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Business Analyst Resume

Huntsville, AL

SUMMARY:

  • 6+ years of extensive experience in the field of Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
  • Combined experience in Software Development Life Cycle and Business Analysis: experienced in gathering user requirements, documenting requirements, technical writing, business analysis, system analysis, testing, and implementation of projects.
  • Experience in Healthcare Payer and Provider Operations, re - engineering claims, benefits, enrollmentand eligibility processes Experience with different modules within healthcare (Sales, Membership, billing, enrollment, claims, capitation, and providers).
  • Expertise in Software Development Life Cycle (SDLC) and Project Management Life Cycle (PMLC), Data Analysis, Post Test Analysis, Object Oriented Design, SOA and Execution of Software Systems employing Industry proven software engineering best practices & support processes.
  • Strong knowledge of managed care payer requirements and procedures.
  • Experience in preparation of Deliverables, Business Requirement Documents (BRD), detailed Functional Specifications and Non-Functional Specifications, developing Use Cases and Test Cases
  • Good understanding of MITA and MMIS functional business areas which include claims, providers services, providers enrollment, recipient services etc
  • Hands-on experience with claims adjudication tools: MMIS and Facets
  • Proficient in using Agile Scrum methodologies, performed roles of Scrum Master following sprint/standup sessions and used Excel extensively to write user stories, analyzed the Iteration Burn Down charts and reviewed defects.
  • Extensive experience working in back end tester by writing SQL Queries and PL/SQL scripts on large data warehouse systems involving Terabytes worth of data.
  • Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
  • Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from a Operational Data Store to a Enterprise Data Warehouse
  • Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
  • Highly skilled in creating, writing, and executing Test Cases, Test Scripts from Business User Requirement documents and Functional Design Documents.
  • Experience in Creating Business Requirement Documents (BRD), Use Cases, Functional Requirement Documents (FRD) and Use Case Narrative.
  • Strong business knowledge of Healthcare sector and very good knowledge about HIX and proven experience with ICD9-ICD10 conversion.
  • Interacted and involved with Business users to gather requirements and support them with Business Intelligence solutions and products.
  • Experience working on Healthcare Reform Projects such as Health Insurance Exchange (HIX), ICD 10 Remediation and HIPAA 5010 Implementation.
  • Experienced working with x12 version 5010 transactions and ICD 10-CM and ICD 10-PCS Code set changes analysis, design and migration strategy.
  • Solid understanding of Business Process definition, Risk Analysis and SDLC methodologies
  • Experience with Business Intelligence, Data Analysis, Data Mapping, Data Privacy, Data Compliance, Documenting Business Requirements, Functional Requirements.
  • Good working knowledge of Claims processing, HIPAA Regulations and 270, 837P, 837I, 837D EDI Transactions for health care industries.

TECHNICAL SKILLS:

Software/Hardware: RUP, UML, SDLC, Agile/Scrum, Waterfall, ETL, QA, MS Access, Amisys, SQL Server, MySQL, PL/SQL, Oracle, DBA,DB2. Windows 98/2000/XP, basic UNIX, HTML, basic DHTML, basic XML, MS Office Suite-Excel Macros, Project, Visio, Adobe Photoshop, Flash, Rational- Rational Rose, Rational XDE.

PROFESSIONAL EXPERIENCE:

Confidential, Huntsville, AL

Business Analyst

Responsibilities:

