- Over 8 years of extensive experience as Sr. Business Systems Analysis with hands on experience in integrating business needs into IT solutions with core activities likeRequirement Gathering &Analysis, GAP Analysis, Designing, Software Development, Implementing, and Software Validation/Testing,Project Cycle Management (PCM) in industries like Healthcare, Insurance and Pharmaceuticals.
- Extensive experience in gathering requirements by conduction of JAD sessions(Joint Application Development),Interviews, Workshops and Requirement Elicitation sessions with end - users, clients, stakeholders and development team and converting them in to BRDs (Business Requirement Documents) and FRDs (Functional Requirement Documents) or NRFD (Non-Functional Requirement Document).
- Expertise in broad range of technologies, including business process tools such as Microsoft Project, MS Excel, MS Access, MS Visio, technical assessment tools, Micro Strategy Data Warehouse Data Modeling and Design.
- Thorough Understanding of SDLC (Software Development Life Cycle).
- Experience in Classic Waterfall,RationalUnifiedProcess (RUP), Agile, Scrum, RAD (Rapid Application Development) methodology.
- Expertise in defining Scope of projects based on gathered Business Requirements including Documentation of Constraints, Assumptions, Business Impacts, and Project Risks.
- Expert in working with SME’ Confidential (Subject Matter Experts) across each group during entire SDLC with strong experience in conducting GAP Analysis,, Cost Benefit Analysis, SWOT Analysis and Return of Interest (ROI) Analysis.
- Assist the PM in documenting Scope and vision and feasibility of the project
- Conducted Stake Holder analysis to get a clear understanding of the process and various roles and responsibilities of the team members.
- In-depth working experience with different requirement elicitation techniques like, Document analysis,Interface analysis, Reverse engineering, Prototyping, Role playing, Observation, Survey, Interview, Brainstorming, Requirement workshop.
- Extensive experience in documentation of business requirements and system functional specifications, including BRD, FRD, and FSD.
- Written Use cases and have produced Use Case Models, creating Behavioral diagrams (use case diagram, Activity diagrams and Sequence diagrams) based on UML Methodology & Business process flow diagrams.
- Created wireframes/ mockup screens using MS Visio at the time of elicitation of Requirements from the stakeholders
- Expertise in broad range of technologies, including business process tools such as MS Excel, MS PowerPoint,MS Access, and MS Visio.
- Experience in Data Migration, collected data on the old system and mapped to the new system providing a design for data extraction and data loading. The design relates old data formats to the new system' Confidential formats and requirements were drafted accordingly.
- Experience in ER Diagramming, logical data modelling, Enterprise Data ware House concepts.
- Experienced in conducting User Acceptance Testing at both company and clients premises
- Collaborated with product owners to write up and prioritize customer centric documents like User Stories for Product Backlogs.
- Facilitated Daily Scrum Meetings and Monthly Reviews meetings. Conducted sprint retrospective and followed up on action items for continuous improvement
- Experienced in writing complex SQL queries: sub-queries, joins, and union.
- Experience in creating user documentation, user training, deployment process planning and post- production support documentation.
- Experience in creating test strategies, test plans and test scenarios for Unit/ End-to-End /System/ User Acceptance Testing (UAT).
- Utilized a combination of business knowledge, technical skills, and strategic analysis to provide solutions and creative insights to critical business problems.
- Experience in SLA' Confidential preparation, Cost benefit analysis, Cost to profit ratio, change request controls drafting.
- Worked as PM for the ITservice request project for the ongoing projects.
- Expertise in assisting the Testing Team in creating the Test Plans, Test Cases and Test Scripts and efficiently prioritize and manage the defects using the Defect Tracking system
Business Documentation Skills: Documented Business Requirement, Use Case Specifications, Functional and Non-functional Specification, System Requirement Specification, UML Diagrams (Use case, Class and Sequence), Traceability Matrix, Project Estimate, Change- Training and User Manuals.
Programming Languages: SQL, C, C++, PL/SQL, JAVA, HTML, DHTML,, XML, VB,.NET,JSP.
Scripting Languages: Power Shell, Java Script, VBA, Perl, HTML, VBScript, PHP, GUI Scripts, C++.
Methodologies: OOAD, Joint Application Development (JAD), Rapid Action Development (RAD), Rational Unified Process (RUP), Unified Modeling Language (UML), System Development Life Cycle (SDLC), Crystal Reports, 1Visual Source Safe, Waterfall Model, Agile Model, SCRUM, Rational Unified Process (RUP)..
