SUMMARY:

• Over 7 Years of experience in the Field of IT as a Business/Systems Analyst.
• Strong knowledge of the Software Development Life Cycle methodologies (phases and gates) like Agile and Waterfall models
• Effectively used Rational Requisite Pro to organize, track and change requirements of the system.
• Expertise of UML in visualizing and documenting the artifacts using Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams, Sequence Diagrams using MS Visio
• Experience in creating Configuration Design Documents, Impact analysis, unit testing and auditing.
• Experience in facilitating Joint Application Development (JAD) sessions, Rapid application development (RAD) sessions, conducting user interviews and acting as a liaison between the customers, development team and testing team.
• Analytical, methodical and resourceful approach to problem - solving, identifying root causes and corrective actions to meet short and long-term business, financial and system requirements.
• Hands on experience with Source to target mapping in enterprise data warehouse environment.
• Excellent verbal/written communication skills and strong analytical abilities and can perform well both independently and as a team player.
• Experience in using methodologies such as UML (Unified Modeling Language) and OOAD (Object Oriented Analysis and Design).
• Experience in Healthcare Payer and Provider Operations, re-engineering claims, benefits, enrollment and eligibility processes Experience with different modules within healthcare (Sales, Membership, billing, enrollment, claims, capitation, and providers).
• Performed Back-End testing by using PL-SQL/SQL commands to verify the database integrity.
• Data Warehouse skills include architecture/design familiarity with Star schemas, conformed dimensions, data quality, developing complex ETL packages, metadata.
• Project Management experience, especially in Project Planning, Project Design and coordinating/managing multiple BI and DW projects.
• Proficient in writing SQL queries to manage customer database, good knowledge of Data warehousing.
• Have developed standards for data definitions, data element naming conventions, and logical/physical database design for applications and data warehouse development.
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
• Interface with clients from Operations, Marketing, Sales, Technologies, and Outside Vendors and act as their customer interface point as the lead of the Projects.
• Highly motivated team player with excellent Interpersonal and

TECHNICAL SKILLS:

• JIRA
• Bitbucket
• Confluence
• Kanban
• AGILE
• Web services
• SOAP UI
• Salesforce Admin
• Oracle DB
• Tomcat Apache
• MS Visio

PROFESSIONAL EXPERIENCE:

Confidential, Grand Rapids, MI

Business Systems Analyst

Responsibilities:

• Participated in creation of Business Process Workflow Diagrams with Stakeholders.
• Conducted meetings with business users and SMEs to identify and gather various functional and non-functional requirements.
• Utilized agile methodology to configure and develop process, standards, and procedures to create a Business Requirement Document (BRD) and conducted GAP analysis.
• 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.
• Was involved in managing the Daily Standup meetings and ensured that quality standards were enforced as per the build-release schedule.
• Validate data extracts from Enterprise Data Warehouse and other interfacing applications.
• Extensive understanding on EDI-837 Institutional and Professional Claims
• Analyzed corporate healthcare business processes to develop customized solutions.
• Perform root cause analysis of payer denials; recommend and implement process improvement solutions
• Attend payer meetings as necessary
• Developed flow charts and work instructions to help provide guidance and support to the MDM (Master data management) team.
• Ability to interact with stakeholders for “As-Is” and “To-Be” process flows using UML diagrams.
• Created artifacts such as Use Cases, Activity Diagrams, and Sequence Diagrams using MS Visio.
• Developed technical design documents and mapping documents for implementing health care HIPAA transactions like 834, 837I, 837P, 837D, 997,270, 271, 276, and 277.
• Performed data driven test for multiple scenarios with different sets of data using internal and external data sources.
• Complete study and analysis of Revenue Cycle management of the health stream respective to existing billing system, Claims processing etc.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stores workshop.
• Tracked all required resolutions required that were identified as needed from Vendors or Payers based on testing results.
• Wrote SQL queries to validate data in database and Facets.
• Involved in Data mapping to/from legacy to Facets that will be used to populate the database
• Involved in writing extensive SQL Queries for back end testing Oracle database.
• Involved in configuration changes in Facets testing
• Performed QA Acceptance testing for test workflows with business users and performed data encryption testing as per HIPAA guidelines to ensure the privacy, security and confidentiality.
• Acted as a liaison between client and payer/intermediary. Experienced in payer rules, requirements, governmental regulations and HIPAA compliance.
• Played major role in 24/7 production support for transactions like 834, 837I, 837D, 837P, 270, 271, 276, 277.
• Processed EDI 837P, 837I, 834 and 837D transactions, verified 837 transactions were converted correctly to XML file format and verified the claims data loaded to Facets for further processing
• Extensively used HP Quality center for defect tracking management of test cases.
• Extracted data by running SQL queries, and analyzed customer metadata that gets populated on the web application.
• Used UML diagrams for data capture activities which required working with SMEs ensure consistency and accuracy
• Involved in data warehouse testing by checking ETL procedures/data mappings
• Communicated with business and development teams to resolve issues during test execution and ensured enhancements meet established quality and end user needs.
• Logged the errors, reported defects, determined repair priorities and tracked the defects until resolution using Mercury Quality Center.
• Quality Center was used to create the test plan, store test cases and run the test sets.
• Used Quality Center to analyze, track and report defects.
• Worked on uploading all the Test cases to the Quality Center for the current and prior releases.
• Responsible for performing System and integration testing for release.

Environment: Quality Center, IBM Mainframe, MDM, HIPAA standards, Facets, UML diagrams, Oracle on Windows, SQL, MS Outlook, Java, HTML.