  • Gathered Business Requirements through brainstorming sessions on global calls.
  • Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects of both ETL jobs and Reporting jobs.
  • Acted as a liaison between the development team, QA team and the Business team and resolved any conflicts due to change in requirements.
  • Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Developed gap analysis and risk assessments for the FACETS upgrade project including effects on internally developed extensions and third party software for pricing and contract configuration.
  • Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop. Documented User Stories and facilitated Story Point discussions to analyze the level of effort on project specifications
  • Involved in gap analysis and implementation of HIPAA 5010, ICD10 and Claim Validations
  • Designed, developed and maintained system configurations, such as Procedure Codes, Pay Codes, Payor/Benefit Plans, Follow-Up Workqueues, Charge Entry and Claim Edits
  • Support for, and documentation of, required changes to business processes in connection with ACA ( Affordable Care Act)
  • Report on project status to appropriate project management chain using Jira
  • Participate in projects when assigned infrastructure tasks in Jira
  • Document and track application failures and bugs using tools like Jira and Confluence.
  • Expertise in the EPIC Medical software application (EMR, HER) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
  • Currently leading, coordinating EMR/EHR (iHelix Suite) implementation to achieve meaningful use stage 1.
  • Performing business analysis, software validation and testing for client/server, multi-tier and web-based applications for EMR and commercial business for managed healthcare plans and Industries
  • Testing the accuracy of iHelix inpatient EMR for Stage 1 meaningful use clinical quality measure calculation by using Cypress tool.
  • As Interface Architect designed and developed Admission, Scheduling Charge messages flow and transformations for 50 applications such as Dietary, Oncology, Radiology, Professional Billing, Operating Room, materials management, HIM Coding, Lab, External Partner EMRs additional Hospital Billing Systems, and HIEs
  • Automating the ETL applications using Tidal tool
  • Co-ordinating/Managing ETL Offshore team
  • ETL Architect(Informatica and PL/SQL) /SME
  • Converting the Business rules into Technical Specifications for ETL process
  • Scheduled the ETL jobs daily. Weekly and monthly based on the business requirement
  • Extensively worked in the performance tuning of programs, ETL procedures and processes.
  • Tuned the Performance for ETL jobs by tuning the SQL used in Transformations and fine tuning the database.
  • Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
  • Coordinate changes with customers, vendors and users for EDI..
  • Track tickets related to EDI and provide periodic updates
  • Troubleshoot issues with EDI partners and transaction processes.
  • IRS, CMS, HHSC, HEDIS reporting
  • Meets time sensitive deadlines from Confidential health plans, state agencies, and CMS.
  • Work with Business area to translate CMS, state government regulations, and NCQA requirements
  • Strong functional expertise in the Healthcare Payer Area - Membership claims, benefits, eligibility check, ICD10,HIPAA, CMS HCPCS Exposure to Health Care Industry standards like HIPAA / PHI.
  • Published detailed guide describing data file content and structure for business partners; created quick reference guide for HIPAA EDI ASC X12 834 transaction set for Confidential enrollment.
  • Translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) in an SOA environment
  • Created process flow for moving the claims related data from EDW to EDM.
  • Tested claims adjudication and group and enrollment in Amisys for New Confidential advantage members.
  • Extracted the Business Requirements from the end users keeping in mind their need for the application and prepared Business Requirement Documents (BRD) using Rational Requisite Pro.
  • Performed Gap Analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
  • Served as a point of contact for CMS and trading partners to do the testing for various types of claims and real time transactions like 270/271/276/277 for Confidential and Confidential programs in FACETS .
  • Involved in claim adjudication process of facets application
  • Worked extensively through Agile development methodology by dividing the application into iterations
  • Supported SOA, data warehousing, data mining, and Enterprise Service model standards in designs, and developed standardization of processes like configuration management
  • Worked on customizing the claim module of FACETS for repricing Nursing home claims.
  • Involved in testing the ICD-10 codes by sending the test transactions to clearing houses or payers
  • Deep understanding of all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
  • Data mapping on Enrollment Module (EDI 834) of FACETS .
  • Used MQ test and SoapUI for XML response for the member information from Siebel GUI interface purpose and WSDL files uploaded in SoapUI testing using client security certs.
  • Extensive analysis on conversion of Claims, Members and Providers files from Amisys.
  • Coordinated testing for contract set-up, enrollment and claims processing for four new managed care contracts for Confidential mental and physical health providers.
  • Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems.
  • Worked in mainframe environment and used SQL to query various reporting databases.
  • Inspected and worked on HTTP web services application and on SOAPUI
  • Analyzed the functionality and came up with test scenarios for split-billing process on FACETS .

