development team and testing team
  • Comprehensive experience in Root-cause analysis, SWOT analysis, Feasibility studies, GAP and Variance analysis, Impact analysis, Risk analysis
  • Experience working with query languages like SQL
  • Experience in working with QA team to develop the Test plans, Test scenarios, Test procedures, and Test cases to ensure adequate testing of software both before and after completion.
  • Proficient in using version control tools such as Clear Case, Bug tracking tools such as Clear Quest, Test Director
  • Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users as well as trained users to use the system configured.

TECHNICAL SKILLS:

UML Tools: MS Visio

Req Mgmt Tools : Requisite Pro, Clear Case/ Clear Quest

Testing Tools: Quality Center, Test Director, Win Runner, QTP, Load Runner

Databases : Oracle, Microsoft SQL Server, Tableau, DB2, MS Access

Languages : JAVA, J2EE, SQL, PL/SQL, .NET, Java Script, VB Script, C, C++

Web Technologies : HTML,DHTML, CSS, XML

Operating Systems : Windows XP/2003 Server/NT, UNIX

Others /Reporting Tools : Microsoft Office Suite, Business Objects, Crystal Reports, Agile, RUP

PROFESSIONAL EXPERIENCE:

Confidential, Hartford, CT

Business Analyst

Responsibilities:

  • Complete study and analysis of Revenue Cycle management of the health stream respective to existing billing system, Claims processing, etc
  • Worked in Data Analysis, Data Reconciliation and Data Mapping for ETL process
  • Worked closely with PMO and Project Manager to prepare Project Plans, Project Milestones including the Project Charter, Scope and interacted with PMO office to ensure timely submissions of all project
  • Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
  • Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions
  • Develop detailed unit test plans and scripts and conducted rigorous testing per requirements and assisted in data mapping
  • Worked closely with PMO in all the phases, Project Initiation, Project Planning & Design, Execution & Build, Implementation, Project Closeout
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
  • Responsible for Revenue Cycle Management accounts receivable and reporting
  • Worked with development, technical staff, and branch operations staff, to implement new hardware, and Imaging and Workflow application technology in order to streamline Medical Billing operations.
  • Proficient in Data modeling and mapping ER diagrams and hands on experience with ERWin data modeler
  • Performed gap analyses and gathered requirements for multiple components on Prime Suite such as -eRx (*Electronic Prescription), Prime Patient, RCM/AR Management (*Claims Processing, Registration process, Charges page, COB page, Statement Generation, Schedule Actions page, HIPAA 5010 Compliance) and XBAP conversion into Silverlight).
  • Introduced Agile and RUP methodologies to reflect liquid nature of front-office improving time-to-market
  • Defined rules for data migration as part of 5010 project (*Prepared data flow diagrams, identified datasets, defined rules for data fields and data validation).
  • Provide solutions on Claim Processing Application for the implementation of HIPAA mainly used for AR (Accounts Receivable) claims
  • Designed mock ups using Balsamic tool for the-Criteria Set Editor page (*Claims Maintenance Page), statement generation wizard (*Statement page), documented rules for user navigation and user control buttons.
  • Involved in eliciting requirements via SME interviews, document analysis, requirements workshops, surveys, business process descriptions, use scenarios, and workflow analysis.
  • Developed problem statements, system specification document according to the standard templates.
  • Decomposed high-level business requirements into system specific details (* use cases and user stories),
  • Involved in coordinating between the onshore and offshore technical teams and successfully resolved technical issues.
  • Automated GL offset entries between Accounts Receivable and Accounts Payable for customer and vendor invoicing.
  • Responsible for providing RCM recommendations for all the identified gaps for each transaction the 5010 compliance
  • Proactively communicated and collaborated with stakeholders as appropriate to achieve consensus on requirements.
  • Critically evaluated the information gathered from multiple sources and reconciled conflicts.
  • Served as a business process expert/point of contact within the agile project team
  • Involved in product implementation and roll out process (*TFS, Sharepoint, SourceSafe)
  • Successfully engaged in multiple initiatives simultaneously and involved in testing operations and defect follow up and developed test plans and scenarios (*Mercury Quality Center)
  • Provided oversight for application development to both the technical team and QA team
  • Worked on developing Greenway Product documentation.
  • Provided demo of the applications, obtained user feedback and approval.