Confidential, Bronx, NY

Business Systems Analyst

Responsibilities:

• Performed GAP analysis as it pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
• Coordinated JAD session with system analysts, development team, project manager for application development and Pre-validation specifications.
• Created various Use Cases, Activity diagrams, Sequence Diagrams and other UML diagrams by using MS Visio.
• Participated in all Iteration, Scrum, Daily stand-ups and Iteration review meetings working in an agile development methodology.
• Created functional and non-functional requirement for data movement from all source systems into MDM (Master data management).
• Produced Activity diagrams with defined swim lanes as part of the claims process analysis.
• Worked on the configuration of FACETS with Benefits, Claim processing, Subscriber/Member, and Enrollment.
• Collaborate with EDI team on revenue cycle improvement opportunities
• Prepared documentation and reference materials for team members for future reference of FACETS configuration setup. Worked on Process Flow Models and Captured Process flow diagrams.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Translated business requirements into functional specifications and documented the work processes and information flows of the organization.
• Dealt with the EDI transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.
• The responsibilities included requirement definition & gathering, Source to Target mapping, conceptualization/design/development of the MDM(Master data management) solution & processes. .
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I, P, D) standards.
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases.
• Supporting end-to-end third party data process into MDM(Master data management)
• Involved with various aspects of the project's needs such as the logging, tracking, and resolution of issues, current state workflow assessments.
• Created Wire Frames for the Confidential System/portal used for showing claims process in Facets.
• Created UML class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
• Assisted the Quality Analyst (QA) in creating test plans, test data and conducted manual testing to validate functionality.
• Direct contact with the payer on behalf of the provider to discuss claim rejection reasons concerning claims and enrollment
• Prepared Use Cases, Business Process Flows, and Activity Diagrams using Microsoft Visio for complex processes and walks business and development team through the documentation.
• Assisted the QA in performing simple SQL queries for QA testing and data validation.
• Developed mapping spreadsheets for (ETL) team with the source to target data mapping with physical naming standards, datatypes, volumetric, domain definitions, and corporate meta-data definitions.
• Analysis of existing data requirements using SQL to document functional requirements from high-level User Stories.
• Extensively involved in creating and entering dummy data to test the functionality of various modules of EDW and how the modules integrated with the EDW database and the Facets database in the backend.
• Worked in ETL environment involving Informatics/Data Stage and Business Intelligence tool - Business Objects.
• Worked on Claims Processing, Claims Enquiry, Remittance, Payments and Reductions, Eligibility, Accounts for Subscribers, Providers, Members, Payers and Claims Editing.
• Conducted Data analysis using SQL on the backend databases for producing mapping documentation and transformation rules for developers.
• Worked on ETL documentation and created data mapping document.

Environment: XML, JIRA, Ms. SharePoint, X12, Soap UI, Web based, AGILE, MDM, UML diagrams,, Confluence.

Confidential, Watertown, MA

Business Analyst

Responsibilities:

• Followed Agile Methodology
• Helped define technical requirements, as well as the business rules for data population and transformations at Confidential
• Develop and manage service definitions and data mappings for multiple system integration realized through standard EDI (27x, 278) and other Enterprise Business Services
• Created high-level Use Cases from Business Requirements and created UML diagrams like Use Case and Activity diagrams using MS-Visio.
• Created and maintained SQL Scripts to perform back-end testing on the oracle database.
• Wrote some basic SQL queries for Oracle database and prepared test data.
• Worked closely with the Development team on the Healthcare Data mapping and Technical Requirements Document (TRD
• Created, processed and facilitated troubleshooting for SQL data loading scripts for QA and Production environments.
• Worked to create interfaces and extensions for Facets Billing & Enrolment and Provider contract applications.
• Developed Incident documents and portrayed the As-Is reporting structures versus To-be Reporting needs for data integrity and accuracy.
• Worked on various subsystems within the MMIS including but not limited to Recipient Payer, EDI etc.
• Carried out detailed and comprehensive business analysis with the Agile methodology
• Assisted the Product Managers in setting up timelines for the various teams (development and testing teams) as per the Agile SDLC.
• Streamlined Claims (837, 820 EDI X12) Migration project by gathering functional specifications.
• Performed Data mapping and data modelling and used Canonical data model to map data from X12 834 transactions.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as, 835 / 837 transactions.
• Conduct peer reviews with technical staff, project manager, and SME and product owner.
• Created test data for 837I, 837D, 837P to have Segments/loops information with different combination of Submitter, Receiver, Billing Provider, Pay-To-Provider, Subscriber, Payer, Patient, Claim Information, Physicians, Referring Provider, Service Line Info, Adjudication Information
• Analyzed the existing healthcare insurance claims processing systems and perform gap analysis for effective development of the future healthcare claims enrollment and eligibility solutions
• Converted X12 834 files using Ultra edit tool in a readable format to understand the exact 834 file structure Worked with the Management team for setting up expectations, coordination and conduction of information within the project team and with healthcare application vendor
• Involved in Facets implementation, end-to-end testing of modules like Billing, Payment, and Provider and Claim of Facets applications.
• Analyzed HIPAA 4010 and HIPAA 5010 standards for 837I/P, 27x's and 835 transactions and prepared gap analysis document for each transaction.
• Performed data analysis and wrote SQL queries to understand the data transmission.
• Worked with QA to help establish integration test criteria (CIT) and environment
• Used Facets to provide seamless transactions between the provider, members and the plan.
• Conducted QA testing and supported user acceptance training (UAT) for the development of data transmission interface system.
• Extensively participated in verification of EDI file formats against HIPAA ANSI X12Standards

Environment: XML, X12, XSL, SQL, PL/SQL, SDLC, MDM, Rational Clear Quest, UML diagrams, ETL, Rational Clear Case, Rational Requisite Pro, Rational Rose, UML, RUP, HP- Mercury Test Director, Agile, HP quality center, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.