Environment: Windows 2000/XP, MS Office, SQL Server, Agile, Oracle, MS Project, MS Access, XML, TestDirector, LoadRunner, Rational Rose, UML,RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Confidential, Indiana

Systems Analyst

Responsibilities:

  • Wrote Business Cases after conducting meetings with business users, risk team and finance team.
  • Acted as IO Analyst and worked closely with IO Manager, BU Sponsor and BU Contact. Measured business opportunity, description of solution and scope. Measured and documented Labor and Material Detail, Skill Set, Budget Cost to Achieve (CTA) Summary, Inflow Summary and Economic Analysis.
  • Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837, 835, and 834 and ICD-10 Code sets.
  • Was responsible for data mapping of HL7 messages into relational database.
  • Develop, design and implement department plan to operationalize new FACETS integrated processing system, to include but not limited to workflow, management oversight and performance analysis.
  • Facilitated Change Control Board and Governance Board (CCB) meetings and acted as a liaison between parties impacted by the change requests.
  • Worked on SQL Server 2005 concepts SSIS (SQL Server Integration Services), SSAS (Analysis Services) and SSRS (Reporting Services).
  • Creating, documenting and maintaining macro library. Writing SAS Macro for the creation of a Generic Treatment File.
  • Developed straightforward RDBMS queries, knowledge of HL7 and xml interface messaging.
  • Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
  • Mapped all as-is business processes using BPMN standards on MS Visio.
  • Conducted JAD sessions and created functional and technical requirement specification for application development based on Solution Delivery Process.
  • Created a test plan and a test suite to validate the data extraction, data transformation and data load and used SQL and Microsoft Excel.
  • Identify possible solutions to EDI issues
  • Analyzed EDI X12 - 837I/P, 835 and 834 transactions consistency related to providers, payers, subscribers and other related entities
  • Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers. Worked on ICD 9 codes and gathered future requirements based on ICD 10 codes. Managed creation of sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
  • Provide technical, business, management expertise, and support the Department of Health and Human Services and Centers for Confidential and Confidential Services \(CMS\) in building and maintaining a comprehensive enterprise architecture program
  • Experience in CMS and MMA Guidelines.
  • Served as Healthcare Informatics Analyst for nation's largest touch screen and clipboard vendor with partnerships including various EMRs, GE PACs, GE Centricity, Imagecast Radiology, Meditech, Seimens
  • Provide EMR/EHR go-live support
  • Experience in EMR, EHR, and HIE data interfaces and standards
  • Lead the EMR interface project management
  • Working knowledge of implementing software development projects using methodologies such as Waterfall, Rational Unified Process, Agile/Scrum.
  • Being able to adapt and work efficiently in an agile environment where the cumulative Standard Operative Procedure (CSOP) and Policy directives and decision Matrix documents were in process and unstable during the initial phase of the project.
  • Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them
  • Established Connection between Java and Database using JDBC .
  • Developed estimates, project plans (Microsoft project), training material, BI reports using Microstrategy
  • Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
  • Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
  • Used the BPMN to GAP Analysis to bridge the gap between business processes.
  • Coordinated end to end testing efforts of the HIPAA Compliance and EDI Transactions.
  • Ran queries monthly to verify tie-outs for the business prepared by the technical resource to provide support for applications solutions supported by the Reporting and Analytic Finance team with emphasis on the Corporate Finance Cognos Planning Models.
  • Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
  • Performed Impact Analysis and Gap Analysis.