Operating Systems: Windows, DOS, Unix, Linux, MacOS/OS X Sun Solaris
Healthcare: ANSI X12, HL7, HIPAA, HIX, PPACA, EDI, HL7, Enrolment/Claims, Medicare, Medicaid, CHIP, DHR, Facets
BI Tools: Business Objects(Designer, Webi, Dashboard), Cognos, Informatica, OBIE
Standards: HIPAA 4010/5010, ICD9/10, ANSI X12, CPT, CMS form., Six Sigma, CMMI, PMBOK
Development Tools: People Tools (8.53/8.52/8.51/8.50/8.49/8.47/8.42 ), Application Designer, People Code and Application Engine, File Layout.
- The primary function of the role is to maintain accurate, up-to-date information in the Product Information System (PIM). To input product data within the PIM system relating to product specifications and configurations, etc. and to maintain the integrity of this data. Requests will come from various product managers around the world that need to adjust the data on their products that is displaying to dealers and/or customers.
- Defined Scope of Project, gathered business requirements and documented Scope, BRD, CBS, FSD.
- Extensively involved in Payer life cycle encompassing Claims, Payments, Provider, Billing, Portal, Benefits.
- Developed business process models using Agile Methodology by document user stories existing and future business processes.
- Evaluated all the information gathered from multiple sources, reconciled conflicts, decompose high-level information into details, abstract up from low-level information to a more general understanding, distinguished user requests from the underlying true needs and distinguished solution ideas from requirements.
- Organized brainstorming, JAD sessions and interview sessions with stakeholders, business users, and technical teams, testing team to analyze and validate the business requirements, system life cycle and explained the key performance indicators and documented the specifications.
- Helped implement ANSI ASC X12 standards for Data Mapping when transferring data using Electronic Data Interchange (EDI).
- Ensure that all data conforms to Corporate and/or Doosan Trading standards.
- Liaise with internal and external customers ensuring that SLA' Confidential with our customers is met and maintain data in response to changes in business requirements.
- Conduct well planned relevant initial and continuing education for EMR systems for improving staff professional development, EHR responsibilities and medical billing expertise.
- Involved in Claim Processing from End to End and major work was involved with 837 P/I Claims Processing systems and 834 benefit enrollment
- Using Facets to compare and test the claims Facilitated requirement gathering sessions with the business team to collect the business, security and service level requirements and documented them.
- Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
- Create/Maintain product information.
- Manage change request tickets and work to complete within a timely manner.
- Create and Maintain process documentation.
- Assist, where necessary, in the correction and cleaning of corrupt data, help Project Team validating data for various business migrations.
- Identify process improvement opportunities and work to increase efficiency
- Developed a work plan that ensured RFP would meet federal prior approval requirements including use of modular project development, compliance with MECT, MITA, HIPAA and other federal guidelines.
- Exported and extracted HEDIS measures from NCQA certified SQL-based software into user-friend MSExcel formats.
- Responsible for leading, executing and coordinating tasks in support of the CMS Certification of a Medicaid Management Information System ( MMIS ).
- Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
- Facilitate and manage meetings, issue management, and facilitation of regular checkpoint meetings throughout the SDLC .
- Develops process for participation in the reporting and improvement of QCDR measures to fulfillPQRS reporting requirements.
- Reviewed statistical data on HEDIS measures and manages special projects that are related to disease prevention, and quality improvement.
- Involved in requirement gathering and testing of consumer web portal for the enrollment of Medicare members.
- Organize meetings and led JAD sessions to ensure legal and compliance deadlines of CMS (Centers for Medicare and Medicaid Services) are met.
- Familiarity with Amisys, SQL, EDIFACTS, XML, Edifecs, B2B, BizTalk, RUP, SDLC .
- In-depth knowledge of healthcare organization operations including outsourced operations, health insurance, HIPAA , and Medicaid/ MMIS , including MITA .
- Worked on Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare .
- Collaborate with Clinical and IT staff to support HEDIS business requirements and maintain consistency and integrity of data collection and storage.
- Worked directly with the business sponsors, providers, stakeholders to establish reporting programscope and comprehensive quality reporting requirements for PQRS/MIPS, QCDR.
- Coordinated and conducted meetings with State Medicaid staff, programmers, and project managers to discuss and develop technical and business solutions for all tasks where problems and disagreements arise.
- Generated and designed reports for HEDIS specifications to analyze complex data through internal databases.
- Collaborated with project stakeholders throughout all SDLC phases to ensure timely delivery of specified business solutions. Wrote Business Requirement Documents ( BRD ).
- In-depth analysis of system functions and operational procedures for compliance with CMS Certification requirements
- Validating the EDI 837 claim billing (professional, institutional and dental claims) & 835 (remittance advice or payment) claims adjudications.
- Gathering business requirements from the client and translating them into use cases and functional specifications.
- Communicating to various business stakeholders and understand their vision and ensuring this achieved in the course of the project.
