- Experienced data analyst and business analyst with 9 years of experience in Business analysis and Project Management.
- Good knowledge and experience in Software Development Life Cycle (SDLC) and its phases: Requirement gathering, Analysis, Design, Implementing, Testing, Deployment, and Maintenance.
- Used various approaches of SDLC like Agile, RUP, and Waterfall
- Experience in design, development, testing, implementation and support of Enterprise Resource Planning (ERP).
- Create Functional Specification Documents and Data Mapping Analysis for System Integrations.
- Technical experience in Interfaces, Data conversion and Data mapping.
- Experience in conducting GAP analysis, SWOT analysis, Impact analysis, Cost benefit analysis, Risk analysis.
- Well versed in Business Process Modeling with expertise in creating User Cases, Sequence Diagrams, Class Diagrams, Activity Diagrams, writing User Stories.
- Experience in tracing requirements and using Requirement Traceability Matrix (RTM).
- Good knowledge on Patient Protection and Affordability Care Act (PPACA), Clinical, Health insurance Marketplaces, Medicare, Medicaid, Medicaid Management Information system (MMIS).
- Knowledge of healthcare and pharmacy data (claims, billings, fees, eligibility, benefits, encounter) and statistical analyses.
- Well versed in generating and evaluating Functional Requirement Documents (FRD), Business Requirement Documents (BRD), Work Breakdown Structure (WBS).
- Well versed with the HIPPA 4010, 5010, ICD - 9, ICD-10, HMO, PPO, HL7.
- Conducted and participate in Joint Application Development (JAD). Worked with HIPPA ANSI X12 4010 and ANSI X12 5010, and medical transactions like 270, 271, 276,277, 835, 837I, 837P, 837D.
- Highly motivated with multitasking capabilities, and analytic thinking. Efficient in working alone and in a team, with a proven ability to work under pressure, and meet deadlines.
- Good interpersonal and communication skills, ability to work in a diverse environment, and highly desired to learn client’s business requirements.
Methodologies: Agile, Scrum, RUP, Waterfall
FrontEnd Tools: MS Excel, MS Office, MS Project
Testing Tools: Testing Tools: Quality Care, HP ALM, HP Mercury Quality Center, Quick Test pro, SOAP UI, Log defects
Bug Tracking Tools: Rational Clear Case, Jira, TFS
Modeling Tools: Rational Rose, MS Visio, Caliber RM
Project Management Tools: MS Visio, MS Project, Share Point 2010
Languages: UML, XML, HTML, SQL C, C++, JAVA
Databases: IBM Mainframe, Oracle 12, FACETS, SQL Server, NoSQL
Web Services: XML, XSD, JASON
Confidential, St Paul, MN
Senior Business Analyst
- Served as Senior Consultant responsible for designing, developing, testing, documenting and delivering technology solutions for Microsoft Dynamics ERP, Management Reporter, Crystal Reports, and SQL Server including customizations and alterations to existing applications.
- Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
- Worked in a combination of Agile and Waterfall.
- Studied existing business process and created AS-IS workflow to illustrate the existing system.
- Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation, and testing for Medicaid Claims.
- Analysis of complex MMIS System database design, reports and system processes. Supported the implementation and enhancement of Statewide MMIS, Web portal, and integration.
- Responsible for gathering requirements, data mapping, and gap analysis in changing old MMIS and Involved in testing new MMIS.
- Responsible for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
- Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: application software, networks, servers, internet and desktop configuration.
- Assisting the project manager in creating the business case, project plan and data flow analysis.
- Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
- Actively analyzed current business processes (Claims, Recipient eligibility and enrollment, encounter etc.) and worked with management to improve and implement enterprise solutions to ensure compliance.
- Created process flow of EDI X12 837 P/I/D, 835 rules in claim processing module.
- Responsible for receiving claims and encounters using EDI 837.
- Correctly identified errors and refilled denied/rejected claims.
- Responsible for creating data flow analysis and processes and creating management reports based on the analysis.
- Followed the UML based methods using Rational rose to create use cases, activity ER diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
- Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.
- Defects and bug testing by using Rational Clear-Quest, Configuration management and Version control with Clear-Case.
- Performed security assessment of the health information as per the HIPPA guidelines and also the integrity and confidentiality of the user information.
- Identified UI requirements, created Wireframes, Prototypes and UI specification.
- Performed technical artifacts of the system as per the state guidelines.
