SUMMARY:

• Confidential has 9+ years of professional experience as a Business Analyst with excellent understanding, analyzing, and documenting Business Requirements, Functional Specifications, Business Process Flow, Business Process Mapping, and Modeling.
• Experience as Business Analyst with expertise in Healthcare processes, Business Process Engineering, Systems/ Solutions Engineering, Strategic Planning, and Systems Analysis.
• Extensive experience in analyzing and requirements gathering and writing system functional specifications.
• Strong knowledge of Healthcare industry including HIPAA with emphasis on Business Requirements and Functional Requirements.
• Extremely proficient in using Agile and XP methodologies performed roles of Scrum Master following sprint sessions and used Rally software extensively to write User Stories, assign tasks to individual team members.
• 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).
• Strong knowledge of managed care payer requirements and procedures.
• Familiar with HIPAA EDI transactions such as 834, 837 (P, D, I) 276, 277, 278 etc.
• Excellent Knowledge of Siebel CRM eBusiness Platform and underlying architecture.
• Excellent knowledge of the out-of-the-box capabilities of Siebel Healthcare, Siebel Service Request Management, Siebel Order Management.
• Familiar with HIPAA EDI transactions such as 820, 834, 837 (P, D, I) 276, 277, 278 etc.
• Good Knowledge of HIPAA Compliance Lifecycle, HIPAA Insurance Regulations and Claims Processing.
• Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
• Experienced in developing reporting application using ETL (Informatica) and Cognos Business Intelligence Suite with multiple data sources like Oracle, MS SQL and DB2 database.
• Experience with QNXT 3.4, QNXT 4.6, Facets 4.71, Inbound & Outbound interfaces, EDI configuration, and data mapping using Confidential 4010 and 5010 (834,835,837) .
• Extensive experience working in back end tester by writing SQL Queries and PL/SQL scripts on large data warehouse systems involving Terabytes worth of data.
• Expertise in Logical Modeling, Physical Modeling, Dimensional Modeling, Star and Snow-Flake schema
• Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from an Operational Data Store to an Enterprise Data Warehouse
• Sound understanding of Relational and Normalized databases such as Oracle SQL Server and MS Access
• Solid understanding of Rational Unified Process (RUP) using Rational Rose, Requisite Pro, Unified Modeling Language (UML), Object Modeling Technique (OMT), Extreme Programming (XP), and Object Oriented Analysis (OOA).
• Working knowledge of implementing software development projects using methodologies such as Waterfall, Rational Unified Process, and Agile/Scrum.

TECHNICAL SKILLS:

• RUP
• UML
• SDLC
• Waterfall
• QA
• MS Access
• TOAD
• SQL Server
• MySQL
• PL/SQL
• SQL
• Oracle DBA
• Windows 98/2000/XP basic UNIX
• HTML basic DHTML basic XML
• MS Office Suite-Excel Macros
• JAVA
• JavaScript
• SAS
• Project
• Visio
• ClearQuest
• Adobe Photoshop
• Flash
• Rational- Rational Rose
• Rational XDE
• EMR
• Mercury Test Director
• DOORS
• Business Process Modeler
• RequisitePro
• Analyst Studio
• Crystal Reports
• Business Objects
• Microstrategy

PROFESSIONAL EXPERIENCE:

Confidential, Baton Rouge, LA

EDI/Business Analyst

Responsibilities:

• Defined a complete set of metrics report requirements including a framework that will meet the needs of regional and national business leaders
• Provided analytical data to enable management to make informed decisions to drive continuous revenue cycle improvements by realizing gains in operational efficiency, cost savings and member experience
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes
• Worked on health information exchange (HIE).
• Created and conducted statewide HIPAA 5010 and ICD-10 awareness program for all IDS staff in the client.
• Rendered Confidential Syntax Integrated Testing, Balancing Testing, Code Testing, Specialty Testing and Trading Partner Specific Testing when environment is upgraded.
• Identified various data sources for the system including Charles River Trading System, Murex Trading Platform, and investment systems and data warehouse.
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Familiar with HIPAA EDI transactions such as 834,835, 837 (P, D, I) 276, 277, 278 etc
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Used the DataStage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Schedule SMEs for Business Process Validation Meetings
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose.
• Led HIE (HealthCare Information Exchange) interoperability projects connecting disparate systems using data exchange, while providing a single patient portal for the patient to access their individual patient health records
• Acted as a Subject Matter Expert on Application knowledge for preparing training presentation, Quick Reference Guides and assisting with any issues/questions that arose from training
• Involved in interactions with Subject Matter Expert, Project Manager, Developers, and the end-users in more than one JAD sessions. MS Project proved useful in coordinating activities with project manager and various other team.
• Performed GAP analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Coordinated JAD session with system analysts, development team, project manager for application development and Pre-validation specifications

