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Agile Product Owner / Sr. Business Systems Analyst Resume

New, JerseY

PROFESSIONAL SUMMARY:

  • 10+ years of combined experience in Government healthcare/hospital/clinical, Health Insurance, Health Insurance Exchange (HIX), Hadoop (Big Data Analytics), (Pharmacy Benefit Management) PBM, Financial Modeling, Data Warehousing, ETL and Human Health Services (HHS) environment
  • Excellent understanding of Claim Adjudication & Billing, Enrollments, Children Health Insurance Program (CHIP), Medicare - Medicaid, APTC, State Wrap, Time Clock, FPL, Modified Adjusted Gross Income (MAGI), Medicare Part D, Affordable Care Act (ACA)
  • Expertise in Requirements Gathering, Business Process flows and Business Process Modeling techniques used Industry wide.
  • Strong knowledge of Payer operations (Membership, Provider Ops, claims processing, care management)
  • Proficient with ETL processing methods, underlying data warehouse data models, security, and capabilities of the front-end delivery products
  • Worked on Implementation of ITS application owned by BCBSA into BCBS Michigan for Out of area claims
  • Worked with Technical Analysts to understand Restful Web-services and other potential API calls
  • Worked on projects from conceptualization to implementation with experience working on Waterfall, Agile, and Scrum and Rational Unified Process (RUP) methodologies.
  • Extensive experience of HIPPA EDI 5010 transactions (X12 - 837(P.I.D), 835, 834,820,270/271, 276/277 & NCPDP)
  • Experience with Facets and Microsoft Reporting Services (SSRS) using SQL
  • Experience in creating Project Charter, Business Requirements Document (BRD), Functional Requirements Specifications (FRS), Use Cases, Use Case Diagrams, Sequence diagrams, Activity diagrams.
  • Proficient in creating UML Diagrams including Use Cases Diagrams, Activity Diagrams, Sequential Diagrams using Enterprise Architect and MS Visio
  • Experience in leading Requirements Gathering sessions, JAD sessions, gathering, analyzing and documenting Business Requirements, System Requirements, Functional & Non - Functional Requirements, creating Requirements Traceability Matrix (RTM).
  • Well versed in managing changes to project requirements, scope, and timeline by administering the standard Change Management Processes.
  • Skilled in coordinating and conducting UAT (User Acceptance Testing).

TECHNICAL FORTE:

SDLC Methodologies: Waterfall, Agile, Scrum, RUP, RAD

Requirements Management tools: JIRA, Rational Requisite Pro, Enterprise Architect, ALM, MS Office

Business Modeling Tools: MS Office, MS Visio, IBM Rational Rose, Enterprise Architect, Lucid Chart

Presentation tools: MS Power Point, MS Word, MS Excel, MS Access and MS Visio

Software Tools: Jira/Confluence, Toad DB2, ETL, Eagle, Platfora, Tableau, Facets, SSRS, CMS, Sharepoint, Erwin, Redix, ERstudio, RequisitePro, ClearCase, ClearQuest

Testing Tools: Visual Studio, ALM, Test Director, Quality center, Clear Quest, Win Runner, Load Runner 9.1, Quick Test Pro (QTP)

Environment: Medicaid, Medicare, Medicare Advantage, HIPAA, Hadoop, Data-warehouse, ACA, HIE, HL7, API, Metadata, SQL, ePremis, EOB, Java, Web services, EDI Transactions, XML, JSON, Payer, Provider, Vendor Management

PROFESSIONAL EXPERIENCE:

Confidential, New Jersey

Agile Product Owner / Sr. Business Systems Analyst

Responsibilities:

  • Gathered business, functional and technical requirements from different data sources within the organization located across the globe and managed them by collating them into Epics, Stories and Feature sets using Jira.
  • Managed agile team of 8 resources to build and manage new features and capabilities while providing thought leadership to Program Governance activities such as prioritization and negotiating with stakeholders on backlog priorities.
  • Responsible for owning the technical roadmap and non-functional requirements for product (e.g. page rendering times, how long it takes to log in, response on service calls).
  • Collaborated with business and PMO to prioritize & define release content / schedules
  • Engaged in ITS claim processing from planning and analysis to implementation for out of area claims
  • Produced functional and technical deliverables for Various drug portals, Enrollments/Claims & Benefit Adjudication and payment processing
  • Engaged with entire estimation work effort including T-shirt sizing for all related project modules that involved understanding requirements, analyzing the capabilities and identifying the gaps between the existing and new requirements and budget estimates
  • Worked with vendor management to set-up vendors like ‘Smart-Communications for Correspondence, Hyland for Document Management, Health-Logic for printing by demoing, scoring and evaluating requirements
  • Followed Agile methodology for all modules and maintained Product Backlog/ User stories/Acceptance criteria in Jira. Managed all project artifacts on Confluence
  • Engaged in real-time activation of copay cards with Change Healthcare through API allowing the patient to use their card at the pharmacy
  • Hosted webservices API for receipt of a subset of near-real-time claims adjudication data received from the Inbound claims adjudication API.
  • Monitored and instrumented products for business outcomes and tech product health. Integrated and deployed tooling for team (place hold capacity) enabled test automation (i.e. acceptance criteria should be)
  • Analyzed massive and highly complex data sets, performing ad-hoc analysis and data manipulation.
  • Facilitated meetings for business process reviews, project status, and maintained various project status reports
  • Gathered business and visualization/Reporting requirements for various Tableau and Cognos reports and dashboards
  • Acted as BA/SME to do the mappings and prepare the global document that can be used across projects
  • Worked on EDI X12 transactions: 834, 820, 276/, and 837(P.I.D) to identify key data set elements for designated record set.
  • Developed business use cases using UML for new product functionality after conducting requirements elaboration sessions with client teams.
  • Explained report based requirements to offshore team, reviewing the code and making sure performance is not compromised.
  • Facilitated meetings between data source owners, development team, and data access team.
  • Served as a liaison between the clients’ business units, IT department, and our project team, ensuring the technical work being done met the client’s business needs
  • Participated in Big Data Proof of Concept efforts focused on expanding the Big Data capabilities of the Company
  • Performed project management functions for each data ingestion project. Identify risks and mitigation plans and managed user expectations.

Confidential, Telecommuter

Sr. Business Analyst

Responsibilities:

  • Supported ingestion into Hadoop big data environment enabling reporting and data analytics
  • Gathered business, functional and technical requirements from different data sources within the organization located across the globe by interviewing and maintaining customer relationship.
  • Engaged with entire estimation work effort for all big data related projects that involved understanding requirements, analyzing the capabilities of big data and identifying the gaps between the existing and new requirements.
  • Analyzed massive and highly complex data sets, performing ad-hoc analysis and data manipulation.
  • Gathered business and visualization requirements for various Tableau and Cognos reports and dashboards
  • Researched, documented, and ultimately created data dictionaries for data sources to be ingested.
  • Acted as BA/SME to do the mappings and prepare the global document that can be used across projects
  • Worked on EDI transactions: 834, 820, 835, and 837(P.I.D) to identify key data set elements for designated record set.
  • Developed business use cases using UML for new product functionality after conducting requirements elaboration sessions with client teams.
  • Explained report based requirements to offshore team, reviewing the code and making sure performance is not compromised.
  • Facilitated meetings between data source owners, Hadoop development team, and data access team.
  • Served as a liaison between the clients’ business units, IT department, and our project team, ensuring the technical work being done met the client’s business needs

Confidential, Chicago

Lead Business Systems Analyst

Responsibilities:

  • Worked with business users for defining business requirements, wrote specifications and translated statement of work into business and system level requirements.
  • Performed business and system level analysis, and provided System Use Cases and Functional Requirement Documents for deliverables.
  • Worked with ETL, BI, Data Development and DBA teams to meet project objectives and deadlines
  • Performed Gap analysis between the current and desired functionality.
  • Performed analysis on regulatory requirements for Out of Area Claims (ITS System)
  • Developed requirements using Agile and UML for Request for Information portal for BCBSA.
  • Managed client relations and resolved issues as quickly as possible
  • Used RUP and UML methodologies and Enterprise Architecture/MS Visio to design, document, and manage requirements throughout the full lifecycle of the project, i.e. definition, design, and testing phases.
  • Refined and realized Use Case models and created UML diagrams to reflect use case narratives.
  • Worked on 5010 Transactions (837(I.P.D), 835, 834,820,270/271, 276/277)
  • Prepared Workflows and Activity diagrams.
  • Created the UML Diagrams and wire frames using Enterprise Architecture/MS Visio.