Environment: RUP, ANSI X12- EDI UML, Rational Requisite Pro, SQL, Jira, Oracle 12, SharePoint, MS Visio, MS Excel, MS PowerPoint, MS Word, MS Access, HP ALM.
Confidential, Columbus, OH
Senior Business Analyst and Data Analyst
- Work on Commercial line property insurance in Agile methodology.
- Gathering requirements for Commercial Line Transformation Product and Pricing - Interface team.
- Requirement gathering from Inception and creating RTM, Functional Specification Documents and Data Mapping Analysis for System Integrations.
- Responsible for defining the key identifiers for each mapping and data modeling process.
- Responsible for conversion of data in Data Mapping and writing transformation rules.
- Responsible for documenting the mapping and requirements for interface and conversions between the source and applications.
- Worked with Vendor Interface Program to load data from legacy system in to temporary table on Excel to validate the data.
- Clarify, communicate and document requests for change requests from As-Is to To-Be process and coordinate with the testing and development team.
- Experience with developing User Stories throughout the Agile Lifecycle as well as created UML diagrams such as Use Case, Activity, ER diagram and Chart diagrams with MS Visio.
- Designing storyboard in MS Visio.
- Worked on researching and pre-grooming user stories by understanding the business requirements as stated in the business requirements matrix by including key members from business teams, underwriting team, and closing SMEs and later translating those in an IT standpoint to explain the work to the team.
- Participated in daily Agile Scrum, Sprint Planning and Retrospective Sessions and update the team on status of upcoming User Stories for the a project of changing the client's software maintenance structure of their various software products.
- Provided support for complex business Data Management, for billing, claims, and submission.
- Facilitated Joint Requirement Planning (JRP) sessions with Business User Groups, along with conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
- Identified efficiencies in "current state" of casualty underwriting divisions and helped with development and implementation of "future state" plan (As-Is/To-Be) by removing non-value added process and workflow automation.
- Involved in formal requirements gathering methodologies, and developed reports based on specifications.
- Involve in meetings to analyze the services and process. Conducted detailed assessment of operational workflow.
- Coordinate tasks with other programmers, business users, database administrator, mainframe team, testing team and development team.
- Ensured all technical artifacts complied with corporate SDLC Policies and guidelines.
- Worked with technical team to improve report performance and performed system testing. Performed tasks like test cases, identifying defects, screen mockups, quality reporting, data cleansing and data quality.
- Performed black box testing, integration testing, and User Acceptance Testing. .
Environment: Mainframe system, XML, WSDL, Oracle 12, SharePoint, Rational Requisite Pro, SOAP UI, Windows XP, MS Visio, MS Excel, MS Access, MS PowerPoint, MS Word.
Confidential, Des Moines, IA
Senior Business Analyst
- Developed and participated in business functional requirements planning and enhance IT’s business knowledge base.
- Managed requirements organization, prioritization and their lifecycle/traceability through technical solution delivery and transition to support and operations.
- Worked with client to gather Business/Technical Requirements, Approval of CR (Change request), Design and Implementations for State MMIS.
- Supported the complex MMIS system design, development, and implementation.
- Responsible for designing future state processes for ICD 9-10 Crosswalk Table and drafted High Level Business Requirements for ICD 9-10 conversion mapping.
- Responsible for conversion of HIPPA 4010 in the new system and eventually moving to HIPPA 5010.
- Designed, developed, tested, documented and delivered technology solutions for Microsoft Dynamics ERP and CRM solutions including customizations and alterations to existing applications.
- Worked on creating State based Rule requirement document with Rule ID (CFR number).
- Researched on state based rules, configuration to be implemented in integrated eligibility system.
- Gained extensive experience in designing/modifying the CICS screens for various areas such as Enrollment, Billing, Provider Record and Reimbursement Status in MMIS.
- Wrote clear, concise detailed System Requirements Specification (SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance
- For eligibility, responsible for creating wireframes for the web based application enhancement.
- Experience in implementation of ICD-9 codes and ICD-10 codes changes in the current claim processing modules in MMIS.
- Involved with the 837 (Claims and encounter), 835,834, 820 HIPPA-EDI Transaction Code Sets.
- Analyzed the new NCPDP d.0 fields against existing NCPDP 5 fields and identified the modification, additions and deletion via the As-Is/To-Be process.
- Tracked defects and assured overall performance of the pharmacy claims system.
- Researched, validated, and resolved claims.
