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Advanced Business Analyst Health Care Resume

New Hudson, MI

OBJECTIVE

To take a challenging role on business operations as Business Analyst and give an efficient and effective solution that would help the organization to achieve the best solution in business which would increase its productivity in market.

SUMMARY

  • 6+ years of experience as a Business Analyst.
  • Excellent communication skills, writing skills as well as presentation skills. Experience working with business users as well as senior management.
  • Solid understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment).
  • Broad knowledge of Test plans, Test cases and test scripts from the Requirements Document.
  • In-depth knowledge of Rational Unified Process (RUP); risk engineering, data modeling and mapping, and design using UML (Unified Modeling Language), Rational Rose and Visio.
  • Good knowledge of Oracle and SQL.
  • Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
  • Capable of managing multiple projects simultaneously.
  • Exceptional problem solving and sound decision making capabilities.
  • Experience in writing queries/scripts for data analysis ad QA report testing.
  • Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
  • Experience in User Acceptance Testing, Smoke Testing, Regression Testing Performance Testing and Functional Testing.
  • Experience working in Medicare and Medicaid projects.
  • Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.
  • In-depth experience in financial analysis, Financial modeling, Research, Accounting, and good knowledge of Assets, Liabilities, Equities, Fixed Income and Taxation.
  • Created Requirements Traceability Matrix to keep the stakeholders informed of the progress of the project.
  • Strong expertise in Health Insurance Claim process, social services, Medicaid and banking.
  • Belief in team work, dedication, and professional ethics within the working environment.
  • Extensive experience in conducting Joint Application Development (JAD) sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema and system design.
  • Well versed with HIPAA, Facets, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
  • Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD).
  • Organized, goal-oriented, self-starter, and ability to master new technologies, manage multiple tasks while following through from start to completion.
  • Flexibility in adaption to a wide range of work environments.
  • Good in requirement gathering including Joint Application Development (JAD) and requirement analysis.
  • Extensive experience in working in a Customer - oriented environment.
  • Ability to inculcate new relevant skills with ease in a time sensitive frame.
  • Analysis done to determine if the system abides by the HIPAA regulations.
  • Experience in writing Use cases and Functional Requirement Document.
  • Knowledge of ISO, Six Sigma and CMM standards.

EDUCATION SKILLS

  • Master’s in business Administration, Accounting Concentration
  • Master’s in Business Administration
  • Bachelors in Computer Administration

SKILLS

Databases: MS SQL, MS Access, Oracle Languages: SQL, Visual Basic Methodologies: SDLC, RUP, UML, CMM Testing Tools: Test Director, Quality Center Operating Systems: Windows 95/98/2000/XP/Vista/NT Project Management: MS Office Suite (Microsoft Word, Microsoft Powerpoint, Microsoft Excel) , MS Project Change Management: Rational ClearQuest Business Modeling Tools: MS Visio, Rational Rose

PROFESSIONAL EXPERINCE

Confidential, New Hudson, MI May 2011 – Till Date

Advanced Business Analyst(Health care)

The Michigan Blues have the largest patient-centered medical home program in the nation — with 2,500 physicians at 770 practices across the state. Blue Cross Blue Shield of Michigan has a purpose to provide people with the security of knowing they have health care when they need it. The project is on the conversion of 4010 to 5010 for different transactions such as 837, 277 and 276.

Responsibilities:

  • Assisting in writing efficient and effective Test Plans, Test Strategy, System testing, End-to-End Testing and User Acceptance testing.
  • Participating in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user.
  • Assisting business users in defining UAT test cases and plans; Established and maintained test cases and test data in Quality Center.
  • Coordinated with the QA Team for testing activities across multiple systems and managed Conversion test execution.
  • Helps in conducting Gap Analysis (GAP), User Acceptance Testing (UAT), and System Integration testing (SIT) and SWOT analysis.
  • Involved in implementation of HIPAA EDI Transactions ( 835,837)
  • Facilitated Electronic Data Interchange.
  • Performed GAP Analysis for HIPAA 4010 and 5010 transactions.
  • Used EDI tools to verify mapping to X12 format.
  • Recommend changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
  • Analyze HIPAA EDI transactions in X12 responses and of 837, 835, 277CA and 999 and looked for defects.
  • Do data analysis for various version changes of EDI messages on different sub-systems.
  • Providing the required test data for the developers in order to fix the defects.
  • Participating in QA team meeting and bug tracking meetings.

Environment: User Acceptance Testing (UAT), Rational Clear Quest, MS Access, Windows, Rational Test Manager, MS Office.