Confidential, Boston, MA

Sr. Healthcare Business Systems Analyst

Responsibilities:

  • Performed requirement gathering & analysis for web portal/ web user interface by actively soliciting, analyzing customer requirements using Agile/Scrum methodology and prepared the requirements specification document for state of Massachusetts health connector (www.mahealthconnector.org).
  • Created detailed requirement document for State of Massachusetts web portal that includes Create an Account, Personal information, Household information, Income and review, find a Health Plan, Plan Shopping
  • Preformed data mapping from multiple sources.
  • Created prototypes for Internet application, worked with UI team in designing of Web Pages and micro site for portal application.
  • Worked with solution Architects to understand and analyze Restful Web services as well as potential API calls
  • Worked on implementation of CHIP health Plan.
  • Developed business use cases using UML for new product functionality after conducting requirements elaboration sessions with client teams.
  • Used tools such as MS Visio, Enterprise Architecture to define business use cases, activity diagrams, state and sequence diagrams.
  • Worked on EDI transactions: 270, 271, 834, 820, 835, and 837I (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
  • Defined and presented various solutions and artifacts to the State of Massachusetts to reduce the number of VC1 notices to the applicant when address verification fail.
  • Worked with plan management to upload various SERFF templates into the web portal.

Confidential, New Jersey

Lead Business Analyst/ Business Solution Architect

Responsibilities:

  • Managed scope, planning, tracking, change control, and testing aspects of the project.
  • Coordinated multiple interactions with critical stakeholders-Business SME’s, Program Managers, Development leads to define Business Requirements using Agile
  • Gathered requirements and facilitated business and technical review meetings with stakeholders and technical teams
  • Developed and delivered to Business Process Sequence flows.
  • Participated in morning scrum meetings and sprint sessions to prioritize product backlogs
  • Designed and developed use cases and workflow diagrams using Visio and UML
  • Worked on loading 837 data into ODW.
  • Managed geographically distributed resources across horizontal work teams.
  • Prepared checklist to verify the functionality for multiple projects before it gets delivered into the various environment and production.
  • Held analysis and design strategy sessions for automated test data creation process and workflow.
  • Prioritized UAT scenarios and create training modules for end users.
  • Analyzed and develop defect prevention analysis to prevent the repeated defects in the project life cycle release over release.
  • Performed UAT using knowledge of HIPPA EDI Transactions (270, 271, 834, 820, 835, and 837I (P.I.D)
  • Developed various metrics reports and present to the higher management for all major releases.
  • Prepared cross project dependency to prioritize the test scenarios for execution in UAT environment.
  • Created test plan, test strategy, test scenarios, and defect work flow for the quality center
  • Performed root cause analysis for the change request and present to the customer.

Confidential, Sacramento, CA

Senior Business Analyst

Responsibilities:

  • Worked 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 837I (P.I.D), 997, TA1 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes
  • Used gap analysis framework to identify AS-IS processes of claims transactions of HIPAA X 12 4010/4010 A standard and TO-BE processes (ICD-10-CM and ICD-10-PCS compliance requirements) of 5010 standard.
  • Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
  • Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
  • Implemented through Redix HIPPA.
  • Conducted UAT for client for different EDI transaction files submitted by the providers to the state.
  • Generated daily/weekly/monthly dashboards and reports from various BI sources for readouts and reporting to the Business and IT Leadership.

Confidential, NY

Business Analyst

Responsibilities:

  • Responsible for analyzing results on Electronic Data interchange (EDI) using code sets for 270/271 for Eligibility/ benefits inquiry and response and 276/277 for claim status inquiry and response.
  • Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
  • Created a gap/impact analysis document for changes of the EDI Transactions (837, 835, 276/277, 270/271)
  • Conducted JAD sessions to identify the business impacts to existing Business Process.
  • Presented the weekly and monthly status reports to the client.
  • Collaborated with external and internal customers to analyze information needs and deliver functional requirements, business requirements and Use cases.
  • Analyzed processes and recommended changes to improve efficiency of work.

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