SUMMARY:

• Experience as a Sr. Business System Analyst with extensive industry experience in Healthcare Domain.
• Experienced in software development life cycle such as Waterfall Agile/SCRUM, methodology, Business Analysis and Modeling.
• Outstanding skills in Business Requirements Gathering, Functional requirements. Gathering, Business Process Reengineering, Requirements Traceability Matrix (RTM) and Software/System Requirement specification (SRS).
• Proficient in working with Business Analysis, Risk Analysis, Business Process. Models, Business Flow Diagrams and Business Requirement Documentation.
• Extensive experience in Extract, Transfer and Load process using ETL tools like Informatica, Data stage and SQL Server Integration Services for Data migration and Data Warehousing projects along with good project management skills.
• Good hands - on working experience on Power MHS applications.
• Experienced in performing Business Process Analysis to check the compatibility of the existing system infrastructure with the new business requirements and translating user expectations into detailed specifications by using various Text formats &Unified Modeling Language (UML).
• Strong working experience in the Data Analysis and Testing of Data Warehousing using Data Conversions, Data Extraction, Data Transformation and Data Loading (ETL)
• Work in health care sector with prime focus on claims adjudication, Migration, Provider, Eligibility and prior authorization for Medicare and Medicaid program
• Well-versed in writing and documenting Business Plan, Business Requirement document (BRD), Functional Specification document (FRS), Test Plan, Test scenario, Test Case as well as involved in white box, black box, Integration, Functional, Regression, System and Smoke testing
• Skilled in reviewing Test procedure, Defining Test cases, reviewing and maintaining test scripts, analyzing bugs, interacting with team members in fixing errors and User Acceptance testing
• Strong analytical, communication, problem-solving, decision-making and organization skills
• Extensive experience in designing Use Cases, Process Flow Diagrams, Contest diagram, As- Is, To- Be process.
• Strong SQL skills and prior experience with Oracle/PLSQL, MS SQL tools.
• Skilled at performing Risk Analysis, Impact Analysis and Cost/Benefit Analysis, along with good knowledge of process work flow tools and technique
• Experience in conducting/facilitating Joint Application Design/Use Accepting Testing (JAD/UAT) session with super organizational and presenting skill
• Hands on experience on facilitating and gathering requirements with several elicitation techniques: Document Analysis, Interface Analysis, Prototyping, Reverse Engineering, Observation, Survey, Interview, Brainstorming, Focus Group and Requirements workshop.
• Functional experience in health Care Industry with vast knowledge on Medicare and Medicaid.
• Experienced in Facets and its modules such as Claim, Member/Subscriber, Billing, Provider, Medicare, Medicaid and experienced with several Facets Batches
• Experienced in using Share Point, Microsoft Office and various Agile Sprint Tracking tools
• Knowledge and experience of Health Insurance Portability and Accountability Act (HIPAA)
• Experience in performing GAP Analysis to outline transaction strategy from HIPAA 4010 to HIPAA5010
• Strong knowledge of HIPAA EDI compliance regulations, transactions: 270, 271, 276, 277, 834, 835, 837) and code set.

TECHNICAL SKILLS:

Project Methodologies: Waterfall, RUP, Agile

Databases: Oracle 9x/10x/11x, SQL Server 2000/2005/2008/2012

Operating Systems: Windows 7/8/10, Unix

Business Modeling tools: IBM Rational Modeler, MS Visio

Rational Suite, MSVisio, MS: Project

MSWord, MSExcel, MS: PowerPoint, Requisite Pro, Rational Rose

Other tools: MS Office Suite, MS Project, Share Point, BMC Remedy

PROFESSIONAL EXPERIENCE:

Confidential, VA

Sr. Business System Analyst

Responsibilities:

• Utilized Agile Methodologies to configure and develop process, standards and procedures.
• Analyzed “TO BE” scenarios based on the data that are currently required to generate reports.
• Organized and facilitated Agile and Scrum meetings, which included Sprint Planning, Daily Scrums or Standups, Sprint Check-In, Sprint Review & Retrospective.
• Developed ETL test cases for various lines of businesses based on ETL mapping document.
• Wrote User Stories -- Elaborated User Stories and Acceptance Criteria; Reviewed user stories with team.
• Developed non-functional requirements and documented them as Business Rules, Quality attributes and constraint documents.
• Participated in Requirement gathering, Business Analysis, User meetings with both onshore and offshore team, discussing the issues to be resolved and translating user inputs into ETL design documents along with capturing specific data and analysis of the root cause of problem.
• Validated company’s scalable Rest API web services using Swagger tool.
• Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.
• 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.
• Integrated with other internal applications using SOAP and REST web services by generating the necessary stubs from the WSDL files for extracting the data from other applications.
• Involved in project using SoapUI and run request with input XML to receive a response XML for the request sent.
• Facilitated smooth transition of the project from the project environment to the live environment.
• Analyzed Service Requests and Change Requests available in JIRA and pertaining to everyday business need
• Analyzed Business Requirement Documents (BRD)
• Wrote User stories which included the business logic, expected behavior and user acceptance criteria.
• Tested user stories and sign off on the business functionality completeness.
• Knowledge of several functionality available in the Facets several applications such as Billing, Member/Subscriber, Accounting, and Utilization Managements.
• Facilitated Release session among customers to check as to what is the functionality they would like to enhance which are available in Facets.
• Facilitated JAD session to find out the impacted area of functionality of Facets due to upgrade and cooperate with developer to come up with solution.
• Facilitated the Meetings with Business owners, SMEs and Business user to gather the requirements. This includes face to face as well as WebEx interaction.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes HIPAA 834, 837, 835, and 270/271
• Converted Business Requirements into Functional Requirements and System Requirements
• Provide mapping sheets intended for dev team, QA and analysts
• Organize and present Requirement gathering meetings, SUC review meeting
• Upload documents into Share point server
• Documented the UAT Plan and work with the UAT Team to ensure the acceptance criteria for every requirement has been included in the UAT task plan.
• Coordinated and presented WebEx meetings with senior level management as well as with resources from different domains
• Identify problems by analyzing EDI834, XML documents, mapping sheets
• Collaborating with IT Data Modeling team to ensure data model design is consistent and accurate with the business requirements.
• Creating functional requirements and source-to-target mappings including data transformation rules to the development team for implementation.
• Responsible for Medicaid Claims Resolution/Reimbursement for state healthcare plan using MMIS.
• Gathered requirements and created BRD for the Medicaid managed care incoming 834 enrollment file / data to FACETS for Accumulator Synchronization using ABI Subsystem to load in Facets Accumulator.
• Managing and Billing Medicare, Commercial HMO/PPO claims daily.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals.
• Worked on the claims related to Medicare (Part A, Part B, Part C, Part D).
• Performed Gap Analysis for 5010 enhancements using the TR3 implementation guides and side-by-side HIPAA guides provided by CMS (Center for Medicare & Medicaid Services).

Environment: Windows, Oracle, MS Access, ETL, API, MS Excel, Oracle, Agile/SCRUM, PL/SQL, JAD, MS Office suite, MS Visio.

Confidential, Madison, WI

Business System Analyst

Responsibilities:

• Responsible for creating and maintaining the Requirements Traceability Matrix (RTM)
• Documented and distributed all processes among the five SDLC phases.
• Document Business & Systems requirements for the new DOCIIS system functionalities.
• Created SQL Queries using Oracle and SQL Server in validating data into Data Warehouse/ETL applications.
• Created the conceptual model for the data warehouse using Erwin data modeling tool.
• Implementing new functionalities onto the legacy system.
• Mapped the API request and response in XML format using SOAP webservice API calls.
• Worked with ETL group for understanding & mapping for dimensions and facts.
• Responsible for analyzing Eligibility for State Welfare Program, Children’s Health Insurance Program (S-CHIP), Food Stamps (SNAP), Child Care and Temporary Assistance to Needy Families (TANF) (CHIP, SNAP, and TANF).
• Worked on electronic Medicaid eligibility verification system and the Medicaid and Medicare intermediary along with their roles in claim processing.
• Created Medicare, Medicaid, Coordination of Benefits (COB) claims during the testing effort.
• Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
• Involved in Backend Testing to verify data integrity by using SQL.
• Performed Gap Analysis for 5010 enhancements using the TR3 implementation guides and side-by-side HIPAA 5010 guides provided by CMS (Center for Medicare & Medicaid Services).
• Involved in analysis of requirements for Medicaid and Commercial line of businesses.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Developed Use Cases, Process Flow Diagrams, and Activity Diagrams and Context flow Diagrams.
• Used MS Visio for Process Flow and Workflow diagrams.
• Extensively used the SQL queries to validate data from source system to target systems.
• Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables
• Works collaboratively and proactively with QA Team, BA Team, Development SCRUM teams and others to design and develop effective automation solutions troubleshoot issues and resolve bugs.
• Conduct JAD sessions to gather and document requirements that enhance a wide range of functionalities including claims processing, eligibility and enrollment, provider networks, and electronic data interchange.
• Plan, develop, and implement the research of new or improved processes, tools and systems.
• Provided CTO and CIO with updates to the projects and reports pertaining to the progress
• Analyze software defects; conduct weekly bug triage meetings with development and product management.
• Met with Senior Management and discussed program and project plans for the whole year.
• Thoroughly communicated day-to-day status of current projects to stakeholders.
• Building a high-performance QA team by hiring, training, coaching and mentoring Engineers& Analysts.
• Facilitated walkthrough meetings with Business Users / Directors.
• Planned, estimated and tracked the progress of portal projects.

