PROFESSIONAL SUMMARY:

• 8+ years of experience as a Business Analyst in large enterprise environments at global corporations.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets.
• Experience in System Analysis, Business Analysis and Quality Assurance in Healthcare domain. Experience with communication with all level of management.
• Acute understanding of the Software Development Life Cycle (SDLC) and their variants viz. Waterfall, Spiral, Agile, RUP.
• Specialized in system study and testing Health Care, Financial, Insurance and Banking applications developed on various technologies such as Facets, QNXT, J2EE, JSP, Java, SharePoint, VB.Net, Oracle and SQL Server on Windows NT/2000/XP and UNIX environments.
• Extensive experience in Requirement gathering and SDLC.
• Proficient in MMIS (Medicaid Management Information System), HL7 v2, EMR Interfaces
• Software Analysis & Design, Gathering Functional and Business Requirements, User Interface Specifications, Technical Design, writing Test Cases and Test Plan. Write assisted QA
• Familiar with the current industry improvement standards like Six Sigma (6σ), Capability Maturity Model (CMM), and Capability Maturity Model Integration (CMMI).
• Proficient in conducting Joint Requirement Planning JRP and Joint Application Development JAD sessions with end - users, development and QA team for project meetings, walkthroughs and customer interviews and also work on project charter
• Proven ability to work in team-environment as well as independently.
• Possess excellent interpersonal skills, effective written & oral communication, and presentation skills.

TECHNICAL EXPERTISE:

Operating Systems: Windows

Databases: RDBMS, MS Access, MS SQL Server

Methodologies: SDLC, Rational Unified Process, Waterfall Methodology, Agile

Quality Standards: CMMI, ISO 9001, HIPAA

Tools: MS Project, MS Visio, MS Office, MS Access, MS Query, Open office, Rational Rose, Rational ClearCase, ClearQuest and RequisitePro.

PROFESSIONAL WORK HISTORY:

Confidential, Dallas, Texas

Sr. Business Analyst

Responsibilities:

• Designed Test Plans and Test Cases for User Acceptance testing (UAT) with the help of QA teams.
• Researched, defined and analyzed changes to both state and federal laws affecting the Medicaid Management Information System (MMIS) for Texas Medicaid account.
• Served as a management analyst on multiple initiatives involving maintenance and systems changes for HIPAA implementation.
• Researched and gathered detailed requirements and translated it into proposed systems system enhancements.
• Completed system documentation, researched system requirements, participated in system testing and verification for HIPAA implementation.
• Responsible for enrollment processing functions which included error reports, update terminations, newborns, processing of PCP assignments, 834 Files.
• Responsible and understood Eligibility and Enrollment issues regarding healthcare claims, processed COB eligibility through Molina application to ensure accurate information is represented within Molina’s enrollment system.
• Skilled in microbiology techniques, terminology and equipment and supplies
• Knowledge of laboratory tests used in microbiology work
• Uses detailed knowledge of application features, architectures and functions to assess scope and impact of business needs throughout analysis
• Performs quality control testing, maintain blood product inventory.
• Accomplished doubling of EDI client base ahead of projected schedule.
• Define and document EDI business process requirements.
• Monitor the flow of data through EDI applications to ensure all operational systems are functioning properly when needed.
• Testing of HL7 Message Validation and sending of ADT Messages like ADT A01, ADT A04 and ADT A08.
• Responsible for cleansing the data from source systems using Ab Initio components such as Join, Dedup Sorted, Denormalize, Normalize, Reformat, Filter-by-Expression, Rollup
• Ensured that all production changes were fully documented, supportable and captured in the Enterprise configuration management system ( ECMS )
• Created Visio documents for JDE process flow
• Resolve complex cases related to benefit eligibility and Flexible Benefit Plans.
• Did forward and backward data mapping between the fields in mainframe and FACETS.
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
• Crating High Level Vision and Scope, BRD, RTM, RMP, BPIA and HP ALM Import Document
• Setting one on one interviews, Joint Session, Time management meetings
• Provided test data and prepared test plans with a set of important test cases to assist the QA team in the testing phase.
• Prioritized and escalated identified bugs for updated and customized features and promptly coordinated with the software developers to fix the bugs
• Conducted user acceptance testing and data validation of web applications used to present benefit information
• Involved in creating user manuals, training materials with screen casts explaining important features.
• Monitored Version Controls of company technical documents using Microsoft Visual SourceSafe.
• Conducted live product demos to invite new business opportunities and for training purposes.

