SUMMARY:

• Over 7 years of professional experience as a Business Analyst in the HealthCare domain
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• Extensive experience in analyzing and requirements gathering and writing system functional specifications including use cases.
• Strong knowledge on the Systems Development Life Cycle (SDLC), Rational Unified Process Methodology (RUP), RAD, SWOT, and CRM.
• Strong skills in creating UML Diagrams and Data Models including Use Case Diagrams, Activity Diagrams, Deployment Diagrams, Data Flow Diagrams (DFD) and Entity - Relationship diagrams using Rational Rose and MS Visio.
• Knowledgeable of HL7 Messaging protocols.
• Utilized several software packages, including Meditech, ePremis, Caremedic, and Microsoft.
• Strong knowledge of Project management skills includes time estimation, task identification, and scope management.
• Proficient in designing Data Models(logical and physical) for Oracle, DB2 and SQL Server databases.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Knowledge of healthcare standard Health Level Seven (HL7).
• Organized Joint Application developments (JAD), Joint Application Requirements sessions (JAR), Interviews and Requirement Elicitation sessions.
• Experience in preparing Systems Proposal Reports and performing GAP analysis.
• Experience and skills in creating design models and Extensive use of UML/RUP for modeling views using tools like Microsoft Visio.
• Understanding of BEA WebLogic Portal to simplify the production and management of custom-fit portals, allowing a shared services environment to roll out changes with minimal complexity and effort.
• Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
• Conducted requirement analysis techniques such as Business Process Automation, Business Process Improvement, and Business Process re-engineering.
• Motivated self-starter with exceptional team building, leadership, and verbal skills.
• In depth knowledge Rational Unified Process (RUP) methodology, Use Cases, Software Development Life Cycle (SDLC) processes, Object Oriented Analysis and Design (OOA/D).
• Competent in Creating Unified Modeling Language (UML) diagrams such as Use Case Diagrams, Activity Diagrams, Class Diagrams and Sequence Diagrams.
• Extensive experience in developing Use Cases, creating Screen Mockups, conducting Gap Analysis and Impact Analysis, SWOT analysis, Cost Benefit Analysis, Risk Analysis.

TECHNICAL SKILLS:

Software/Hardware: C#.Net, VB.Net, AS 400, Goldmine, HL7, EMR, SQL, IDMS, QTP, MS Windows NT 4.0/2000, Windows 95/98, Windows XP, MS Visual Studio.Net, IBM WebSphere 5.0, Power Builder 5, 6.5, 7, Rational Rose, UML 2.0, RUP, OOAD, MS Visio and Visual Studio.Net, Sybase SQl Anywhere 5/6, Adaptive Server Anywhere, MSSQL 7, Oracle 6 / 7.x / 8i / 9i, Oracle - TOAD, Informatica, Bbusiness Object, ETL, Cognos, Erwin ODBC, Visual Source Safe 6.0, Cobol, Source Off-Site, Round-Table, Win CVS, NUnit.net, MS Project, MS-Office

PROFESSIONAL EXPERIENCE:

Confidential, Nashville, TN

Sr.Business Analyst

• Gathered high level requirements and developed scope of the project for the implementation of Microsoft Office Share Point 2007.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• After Executive confirmation did Gap analysis to assess needs that could not be met by core EHR.
• Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
• Collaborated with management and senior-level engineers to develop code for new features used within a Health Information Exchange(HIE).
• Analyzed, designed, and coded several online subsystems for the Medicaid System.
• Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Working knowledge of healthcare Technology standards such as HL7, CCR(continuity of Care Record), CCD(Continuity of Care Document), ELINCS, and CDA
• Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Involved in analyzing activities for a variety of major projects including Medicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.
• Applied guidelines, standards and regulations such as HL7 CDA, CDISC, MedDRA, Code of Federal Regulations (CRFs) to clinical data modeling.
• Experience in implementing and managing the implementation of software, hardware and hybrid solutions to enable Electronic Health Records (EHR) and Health Information Exchanges (HIE).

Environment: Windows 2000/XP, HL7, Microsoft Office SharePoint 2007, Cognos, Agile, Rational Requisite Pro, MS Office, SQL Server 2005, Cobol, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0.,UML.

