- Over 7+ years of extensive experience as a Business Analyst in business and functional requirements elicitation, analyzing requirements, statistical data analysis, data mapping, object - oriented designing, Design of Experiments, Regression and Response Surface analysis, Unified Modeling Language (UML), SDLC methodology (RUP, Agile, SCRUM, XP, Waterfall) and project management in Healthcare domain..
- Good knowledge on different Relational databases like Teradata, Oracle and SQL Server.
- Very efficient at performing GAP analysis to check the compatibility of the existing system infrastructure with the new Business requirements and Best Practices, SWOT analysis, Business Rules Analysis, Impact Analysis (Business, Technical), Risk Analysis and Cost Benefit analysis.
- Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall, Scrum and Agile
- Good knowledge of FACETS, and Transaction Manager for migration.
- Knowledge and Implementation experience in Eligibility System, Facets Data model, Configuration Implementation of FACETS module.
- Trained volunteers to become Medicaid/Medicare counselors.
- Experience with claims process and adjudication in the Medicare, and Medicaid.
- Expertise in writing SQL Queries, Views and Stored Procedures in Oracle.
- Ability to produce high quality requirement specifications to support ERP functional design development.
- Familiar with deliverables of learning health system.
- Efficient at conducting UAT (user acceptance testing), Functionality testing, Unit testing, Integration testing, System testing, Operation Readiness testing and Regression testing.
- Extensive experience with Data Warehousing, Extraction, Transformation and Loading (ETL) and Business Intelligence (BI) tools.
- Well- Versed experience in all EDI transactions like 834, 837 P, 835, 27x and conversion of .
- Proficient in producing documents like Business Requirements Document (BRD), Functional Requirement Specifications (FRS), Software Requirement Specifications (SRS), Request for Proposals (RFP), and Requirements Traceability Matrix (RTM).
Programming Languages : Java HTML, XML, SQL.
Data Base: MS Access, Oracle (SQL Series), DB2
Software: MS Office Suite (Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office.
Mainframe: COBOL, DB2, JCL, CICS, MVS
Processes/Technologies: Agile, Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint
Confidential, Hartford, CT
Senior Business System Analyst
- Gathered requirements by conducting one-on-one meetings and brainstorming sessions with end users and SME to gather requirements.
- Documented Detail Business Requirements Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
- Facilitated Joint Application Design (JAD) sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
- Experience with Rx Claim platform.
- MSIS: developing and installing the Medicaid Statistical Information System.
- Analyzed and worked with HIPAA specific EDI transactions for claims, member enrolment, billing transactions. Worked specifically with 837, 835 and 276/277.
- Demonstrated ability to work actively in different phases of Software Development Life Cycle (SDLC) using Waterfall, Rational Unified Process (RUP) and Agile methodologies.
- Worked on analysis of Facets claims processing system and to gathered requirements to comply with HIPAA 5010 requirements.
- Counseled leadership of revisions/modifications to the Georgia Medicaid Incentive Program, and authorized modification to associated applications, leading to improved accountability and program efficiencies.
- Performed GAP Analysis to identify the missing business requirements for Enrollment, Billing and Claims modules along with writing Business use cases for new/improved functionality.
- Involved in using FACETS for various health insurance areas such as products, enrollment, members and other modules related to FACETS.
- Configured Enrollment Data for ID card and Validated the incoming/outgoing data from EDI (834), (837I), (835), (270/271), (276/277) interfaces to administer HIPAA privacy rights for Claims EDI files.
- Created mapping document that help ETL developer to build effective mapping.
- Worked on report creation skills using Microsoft SQL Reporting Services (SSRS).
- Coordinated with Health Insurance Exchange (HIX) program staff and other stakeholders to define and develop requirements for correspondence generation across various business lines.
- Performed analysis of enrolment and eligibility data in the XML format to determine if data is compatible with X12 data.
- Worked on the ETL implementation using SQL Server Integration Services (SSIS).