- Performed End to End testing for the member, provider and claims modules as per the MITA business process.
- Performed gap analysis between a client' Confidential requirements and the functionality within Microsoft Dynamics gather requirements, schedule vender demos for the products and gave industry best practices to the customer.
- Worked on Gathering and understanding client system requirements for CRM software selections.
- Responsible for Functional Specifications Document and signoff for all scheduled requirement deliverables.
- Adhere to all HIPAA rules and regulations regarding the protection of personal health information.
Confidential, Fargo, ND
- Worked on EDI transaction 835 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
- Utilized corporation developed Agile SDLC methodology used scrum work pro and Microsoft office software to perform required job functions.
- Responsible for designing integrated HIPAA and Medicare solutions.
- Track development and monitor quality of changes to CMS MMIS Certification process.
- Improve BusinessIntelligence, and Knowledge Management using Data Management disciplines and MITA processes for Medicaid.
- Strong expertise in Health Insurance Claim process, social services, Medicaid and banking.
- Used agile methodology to execute complete software development lifecycle (SDLC) solutions, including requirements gathering, test planning and execution, design, development, and deployment for clients.
- Involved throughout the System Development Life Cycle (SDLC) and performed a primary liaison between the business and the technical areas.
- Act as the liaison between CMS, stakeholders, the executive team and Medicare-Medicaid Plans enrolled in the nationwide Encounter Demonstration Project.
- Define requirments in accordance with MITA standards.
- Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
- Performed product GAP Analysis to check compatibility of existing system infrastructure with newbusiness needs.
- Prepared Business Requirement Documents (BRD) as well as high-level project plans and used Rational RequisitePro to manage, analyze, and convert business requirements into functional specifications.
- Facilitate, the process for requirements validation that follows the MITA process/sub-process business model.
- Used Visio for Business Use Case Diagrams and Businessprocessmapping. Developed use cases for claim front end, back end, inbound and outbound business process and file processing.
- Interacted closely with QA team in different phases of testing such as System testing, Functional testing, Regression testing and Integration testing for Quality Analysis using Quality Center and resolving the issue assigned on JIRA.
- Closely working and supporting operational, developers, QA and UAT teams.
- Worked in Visio and UML for Business Process Mapping, designing applications and use cases.
- Worked with SharePoint for storing project documentation.
- Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
- Worked extensively in Requirement Gathering, Requirement Analysis, Requirements Change Management, Client Management, Gap Analysis.
- Gathering requirements, interacting with customers using different elicitation techniques.
- Preparing BRD based on requirements gathered.
- Conducting User Acceptance Testing (UAT) and User training.
- Responsible for all aspects of the project from business analysis to plan management, customer engagement and risk management.
- Prioritize requirement using MoSCoW technique.
- Involved in developing the implementation approach and managing the impact on all business areas.
- Managed all types of change requests, defects, enhancements, issues and documentation changes.
- Understanding service objectives and capturing business requirement through active listening and questioning techniques.
- Collaborate with team members to achieve targets and revenue goals.
- Client interaction which evolves from the start till the project is delivered successfully.
- Excellent communication skills to co-ordinate with business and technical consultants to explore business process improvement opportunities
- Determining operational objectives by studying business functions; gathering information from requirements; evaluating output requirements and formats
- Preparing technical reports by collecting, analyzing, and summarizing information and trends based on Business Analytics.
- Identify how test teams aligns within the organization and how team would achieve the roadmap identified for the project and hence organization.
- Identify the scope of the testing required for a particular release based on the requirements document.
- Put out the test plan after discussions with the test team and have it reviewed and approved by the management/ development team.
- Designing new computer programs by analyzing requirements, constructingworkflow charts and diagrams, studying system capabilities and writing specifications.
- Maintaining and enhancing professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, benchmarking state-of-the-art practices.
- Identifying the required metrics and work to have them in place.
- Identify if there are skill gaps and plan training and education sessions for the identified test resources.
- Retaining skilled resources by instilling leadership in them and provide guidance to junior resources as and where needed which would help them to grow.
- Create a fun and conductive environment for all resources to make sure they have maximum throughput.
- Identifying the needed testing effort by calculating the sizing needed for the given release and plan the effort needed for the same.
- Involved in various projects for creating company profile and key management profile.
- Assist Team Leader in preparing team outputs, team development and compliance with company processes.
- Involved in researching and managing various projects
- Carry out data analysis and verification including risk analysis.
- Conduct quality checks on the data prepared by the respective team member
- Carry out competitor analysis, data analysis and verification
- Instrumental in developing and implementing team building strategies
- Conduct quality checks on the data prepared
- Impart training to new hires on project specific aspects