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Business Analyst Resume

Nashville, TN

SUMMARY:

  • Over 6 years of professional experience as a Business Analyst with excellent understanding, analyzing, and documenting Business Requirements, Functional Specifications, Business Process Flow, Business Process Mapping, and Modeling.
  • Experience as Business Analyst with expertise in Healthcare processes, Business Process Engineering, Systems/ Solutions Engineering, Strategic Planning, and Systems Analysis.
  • Extensive experience in analyzing and requirements gathering and writing system functional specifications.
  • Strong knowledge of Healthcare industry including HIPAA with emphasis on Business Requirements and Functional Requirements.
  • Financial products involved: Fixed Income, Equities, Bonds, Mutual Funds, Fund of Funds, Insurance, Retirement Planning, Generation Planning and complete Financial Planning
  • Experience in Confidential Management Information System (MMIS). Expertise in various subsystems of MMIS - Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
  • Good knowledge of Health Insurance Plans ( Confidential Part A, B, C and D), managed care concepts ( Confidential and Confidential ) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
  • 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.
  • Expertise in MOSS 2007 Workflow, SharePoint Designer 2007 and InfoPath 2007.
  • Functional experience with concentration on Use Case modeling using UML, Business Process Modeling, Data Modeling, Change Management, Technical Training, Software Development methodologies, QA testing, and Systems Testing of client server and web-based systems.
  • Excellent knowledge of E-Commerce, healthcare IT along with HIPAA regulations, EDI transaction Code Sets, and CMS regulations.
  • Worked with Internal and External Business teams to determine the needs as required Transaction syntax like ANSI X12 4010, Implementation and Knowledge of HIPAA Code sets, familiar with ICD-9.
  • Expertise in Logical Modeling, Physical Modeling, Dimensional Modeling, Star and Snow-Flake schema
  • Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
  • Hard working, positive thinking, self starter with a strong goal orientation
  • Worked with Internal and External Business teams to determine the needs as required Transaction syntax like ANSI X12 4010, Implementation and Knowledge of HIPAA Code sets, familiar with ICD-9.
  • Excellent meetings facilitator with excellent inter-personal and conflict resolving skills.
  • Involved in meeting with Clinical Users and Clearing Houses to determine the format of the ICD 10CPT codes.

TECHNICAL SKILLS:

Software/Hardware: OOAD (OOA/OOD), RUP, UML, SDLC, Waterfall, QA, WAP,CVS,TEAMMATE, MS Access, SQL Server, MySQL, PL/SQL, SQL,Oracle DBA, Windows 98/2000/XP, basic UNIX, HTML, basic DHTML, basic XML, MS Office Suite-Excel Macros, JAVA, Javascript, Project, Visio, Adobe Photoshop, Flash, Rational- Rational Rose, Rational XDE, EMR, Mercury Test Director,DOORS, Business Process Modeler, RequisitePro, Analyst Studio, CaliberRM, Crystal Reports, Business Objects, Microstrategy,various NIKU products, C, C++, Sharepoint, Docushare, BASIC, Intermediate level-Visual Basic.

PROFESSIONAL EXPERIENCE:

Confidential, Nashville, TN

Business Analyst

Responsibilities:

  • Provide commercial /therapeutic research information for weekly review.
  • Assist in the set-up of the new hospital web portal and document new business processes to support training roll out.
  • Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes
  • Work with Confidential and Confidential to ensure all BPM requirements related to: Computerized physician order entry (CPOE), clinical data repository (CDR), Electronic Health Record, Clinical Research and Pharmacy have been captured.
  • Strong experience of working with Confidential and Confidential insurance data, Confidential parts A, B, C & D, and Insurance Claims.
  • Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication)
  • Exposed to using ICD 9/ ICD 10 /ANSI/HL7 coding standards in Confidential and Confidential domains of the healthcare systems and industry for both inpatients, outpatients, Reimbursement methodology.
  • Used IBM WebSphere 6.1 application server for application development and production.
  • Involved in loading the data into oracle Applications
  • Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
  • Tested HIPAA regulations in Facets HIPAA privacy module
  • Used JIRA tool to track and maintain different versions of the project documentation.
  • Implement SharePoint for team collaboration and Document Management.
  • Comprehensive understanding of MMIS subsystem files, screens and integrated workflow processing
  • Interacted with the Subject Matter Experts (SMEs) and stakeholders, gathering business requirements to get a better understanding of client’s business processes.
  • Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc).
  • Used UML, for gathering requirements, created Use Case Diagrams, and Use Case Specification document (USD).
  • Designed a module to rollover member refunds to qualified retirement plans such as 401(k), 403(b), IRA, Roth IRA, etc.
  • Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.
  • Responsible for researching and documenting existing system features and capabilities and documented findings in user guide for the purpose of various stakeholders and team members in the project to understand the features and functionality of the application accurately.
  • Cleaning of incomplete, inconsistent and noisy data to form a more organized data warehouse to ensure consistency in coding and naming. Organizing this data in terms of various major subjects to provide a simple and a concise view around the entities.
  • Involved in the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Confidential Claims.
  • Involved in gap analysis and implementation of HIPAA 5010, ICD10 and Claim Validations
  • Used Unified Modeling Language (UML) for process modeling and use cases.
  • Worked with tools such as Amdocs CRM/Clarify, MS Project, IBM FileNet P8, UML and MS Visio.
  • Experience in Claims Processing per Confidential Management Information Systems (MMIS) 42 CFR 433.
  • Analyzed CMS comparison documentation highlighting changes of 5010 format and ICD10 diagnosis and procedure codes.
  • Instructed and modeled core Agile principles of collaboration, prioritization, team accountability and visibility, ensured consistent application of SCRUM methodologies across the enterprise
  • Involved in the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Confidential Claims.
  • Develop a strong understanding of the commercial healthcare industry, particularly from a payer perspective
  • Tested the HIPPA EDI, 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data with Facets on different modules.
  • Adhered to HIPAA for the Affordable Care Act (ACA), health insurance & Confidential claims.
  • Experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835, 270/271 and 276/2 77).
  • Defined, developed specs for federal reporting specific to Confidential Advantage
  • Fine Tuned procedures for the maximum efficiency in various schemas across databases using Oracle Hints, Explain plans.
  • Identifying and establishing retirement plan account identifiers for the Customer Profile System.
  • Involved with the coders in evaluation of CPT and ICD-9 codes to ensure that the diagnosis meets medical necessity for the specific CPT code.

