PROFESSIONAL SUMMARY:

• Versatile management professional with 6+ years of work experience as Sr. Business Systems Analyst with in - depth knowledge of software development and exhaustive expertise in business process analysis. Managed highly visible, complex projects with aggressive timelines and delivered cost effective, high performance technology solutions to meet challenging business demands.
• Strong Analytical, Problem Solving, Decision Making and Project Management Skills. Proven Success in Business Requirements gathering, Analysis, Business Process flows (As-Is and To-Be), JAD sessions, UAT, Cost Benefit Analysis, Work breakdown structure (WBS), RACI Matrix.
• Experience in liaising with business and technical stakeholders and coordinating with cross functional team to meet the business objective.
• Expertise in Business Modelling and UML Diagrams (Use Case Diagrams, Sequence Diagrams, Activity Diagrams) using MS Visio.
• Expertise in diverse software engineering practices such as Waterfall, RUP and Scrum.
• Managed and implementation of Lean Six Sigma and Total Quality Management methodologies - DMAIC, DFSS.
• Well experienced of SOA Architecture, Internal and External Web Services (SOAP, WSDL, and UDDI).
• Experience in conducting Impact, SWOT, Feasibility, Risk, and ROI Analysis.
• 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), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrolment).
• Defined Functional Test Cases, documented, Executed test script in Facets system
• Worked in various technologies such as Epic Care Ambulatory, Epic Care Inpatient, IDX/GE Centricity, Cerner Power Chart, Citrix, HL7 (v 2.3/2.4), PACS, DICOM, XML, Java, .Net, Oracle and HTML.
• Extensive experience in creating artifacts like Business Requirements Documents (BRD), Functional Requirement Specifications (FRS), Software Requirement Specifications (SRS) and GUI Mock-up Screens.
• Experience in defining and analyzing services and incorporating them into service oriented processes through extensive uses of Web Services in SOA Environment.
• Developed Test Cases & Test Plans with extensive use of HP ALM & Clear Quest.
• Strong knowledge and working experience of industry standards such as HIPAA, HL7, Six Sigma, and SOX, ICD-9, ICD-10 coding, EDI (Electronic data interchange), transaction syntax like ANSI X12.
• Involvement in Data Dimensional Modelling, Data Extraction Transformation Loading (ETL) and Business Intelligence Reporting using Tableau & Informatica.
• Well-versed with ICD-9 and ICD-10 guidelines, conventions and rules.
• Experience with Facets, Inbound & Outbound interfaces, EDI configuration, and data mapping using ANSI X12 4010 and 4,835,837) .
• Hands-on experience with claims adjudication tools: MMIS and Facets
• Experience in Project Management, Business Process Mapping (BPM)
• Extensive experience on MS Excel, MS Word, PowerPoint, MS Project, MS Visio and SQL.
• Excellent communication and interpersonal skills with strong Customer orientation and Client interfacing skills.
• A self-motivated professional, possessing good Technical, Leadership, and problem solving skills and proven to be a good Team Leader.
• Domain Knowledge - Healthcare Information System, Laboratory Information System, Healthcare Insurance, HIPAA Guidelines, EDI transactions, HL7, NPI, EHR, EMR, Facets, E-Learning & Learning Management System.

TECHNICAL SKILLS:

Modeling Tools: MS Visio, Rational Rose, Mockup Screens, Requisite pro, Clear Case, Clear quest

Project Management Tools: JIRA, Rally

Methodologies: Waterfall, Agile/Scrum/RUP

Data Warehousing: Data Marts, OLTP, OLAP, Query/Reporting

BI Reporting Tools: Tableau 8.3, Crystal Report, IBM Cognos 10, SQL Server Integration Services (SSIS), SQL Server Reporting Services (SSRS)

Database: MS SQL Server 2012/2008/2005 , Oracle 8/9/10/11

ETL Tools: Informatica, Data Stage

QA Testing Tools: HPALM, HP Quality Center

Web Technologies: HTML, CSS, JavaScript, XML, AJAX, C#

Documentation Tools: MS Office Suite, Share Point 2010/2013

PROFESSIONAL EXPERIENCE:

Confidential, Alpharetta, GA

Sr. Business DATA Analyst

Responsibilities:

• Gained insight about the structure, business model, and existing healthcare process referring to legacy documents and SharePoint.
• Correlated the business objective as a part of continuous process improvement using Define, Measure, Analyze and Improve.
• Prepared the Gap Analysis Document & Feasibility Study though extensive use of SharePoint Analytics, various Elicitation techniques like Meetings, Group Discussion, Surveys and JAD Sessions.
• Coordinated with Project Manager to create Work break down structure (WBS), manage schedules, deadlines, resources and the project tasks using MS Project.
• Creates functional specification documents to create content within the EHR application and is primarily responsible for validating this content with the business owner
• Stepped up as a Scrum Master and conducted daily scrum meetings in order to track the progress of the team and resolve any impediments, scrum review, and retrospective meetings.
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
• Calculated Velocity, framed Burn down chart, re-populated the release backlog with unfinished user stories, and guided the stakeholder with the slice of potentially shippable product at the end of every sprint.
• Anticipated and proactively tracked, recorded and removed Impediments.
• Consultant in Healthcare Strategy for ICD-10 Assessments and Implementation Strategy Engaged as Lead for Strategic Planning .
• Currently leading, coordinating EMR/EHR (iHelix Suite) implementation to achieve meaningful use stage 1.
• Performing business analysis, software validation and testing for client/server, multi-tier and web-based applications for EMR and commercial business for managed healthcare plans and Industries
• Working knowledge of MediCare, MediCaid and Commercial Insurance benefits eligibility (834s), contracts set up, billing, claim (837s) processing includes remits (835s) and denials.
• Participate as a key member of the core implementation team charged with successfully implementing and supporting an EHR system by becoming a Next Gen Certified Professional and subject matter expert in the functionality of the electronic practice management and electronic medical records software.
• Facets Product Configuration of new products and components including research, testing and trouble shooting in FACETs.
• Experience with TriZetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Participated in various meetings/discussions, with Product Manager, SME and Project Manager, to discuss and consolidate the business requirements.
• Responsible for executing Epic workflow / flow sheet analysis, system setup and configuring Epic ambulatory and inpatient templates according to the specialty clinic patient order sets.
• Worked in various technologies such as Epic Care Ambulatory, Epic Care Inpatient, Citrix, HL7 (v 2.3/2.4), PACS, DICOM, XML, Java, .Net, Oracle and HTML.
• Testing of Epic billing reports (hospital billing and insurance billing) for Epic billing output and interface accuracy.
• Extensively involved in testing Trizetto Facets and mainly involved in Enrollment and Eligibility modules.
• Designed various Use Case diagrams, process flow diagrams, sequence diagrams using MS Visio and Mockup screens.
• Performed gap analysis of existing Web Services already used by departments like Emergency, Radiotherapy, Nursing, Pharmacy, and Laboratory and utilizing those for the main Dashboard.
• Worked on HIPPA 5010 security and compliance, HL7 and ICD-10 codes.
• Intensive working on the current ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion.
• Reviewed Test Procedures, defined Test Cases, and analysed bugs, interacted with team members in fixing errors through extensive use of HP ALM & Clear Quest and conducted User Acceptance Testing (UAT).
• Identified the impacts the HIPPA 5010 & ICD 10 project had on enrollment Claims, FEP (Medicare and Medicaid program).
• Facilitated User acceptance testing (UAT) and Integration testing.
• Used Rally to manage schedules, deadlines, resources and the project tasks.
• Closely involved with system migration strategies, readiness assessment, deployment and training requirements and execution of training plans.

Environment: Agile/Scrum, MS Office Suite, MS Project, Visio, SharePoint 2010, Mock-up Screens, Rational RequisitePro, HP ALM, Oracle, Tableau, JAVA, HTML, XML, SOAP

Confidential, Fort Washington, PA

Data Analyst

Responsibilities:

• Participated in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user.
• Served as the primary data contact for clients during the implementation timeframe.
• Conducted Gap Analysis (GAP), User Acceptance Testing (UAT), and System Integration testing (SIT) and SWOT analysis.
• Converted business and technical requirements into various User Stories, facilitated Sprint planning meetings to estimate and prioritize various tasks and sub-tasks associated with each user stories.
• Worked on ICD conversion from 9 to 10. Complete a review of existing documentation for orders, referrals, and reports and compare it to the clinical details needed for ICD-10.
• Intensive working on the current ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion.
• Facilitated implementation of HIPAA EDI Transactions (835, 837).
• Familiarity and experience with the ICD-9-CM/ICD-10CM, CMS and CPT code set.
• Performed GAP Analysis for HIPAA 4010 and 5010 transactions.
• Used EDI tools to verify mapping to X12 format.
• Involved in development of the system for data exchange from EMR, EHR to Electronic Lab Reporting Systems.
• Gathered requirements for making changes to the existing Electronic Medical Records(EMR), Electronic Health Records(EHR) and Ambulatory Services for the existing Epic Interfaces.
• Have proven business insight and the technical know-how to implement large-scale EMR and EHR engagements .
• Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports
• Extensively involved in testing Trizetto Facets and mainly involved in Enrollment and Eligibility modules.
• Create and execute revenue cycle medication Epic billing data and reports from decision support and billing systems. Analysed all related medical codes for accuracy to ensure maximum benefit allowed is accurately billed.
• Troubleshoot and track issues and problems related to Epic ambulatory care solution and inpatient management system. Developed Epic patient billing representative training manual, provided new hire operational and application training.
• Involved in intensive system level testing of analyzing the HL-7 messages coming out and in of EPIC Bridges.
• Experience with TriZettos Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Act as primary contact for business requirements related to QHP enrollment functionality including 834 EDI enrollment files to carriers, 834 EDI effectuation files from carriers, and 834 EDI federal enrolment files to CMS.
• Involved in identifying 834 header for business purpose and transaction set.
• Act as a primary contact with business owner for meeting milestones deliverables related to 834 EDI enrolment functionality.
• Served as a healthcare payer by making sure that claim payments are made based on NPI and Tax ID Number.
• As a healthcare payer, identified the format of 835 file which included multiple checks and payment information to the provider group
• 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.
• Analysed HIPAA EDI transactions in X12 responses of 837, 835, 277CA, 999 and looked for defects.
• Performed data analysis for various version changes of EDI messages on different sub-systems.
• Performed General Equivalence Mapping (GEM) to assist in converting any ICD-9-CM-based application to ICD-10-CM/PCS. Involved with ICD10 implementation testing.

Environment: Agile/Scrum, Rational Clear Quest, MS Project, Share Point 13, Web Services, UML, Crystal Report, Rational Test Manager, HTML, and XML.

Confidential, Foster City, CA

Business Data Analyst

Responsibilities:

• Associated in identifying the problem definition as part of continuous process improvement using define, measure, analyze and improve to support the business continuity of the organization
• Acted as a liaison between management and Data Warehouse management team.
• Involved in Project Management activities like defining / managing project scope, schedule management, creating project plans, tracking and communicating project status and deliverables.
• Extensively interacted with data analysts during the ETL operations in identifying the source files/databases and implementing the transformation logic for achieving data uniformity in operational data store (ODS).
• Implemented the ICD 9 codes for regulating Medical and Drug terminology.
• Experience in working with ICD-9-CM HIPPA transaction code
• Researched, analyzed and presented best practices in a Clinical Trials Study environment to determine the best overall solution to leverage metrics with the support of CTMS
• Facilitated JAD sessions with focus groups, requirements workshops, Interface analysis and prototyping to effectively understand the analytical reports needed by the internal clients.
• Negotiated with the DW architects and developers to identify appropriate dimensional modelling (identifying dimensions/facts/referential integrity), measures (additive/semi-additive/non additive) and sizing (in terms of number of columns, records per dimension and fact table).
• Researched, analyzed and presented best practices in a Clinical Trials Study environment to determine the best overall solution to leverage metrics with the support of CTMS-Siebel 8.
• Worked on pre authorization of Claims in FACETS and Knowledge of ICD-9, CPT, REV codes.
• Used Mockup screens to convey the look and feel of GUI screens for the end users to developers.
• Worked on Visio to prepare Use Cases diagrams, process flow diagrams, sequence diagrams.
• Responded to department requests for hands-on assistance within CTMS.
• Demonstrate Requirements Traceability Matrix (RTM) using Rational Requisite Pro to trace the completeness of requirements.
• Manifest Key performance indicators (KPI) for the application performance measurement in specific functional area of the organization.
• Exhaustively used SQL Queries for data analysis, system verification and validation.
• Involved in identifying and suggesting the different dimensions (slowly changing dimensions/rapidly changing dimensions) required for generating the reports and OLAP cubes to facilitate the multi-dimensional view of the data to generate slicing/dicing, roll-up/drill-down reports.
• Thoroughly interacted with the designers, developers to ensure functional implementation of business requirements and QA Team in executing Test Plans, Test Scenarios and Test Cases.
• Coordinated the execution of Unit Testing, System Integration Testing (SIT), Performance & Service level testing and User Acceptance Testing (UAT).