Environment: ASP.net. XBAP, Data Mapping, Silver light, AGILE/SCRUM, JIRA, Business Intelligence, ETL, Mercury Quality Center, SharePoint, Sql server, Source safe, Data Modeling, Web UI, Java, PowerBuilder, COBOL, Balsamic UI tool, Expression Blend, MS Report Builder, TFS.

Confidential, NYC, NY

Business Analyst

Responsibilities:

  • Employed Rational Rose to visually determine the proper structure, key elements and optimal design for database and to aid efficient creation of tables, stored procedures.
  • Involved in Data mapping specifications to create and execute detailed system test plans. The data mapping specifies what data will be extracted from an internal data warehouse, transformed and sent to an external entity
  • Designed and developed Project document templates based on SDLC methodology
  • Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
  • Developed Project Plans, Project Milestones including the Project Charter, Scope and interacted with PMO office to ensure timely submissions of all project deliverables as well as MIS reporting
  • Employed impact analysis, data analysis and risk analysis for User Acceptance Testing (UAT).
  • Monitored client accounts and performed essential revenue cycle management processes to ensure complete and efficient processing of claims by generating and monitoring reports and analyzing data to identify areas for improvement, new sales opportunities, and education
  • Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from a Operational Data Store to a Enterprise Data Warehouse
  • Establish documentation for Agile methodology for implementation with a very water-fall-centric development team
  • Improved the new revenue cycle management and Electronic Medical Record (EMR) for PARTNERS.
  • Developed Entity Relationship Diagrams for Accounts Receivable.
  • Strong Knowledge and understanding of ICD-9-CM and ICD -10-CM coding and claims processing. Also, well versed in Medicare Part A, Part B, Part C and Part D enrollment.
  • Involved in managing multiple projects in the provider domain including but not limited to EHR/EMR and RCM applications
  • Reviewed information gathered from multiple sources during requirement gathering and analysis and employed Rational Requisite Pro for tracking, tracing and managing requirements
  • Accountable for designing future state processes for HIPAA 5010 transaction processing EDI's 837 and 835.In addition Reviewed HIPAA 5010 related to 834 Transactions and conducted gap analysis between HIPAA 4010 AND HIPAA 5010.Proficient in creating and maintaining Workflow plans and artifacts.
  • Familiar with Facet processing system.
  • Enforced an integrated RUP solution with complete line of traceability for all the artifacts of web development projects
  • Planned a strategy, road map and allocation pattern for claims processing, effectively resolving accounts receivable claims.
  • Employed MS Project for various planning and budgeting activities.
  • Supervised, reviewed and model Test plans, Use Case Model cases &Test procedures based on RUP methodology
  • Wrote viable detailed user documentation and System Requirements Specification(SRS) documents with the purpose that developers could formulate application with minimum guidance
  • Organized SWOT Analysis for better market understanding and fool proof project implementation
  • Conducted UAT and registered test results according to the test plans using Test Director.
  • Create Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models
  • Supervised the functional aspect in accordance with the Business Process and validated the interfaces with the other systems and data conversion from the existing system
  • Conducted Requirement Traceability Matrix(RTM) for requirement elicitation and linkup to deliverables
  • Formulated Quality Assurance standard and processes for all levels of project team
  • Conducted Gap analysis for the modules in production, organized feasibility study and conducted impact analysis for proposed enhancements
  • Proficient in creating and maintaining Workflow plans and artifacts

Environment: Rational RequisitePro, Microsoft Office (MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access), RUP, XML Oracle, Web UI, Java, Data Mapping, PowerBuilder, Data Modeling, COBOL, Tableau, JIRA, RUP, AGILE/SCRUM, UML, SQL

Confidential, Minneapolis, MN

Business Analyst

Responsibilities:

  • Interviewed various SME's for detailed business processes and to understand the Collections and Recoveries side of the business segments. Interacted with the Business Team through JAD sessions, to gather requirements and develop complex business maps
  • Having strong Data Modeling experience with detailed source-to-target data mapping and data transformation rules
  • Analyzed data to identify gaps between security policies, practice, prepare report and validate with stakeholders and the business entity requesting HITRUST certification.
  • Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows
  • Followed up on assessment findings and action plans to ensure completion by key stakeholders.
  • Anticipated customer needs around the assessment process and proactively developed solutions to help them be compliant with the HITRUST framework.
  • Extensive working with data modeling diagrams and creating ER diagrams with the understanding of data flow at back end interfaces.
  • Develop detailed unit test plans and scripts and conducted rigorous testing per requirements and assisted in data mapping.
  • Familiar and have knowledge of NIST SP 800-53 recommended security controls
  • Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives
  • Gathered requirements for modules Enrollment/Registration (Patient Demographics, Medical History etc.) and Medical Billing (Demographic entry, CPT/ICD-9 coding, Charge entry, Claims submission, Post payment, etc.) . Documented using Product Backlog.
  • Having strong Data Modeling experience with detailed source-to-target data mapping and data transformation rules
  • Conducted routine meetings with PMO and other cross functional team members for better organization and documentation of existing documents such as project plans, project meetings and requirements
  • Utilize best-practice recommendations to perform billing workflow process re-design and financial analysis to optimize practice revenue cycle management specific to practices' unique needs and specialties
  • Responsible for planning Daily Scrum Meetings and actively participated and assisted scrum master in identifying sprint backlogs and prioritizing requirements for Enrollment/Registration and Medical Billing Process.
  • Managing various levels of Projects in accordance with SDLC standards, worked as a project lead/PM for various projects.
  • Acted as project manager/lead with creating detailed project plans and assisted in developing, scheduling and tracking project timelines using MS Project. Functioning as a primary POC and IT liaison for various projects.
  • Manages the reconciliation of accounts receivable on monthly basis
  • Maintaining a Traceability Matrix to ensure that all Functional Requirements are addressed at the Use Case Level as well as the Test Case Level.
  • Mapping client's requirements and providing them with the best IT solutions involving evaluation and definition of scope of project.
  • Performed GAP analysis to derive requirements for existing systems enhancements.
  • Designed and developed Use Cases and Use Case Scenarios using UML methodologies.
  • Auditing of medical codes (CPT, ICD, HCPCS) coded by team.
  • Develop Business Requirements for all 5010 EDI transactions.
  • Development of business rules and testing for HIPAA compliance certification of healthcare standards.
  • Provide solutions on Claim Processing Application for the implementation of HIPAA mainly used for AR (Accounts Receivable) claims.
  • Directed and managed the Change Management Control process for the projects by facilitating group meetings and/or one-on-one interviews/meetings with work stream owners to discuss change request impact on timelines and scope.

Environment: SDLC, Agile, Web UI, Java, Data Modeling, PowerBuilder, COBOL, Scrum, UML, JIRA, AGILE/SCRUM, HITRUST, Clear Case, XML, Data Mapping, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), SQL, MS Access, MS Project, MySQL, Requisite Pro

Confidential - Burlington, MA

Business Analyst

Responsibilities:

  • Performed internal reviews for the team to improve quality and attain higher productivity
  • Provided analytical inputs for improving cash collection and reducing the assigned AR
  • Reviewed requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows.
  • Took initiatives to design new work strategies that helped in reducing claim resolution time
  • Generated multiple automated reports and strategies for smooth process flow
  • Develop detailed unit test plans and scripts and conducted rigorous testing per requirements and assisted in data mapping
  • Involved in migration of the ICD-9-CM code sets used by medical coders and billers to report healthcare diagnoses and procedures with ICD-10 code sets.
  • Involved in EHR applications, HIPAA 4010-HIPAA 5010 and ICD9 - ICD10 conversions.
  • Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards.
  • Ensured that images are mapped, indexed and made online for real-time availability
  • Quality and error analysis for inputs to the process gap analysis study
  • Providing team with all useful findings in US Healthcare which expedite claim processing Automation of 276/277
  • In depth analysis on web scraping output to reduce manual intervention
  • Analyze the business functionality of CMS
  • Identified many Denial & Carrier specific trends
  • Directed and managed the Change Control process for the project as a whole by facilitating group meetings, one-on-one interviews/meetings and corresponding through emails with work stream owners to discuss the impact of change request on the project
  • Providing detailed reports to show the status of accounts
  • Assigning work to team based on the client requirements

Environment: Data Modeling, MS Office, SQL Server, Agile, SCRUM, Rational Clear Quest, Rational Clear Case, Rational Requisite Pro, Rational Rose, UML, RUP, .Net, JIRA, Tableau, Web UI, Data Mapping, Java, PowerBuilder, COBOL, MS Excel, MS Word, MS Power Point, MS Visio, MS Access

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