- Worked on analyzing, designing, building &, testing of OLAP cubes with SSAS for the project.
- Worked on the Documentation for all kinds of reports and SSIS packages.
Confidential, Woonsocket, RI
Business System Analyst
- Performed requirements gathering from the stakeholders while adhering to SDLC industry best practices.
- Used MS Project to create the project plan, allocate budget, resources and set milestones.
- Created relevant artifacts Interface Design Document, Detailed Design Document, Supplemental Document and Solution Specification Document.
- This project comprised of providing a software solution with various functionalities such as patient admission, lab investigation and diagnosis, patient billing, patient discharge, summary and doctor consultation billing. Using this software, a provider can enter a patient information, time spent, case type, fee, and some other related information. This information is authenticates by Case Reviewers for claims & benefits processing and billing. Work on Rx Claim processing system
- Expert in generating and analyzing custom reports and dashboard for management and various business unit personnel to provide detail information on key performance indicators.
- Hospitality Rx is a full service PBM for UHH. I worked on Drug Utilization Review (DUR) claim safety modules and enhancing the claim processing platform based CMS’ Medicare and Medicaid compliance guidelines and annual compliance call letters.Additionally work on prescriptions synchronization project to combine patient prescriptions to save trips to the pharmacy.
- Performed Gap analysis and conducted business modeling by reviewing the existing business artifacts.
- Authored the Functional Requirements Specification (FRS) and Business Requirements Document (BRD) and System Requirements Specification (SRS) for the project.
- Worked on Data migration, FACETS version upgrades Reports Implementation, letters, Inbound/outbound Interfaces and FACETS Extensions. Implemented EDI transactions 837, 835, 270/271, 276/277 and 834.
- Utilized UML for process modeling and created Use Cases, Activity diagrams and Sequence diagrams using Rational Rose and MS Visio.
- Maintained project documents to be used for collaboration with developers, QA, project manager, etc. on SharePoint.
- As System Analyst, created complex queries to identify gaps in ICD10 implementation, mapped their older ICD9 counterparts, and facilitated design to replace the older codes with the newer ICD10 codes, while also ensuring that the ICD9 to ICD10 crosswalk was functional and working effectively, leveraging the older codes until they sun-set and ICD10 completely took over.
- Wrote SQL queries in MS Access for data manipulations.
- Implemented pseudo code after analyzing data sets and gaps, and advised Developer in order to ensure timely and accurate delivery of product.
- Implemented Agile Scrum methodology of application development and set the velocity for each sprint cycle.
- Conducted daily Scrum meeting, planning meeting, review meeting, retrospect meeting and created the Product backlog.
- Analysis and Design of the Facets data model to ensure optimal system performance and tuningprovided data modeling and migration data and developed user interface mocks using Microsoft Visio.
- Collaborated with DBAs to perform data mapping using MS Excel and executed complex SQL queries to filter data from the MS SQL database.
Confidential, Saint Charles, MD
- Built an Information Security Risk Assessment (ISRA) for the secure exchange of health insurance data as part of the Affordable Care Act (ACA).
- Responsible for implementing payers onto the Health Care Exchange (HIX) for the Affordable Care Act.
- Strong working knowledge of the 834, 837 & 835 EDI Healthcare files and Transactions.
- Compile, validate and report system-wide metrics to attest meaningful use of Confidential to the Centers for Medicare and Medicaid Services.
- Created, altered and implemented T-SQL Stored Procedures for the use of processing consumer data and developing new web delivered tools.
- Served as subject matter expect and key liaison for key initiatives regarding Georgia Medicaidprograms, and facilitated executive level appeals and denials from vendors and hospital networks for the HIT division.
- Responsible for UAT project planning like creating testing scenario, test plans, and test scripts.
- Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI x12 Transaction, Code set and Identifier aspects of HIPAA.
- Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA).
- Developed Schemas of EDI x12 Claims (837) and Eligibility forms in XML.
- Perform responsibilities of conducting research on IT requirements and business requirements in UAT areas.
