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Technical Analyst Resume

MN

PROFESSIONAL SUMMARY:

  • Goal oriented, Adaptable, Results driven professional with 6+ years of experience in working with cross - functional teams as Senior Business Systems Analyst in Healthcare domain. Demonstrated excellent communication and interpersonal skills. Detail oriented person with in-depth understanding of Software Development Lifecycle (SDLC) in Traditional and Agile methodologies to execute projects from end to end as per requirements.
  • Experience as a Business System Analyst with in-depth knowledge in Healthcare Industry.
  • Experienced in Software Development Life Cycle (SDLC) methodologies such as Waterfall Model, Agile Scrum methodology.
  • Proven excellence in analyzing business processes, eliciting requirements, defining business needs, and translating to business and technical specifications documents.
  • Design and Review of various documents including the Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM).
  • Experienced in performing Gap Analysis, SWOT Analysis, Feasibility analysis, Business Impact Analysis and Risk analysis.
  • Sound proficiency in analyzing and creating, Use Case diagrams, Sequence diagrams, Activity diagrams, Data flow diagrams, Business flow diagrams using MS Visio.
  • Very well versed with Data Warehousing concepts, CRM data and Master Data Management (MDM).
  • Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277 and ICD-9 and ICD- 10.
  • Recurrently conducted Joint Application Development (JAD) sessions with end-users, SME and development team for project meetings, walkthroughs and customer interviews.
  • Excellent working knowledge with ANSI X12 4010 including medical transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claims status response), 820 (enrollment).
  • Processed Medicaid claims and worked on X12 format of EDI 837 for Medicaid claims.
  • Extensive knowledge about the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO (Preferred provider organization), HMO (Health maintenance organization), Medical Management Information Systems MMIS.
  • Proficient Experience in Structured Query Language (SQL).
  • Extensive use of structured techniques for analysis and design with tools like Enterprise Architect, Rational Requisite Pro, MS Visio and Rally.
  • Proficient in Functionality Testing, System Integration Testing, and Regression Testing including Effective defect tracking and reporting using HP Quality Center, JIRA and Application Life Cycle Management (ALM)
  • Exposure in creating and analyzing Data flow diagrams, and Entity Relationship diagrams.

TECHNICAL SKILLS:

Methodologies: Waterfall, Rational Unified Process (RUP), Agile (Scrum, Rally)

Business Modeling Tools: Rational Rose, MS Visio, Dream weaver

Content Management System: SharePoint

Documentation Tools: MS Office Suite - Word, Excel, PowerPoint, Access

Database Skills: Overview of Database Design, SQL 11.0,12.0, oracle 12.10

Testing Tools: HP Quality Center/ ALM, JIRA (Defect Tracking)

PROFESSIONAL EXPERIENCE:

Confidential, MN

Technical Analyst

Responsibilities:

  • Responsible for gathering the functional requirements for the health benefit claims receiving and processing system.
  • Prepare business requirement document (High Level Design) and system requirement study (Low Level Design) for the functional changes desired by the client.
  • Analyse change orders requested by client.
  • Document change request in a function specification document for client and development team.
  • Validated Professional and Institutional Claims, Processed and Adjudicated the Claims according to test scenarios.
  • Held pre-kick-off and kick-off calls to help developers understand the requirements.
  • Experience in writing SQL queries for the requirements provided validate the data from the claim tables.
  • Worked on Exclude/Include the claims, Pull the PAR, NON-PAR claims based on the requirement.
  • Experience to pull the input files and validate them at the time of testing using IP Switch FTP and Ultra edit.
  • Knowledge on Extraction, Transformation and Loading process (ETL).
  • Working experience in a cross-functional team environment/different geographical locations teams.
  • Perform UAT and unit testing after the development in Test environment before applying to Production environment.
  • Experience in claims processing subsystem - Enrollment and Eligibility verification for recipients and providers, claims processing, Claims Pricing, payment scheduling and claims reporting.
  • Prepared change request documents for any changes in Business requirements.

Environment: Share point, UML, SQL, TOAD, IP Switch, Ultra Edit, MS Office Suite - Word, Excel MS project, UAT.

Confidential, Minneapolis, MN

Business Analyst

Responsibilities -

  • Worked as an Interface between the users and the different teams involved in the application development for better understanding of the business and IT processes.
  • This project was to quicken loan application process by eliminating inefficiencies and achieve a greater customer satisfaction.
  • Served as a liaison between mortgage specialists and the project team.
  • Responsible for conducting JAD Sessions with different IT Group product owners & refined the requirements.
  • Wide experience in Business Requirements Analysis, Gap Analysis, Production Support and Training Business Users for Oracle ERP Implementations
  • Facilitate working/ discussion/ review sessions with Business Partners, Subject Matter Experts (SME) to discuss on the improvement/ changes that needed to be implemented.
  • Working in an Agile Framework for Mortgage Banking Project for Loan Origination Project.
  • Expertise in Agile methodology (Scrum)- creating user stories, facilitating planning meetings, sprint retrospective, backlog grooming, sprint reviews and maintaining the product backlog.
  • Expertise in communicating with stakeholders to provide accurate reporting information regarding the ongoing projects and initiatives via Daily Stand-ups, Status Reports, Burn-down charts.
  • Assisted the User Acceptance Testing (UAT) team and documented any issues or defects and eventually got sign off from the right parties.
  • Relevant experience in invoice to Cash, Procure to Pay and Record to Report processes with deep understanding of one of these. Good understanding in iProcurement modules in Oracle ERP.
  • Responsible for gathering user requirements and specifications for designing a mortgage-based loan system using and documenting the same.
  • Used JIRA to plan, track and report issues and tasks on a predefined workflow.
  • Develop metrics and reports using JIRA to help the team understand its health and progress and to set goals.
  • Attended daily status meeting with development team, deployment team and business during UAT to resolve outstanding issues and assign priority.
  • Reviewed User-Stories, Test scenarios, and Test cases for testing functional and non-functional requirements.
  • Worked extensively with ETL developers to facilitate the extraction and storing of data.
  • Mapped new service codes to existing ones to normalize according to current system specifications.