Environment: Windows 7, Oracle, PL/SQL, MS-Project, MS-Office Suite, MS Visio, Rational Requisite Pro, UML, Clear Case, Clear Quest, MS Visual Source Safe

Confidential, Bismarck, ND

Business Analyst

Responsibilities:

• Defined a complete set of metrics report requirements including a framework that will meet the needs of regional and national business leaders
• Provided analytical data to enable management to make informed decisions to drive continuous revenue cycle improvements by realizing gains in operational efficiency, cost savings and member experience
• Created drill down from the high level summary metrics to the supporting detail in the current report format
• Collaborated with management and senior-level engineers to develop code for new features used within a Health Information Exchange(HIE).
• HIPAA EDI transactions such as 834,835, 837 (P, D, I) 270, 271, 276, 277, 278.
• Identified performance indicators that provide reliable daily trend information as a primary input towards the monthly executive dashboard report.
• Experience in implementing and managing the implementation of software, hardware and hybrid solutions to enable Electronic Health Records (EHR) and Health Information Exchanges (HIE)
• Converted Confidential data to XML (using DI) and verify the data by performing schema validations.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Conducted JAD sessions with SMEs and technological experts to gather data requirements such as securities pricing, corporate actions, trade and custodial data.
• Analyzed and drafted a functional and technical features list for each vendors, thus identifying the best to send out a RFP
• Responsibilities included source system analysis, data transformation, loading, validation for data marts, operational data store and data warehouse.
• Identified and drafted the calculations used for various regions, using their source SQL’s for standardization purpose.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Prepared for GAP Analysis; identified and documented improving areas to meet capital requirement regulations.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• Responsible for scheduling meetings with users, SME’s and stakeholders to identify problems resolve issues and improve the process to ensure a stable and accurate solution.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Involved in interactions with Subject Matter Expert, Project Manager, Developers, and the end-users in more than one JAD sessions. MS Project proved useful in coordinating activities with project manager and various other team.
• Modelled the information and then came up with the requirements prioritization. Eliminated false requirements by screening out multiple versions of user input. Final prioritization was based on both, product and process requirements.
• Performed GAP analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• Coordinated JAD session with system analysts, development team, project manager for application development and Pre-validation specifications

Environment: Windows XP/2000, Oracle, PL/SQL, MS-Project, MS-Office Suite, MS Visio, Rational Requisite Pro, UML, Clear Case, Clear Quest, MS Visual Source Safe

Confidential, PA

Business Analyst

Responsibilities:

• Translated Business Requirements and user expectations into detailed specifications employing Unified Modeling Language (UML), MS Visio.
• Using UNIX console commands to check database has been connected the other functionalities.
• Worked With HIPAA compliant Confidential 837 formats for both professional claims and institutional claims.
• Written multiple Use Cases for EDI transactions (Inbound and Response) including 837, 276, 277, 835, 834, 820, 270, 271 transactions.
• Designed conceptual and logical data models of Data Warehouse and tables.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Enrollment pre-processing and Facets Enrollment MMS batch loading processes. This included mapping 834 & proprietary enrollment files & data to to FACETS enrollment keyword files.
• Involved in performance measurement of ongoing data collection to determine if a program is implementing activities and achieving objectives.
• Developed and distribute necessary documentation required for releasing changes into the company’s production environment. Also, follow the software development life cycle and documentation standards.
• Participated in the external IV&V activity performed on the project by an independent third party
• Created appropriate business work flows suitable for systems developers and users for project planning in the future.
• Designed and facilitated the implementation of data warehouses required by application systems.
• Conducted walkthroughs with the end users to gather the modification requests from the user to update or change the business specifications
• Used UML notations for Object Oriented Design and Documentation
• Monitored the "As is" and "To be" of the project's progress using MITA "gap analysis" tool.
• Provided mapping of XML from Auto Web to policy management system.
• Integrated RequisitePro with ClearQuest and Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests
• Managed all the requirements in RequisitePro, making requirements available to all team members.
• Set up test environment to facilitate Test Plan.
• Responsible for status check at regular timeframe.