Environment: Windows, UML, Agile/SCRUM, ETL, API, PL/SQL, JAD, BRD, FSD, PRD, MS Office suite, MS Visio.

Confidential, Buffalo, New York

Business System Analyst

Responsibilities:

• Gathering requirements as well as scheduling a daily scrum meeting to elicit, analyze, verify, and manage the needs of the project stakeholders, customers and end users.
• For Medicare services such as Hospital, Medical insurance, Medicare advantage plan and Prescription drug coverage.
• Work on project documentation that defines the process requirements required to implement Guiding Care.
• Configure provider demographics, billing information and contract information in claim system while maintaining departmental quality and production goals and objectives.
• Configure Facets Procedure Codes application on Application Support Application by setting up the table and populate the field's name, description, Table name and Columns' name.
• Partnering with third party vendor to drive and assess strategic initiatives like; cloud compatibility, application rationalization and datacenter migration.
• Created and modified queries utilizing Facets data tables.
• Used and prepared UML models to define Business Rules of the application. Contained the role of a Business SME by solving queries from developers and testers of the application.
• Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 7 transactions.
• Gathered requirement on FACETS EDI 834 Benefit Enrollment and Maintenance subsystems
• Conducted Manual testing (Functional, Integration, System, UAT) of the application and provided the Sign-Off on the application deliverables.
• Configure different applications of Facets such as, Individual user set up, Group set up, Process Control Agent and Duplicate claim rule application on Medicare application, ICD Procedure codes, MDC Codes on Application Support Application.
• Knowledge of several functionality available in the Facets several applications such as Billing, Member/Subscriber, Accounting, and Utilization Managements.
• Tested claims adjudication and group and enrollment in for new Medicare advantage members.
• Conduct impacted analysis on the Facets functionality that is affected by 5.01 upgrade
• Collaborated with third-party vendor to analyze and decompose Target's product backlog items to ensure appropriate prioritization.
• Work on Rapid SQL to get access to Sybase Data base to see impacted table and column that is affected by upgrade
• Created SQL queries to read data from databases
• Created and maintained SQL Scripts to perform back-end testing on the oracle database.
• Facilitated Release session among customers to check as to what is the functionality they would like to enhance which are available in Facets.
• Created conceptual diagram using MS. Visio of the business process to find out the impacted area and to fix the problem.
• Tested the eligibility inquiry, enrollment in Facets, Billing and Invoice in Facets.
• Enhanced test cases and scripts by adding the required functionality as per the new business requirements
• Provided the management with test metrics, reports, and schedules as necessary using MS Project and participated in the design walkthroughs and meetings.
• Facilitated JAD session to find out the impacted area of functionality of Facets due to upgrade and cooperate with developer to come up with solution.
• Gathered Functional requirement and documented them.
• Adhere to existing configuration procedures established by department seniors and/or management.
• Communicate with vendor to regarding new updates on Facets and solution to their existing system.

Environment: Windows XP Professional, Oracle, MS Access, MS Excel, Oracle, UML, Agile, PL/SQL, Rational Clear Quest, MS Office suite, MS Visio.