Confidential,Bloomington, IL Dec 2009 – Mar 2010

Senior Business Systems Analyst

State Farm Insurance is the company of several wholly-owned subsidiaries that provide property and life insurance, banking products and mutual funds. . It is ranked No. 34 on the Fortune 500 list of largest companies. State Farm's® mission is to help people manage the risks of everyday life, recover from the unexpected, and realize their dreams. Their vision for the future is to be the customer's first and best choice in the products and services we provide.

The project provided a platform, which collects and synchronizes information of each person all in one place, including medical claims, lab results, self –reported data and other relevant information and also in an efficient and effective manner.

Responsibilities:

  • Designed Test Plans and Test Cases for User Acceptance testing (UAT) with the help of QA teams.
  • Utilized RUP to configure and develop process, standards and procedures.
  • Interfaced with business users to prepare and update Business Process Requirements for the new release of Healthcare tools.
  • Prioritized outstanding defects and systems problems, ensuring accuracy and deadlines were met.
  • Worked with the management for improving and giving new ideas for designing future processes of the HIPPA transactions dealing out with EDI’S 271, 276 and 270, 470, 835, 837, 834, HIPAA 4010, 5010, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles and also well versed with ICD10, Facets.
  • In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors.
  • Performed GAP analysis of business rules, business and system flows, user administration and requirements.
  • Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
  • Used the Rational Unified Process (RUP) to develop the different phases of Software Development Life Cycle (SDLC).
  • Prepared Business process models; used Visio to create use case diagrams.
  • Designed mockup and wireframes to communicate visual data flow to the end users.
  • Developed use cases, activity diagrams and sequence diagrams for a clear understanding of the vision document.
  • Recommended corrective actions, if necessary, along with the progress against Development/Action Plan routinely to the Project Manager.
  • Administered and coordinated User Acceptance Testing and obtain final system acceptance sign-off with the help of Program Manager.
  • Conducted Risk Engineering to derive and execute action plans on time.
  • Conducted Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
  • Wrote SQL Queries in MS Access to sort data and analyze the large set of data during project life cycle.
  • Used Rational Clear Quest for defects and bug testing.

Environment: User Acceptance Testing (UAT), Rational Unified Process (RUP), Rational Clear Quest, Joint Application Development (JAD), MS Access, Windows, Rational Test Manager, MS Office, Requirement Traceability Matrix (RTM).

Confidential, Oakland, CA June 2008- Oct 2009

Business Analyst

Kaiser Permanente Colorado is one of America’s Top private Health plans. Kaiser Permanente is serving more than 8.6 million members, with headquarters in Oakland, California. Permanente Medical Groups, which provide care for Kaiser Permanente members, continuously develop and refine medical practices to help ensure that care is delivered in the most efficient and effective manner possible. The project was to give the payers the clear vision of claim life cycle from submission to Kaiser through payer adjunction. The project is to implement a web based claims processing and management application health insurance claims automatically. It connected the organization to the largest all-payer network of commercial and government health plans nationwide to provide a wealth of real-time patient benefit information.

Responsibilities:

  • Implemented the SDLC for the developing life cycle and followed the standards process in the application.
  • Translated business requirements into functional requirements and approaches for developers.
  • Provided management support to the off-shore End to End integration/ Regression Test Team.
  • Workflow documentation and comprehensive training to the healthcare clients.
  • Analyzed corporate healthcare business processes to develop customized solutions.
  • Working with Medicare operational management to monitor, trend and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
  • Interacted with healthcare clients to gather requirements, objectives, and input and output requirements.
  • Developed test cases and scripts for front end testing.
  • Performed execution of test cases manually to verify expected results.
  • Ensured the accuracy and consistency of the data during the data loading process.
  • Developed Use case, Functional, Object diagrams using Rational Rose.
  • Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
  • Was involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
  • Developed a detailed test plan and test cases to cover all the requirements.
  • Used rational Rose to create UML diagrams such as use case, activity, sequence, class and component diagrams.
  • Developed Flowchart and process diagram using Microsoft Visio.
  • Analyzed data architecture, documented and delivered data mapping, performed risk analysis.
  • Frequently communicated with developers to resolve technical issues.

Environment: SQL, Test Director, MS Office, UML, Rational Rose, Windows XP.

Confidential, Hartford, CT June 2007- May2008

Business Analyst

Aetna is one of nation’s leading providers oh health care, dental, pharmacy, group life, and disability insurance and employee benefits. Aetna puts information and helpful resources to work for its members to help them make better-informed decisions about their health care. The first national, full-service health insurer to offer a consumer-directed health plan, Aetna continues to lead the way with its Aetna HealthFund2 line of products, including HSA, HRA and RRA options. The project that I was worked is to improve the Claims Reimbursement user interface of Aetna for a better user experience and incorporate changes as per HIPAA guidelines. The main object of the system was to secure the health information entered by the user at the time of submitting the claim and also ensured the integrity and confidentiality of the user information.