Environment: Rational Unified Process (RUP), DB2, SQL, Trizetto’s Facets, UML, Facets, Quality Center (QC), Windows XP, Webserver, MS Project, MS Word, MS Visio, MS Excel.

Confidential, Portland, OR

Sr.BusinessAnalyst

Responsibilities:

• Documented future states and validated existing SOP as per needs of experts.
• Lead PM and vendor management of Client to ensure the implementation of QNXT system.
• Succeeded in reducing production time by 3% through TimeStudies/statistical data analysis using Minitab and established improvement in work methods.
• Responsible for the implementation and maintenance of all interfaces between Epic Application and external applications / parties. This involves working primarily in Epic's Bridges application and coordinating interface design and development involving other interfacing engines as well. Lead analyst for SoftLab implementation conversion analysis, build, testing,
• Conducted Gap Analysis on the AS-IS and TO-BE business processes and technology and identified potential risks and issues.
• Adapted core solution for client companies to determine eligibility and administer Health and Welfare Benefit Plans.
• Documented and maintained client flexible benefit plan design, procedures and eligibility rules.
• Embed SQL queries in Micro Focus Cobol programs.
• Creation and maintenance of SQL tables related to enrollment, billing, and group set up in QNXT.
• Used TriZetto HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions
• Did gap analysis (HL7 specifications), map, interpret HL7 messages; monitor, troubleshoot/test using analyst skill sets-SDLC for correct implementation.
• Validated FTE saves through hypothesis generation and implemented corrective measures for time, labor and cost reduction. Involved in configuration of FACETS Subscriber/Member application.
• Worked on FACETS Data tables and created audit reports using queries. Manually loaded data in FACETS and have good knowledge on FACETS business rules.
• Accomplished migration of EDI client base ahead of projected schedule.
• Worked on creating, testing and implementing of Customer Relationship Management (CRM) tool and fixed mature Identity and Access Management (IAM) capabilities on it.
• Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches
• Create technical and user documentations for existing ad-hoc reports and standardize selection criteria for common reporting attributes; Prepare documentation for report conversion to be used in the new Child Care/ Head Start application.
• Wrote functional specification documents for migration from Mainframe to a Java based application
• Compile system reference documentations for Child Care and Head Start systems, by working as facilitator for multi-unit management groups and utilizing existing documentation and SQL scripts.
• Analyze agency wide workflow systems to identify opportunities for improvement through automation.
• Develop detailed specifications for user enhancements; prepare training curriculum and learning aids for computer systems; write user manuals and guides.
• Responsible for conducting user Acceptance Testing (UAT).
• Conducted meetings with cross functional teams and ensured that project deliverables and milestones were met.
• Interviewed businesses to extract their requirements for the system.
• Provided recommendations for achieving Productivity improvement based on statistical data analysis and data validation.
• Took part in the meeting held for the analysis of migration to HIPAA 5010 from 4010 and migration of ICD9 codes to ICD10.
• Managed time study projects which helped set time standards and reduce variation for claims processing.
• Performed Ad-hoc analysis and provided support to address matters relating to performance measurement.
• Communicated challenges and issues as appropriate to the stakeholders.
• Rationalized variation in process times through 5Why to make business more efficient.
• Eliminated non value added activities using value stream mapping technique for process improvement.

Environment: Rational Unified Process (RUP), DB2, SQL, Trizetto’s Facets, UML, Facets, Quality Center (QC), Windows XP, Webserver, MS Project, MS Word, MS Visio, MS Excel.

Confidential, San Francisco, CA

Business Analyst

Responsibilities:

• Interviewed business experts including participating provider and referral coordinator to gather the business requirements.
• Analyzed Technical Design Documents (TDD) of existing Electronic Medical Record to understand the site for integrating the new system.
• Involved in UAT of the applications by providing users with test cases and scenarios, and guiding them during the testing process.
• Creation and maintenance of SQL tables related to enrollment, billing, and group set up in QNXT.
• Documented Business Requirements Documents and Functional Specification Documents for various required functionalities of the eReferral System.
• Administered Identity and Access Management (IAM), (including password management) controls for staff and vendors assigned to department-level projects
• Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements.
• Used SQL queries to access database before writing use cases to understand different field names and character specifications.
• Developed use cases, activity diagrams, and sequence diagrams using MS Visio.
• Conducted highly interactive JAD sessions with project stakeholders to review the requirements and identify the solutions.
• Responsible for Change Management Processes (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
• Ensured consensus between Line of Business and IT Teams.
• Developed new documentation, participated in development of departmental procedures and implementation policies.
• Assured that the system privacy and security is in compliance with HIPAA.
• Collaborated with QA team to refine test plans and test cases.
• Participated in User Acceptance Testing (UAT).
• Used Quality Center (QC) to track and report bugs.
• Designed reports and presentations according to department guidelines.
• Prepared training manuals for employees.

Environment: Rational Unified Process (RUP), DB2, SQL, UML, Quality Center (QC), Windows XP, MS Project, MS Word, MS Visio, MS Excel.

Confidential, Lincoln, NE

Business Analyst

Responsibilities:

• Created Use-Cases and Business Use-Case Model after accessing the status and scope of the project and understanding the business processes. Gather High Level Business Requirements (HLBRs) and Detail Level Business Requirements (DLBRs) from client and stakeholders through interview process.
• Transactions of ICD-9 standard and TO-BE processes of ICD-10 standard.
• Captured, defined, analyzed and translated functional and non-functional business requirements into functional and non-functional business requirements into activity diagrams, system use cases and prepared business requirement documents (BRD).
• Administered Clinical rotations included compatibility, immunohematology, component therapy, coagulation, tissue typing, donor room, apheresis, component processing, donor testing, technical service, quality control and distribution. Structured a new consignment format for the American Red Cross to improve blood distribution.
• Assisted with Advanced Pricing, and other Distribution and Finance modules. Worked closely with OMW to create versions, design menus and set-up UDC's for the different functional areas of JD Edwards. Performed system configuration, business process documentation to support system design and integrated Conference Room Pilot. Created end-user documentation.
• Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Conducted JAD sessions with team members and users to explain the impacts.
• Performed manual testing, focusing more on functional testing of the biological analysis that required technical knowledge and understanding of the biological components
• Prepared Business Documents such as Business System Requirements Document, Functional Specifications Document, Requirement Traceability Matrix, Flowcharts etc. to document the current and solution process.
• Thorough understanding of business process to help determine the user needs and remedy any defects in the current process.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 to identify key data set elements for designated record set.
• Collaboration and reviews with different application owners and SME’s to ensure the GAP Analysis was performed accurately.
• Performed Impact analysis for readiness of ICD-10 conversion and helped in creating the ICD-10 Impact Analysis Document.
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Involved in the analysis of HIPAAcompliance and actively participated in the designing of EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes.
• Requested Client Eligibility information using the 270 transaction and matched the information returned with the online Medicaid Eligibility Verification System in MMIS and the automated Interactive Voice Response application of the Nebraska Medicaid Eligibility System.
• Prepared questionnaire based on the System Analysis Performed for all entities.
• Knowledge of the complete EDI format used in electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
• Coordinated meetings and Worked with Managed Care Organizations like Arbor Health Plan, Coventry Cares of Nebraska and Confidential Community Plan for applying the ICD-10 changes to their Inbound and Outbound files.
• Dealt with the daily and monthly Managed Care Enrollment files.
• Worked on the MMIS (Medicaid Management Information Systems).
• Implemented the mandatory Statewide Managed Care Enrollment.
• In depth knowledge of Medicaid Claims processes.
• Identified, wrote requirements and tested the Mainframe Screens that are impacted by ICD-10 changes
• Worked in mainframe environment and used SQL to query various reporting databases.
• Implemented the concept of ICD Version Indicator to distinguish between ICD-9 and ICD-10 Claims.
• Developed and maintained a requirement work plan and assessed the performance metrics of team members.
• Analyzed and worked on issues related to EDI transactions.
• Conducted weekly discussions with Production team to update any current enhancements done on modules and find out its impact on ICD-10 project.
• Tested the Case Management and Prior Authorization modules in Facets.

Environment: Windows XP/7/8, MS Word, MS Excel, Agile, MS outlook, MS PowerPoint, MS Project 2010, MS Visio, Rational Rose, SQL Server, MySQL, Load Runner, Quality Center.