Environment: Hybrid, .Net, Windows (98/XP/7/Vista/8), MS Office Suite, MS Project, Rational Rose, UML, SQL Server Services, Pentaho, Informatica, HTML, XML, SQL.

Confidential, Mountlake terrace, WA

Business System analyst

Responsibilities:

• Responsible for the requirement-gathering phase and project plan.
• Responsible for requirements analysis, design and developing technical requirements.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
• Embrace agile principles. Support iterative user experience design, involving UX research and UX design at all stages of product development
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Created customized reports with complex calculations that were used to study the potential financial impacts of changes to Medicare and Medicaid payments.
• 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, an d 834 and ICD-10 Code sets.
• Acted as a SME for the application team and the Infrastructure team.
• Analyzed HIPAA 5010 related to 837,835, 834. Transactions and performed gap analysis between the 4010 and 5010.
• Used RequisitePro for writing/analyzing project vision, goals, specifications and requirements.
• Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• Conduced Joint Application Development (JAD) sessions and walk in interview with the business users to gather requirements.
• Responsible for creating UML Diagrams like Use Case, Activity and data flow diagrams using Rational Rose and MS-Visio and consistently translate business requirement into IT solutions.
• Built business requirements into the Medicare Advantage (MA) requirements database and created the Project Requirements Document for the three functional areas
• Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Incorporated Rational Unified Process (RUP) to create Business Requirement Document (BRD) Specifications using MS Visio and MS Word.
• Matched the requirements for programs such as Medicare and Medicaid, which are part of the Social Security Act.
• Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in RationalRose for the Business Use Case and System Use Case.
• Conducted the FRS and URS reviews and walkthroughs with designers, developers and stakeholders. Also conducted feasibility and adaptability study.
• Worked on following applications Business Objects, Enterprise Architect, Toad, PlanView (project management), Microsoft Suite (Word, Excel, PowerPoint, Visio, Access, Project)
• Created automation Framework solution to automate provider contract migration to facilitate the pricing engine on NetworX Pricer (Trizetto Product) to apply the configured pricing rules to determine claim pricing and configured routing rules during claim processing from the mainframe systems.
• Conducted JAD Sessions with Infrastructure management team, SME, policy holders and stakeholders for issues which were open and pending.
• Analyzed forms and successfully crosswalk details to corresponding ANSI X12 formats.
• Tested the changes for the front end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc).
• Developed the business anomalies workarounds and described them in documentation and presented the matter to the upper management for review.
• Developed non-functional requirements and documented them as Business Rules, Quality attributes and constraint documents.
• Interacted with database developers for formulating the ER diagrams and data flow diagrams.
• Responsible for GAP analysis of ICD9-ICD10.
• 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 the minute details of the project were discussed and issues were resolved beforehand.
• Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
• Extensively involved in testing Trizetto Facets and mainly involved in Enrollment and Eligibility modules.
• Performed configuration/ compatibility and user interface testing manually.
• Worked with QA lead in validating Test Plan and Test Scenarios.
• Used HP Quality Center for tracking Defects and tracing requirement functionality performances.
• Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual(s) for resolution.
• Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release
• Review of high-level design document and low level design of classes and sequence diagrams.
• Ensuring that deliverables were delivered on time as scheduled.

Environment: UML, RUP, Rational Requisite Pro, Rational Rose, Facets, Rational ClearQuest, Excel, SQL, DB2, Crystal Report, HP Quality Center