- Business Acumen, MS degree holder specialized in - IT Management, Marketing and Business Strategy with 9 years of progressive experience in Software Development Life Cycle (SDLC) and Business Process Reengineering in Healthcare and Retail industry.
- Agile Business Analyst, prime focus on claims adjudication, eligibility and prior authorization for Medicaid and Medicare programs. Proven ability to analytical, technical and problem solving skills in designing, developing and implementing innovative business processes using new approaches and technology.
- SDLC like Agile, Scrum, Waterfall, Joint Application Development (JAD)
- Requirement gathering and Analysis, Business Process flow, Process Modeling, Data Analysis, Data Governance, Data Mapping and Master data management (MDM)
- Facilitating JAD sessions for project definition, user interface documents, analyzing requirements, and creating prototypes.
- Preparing - Business Requirement Document (BRD), Requirement Traceability Matrix (RTM), Functional Requirement Document (FRD), Data Mapping Document (DMD), wireframes, Graphical User Interfaces (GUI)and other client specific documents.
Methodology: Agile, Waterfall, and Scrum
Operation Research Techniques: SWOT Analysis, GAP Analysis, Risk Analysis, Root Cause Analysis
Project Management Tools: MS Visio, MS Project
Wire framing Tools: Balsamiq Mockups
Management Tools: MS Word, MS Excel, SharePoint
Database/Query Tools: Informatica Analyst, MS Access, My SQL, MS SQL server, Oracle
Defect Tracking Tools: HP Quality Center (ALM), JIRA
Testing and Reporting Tools: Selenium, Tableau
Operating Systems: Windows, Mac, UNIX
Domain Knowledge: Healthcare, Retail
Confidential, Egan, MN
Sr. Business Analyst
- Gathered Business Requirements by using HIPAA EDI guides and reviewing business process and companion guides.
- Worked on medical and pharmacy claims data, eligibility and member enrolment process.
- Created and maintained HIX Compliance documentation and educated other team members about regulatory compliance with all government agencies (including HIPAA) involving the Obama care.
- Design and document Business Requirements by using HIPAA EDI guides and companion guides
- Prepare and update the Business process flow, Functional requirement specification (FRS) and Technical Design document for enhancing the existing product.
- Worked with data warehousing team to create Relational and Dimensional Data modeling for creating Logical and Physical Design of Database and ER Diagrams using multiple data modeling tools.
- Responsible for creating different sessions and workflows to load the data to Data warehouse using Informatica.
- Worked on different EDI transactions like Claims (837), Benefits Enrolment (834),Premium Payment (820), and Eligibility (270) to send outbound file to external vendor.
- Responsible for calculating ROI and evaluated other Financial aspects.
- Worked on FACETS modules such as pricing, payer, eligibility under claims processing system.
- Created use cases diagrams and business process workflows using Visio.
- Prepared and perform testing on Algorithm of PPO plans for large group exchange standard products.
- Conducted JAD sessions between the end users and the development team.
- Performed User Acceptance Testing (UAT) and reporting the bugs to the development Team.
- Have done regression and integration testing.
- Conducted project related presentations and provided reports to the higher management.
- Created Test cases using Quality Center.
- Worked with the testers and maintain the Test plan document and test cases.
Confidential, NYC, NY
- Gathered business requirements by driving user-group meetings, cross-functional and virtual teams
- Working within a growing knowledge of X12 5010, HIPAA transaction EDI 834, 837, 835, 820,276, 277, 278, Privacy, Security, and Medicaid.
- Worked with subject matter experts to update existing Medicaid Management Information System (MMIS) in order to ensure HIPAA compliance.
- Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
- Mapped process flow; assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
- Analyzed the data collected and process maps to determine the root causes and identify opportunities.
- Creator and co-owner of Product Backlog, BRD and Test Case templates design, taking into account waterfall PMO requirements and agile philosophy.
- Performed extensive requirement analysis including data analysis and gap analysis.
- Worked with the QA team in testing the upgraded system for data retrieval, using complex SQL queries.
- Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
- Worked in all the different processes of Claims processing from Claim Online editing /processing /Adjudication /Payments systems
- Responsibility included interacting with the users and business relationship managers and implementing changes on the database in order to ensure approval.
- Process mapping, data cleansing, data migration and validation of data table structure in areas of sales, inventory, procurement, production and distribution.
- Developed detailed Developer specification to reflect technical details of the business requirements
- Extensive experience in using collaborative tools like Quality Center to facilitate development across disparate teams
- Identify underlying issues with Medicaid Pending policies and procedures on a facility specific level
- Interacted with the users and logged any defects, enhancements from the UAT and communicated them to development team
- Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
Confidential, Columbus, OH
Business System Analyst
- Performed SWOT and Gap analysis for the new functionality requirements.
- Interacted with stakeholders for a better understanding of client business processes, gathered business requirements and documented them in Business Requirement Document (BRD), Functional Requirement Document (FRD).
- Followed UML methodology to generate Activity, Sequence, Class and Collaboration Diagrams using MS Visio.
- Developed business process models in Agile Methodology to document existing and future business processes.
- Performed data governance, backups and disaster recovery operations.
- Planned and defined system requirements to Use Cases, Use Case Scenarios and Use Case Narrative using the UML methodologies.
- Conducted JAD sessions with management, SME’s, vendors, users & other stakeholders for open & pending issues.
- Scheduled meetings with developers, system analyst, testers to collaborate resource allocation, project completion and for budgeting activities using MS Project.
- Defined what data should be in the data mapping and the metadata information associated to customer data (including the documentation of business data definitions and rules).
- Performed Data Analysis and data manipulation of source data from SQL Server and others to support business organization.
- Wrote requirements for data conversion process worked with Data Centers and third party Vendors and design documentation.
- Experience in reviewing Test plans, Test cases and Test case execution using Test Director.
- Designed and implemented basic SQL queries for QA testing and report.
- Defects were tracked, reviewed and analyzed using Quality Center.
- Worked with the development team in investigating and correcting software bugs and deficiencies based on testing results
- Supported the reporting team in data preparation, test loads and query designing.
- Performed System Integration testing (SIT), User Acceptance Testing (UAT) and created test cases and test scripts
System Analyst | Product Development
- Analyzed business end user data and identifying gap analysis strategies of customer requirements with respective to source systems and technology feasibility.
- Prepared various technical and functional documents, created prototyping for each phase of project life cycle
- Worked directly with QA & developer and capture results including system, functional, regression, load, and integration testing
- Collaborated with corporate executives to identify needed business intelligence systems and implementation strategies
- Migrated the existing Excel reports using Excel power BI (Power pivot, Power query and Power View).
- Stored procedures to pull the data from different sources.
- Created excel reports and dashboards as per the client requirements
- Creation of load stored procedure for implementing end user's esteemed business logic.
- Taking care of refreshable reports of recurring tasks like weekly, monthly, Quarterly.
- Addressing end user's ad hoc (On demand) request's instantly.
- Involved in back end validations in MS SQL and MS excel report validations.
- Worked on performance related issues and automation of the loads.
- Involved in troubleshooting issues.
- Worked on PIVOTS which is the main Platform for building the reports.
- Maintained data privacy and followed rules regarding data security.