- Worked on HP Quality Center 10.0 which include Defects Management, Test Plan and Dashboard.
- Talking to the client based on requirements of that particular defect, uploading document required, checking history, status notes, setting up resources to handle and fix it.
- Worked on Rational Requisite Pro application to handle various requirements including Functional requirements, High-level requirements, Non-functional requirements, Scope statement and User requirements.
- Prepared SQL queries and generated security reports,
- Created standard business process models as well as conceptual prototypes and mock-ups when necessary.
- Managed System Integration testing for delivery teams and User Acceptance Testing.
- Managed and documented business, functional and non-functional requirements.
- Assisted in designing and implementing solutions for storing documents from Onbase repository.
- Implemented Unified Modeling Language (UML) methodologies for process modeling and developing use cases.
Environment: IBM Mainframe System, IBM Cognos, SQL Server, FACETS, Jira, Oracle 12, Microsoft Dynamics, SharePoint, HP Quality center and ALM, Rational Requisite Pro, MS Access, Excel.
Confidential, Columbus, OH
Business System Analyst
- Implemented the SDLC for the developing life cycle in agile approach and followed the standards process in the application.
- Translated business requirements into functional requirements and approaches for developers.
- Provided management support to the off-shore End to End integration/ Regression Test Team.
- Workflow documentation and comprehensive training to the healthcare clients.
- Analyzed corporate healthcare business processes to develop customized solutions.
- Working with Medicare operational management to monitor, trend and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
- Gathered requirements for Medicaid and CHIP insurance coverage and performed data analyses.
- Analyze federal and state regulations/ policies for Medicaid and CHIP reimbursements.
- Interacted with healthcare clients to gather requirements, objectives, and input and output requirements.
- Developed Use case, Functional, Object diagrams using Rational Rose.
- Supported in collecting HIPAA related EDI transactional data from data warehouse.
- Worked on changes of implementation, expected of HIPAA X12 transactions EDI 837,835, 270/271,278,834 in future upgraded system.
- Responsible for architecting integrated HIPAA, HL7 messages, Medicare solutions, Facets.
- Assisted in planning and test process for Pharmacy Claims.
- Developed test cases and scripts for front end testing. Performed execution of test cases manually to verify expected results.
- Ensured the accuracy and consistency of the data during the data loading process.
- Assisted in documentation of the Onbase solutions using Microsoft Visio and Project.
- Developed a detailed test plan and test cases to cover all the requirements.
- Used Rational Rose to create UML diagrams such as use case, activity, sequence, class and component diagrams.
- Developed Flowchart and process diagram using Microsoft Visio.
- Analyzed data architecture, documented and delivered data mapping, performed risk analysis.
- Frequently communicated with developers to resolve technical issues.
Environment: SQL, IBM Cognos, MS Office, SharePoint, MS Visio, UML, Rational Rose, Jira, Windows XP.
Business Analyst and Data Analyst
- Assist with creation and maintenance all necessary documentation and training materials for Epic Ambulatory application.
- Performed analysis, design, development and maintenance of the Epic Ambulatory applications and other clinical information systems.
- Experience with EPIC user and provider record provisioning, including the development of role-based, security classes, and user profiles.
- Experience in Epic Resolute product implementation and deployment.
- Hands on experience with Epic Hospital Billing and Ambulatory.
- Experience with Epic Healthcare Information Systems.
- Conducted user interviews, gathered requirements, and analyzed the requirements.
- Worked with the business team to collect the business requirements, security and service level requirements and documented them.
- Analyzed set behavior and contribution to business performance, critical business metrics & tracking underlying business trends using Business Objects.
- Participated in the logical and physical database design sessions and developed design documents.
- Performed collection, coding, and assessment and reporting of adverse event data using ARISg.
- Worked in the ARISg Implementation of the EHR-Pharmacy Module.
- Captured all HIPAA-related EDI data in the repository using FACETS.
- Accepted inbound transactions from multiple sources using FACETS.
- Supported integrated EDI batch processing and real-time EDI using FACETS.
- Recommend tactic to implement HIPAA 4010 (EDI X12 835, 837,834,278,270) in the new System.
- Worked on Electronic health record system as a CRM web based application.
- Working Experience in Electronic Submissions in standard format E2B.
Environment: SAS, MS Project, JAVA, MS Visio, MS Excel, MS PowerPoint, MS Word, MS Access, EPIC, FACETS, and Rational Requisite Pro.