Confidential, MI

Business Analyst

• Interacted with business heads to finalize the Business Requirements for the application.
• Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Ability to manage with Meditech and interpret IT projects
• Provided clear and concise documentation regarding requirements management plans, Functional Requirements, supplemental Requirements, Test Plans and Test Cases.
• Implemented Data Modeling standards, including element-naming conventions.
• Was responsible for data mapping of HL7 messages into relational database
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 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.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Design and develop HL7 interfaces between HIS system and all the downstream ancillary systems. Created data mapping documents to map the data fields, which assist the middleware team to route and parse interface messages between different applications
• Conversion of data from different database environments, while performing Back End Testing.
• Developed extensive experience in eligibility and benefits calculation for state, federal and local services such as Medicare and Medicaid.
• Performed Requirement Gathering & Analysis by actively soliciting, analysing and negotiating customer requirements and prepared the requirements specification document for the application using MS Word.
• Developed criteria for IVR and online interface preauthorization process for providers.
• Was providing broad enterprise business system deployment analysis and support of Oracle Financial.
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows.
• Worked on HL7 and xml interface messaging.

Environment: Rational Rose and Requisite Pro, MS Visio, MS Office, MS Project, Agile, UML, XML, Windows XP, NT/2000, HTML, Cobol, SQL Server 2000, HL7, Vignette Content management Tool, J2EE (JSP1.2), XML, XSL, XSLT, HTML, Oracle 9i.

Confidential,Dublin,OH

Business Analyst

• Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Extensive knowledge of Medicaid Management Information Systems (MMIS), National Provider Identification (NPI), Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Health Level -7 (HL7), HIX (Health Information Exchange), EMR/EHR, Health Care Reform.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Designed and Developed Various Business Intelligence reports against ODS, Claims systems such as Facets, HER systems such as NEXTGEN and Care Management systems, Network Management systems, Revenue Cycle Management systems.
• Used Data warehousing for Data Profiling to examine the data available in an existing database.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
• Worked with FACETS edits and EDI HIPAA Claims (837/835/834) processing.
• Involved in Up-gradation of HIPAA X12 4010 transactions to HIPAA X12 5010 and ICD-9-CM to ICD-10 CM/PCS (Clinical modification/procedure coding system) simultaneously.
• Provide support for technical design activities related to application software, HL7 messages, relational databases, and other infrastructure components on an assigned project basis.
• Created HL7 Interface connections; performed routing, filtering, and mapping configurations.
• Worked on EDI transactions: 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.
• Data Migration (Worked with internal architects and, assisting in the development of current and target state enterprise data architectures, involved in defining the source to target data mappings, business rules and data definitions.)
• Provided leadership with respect to integration issues including process mapping, business process re-engineering, SAP integrations, and change management.
• Hands on experience on Software Development Life Cycle (SDLC) of the project using methodologies like Waterfall, Agile, RUP and hybrid methods.
• Worked extensively in data consolidation and harmonization.
• Good working knowledge of Rational Unified Process (RUP), Risk Mitigation, UML and Visio.
• Experience in Conducting GAP epic and SWOT Analysis.
• Extensive experience in conducting Joint Application Development (JAD) sessions for project definition that involved analyzing the requirements and creating prototypes.
• Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and Sequence diagrams. Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.

Environment: Windows XP Professional, SQL 2000, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Cobol, Cognos, HL7, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential, Austin TX

Business Analyst

• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)
• Thorough knowledge of Eligibility and membership Affairs for Medicare and Medicaid. Also knowledge of HIPAA, X12, and HL7 standards, and Medicaid provider best practices
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Maintained benchmark controls to policies, company standards and contracts, performed vendor sourcing, pricing and contract negotiation, performed procurement, ensured compliance with service/joint interest contracts.
• Completed the documentation of Claims Scenario’s for the source system
• Used Rational Clear case for version control
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Experienced with Medicare and Healthcare Insurance; as well as Medical Standards (HIPAA and HL7)
• Designed and implemented integrated business model using Cognos ePlanning Analyst Software.
• Participated in the development of the data modeling methodology to be used in the project.
• Analyzed trading partner specifications and created EDI mapping guidelines
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.

Environment: Windows 2000/XP, Microsoft Office SharePoint, Cobol, Cognos, HL7, Rational Requisite Pro, MS Office, SQL Server, MS Project, MS FrontPage, MS Access, EDI, Documentum 2.0.,UML.