SUMMARY:

• Professional experience of 12+ years as a Program Business Analyst in Healthcare - Payor & Confidential Management domains.
• Proficient in preparing Business Requirement Document (BRD), Functional Specifications, Use Cases, Functional User Stories and User Manuals.
• Strong understanding working with HIPAA 5010 EDI transaction 278 (215, 216 & 217 X12 formats) and many more transactions like EDI 270/271, 834, 837 etc.
• Experience in Healthcare - Confidential Management domain with exposure to Electronic Medical and Health Records (EMR & EHR), HIE - HL7 CCD, Nurse Portals, PHR portals, Clinical decision support platforms, ACOs and Quality Measures.
• Experience in Healthcare - Payor domain with exposure to Benefit Coding, Sales Portal, Individual enrollment, Broker Portal, Small group renewals and Healthcare Reform.
• Experience in translating business requirements and user expectations into detailed specifications employing designing applications like OOAD techniques and Unified Modeling Language (UML).
• Conducted Joint Application Development (JAD) sessions with end-users, SMEs and development team for project meetings, walkthroughs and customer interviews on regular basis
• Sound proficiency in analyzing and creating, Use Cases diagrams, Sequence diagrams, Data flow diagrams, Business flow diagram using MS Visio.
• Extensively worked with business users, product owners to identify business scenarios by conducting user interviews, meetings, brainstorming sessions etc.
• Adept in conducting User Acceptance Testing and verifying performance, reliability and fault tolerance issues. Also familiar with testing tools to design and develop test plans and test scripts.
• Worked closely with Developers, QA Testers and Project Managers to translate functional designs into technical designs.
• Extensive knowledge in data collection, analysis and evaluation, analytical problem solving, decision making, and interpersonal skill with ability to interact with individuals at all levels.
• Backed by strong credentials including PAHM & AHIP certifications (Healthcare Domain)
• Experience with SQL Developer, SQL Server 2017, Toad 9.5 and PL/SQL for database analysis.
• Hand on experience in tools such as HP Quality Center, IBM ClearQuest and Rally.
• Experience working in Agile Scrum and Waterfall methodologies.

SYSTEMS EXPERIENCE AND PROFICIENCIES:

• SQL Server 2017 - PL/SQL Programming
• SQL Server Reporting Services - Reports Design
• Oracle - Data Modeling and Design
• Toad - PL/SQL Programming
• Microsoft Visual Studio ASP.NET 2.0, ADO.NET - Application Design and Development
• Rally
• R Programming
• ERWin
• MS Visio, MS Access
• C# Programming - Windows and Web based Application Design and Development
• AJAX & Javascript Programming
• JQuery and GUI Designing
• NASCO Claim Engine (Mainframe System)
• QNEXT Claim Engine
• Drupal Content Management System
• Cognos
• Google Analytics, Webtrends
• Data Mining
• Python

PROFESSIONAL EXPERIENCE:

Confidential

Program Business Analyst, New York

Responsibilities:

• Designed and Implemented “Health Your way” program integrating Confidential management program experiences by developing story maps, managing BA team and developing functional stories which improved member retention rate by 75%.
• Designed technical solution to enable Day 1 access for members to all program features offered via Member Portal, Mobile App, Nurses’ portal and Incentives platform by creating data models and workflows which improved member Health Journey experience and enrollment rate by 20%.
• Implemented specialized Diabetes programs for the members via the portals and Mobile App by developing business workflows and optimizing technical solution which increased the engagement rates by 30%.
• Fixed the member instances duplication which reflected in front end applications by implementing new aggregation logic thereby decreasing the data errors and L3 support requests by 50%.
• Implemented the mandate of member’s cases in the nurse portal to be assigned to the licensed clinicians in the member’s state by designing story maps, wireframes and fully blown functional user stories.
• Created prototypes for Confidential Manager Dashboard by driving user research/usability tests and by evaluating the technical feasibility & the business value addition to Confidential in terms of API design.
• Designed solution for the usage of ‘client consent’ in the email processing logic and workflows by eliciting business requirements and creating user stories to support improved member communication experience.
• Designed workflows to trigger Health Events based on patients’ clinical information and developed member portal/mobile prototypes and specifications to engage patients with the in-built programs and health components catered for the specific health event.