- Responsible for support and enhancement requests for a SQL data warehouse and transactional database.
- Performed Regression, UAT, Integration, User Interface, GUI, and Usability Testing and wrote test cases and test scripts, execute test scripts and analyzed outcomes.
- Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models.
- Generated and maintained SQL Scripts to perform back-end testing on the oracle database.
- Produced customer functions, complicate SQL commands in Business Object Enterprise XIR2 and Oracle 10g, Crystal Reports XI environments.
- Implemented Agile for some new projects while also maintaining Waterfall for existing stable projects.
- Assist clients in resolving billing issues for Medicare, Medicaid, and private insurance.
- Involved in creating sample mappings for the conversion of EDI x12 transactions code sets.
- Lead projects to design a state-customized Financial Management solution for Health Insurance Exchange (HIX).
- Involved in HIPAA/EDI Medical claims analysis, design, implementation and documentation.
- Developed various test cases for testing HIPAA 8371/P/D 834/835 and 276/277.
- Troubleshoot EDI and XML document errors and troubleshoot translation and mapping errors.
- Developed EDI specifications and applications structures for data feeds and mappings for integration between various systems, including XML and performed back-end testing on the Oracle database by writing SQL queries
- Handle the tasks of helping the organization staff in planning data sets for UAT.
Confidential, Milwaukee, WI
- Interacted with Senior Executives and Stake Holders to understand needs and identify key challenges, constraints and risks; thereby define scope.
- Gathered High-Level and Detailed-Level functional and non-functional requirements via daily JAD sessions to define the Business requirements and also created Requirement Traceability Matrix (RTM).
- Created Use-Case documents, UML Diagrams using MS Visio for all functional requirements to help architects, Developers and testing team.
- Coordinate with the development team in making them understand the requirements
- Coordinated the upgrade of Transaction Sets 837 to HIPAA compliance.
- Did gap analysis for HIPAA 4010 EDI 837 and HIPAA 5010 EDI 837.
- Involved in impact analysis of HIPAA transaction sets on different systems in Assurant Health.
- Conducted walkthroughs and participated in defect triage meetings periodically to assess the status of the testing process and discuss areas of disparaging
- Identifying the requirements for accommodating HIPAA 4010 and 5010 standards for EDI X12 transactions
- Collaborated with testing teams in reviewing test strategy, test plans and test scripts.
- Performed UAT Testing with QA and Business Team.
- Performed data validation using SQL queries.
- Managed and controlled the project documentation using SharePoint
- Ensured the timely delivery of Business Analyst team artifacts.
- Participated and Facilitated Status meeting, Business Requirement Elicitation and Solution meetings
- I was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
- Contributed in reviewing and editing of the test scripts.
Revenue Cycle Analyst
- Checking Eligibility, Benefits & Analyze EOB, AR follow-up with Insurance.
- Performing different tasks that include posting cash receipts, updating cash flow reports, researching charge backs and making final decision for write off.
- Analyzing Global trends in the given work order and resolving at the earliest for reduction in backlog.
- Making decisions with clear authority to write off balances according to strict guidelines.
- To analyze recoupment's and provide the solutions.
- Calling-up the insurance carrier to check the status of claims filed with them, the payment issued on each claim, the denial reason and if the claims are outstanding, taking appropriate action over the phone if claim is denied incorrectly by insurance carrier. Also document the conversation in the work-order.
- Analyzing the recoupment made by insurance carrier and resolving the same at the earliest for payment. Responsible for resolving the outstanding AR for the process and handing claims denials for both Federal and Commercial Insurance.
- Recovery of purged claims filed after the Timely filling limit or charges entered late. Appealing on the same with proper timely filling proofs.
- Training team on standard operating procedure guidelines and daily updates from client's end.
- Handling Provider denials (Credentialing) and resolving the same as a project.
- Downloading reports from Confidential 's, Analyzing the data and identifying global trends to resolve bulk AR.
- Preparing monthly reconciliation status reports for management..