Environment: MS Office Suite - Word, Excel MS project, Microsoft Visio, Oracle, Microsoft Share Point, UML, UAT, JAD, GAP, PL/SQL, Agile Scrum, ETL.

Confidential - Bethesda, MD

Business Analyst

Responsibilities:

  • Worked on insurance data related to Medicare, Medicaid, and Insurance claims.
  • Interacted with Claims, Payments and Enrollment hence analyzing and documenting related Business processes.
  • Performed Requirements Gathering and Analysis through interactions, meetings and periodic walkthroughs with potential users of the application along with the creation of Epics, Features, User stories, AS IS and TO BE processes, mockups, etc. based on business requirements and business rules.
  • Involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD 10 codes.
  • Followed Scrum development process using Agile methodology.
  • Support the product owner in maintaining the product backlog and scheduling next release
  • Worked on HIPAA standard/EDI Standard Transactions: 834,835,837 to identify the key data set elements to the designated record set. Collaborated with the Claims, Payment and Enrollment Team in analyzing and documenting the process.
  • Validated Professional and Institutional Claims, Processed and Adjudicated the Claims according to test scenarios.
  • Validated all HIPAA Transactions including 837 I, 837 P, 270, 271, 276, 278 and 277 CA HIPAA 5010 versions.
  • Experienced with Medicare and Healthcare Insurance; as well as Medical Standards (HIPAA and HL7).
  • Built benefit plans for all lines of business and conducted unit systems integration and regression testing of those plans.
  • Part of Business Process Reengineering Support Team that leveraged Lean Six Sigma, Change Management and other Continuous Process Improvement methodologies to improve Claim Processing Cycle.
  • Discovered root cause of missing data or incorrect data displayed on the UI and provided suggestions and solutions for user’s data collection.
  • Reviewed various customer transactions using the FACETS application.
  • Conducted Functional Walk-throughs, User Acceptance Testing (UAT), and supervised the development of User Manuals for customers.
  • Prepared change request documents for any changes in Business requirements.

Environment: HTML, XML, MS Visio, MS Excel, MS SQL, Rational Requisite Pro, UML, Rational Unified Process, SQL.

Confidential

Business Analyst/ Systems Analyst

Responsibilities:

  • Gather requirements (from key stakeholders) and created Business Requirements Documents,
  • Functional Requirements Specification document, including use cases. Prototype screen elements to help development team understand requirements.
  • Facilitate JAD sessions with project stakeholders, subject matter experts and development and QA teams.
  • Extensive experience with Medicare (Part A, Part B, Part C and Part D) and Medicaid benefits, NASCO, TriZetto’s QNXT, FACETS as well as ICD 9 and 10.
  • Coordinate with onshore and off-shore development team.
  • Created Use Case diagrams and UML diagrams using MS Visio.
  • Experience working on Medco Medicare Prescription Plan Claims processes from Admin/Provider/Payer side.
  • Hands on experience with various sub-systems of MMIS - Provider subsystem, claims subsystem, reference subsystem and recipient subsystem.
  • Responsible for claim adjudication such as Medicare claims, professional claims, institutional claims.
  • Worked on Claim processing / Claim Transition for improving database for storing user files.
  • Followed Scrum development process using Agile methodology.
  • Experience in 834/835, 270/271, 276/277 processes of medical claims/underwriting for support and point of reference for the vendor in business issues.
  • Provided support during the integration and UAT.
  • Involved in writing Data Mapping Documents for the system and involved in documenting the ETL process and writing SQL Queries for the retrieval of the data.

Environment: HIPAA., MS Office Suite (Excel, Word, PowerPoint), MS Visio, UML, JAD, Requisite Pro, SharePoint 2010, CA Clarity, UAT, Agile

Confidential

Jr Business Analyst/Quality Analyst

Responsibilities:

  • Worked with functional teams in an Agile environment.
  • Documented business requirements and communicated these requirements to the development team for the design and implementation of business solutions.
  • Organized and participated in daily SCRUM meetings, to resolve issues with developers and product architect.
  • Performed GAP analysis to meet the end state requirements.
  • Collaborated with internal and external stakeholders to elicit, analyze, communicate, and validate requirements for changes to business processes, policies, and information systems.
  • Facilitated Sprint Retrospective to understand the effectiveness of the current process and recommend process improvements if possible.
  • Created AS-IS and TO-BE business process flow diagrams integrated process flow diagrams to show end-to-end business model and processed mapping exercise including swim lanes.
  • Helped testing team to prepare Test Plans and Test Cases based on the functional requirements.
  • Involved in Manual Testing to check the usability of the application.
  • Performing knowledge transfer to the technical/development and QA team by creating quality test cases and providing accurate test data.
  • Involved in UAT to confirm that the system under test meets the user needs and provides confidence in its use.
  • Performed verification tests to make sure the data integrity
  • Used excel to perform pivot table to make sure the data was easily presented and actionable for the executive team

Environment: Rational Test Manager, Data Stage, Rational Requisite Pro, Rational Clear Case, Clear Quest, Rose, SQL Server, UNIX, Oracle 8i, PL/SQL, MS Word, MS PowerPoint, MS Access, MS Visio, MS Excel.

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