Confidential

Program Business Analyst, New York

Responsibilities:

• Analyze the data attributes, page layout and user workflows of the functional areas on MyActiveHealth (MAH) portal
• Brainstorm discussions with product team on preparing the high level use cases.
• Discuss and finalize the architecture and technical solutioning with the Product team, Architecture team and implementation team.
• Provide technical impacts and high level estimates during the BMC (Business Model Canvas) reviews and help team define MVP (Minimum Viable Product).
• Create and baseline the scope document for the release cycle by capturing all impacted areas and the work involved.
• Identify the key data attributes for each functional area corresponding to the identified use cases.
• Prepare functional user stories to create web services that expose attributes to IBM Datapower for implementing APIs.

Confidential

Program Business Analyst, New York

Responsibilities:

• Analysis of the existing Benefit Coding process by discussing with the SMEs and QA team
• Detailed analysis and documentation of the QA team pain points and the business impacts due to the lack of automated testing.
• Requirement elicitations and brainstorm sessions on the automation workflows.
• Create use cases and process flow diagrams for the proposed automated testing process on NASCO and QBLUE claim engines.
• Create, baseline and hand off Business Requirement Document (BRD), Technical Requirement Document (TRD), Requirement Traceability Matrix (RTM) for the project.
• Support Dev and QA team in providing clarifications and reviewing deliverables.
• Perform end user training and create user manuals for the benefit coding testing tool.

Confidential

Program Business Analyst, New York

Responsibilities:

• Analyze and understand the clinical definitions issued by CMS (Numerator, Denominator, Exclusion Criteria etc) of the ACO Quality Measures
• Interviews and brainstorming sessions with the end users and product owners and identifying the key business requirements.
• Prepare and baseline prototypes and detailed use cases on the Admin screen and various sub modules within ACT - Quality Measures module.
• Identify the impacts and the tasks involved for implementing the feature and provide high level estimates during the BMC meetings.
• Identify system level features and define tasks for developing MVP.
• Discuss, prioritize and finalize the scope document for various releases and assist scrum master in maintaining the product backlog
• Discuss and finalize the UI attributes and the corresponding calculation logic, front end display logic and the business value that it provides.
• JAD sessions with the Dev & QA teams on elaborating and refining the functional user stories.
• Define, estimate and hand off the functional user stories to the Dev & QA teams.
• Assist scrum master and scrum team to schedule the user stories across various sprint cycles
• Define, estimate, baseline and hand off user stories to the Scrum team.
• Support scrum team by coordinating with product owners, providing clarifications, answering questions and track the progress of each user stories.
• Review test cases and provide timely feedback to the QA team.
• Perform sprint demo to the product owners and obtain user stories acceptance
• Provide walk through sessions and support UAT users for testing all user stories.
• Conduct feature level demo sessions to the business users and provide clarifications
• Support Release management team and perform post production check out for the features.
• Track production issues and maintain product backlog

Confidential

Program Business Analyst, New York

Responsibilities:

• Created high level use cases and dataflow diagrams for processing various EDI 278 transactions
• Defined functional user stories for Precert and Notification transaction workflows.
• Performed elaborations and created functional user stories for the below enhancements.
• Duplicate check for the patient events coming in through EDI 278 request.
• Inquiry request - if the requestor is not part of the event send ‘Access restriction’ error on HL21 loop.
• When ActiveAdvice users update the status of an event to “Cancelled” or “Not a Record” or “Duplicate”, ActiveAdvice will update all decisions within that event to “Cancelled”.
• System will reject the authorization transaction and send the response to the Provider, if an unknown diagnosis code is submitted.
• If no quantity was received in the precert/notification requests, ActiveAdvice will consider the default quantity as 1 days if the request was for inpatient and 1 units if the request was for outpatient.
• Define, estimate, baseline and hand off user stories to the Scrum team.
• Support scrum team by coordinating with product owners, providing clarifications, answering questions and track the progress of each user stories.
• Review test cases and provide timely feedback to the QA team.
• Perform sprint demo to the product owners and obtain user stories acceptance

Confidential

Senior Business Analyst/Data Analyst, New York, NY

Responsibilities:

• Identify system impacts and provide estimates for the features identified for each system during the BMC (Business Model Canvas) sessions for an initiative.
• Identify system level features and define tasks for developing MVP (Minimum Viable Product) for each initiative.
• Discuss with system SMEs, business stakeholders and Product owners and prepare the scope document for a feature
• Perform elaboration sessions with the product owners and SMEs to finalize the business requirements for each scope item.
• Conduct JAD sessions with the Dev team, QA team, SMEs and Product owners to create fully blown functional user stories for each business requirement.
• Create Data Flow Diagrams and Business Flow Diagrams for the features.
• Assist scrum master and scrum team to schedule the user stories across various sprint cycles
• Define, estimate, baseline and hand off user stories to the Scrum team.
• Support scrum team by coordinating with product owners, providing clarifications, answering questions and track the progress of each user stories.
• Review test cases and provide timely feedback to the QA team.
• Perform sprint demo to the product owners and obtain user stories acceptance
• Provide walk through sessions and support UAT users for testing all user stories.
• Conduct feature level demo sessions to the business users and provide clarifications
• Support Release management team and perform post production check out for the features.
• Track production issues and maintain product backlog.
• Analysis of EMR data modules containing the attributes pertaining to Social History of the members

Confidential

Business Analyst, New York

Responsibilities:

• Identify, Analyze and study the overall business and information needs of an organization in order to develop appropriate Information Technology solutions and strategies.
• Validate and document business, organizational and operational requirements.
• Design Solutions often including a systems development, process improvement or organizational change.
• Design and execute strategic solutions supporting performance improvements, minimize development costs and project delays.
• Define and document business and user requirements after thorough fact-finding with customers and analysis of business workflows and system requirements.
• Work closely with development team in translating business requirements into high level design specifications and technical level design specifications.
• Review and provide feedback on test cases and test plans.
• Review and provide Release, Deployment plans and Project trackers covering the various phases of the Project

Confidential

IT Lead/Business System Analyst, Newark, NJ

Responsibilities:

• Requirement Analysis of the changes that will be implemented on Central Product Library and the Product Catalog
• Requirements Elicitation, Requirements Analysis and Requirements Gathering to propose the changes that needs to be made on the Online Provider Directory to integrate with the sales portal.
• Creation of Functional Requirement Documents for the changes that needs to be made on the Consumer Console for supporting Individual enrollments in the proposed Sales Portal
• Requirements Elicitation, Requirements Analysis and Requirements Gathering to integrate CRM online and telesales channels to the overall enrollment process
• Coordination with the applications teams to support and manage the overall process as an ongoing activity
• Coordination with the Development, Testing and Release Management teams to support and manage smooth implementation of the changes

Confidential

IT Lead/Business System Analyst, Newark, NJ

Responsibilities:

• Definition of the reporting needs based on the brain storm sessions with e-Business team management
• Identifying the data sources spanning across the organization and granularity & attributes related information on the data
• Tasks List identification and Project Plan charter for each sprint
• Coordination with the technical team of the data sources for building requirements around data sourcing
• Coordination with the EDM & Cognos reporting team to build requirements around the Centralized Data Repository
• Definition of report front end, views, filters and drill down capabilities leveraging Cognos features, based on organizational needs.

Confidential

IT Lead/Business System Analyst, Newark, NJ

Responsibilities:

• Requirements Gathering and Analysis based on the discussion with the stake holders and end users.
• Preparation of Business Requirement Document and Technical Requirement Document for the project.
• Managing and Coordinating tasks between Dev team, SQA team and Release Management team

Confidential

IT Lead/Business System Analyst, Newark, NJ

Technology: .Net, SQL Server 2005

Responsibilities:

• Analysis of the existing Change Management process and thorough understanding of the end user pain points.
• Requirement elicitation, user interviews, brainstorming sessions with the key IT stakeholders and documented the feedback/suggestions from various IT units.
• Create sequence diagrams and detailed use cases for the application modules.
• Create, baseline and hand off Business Requirement Document (BRD), Technical Requirement Document (TRD), Requirement Traceability Matrix (RTM) for the project.
• Support Dev and QA team in providing clarifications and reviewing deliverables.
• Perform end user training and create user manuals for the new process
• Conduct steering committee meetings with various IT Unit managers to brainstorm and implement enhancements and break fixes
• Create and baseline the technical Confidential (Document of Understanding) for all enhancements and break fixes required by the end users.