PROFESSIONAL SUMMARY:

• 5+ years of HealthCare industry experience as a Business Analyst with good understanding of Business Requirements gathering, Business Process Flow, Business Process Modeling, and Testing
• Knowledge in (RCM) Revenue Cycle Management and PMS (Practice Management Software)
• Strong subject matter expertise in Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837, 270, 271, 276, 277, 834, 835, 999
• Proficient at implementation of HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system
• Strong knowledge in Electronic Health Records (EHR) and Personal Health Records (PHR)
• Extensive knowledge of healthcare Standard Health Level Seven (HL7)
• Strong knowledge of NCQA Accreditation and HEDIS scoring
• Good understanding of Facets and worked on different modules of Trizetto Facets
• Experienced in HIPAA, ICD9/10, EDI, HMO, PPO, Medicare, Medicaid, Medigap and SOPs (Standard Operating Procedures)
• Experience working in all phases of Software Development Life Cycle (SDLC), and using best practices of RUP (Rational Unified Process) and Agile
• Experience in conducting GAP Analysis, in depth knowledge of AS - IS and TO-BE business processes
• Excellent documentation of Business Requirements gathered using Interviews, Brainstorming sessions, Surveys and Questionnaires; Evaluating Data Sources, Translating Requirements into Specifications and Application Design
• Experience in facilitating Joint Requirement Planning (JRP) sessions with Business User Groups, conducting Joint Application Development (JAD) sessions with IT Groups, SME’s and other project stakeholders
• Design, documentation and review of business documents like Business Requirement Document (BRD), Functional Requirement Document (FRD) and System Requirement Specification (SRS)
• Facilitated Change Management and Conflict Resolution at various stages of the project life cycle by streamlining communication among the project stakeholders and interacting with Change Control Board
• Extensive experience with MS Visio for drawing flow charts and screen mock ups and MS Project for status reporting and planning
• Expertise in Functional testing to ensure a quality product and rich experience in conducting User Acceptance Testing (UAT) to guarantee all business requirements have been fulfilled by the application
• Competent in creating Unified Modeling Language (UML) diagrams for Business Process Modeling like Use Case Diagrams (UCD), Activity Diagrams (AD), Data Flow Diagrams (DFD), Sequence Diagrams (SD), Flow Charts (FC) and Wireframe Prototypes
• Expert in Tracking and Managing the requirements using Requirement Traceability Matrix (RTM) that links and controls numerous artifacts produced by several teams across the deliverables of the project
• Assisted QA team in generating test plans, test scenarios, test cases, and managed complete defect tracking life cycle using various defect tracking tools
• Strong ability in thoroughly documenting User Manuals after subsequent releases and conducting User Training Workshops to familiarize users to the application changes
• Participated in Post-Production Validation (PPV) and worked with the production support team for issues reported by the user group in the production environment

TECHNICAL SKILLS:

Requirements Management Tool: Power Designer, Requisite Pro, Rational Rose, Rational DOORS

Languages: SQL, UML, XML, HTML

Methodologies: Waterfall, RUP, Agile, Scrum

Business Modeling Tools: Just in Mind, Smart Draw, MS Visio, Prototyper

Defect Management Tools: Jira, Bugzilla, Load Runner, HP Quality Center, Silk Central

Project Management Tools: MS Office Suite (Word, Excel, Access, Powerpoint), MS Project

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst

Responsibilities:

• Conducted JAD sessions to prepare Business Requirements Document, functional specifications and obtain approval for all projects
• Responsible for requirements analysis, design and developing technical requirements
• Responsible for gap analysis in changing old MMIS and involved in testing new MMIS
• Performed legacy system upgrades, new tool implementation & business process improvement (streamlining requirements - gathering - approval and manageability) for large-scale complex project
• Wrote SQL queries using WinSQL to do data analysis and data validation as per the requirements
• Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837, 835, and 834 and ICD-10 code sets
• Coordinate the gathering and reconciliation of detailed business requirements and system requirements for system development within an agile development model
• Performed analysis on checking member eligibility, provider enrollment, member enrollment for Medicaid claims
• Performed Gap Analysis by matching the requirements for managed care programs
• Gathering High-level deliverables for ICD-10 Remediation of Configuration Rules to comply with ICD mandate, to regroup with Sequential ICD-10 codes
• Performed technical integration between State Medicaid Enrollment and Eligibility (E&E) system and the Federal Data Services Hub (FDSH)
• Held regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as minute details of the project were discussed, and issues were resolved beforehand
• Did MITA assessment and performed impact analysis/GAP analysis on EDW Upgrade and created detailed BRD
• Did Medicaid Claims Resolution/Reimbursement for state health plan using MMIS and prepared detailed system context diagrams using UML techniques (MS Visio)
• Involved in testing of web portal of new MMIS system
• Performed quick Smoke tests and UAT tests to ensure that the deliverables are meeting the expected outcomes

