SUMMARY:

• A progressive Business Analyst and Data Analyst in Healthcare, with experience in business process analysis/modeling, business requirements gathering, database design and development of Web based, and Client/Server applications.
• In depth Knowledge of Health Insurance Portability and Accountability (HIPAA) standards, Facets, Electronic Data Interchange (EDI), HL7, EHR ICD - 9 to ICD-10 transfer coding, CPT codes, Medicare, Medicaid Insurance and HIPAA versions.
• Experience using software development life-cycle methodology like (such as Agile, RUP, waterfall)
• Experience in Healthcare EDI transaction sets like 834, 837, 835, 270/271, 276/277 & 278 and experience in translation of EDI transactions (837,834) to Facets Gateway format and also ability to understand carrier EDI or data companion guidelines.
• Health plan operations experience in one or more areas: enrollment and billing, claims and benefits, network management, medical policy and utilization management desired
• Well versed with various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO, HMO, and POS.
• Extensive knowledge of MMIS, EMR, EHR and healthcare reforms like PPACA, EMTALA.
• Expertise in using AGILE Extreme and Scrum programming for creating use cases, story writing, version control, and defect tracking, monitoring and all areas of the software development life cycle (SDLC).
• Experienced in conducting requirement analysis, use case design, designing test plans and developed database schemas based on the logical models.
• Created Master Test plans and participated in all the aspects of UAT Testing.
• Experience with database models like conceptual, logical and physical database models.
• Extensive experience in performing Data Analysis using complex SQL queries, ETL, like Data Profiling, Data Quality and Data Validation
• Ability to gather business and technical requirements from both formal and informal sessions utilizing a variety of software tools including, Use Cases and the Rational Unified Process.
• Result oriented Joint Application Development (JAD) Facilitator and meetings coordinator with excellent interpersonal skills
• Expertise in broad range of technologies such as Microsoft Project, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
• Modeled the Fact and Dimension tables in Erwin required for data warehousing based upon the requirements gathered from various business users.
• Creating and maintaining the data model and physical integrity of the databases.

TECHNICAL PROFICIENCY:

MS Visio, JIRA, Rational Rose, Rational Requisite Pro, Rational Clear Quest, Windows 7, Windows 8, Microsoft Project, Microsoft Office suite, HTML, XML, MS SQL Server, MS Access, MS Excel, SAS 9.3, HTTP, FTP, SharePoint, Corvid- EXSYS, FACETS 5.01, ANSI X12 standards, HIPAA code sets, HP ALM, HL7, MATLAB, Prime RX, SPSS 23, UML, EDIFACT, Flat Files, CSV.

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst

Responsibilities:

• Worked for operating support group involved in multiple projects for the claims and compliance department.
• Expertise in using AGILE Extreme programming for creating use cases, story writing, version control, and defect tracking, monitoring and all areas of the software development life cycle (SDLC).
• Worked on EDI 270/271,276/277,835 &837 for the claims department and interacted with companies compliance.
• Mapped various transactions from HIPPA ANSI X12 format to Health Partners internal formats - 837P, 837I, 837D, 270/271, 835, 834, 278, 276/277.
• Extensively used SQL queries to fetch data from different claim & membership table(CLCL CLAIM,CDML CL LINE,MEME MEMBER,SBSB SUBSC)
• Interacted with Confidential Medical management, Customer service & Intake team (provider authorization)
• Developed mapping documents based on Clearing House’s specs & CAQH core operating rules
• Mapped clearing house provided service codes to Facet by developing crosswalk tables
• Worked with plan data model in Facet front end (2X) & backend (CMC PLDS PLAN DESC, CSPI CS PLAN, CMC SETR TIER)
• Carried out Data quality checks and Data Profiling on EDI format files.
• Used complex SQL queries to perform Data Analysis like Data Profiling, Data Quality to maintain the integrity of data.
• Created ETL mapping documents to match keyword file format of Facets, in order to process claims.
• Documented claims extraction process using Visio and worked with provider relation & membership department
• Performed Root Cause Analysis for errors found in facet for membership and claims status
• Conducted offshore testing with team in Chennai, India
• Facilitated issue resolution and created RFC’s presenting in CAB (change advisory board) meetings
• Performed UAT, modified requirement to improve functionality based on user input

Environment: Agile/Extreme, MS Excel, Visio, SQL server, Facets 5.01, MS Outlook, Share point, JIRA, HP ALM

Confidential

Business Analyst

Responsibilities:

• Gathered Requirements and documented the proposed additional extension to the existing HIPAA application.
• Facilitated - Joint Application Development (JAD) sessions with the Management, Mainframe users and HIPAA team to make sure everyone is in sync with the business requirement processes.
• Developed mapping specifications for EDI transaction sets supporting EDI Health Care Claim Status inquiry/response i.e. 276 and 277
• Expertise in using AGILE Scrum programming for creating use cases, story writing, version control, and defect tracking, monitoring and all areas of the software development life cycle (SDLC).
• Created claim verification letters to check healthcare frauds using SQL.
• Analyzed and evaluated User Interface Designs, Technical Design Documents, and Quality Assurance Test condition for the claim verification letters.
• Used MS Visio to create Use Cases and Sequence Diagrams.
• Involved in weekly walkthroughs, inspections, and verification meetings with various stakeholders in the project.
• Worked on FACET modules such as pricing, payer, eligibility under claims processing system.
• Developed several functional maps to implement the business rules and validations.
• Created and Maintained the Requirement Traceability Matrix (RTM).
• Initiated Test Plans, developed and executed test cases and scenarios, worked with users to develop specific acceptance criteria, and prepare test exhibits.
• Analyzed the source using SQL queries to create ETL mapping document to load the Facet data from source to target.
• Reviewed defects, logged in HP ALM and maintained an issue log to keep track of the bugs and follow-up to resolve them.
• Conducted- User Acceptance Testing (UAT) sessions with business users and prepared document for enhancements and bug fixes.

Environment: Microsoft Office Suite, MS Visio, MS Project, Windows 8, HIPAA EDI, ANSI X-12 standards, SQL Server, HP ALM, Agile/Scrum, UML, FACETS 5.01, MS Visio, JIRA.

Confidential

Sr. Business Analyst / Data Analyst

Responsibilities:

• Supported in developing the Data Conversion from legacy system to EPIC implementation program/ projects.
• Actively perform Elicitation, Gap Analysis for Business Requirement Document (BRD), and Functional Requirement Document (FRD) creation in EPIC Data Conversion.
• Actively participated in preparing the scope of the program/project.
• Supported in preparing resource, budget and effort estimate.
• Elicited requirements by interviewing SMEs (Pharmacists, Physicians, Nurses and technologists and Lab Managers)
• Worked with the business users to define the business processes changes required to implement business intelligence solutions.
• Interacted with programmers and developers for elicitation and business guidance.
• Assisted in translating business requirements into conceptual, logical and physical data model.
• Engaged with business partners to understand functional requirements to design best possible global solutions.
• Analyzed business and data requirements and help define the best solution keeping long term goal in mind of reducing data redundancy.
• Own the BRD process - ensure that the business is providing high quality business requirements and ensure traceability through development and test phases.
• Determined utilization of HL7 messages specifically ADT messages
• Assisted the business in assessing the data quality and requirements for the project need.
• Used SQL queries for data analysis, source - target mapping specifications.
• Documented the functional specifications of the solutions.
• Prepared Test scenarios based on the real Business scenarios obtain from the end user for both internal testing as well as external testing for implementation readiness.
• Written Test Cases after analyzing the Business Requirement Documents and Design Documents in Quality Center.
• Performed data integrity and database migration tests by running SQL queries.

Environment: HL7, SQL Server, HP ALM, Windows 7, MS Office, MS Access, MS excel, MS Power Point, MS Visio, EPIC.

Confidential

Business Analyst / Data Analyst

Responsibilities:

• Reviewed and analyzed the business requirements to derive the functional specifications and assisted in the preparation of System Requirement Specifications for Prime Rx.
• Collaborated with team members to share knowledge of issues corresponding resolutions or workarounds.
• Captured the requirements in Rational DOORS, analyzed and managed changes to the information while maintaining compliance.
• Use case created and storyboarding to synchronize requirements with the vision plan and to accommodate all the software features.
• Prepared Use Case scenarios for a clear understanding for functionality using the vision document.
• Used the guidelines and artifacts of Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases of the Software Development Life Cycle (SDLC).
• Maintained the Requirements Tractability Matrix (RTM) for tracking the component functionality.
• Data analysis by analyzing the specification required for the Prime Rx.
• Data Governance to provide limited accessibility to pharmacy technicians, pharmacists, nurses and other customer service staffs.
• Data Reporting for any issues and provided suggestions.
• HL7 mapping was also done for some pharmacy claims.
• Manually executed test cases on every module, documented the test results.
• Performed database testing using SQL queries on document database where third party add-on software of Electronic signatures was saved in the database for insurance acceptance.

Environment: Windows 7, HP Quality Center 10.0, Software-as-a-Service (SaaS), SQL Server, XML, iOS, Android, EDI with WholesalersHL7, Rational Doors, Rational Rose, Rational Requisite Pro, Rational Clear Quest.

Confidential

Business Analyst

Responsibilities:

• Accumulated business requirements from various business users and translated them into business requirements document.
• Documented all the discussions, stored the requirements and tracked the changes maintaining the versions of document.
• Created use case scenarios and documents work flow and business process with use case diagrams, activity diagrams and sequence diagrams with Rational Rose.
• Created wireframes and screenshots for the application using MS Visio to assist development and engineering in understanding the requirements.
• Assisted in UAT to ensure all applications were tested for functionality and were adequately accepted by user community
• Managing the system and addressing day to day user queries

Environment: Microsoft Office, HTML, MS Visio, Share Point, XML schema, UML, JIRA