Environment: Windows 2000/XP, Rational Requisite Pro, MS Office, MS Project, SQL Server, Agile, MS Project, MS Visio, MS FrontPage 2003, MS Access, EDI, Documentum 2.0, UML

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
• Design, development, implementation and roll-out of Microstrategy Business Intelligence applications
• Working knowledge of MediCare, MediCaid and Commercial Insurance benefits eligibility (834s), contracts set up, billing, claim (837s) processing includes remits (835s) and denials.
• Performed System testing of the Claims processing systems (Pricing Rules, Duplicate/Limits validation, Member Eligibility, Provider Enrollment, et al).
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Perform Gap Analysis of the processes to identify and validate requirements.
• Supported the development of training curriculum, matrices, and materials to conduct the MITA Education and Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Involved in the testing phase right from the Unit testing to the User Acceptance testing.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Use Cases and other Process Flow Models were designed using Visio and Rational Rose.
• Involved in jobs and analyzing scope of application, defining relationship within & between groups of data, Star Schema etc.
• Tuned the batch programs and online transactions to alleviate performance problems.
• Developed & executed several Optimized queries in SQL on this data.

Environment: RUP, UAT, GAD (Gap Analysis Document), Microsoft Office 2003 Professional (Outlook, Word, Excel, Visio, Access), Microsoft SharePoint 2003

Confidential, Schenectady, NY

Business Analyst

Responsibilities:

• Complete study and analysis of Revenue Cycle management of the health stream respective to existing billing system, Claims processing, etc.
• Responsible for DFCI is the medical equipment manufacturing company, manufactures diabetic disease related diagnostic and therapeutic products.
• Met with physicians, nurses, billing and administrative personnel. Documented the clinical administrative business practices, procedures and work-flows.
• Executed Test cases using Quality Center in the Test of Lab Billing.
• Developed HL7 messaging for bi-directional case and disease report exchange, in text and XML formats, in accordance with HL7 specifications.
• Deploy/Install the builds provided by the developers in the Integration Lab Billing and perform Integration tests and Smoke tests.
• Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
• Organized and summarized the data in OLAP cubes.
• Responsible for preparing Software Requirement Specification (SRS) and documenting them.
• Gathered requirements, organized team meetings requirements from business users such as insurance policy managers, generated business process models, & use-case models, and created business requirements document (BRD) & functional requirements document (FRD.
• Designed, developed and tested data mart prototype SQL, ETL process (SSIS) and OLAP cube (SAS) for Computer Maintenance Management System (CMMS).
• Emphasis on requirements capturing/gathering through research, formal/informal JAD sessions with SMEs and end users.
• Prepared Business Requirement Document (BRD) and Software Requirement Specification (SRS).
• Coordinated the collection of data and formatted the data to flat files for feed to SRS.
• Defined Functional Test Cases, documented, executed test script in Facets system
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS) and Change management.
• Used TOAD to create SQL queries that perform DML and DDL statement/ actions on tables to effectively test rows in columns spread across diverse table joins to ensure consistency and referential integrity.
• Conduction JAD Session and communicating with Stakeholders, Development team, SMEs System Analyst, Business Analyst.
• Worked on X837 processing of claims for electronic media claims (EMC), National Council for Prescription Drug Programs (NCPDP), and Office for Civil Rights (OCR) claims
• Extracted the Business Requirements from the end users keeping in mind their need for the application and prepared Business Requirement Documents (BRD) using Rational RequisitePro
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI Confidential Transaction: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.

Environment: RUP, UAT, GAD (Gap Analysis Document), Microsoft Office 2003 Professional (Outlook, Word, Excel, Visio, Access), Microsoft SharePoint 2003