Environment: Waterfall, Agile, Jira, Quality Center, SharePoint, Microsoft Office, MS Visio

Confidential

Business Analyst

Responsibilities:

• Conducted brainstorming sessions to get data from all our primary vendors/clients, Trading partners, Direct submitters and create a data warehouse/repository
• Conducted interview sessions with users and different levels of management so as to gain insight on insurance system, EHR/EMR data repository and various guidelines (CMS, HIPAA, Health Reform, Health Insurance Exchange etc.) to extract requirements to understand the functional specifications of the AS-IS system
• Performed GAP and IMPACT analysis to design the TO BE system with Master database
• Worked with HIPAA rules and regulations to draft business rules and claim processes
• Create and maintained requirement documents for Facets for the different modules like Billing, Member enrollment and claim adjudication
• Proactively identified areas of need by interviewing, asking questions, probing at potential gaps in the requirements
• Designed a high-level specification documents to show various paths that needs to be taken into consideration for the transformation phase of
• Extensively worked on ICD 10
• Worked with HIPAA compliant ANSI X12 834, 837, 276/277, 999 formats for both professional claims and institutional claims
• Developed straightforward SQL queries, knowledge of HL7 and xml interface messaging
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 message
• Mapped data elements along with associated business rules in the requirement’s template using Use-Case and Use-Case diagrams
• Established and followed sign-off procedures from business customers / Subject Matter Experts (SMEs) on the requirements
• Created prototypes forms in MS PowerPoint for better visualization and understanding of the software solution
• Worked closely with technical staff, e.g designers and developers, to help determine the best solution balancing technical needs and business aspects
• Delegated the provider communities and trading partners to ensure that HIPAA transactions pass the EDI gateway and interpret technical difficulties into simple language
• Performed Smoke test for 270/271 transaction of the HIPAA 5010 version, transactions focused on were 270, 271, 276, 278, 834, 835 and 837
• Maintained requirements and testing documents throughout the project life cycle
• Directed/participated in the testing phases including development of test conditions, scenarios, test plans, expected results and Business acceptance, as appropriate; working with business customers, Designers/Developers and end customers to achieve these results
• Performed UAT tests to ensure that the outcome achieved matches with the expected results

Environment: RUP methodology, Oracle, Power Designer, XML, Jira, Microsoft Office, MS Visio

Confidential

Business Analyst

Responsibilities:

• Communicated with Health Care Business Users to identify needs, defined project scope, and detail functional and non-functional requirements
• Conducted JAD sessions for gathering requirements by communicating with the Project directors and stakeholders, created process workflows and project initiation artifacts
• Worked on Business Process Management (BPM) and implemented process management principles
• Reviewed documents/templates to create BRD and implemented the RUP process
• UML diagrams such as activity and use case diagram were used to document the requirements and ensure creation of high level business requirements documentation
• Performed Data Analysis using a variety of statistical analysis
• Worked on the Flowchart and Process diagrams using MS Visio, Created use Cases and test cases
• Held and attended presentations and meetings to coordinate efforts among all the groups, leading the inception phase.
• Assisted Health Care Client business in forming creative alliances with centers of excellence to obtain and develop lead compounds and technologies

Environment: Business Process Analysis, MS Visio, MS Office, Requisite Pro, Bugzilla, Rational Rose and MS Project

Confidential

Business Analyst Intern

Responsibilities:

• Prepared a Functional Requirements Document to gather requirements for several email alerts
• Enriched email format provided by the client
• Worked closely with the client to gather requirements
• Collaborated with development team of Primeleaf and client (Deutsche Bank)
• Collaborated testing process with QA team
• Worked closely with business, development and testing teams to ensure that project deadlines are met successfully

Environment: MS Office Suite, RUP methodology