Environment: Rational Unified Process (RUP), UML, Dreamweaver, SAS, Rational Test Manager, WinRunner, Rational Clear Quest, Windows, MS Office, HTML, Windows

Confidential, Bluebell, PA

Business Analyst

Responsibilities:

  • Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
  • Gather detailed business and technical requirements and participate in the definitions of business rules and data standards.
  • Acted as a liaison between client and payer/intermediary. Experienced in payer rules, requirements, governmental regulations and HIPAA compliance.
  • Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
  • Worked on MITA to upgrade the existing MMIS and also conducted mapping for EDI transactions
  • Strong knowledge of web services testing using SoapUI, XML.
  • Been a part of Architecture and modeling team and have used SOA (Service Oriented Architecture)
  • Created the SQL scripts for demonstrating the prototypes and for verifying the result sets
  • Managed the systems development and built the business processes to activate Confidential parts A-B-C & D, Special Needs Programs (SNP) and Private Fee For Service (PFFS) plans on FACETS version 4.41 platform.
  • Experience on working with the Trizetto FACETS 4.31, 4.51, 4.71Data models.
  • Experience working with Health Care Client Server Product TRIZETTO/ERISCO FACETS
  • Tested and delivered Inbound/Outbound Facets interfaces
  • Experience on working with the Trizetto FACETS 4.31, 4.51, 4.71Data models.
  • Experience working with Health Care Client Server Product TRIZETTO/ERISCO FACETS
  • Performed Gap Analysis for 5010 enhancement using the TR3 implementation guides and side-by-side HIPAA guides provided by CMS
  • Validated EDI X12 files for Connecture (CNX) and CMS using Ingenix Claredi and manually edited and fixed the errors to make it error free and ready for processing.
  • Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
  • Ability to analyze engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production issue and using this as a training opportunity for other team members
  • Maintained Gitlab repositories, JIRA bug tracking system. Created custom JIRA workflows
  • Install, configure and maintain JIRA bug tracking system
  • Technical experience working with EMR/EHR vendors and hospitals within a broad range of healthcare settings
  • Experience with Direct Messaging, HISP, HIE, and HER
  • AthenaOne system knowledge, or similar EHR/EMR
  • EMR/EHR data knowledge from Epic Clarity, Allscripts, McKesson, Meditech, AthenaHealth or equivalent
  • Lead the analytical-interrogation of their EMR/EHR and/or claims data to perform data quality checks
  • Responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records EMR/EHR/PHE/PMR, ASP technology, and full integration tools.
  • Expertise in validation of ETL process by writing SQL queries using complex joins and Analytic functions against Oracle & SQL Server databases. years of strong data warehousing experience using Informatica PowerMart 6.1/5.1/4.7, PowerCenter 8.x/7.x/6.x/5.1/1.7 as ETL tool
  • POC for Liferay,Canvas and Salesforce ETL move
  • Primarily responsible for ETL design, coding and testing strategy
  • Converting business rules into ETL technical specifications
  • Coming up with Design plan and Preparing the ETL Design document
  • Responsible for the use of scarce resources through the development and sharing of reusable software making use of ( Confidential Information Technology Architecture) MITA.
  • Re-engineering and capturing of EDI transactions with legacy systems Enrollment -834, Eligibility Transaction (270/271), Claims (837), Claim Status Request and Response (276/277), Remittance (835) .
  • Analyze Business Requirements (BRD) and translated them into Functional Requirements (FRD or Use Case Model)
  • Extensive experience in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data.
  • Prepared and maintained EDI maps for different EDI transactions
  • Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange EDI in 4010 and 5010 formats.
  • Validated EDI X12 files for Connecture CNX and Center for Confidential System CMS using Ingenix Claredi and manually edited and fixed the errors to make it error free and ready for processing.
  • Thoroughly analyzed EDI raw data for transactions 834 in the 5010 format to verify the changes as per the 5010 format.
  • Worked with IT teams regarding EDI transaction such as 834, 837 as per the guidelines of ANSI ASCX12 5010 implementation guide.
  • Involved in Service Oriented Architecture (SOA) of the claims processing system
  • Defined Business Process aligns with Company goals and existing HIPAA regulation to communicate with CMS Programmatically from Confidential .
  • Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
  • Facilitate System Integration Testing on FACETS systemtoverify HIPAA compliance from 4010 to 5010.
  • Experience of working with Confidential and Confidential insurance data, Confidential parts A, B, C & D, FACETS 4.5/4.7 system, Claims Processing, Insurance Pricing and Claim Adjudication. Strong Experience in FEP (Federal Employment Program) and CDA (Clinical Development Analytics) . Healthcare Domain Knowledge with SQL knowledge (in Oracle environment) and 5010, ICD-10 experience.
  • Ensure data integrity through effective configuration of fields and tables; proficiently review and correct 837 rejected files as well as evaluate 835 files to determine optimal solutions for creating payor matches.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Confidential Claims.
  • Preparing BRD, Business Cases, and presentation to the clients, Business Re-engineering proposals.
  • Deflected the impact of multiple report requests from the Business Intelligence users.
  • Design, develop and went live after migrating several MS Access & SQL Server databases for corporate developers, resolving typical database issues.
  • Captured all HIPAA-related EDI data in the repository using FACETS.
  • Defined Business Process aligns with Company goals and existing HIPAA regulation to communicate with CMS Programmatically from Confidential .
  • Established traceability matrix using Rational Requisite Pro to trace completeness of requirements in different SDLC stages.
  • Interpreted legal and financial payor-provider contracts between healthcare practices and health insurance providers surrounding the methodology and rates of insurance reimbursement.