Responsibilities:

  • Prepared the Functional Specification Document (FSD) and Software Requirement Specifications (SRS) as per SEI CMM standards.
  • Conducted the JAD Sessions with stakeholders and developers to have a clear picture of a project.
  • Implemented RUP (Rational Unified Process) methodology for iterative and incremental development of the system.
  • Worked on improvement of Claims Reimbursement User Interface for a better experience and incorporate changes as per HIPAA guidelines using the gap analysis.
  • Wrote SQL scripts for creating performance evaluation reports.
  • Developed test cases and test plans on the basis of requirements and also did manual testing of the functionality of the application to ensure that the application is able to handle a lot of data.
  • Used UML to create use case diagrams, sequence diagrams and activity diagrams.
  • Performed Backend testing by using PL/SQL queries to test the integrity of the application.
  • Developed flowchart and process diagram using MS Visio.
  • Conducted interviews with clients to analyze their data and gather requirements.
  • Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
  • Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
  • Identified bugs during the test phase and reported them using HP Quality Center.
  • Maintained Traceability Matrix throughout the project.
  • Used the Rational Unified Process (RUP) to build the different phases of Software Development Life Cycle (SDLC).

Environment: RUP, SQL, MS Visio, MS Office, UML, Windows XP, Rational test Manger.

Confidential, North Broke, IL Jan 2006- May 2007

Business Analyst

The Allstate Corporation is the nation’s largest publicly held personal lines insurer. Allstate sells 13 major lines of insurance, including auto, property, life and commercial. Allstate also offers retirement and investment products and banking services. Allstate is widely known through the "You're In Good Hands With Allstate®" slogan. I worked on the improvement of the existing system and did testing for the proper use of the existing system and also did new additions to the system such as COB (Coordination of Benefits) which prevents over insurance. The idea behind coordination of benefits is that someone on multiple plans might be tempted to submit claims to all of them, pocketing the excess cash.

Responsibilities:

  • Fully responsible for understanding business logic and designing requirements, assisting other business analysts in generating Functional Requirement specifications (FRS) and User Requirements Specifications (URS) and communication with the developers.
  • Developed use cases, workflow, screen mock-ups and conversion requirements.
  • Coordinated work plans between project manager and client using MS Project.
  • Helped in reviewing and editing of the test scripts.
  • Followed UML based methods using Rational Rose to develop use cases and activity diagrams; assisted developers in creating sequence diagrams and collaboration diagrams.
  • Reviewed business process, URS, and functional requirements.
  • Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.
  • Created and tested scripts for the premium calculations and claim limits and deductible.
  • Involved in detailing project mission, data process flow diagrams, and timelines.
  • Developed Test plans and Test cases according to business requirements with the help of Mercury Test Director.
  • Used Rational ClearQuest for handling change requests.
  • Participated in automated regression and Non-functional test plans.
  • Provided assistance in building EDI’s 270, 271, 276, 277, 470, 835, 837 and 834 transactions.
  • Maintained Requirement Traceability matrix throughout the project.

Environment: RUP, Rational Requisite Pro, Rational ClearQuest, MS Office, Visio, Project, Windows XP, UML, SQL.

Confidential, New Delhi Jan 2005-Nov 2005

Business Analyst

The State Bank of India, the country’s oldest Bank. The bank is entering into many new businesses with strategic tie ups – Pension Funds, General Insurance, Custodial Services, Private Equity, Mobile Banking, Point of Sale Merchant Acquisition, Advisory Services, structured products etc – each one of these initiatives having a huge potential for growth. the bank operates more than 15,000 branches within India, where it also owns majority stakes in six associate banks. The project was to develop the system for the education loans division in order to monitor the interest rates, period of payments, maximum amount of getting loans and many more features and also want to make it user friendly for the users.

Responsibilities:

  • Experience of doing documentation on business requirements.
  • Clarified client requirements, business needs and project objectives, via feedback sessions and client meetings, in collaboration with all stakeholders.
  • Assigned Q.A. team members to develop test cases, browser requirements, functional analyses of online products, and worked with internal and external clients, content producers and stakeholders to conduct interim project reviews and final project weeks prior to launch.
  • Developed test plans and test cases.
  • Interacted with the developers on resolving the reported bugs and various technical issues.
  • Gathered Business Requirements and wrote Business Requirements Document (BRD) by working with the client IT staff, project managers.
  • Supported the Program Manager in balancing project goals and business needs
  • Assisted the Account Management people in reviewing the account of the customers.
  • Documented various workflow diagrams like AS-IS and TO-BE processes.
  • Translated Business requirements to functional and technical language with the help of Use cases and UML diagrams for developers.

Environment: Project Plan, project scope, use cases, sequence diagrams, production plan, Business Requirements Document, UML.

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