Environment: Ascential DataStage, (Designer, Director, Manager, Parallel Extender) Debugger, Oracle, MS Word, Excel, Visio, Access, and Project, Mercury TestDirector Agile, Waterfall.

Confidential, Austin, TX

Business System Analyst

Responsibilities:

  • Perform a baseline assessment of Confidential and related interfaces, the existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA as well as ICD-10 requirements.
  • Have strong experience in requirements gathering by conducting interviews with end users
  • Actively worked on Data analysis and Report analysis with respect to ICD-10 impact
  • Assisted with training of associates on small enhancement processes; worked with ACES claims data for claims subject area, Enrollment and billing data for membership subject area
  • Conducting business validations covering the following deliverables: Facets Providers, Facets Claims and Facets Membership areas
  • Reviewed extensive SQL Queries with complex multi-table joins and nested queries.
  • Experienced with BI Reporting Tools like SAS, Databases like SQL, Oracle.
  • Managed the entire UAT set up & UAT testing effort with the Business users.
  • Participated in weekly status meetings to present status and in corporate any digressions from the original scope.
  • Carried out a thorough target organization assessment and risk analysis.
  • Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS Visio.
  • Tested and delivered Inbound/Outbound Facets interfaces
  • Validated member eligibility and eligibility inquiry in the facets application to the legacy application in order to confirm the migration successful or not.
  • Capture Feature/Function information at varying levels of granularity and document them in a requirements management tool (e.g. Microsoft TFS, JIRA, etc.)
  • Familiarity with a requirements management tool like MS Team Foundation Server, JIRA or the like
  • Helped lead the transition of Requirements Management in the Business Analyst Team to the agile methodology by creating and managing user stories and Requirements Traceability Matrices in the JIRA toolset.
  • Scheduled the ETL jobs daily. Weekly and monthly based on the business requirement
  • Extensively used ETL to load data from different sources
  • Preparation ETL specifications and Creating Mappings in Informatica PowerCenter/PowerMart 5.1.0 for the incoming data.
  • Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
  • Assigned tasks among development team, monitored and tracked progress of project following Agile methodology
  • Requisite Pro, Rational Rose, Agile, HL7 Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.
  • Exposed to Agile methodology
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile
  • Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
  • Designed and implemented basic SQL queries for QA testing and report / data validation.
  • Worked with the clients on the final signing process in the User Acceptance stages.
  • Mapped the collected data with the existing data provided by the hospital departments.
  • Used Word, Excel and Visio as a working tool.
  • Involved in reviewing complex SQL queries, views, functions and stored procedures and spotting issues before/during code migration.
  • Hands-on experience and good understanding of the hospital working system including Registration, Scheduling, Radiology, Laboratory, Pharmacy, Patient Accounting, HIM, Claim Processing etc.
  • Met the deadlines and scheduled day to day meeting sessions

Environment: Facets, Oracle, HIPAA, EDI, Mainframe, XML, SharePoint, MS Word, MS Excel.

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