Environment: EDI ANSI X12/HIPAA, MEDISTAT, JavaScript, MERCATOR, XML, MS OFFICE, MS PROJECT, MS Visio, RATIONAL ROSE, TESTDIRECTOR, DB2, TOAD, Cobol, IBM WebSphere, WINDOWS NT/XP.

Confidential, Austin, TX

Business Analyst

Responsibilities:

  • Involved in development phase meetings for Business Analysis and Requirements Gathering.
  • Worked on Confidential Bureau data, including demographic, economic, and geographic data
  • Designed DataStage ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
  • Facilitate all agile ceremonies including daily stand-ups, weekly grooming, retrospective, and review and planning session.
  • Worked on analysis of FACETS claims processing system and gathered requirements to comply with HIPAA
  • Worked with 837, UB92, UB04, CMS 1500 claims and HIPAA 835, 270/271, 276/277, 278 transactions.
  • 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.
  • Strong knowledge of working on JIRA and Tableau.
  • Highly involved in understanding of department workflows and process flows with respect to applications. Developed business process models in RUP to document existing and future business processes. Improved process for payment of Confidential Secondary Payer claims through revised workflows.
  • Performed testing for Confidential, Confidential and X-Over claims for Confidential Management Information System (MMIS)
  • Took lead role in migrating pages and data from old intranet to new SharePoint platform
  • Upgrading and Patching of SharePoint and its' related systems
  • Worked on System Integration (X12 EDI-HIPAA-835) with Health plans eligibility and claim (CPT, ICD 9 codes).
  • Used XML, XSL and XSLT for developing a dynamic and flexible system for handling data.
  • Provided support to the completion of the MMIS Data Dictionary. Evaluated and identified all system problems
  • Trouble-shooted jobs using Data Stage Debugger.
  • Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS ñ enrolment and benefits.
  • Used Soft Test software with pseudo code to ensure test cases covered all branches of project's code impacting the system. (The system is an IBM mainframe based system that contains the master set of customer information used to bill customers).
  • Built business requirements into the Confidential Advantage (MA) requirements database and created the Project Requirements Document for the three functional areas.
  • Worked on performance tuning and enhancement of Data Stage job transformations.
  • Creation of database objects like tables, views, procedures, packages using Oracle tools like SQL* Loader, SQL* Plus and PL/SQL.
  • 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
  • Performed testing for Confidential, Confidential and X-Over claims for Confidential Management Information System (MMIS)
  • Was Involved in meeting with Clinical Users and Clearing Houses to determine the format of the ICD-10CPT codes
  • Was responsible for the hardware, software, upgrades, and patching of SharePoint equipment.
  • Experienced working with x12 version 5010 transactions and ICD 10-CM and ICD 10-PCS Code set changes analysis, design and migration strategy.

Environment: Ascential Data Stage 6.0(Manager, Director), JavaScript, IBM DB2/UDB Universal Database Oracle 8/9i,, Teradata, MS SQL Server 7.0, Ms Word, Cobol, MS Excel, IBM WebSphere,MS PowerPoint, MS Project, MS Visio, HTML, XML, UNIX, DB2, GIS Tools, Windows NT, Sybase.

Confidential, Lansing, MI

Business Analyst

Responsibilities:

  • Performed Requirement Gathering & Analysis by actively soliciting, analyzing and negotiating customer requirements and prepared the requirements specification document for the application using MS Word.
  • Identified opportunities for business process improvement through various meetings with business users and developers and initiated efforts to make improvements.
  • Developed the project plan with assistance from the management, and included provisions for project scope changes and issues and initiated efforts to make improvements.
  • Created and maintained requirement documents for Facets for the different modules like Billing, Member enrolment and Claim adjudication.
  • Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
  • Negotiate on behalf of MSHS to expedite payments from all commercial payer insurance companies
  • Create, test, and implement custom billing/payer edits, reducing payer denials.
  • Utilized JIRA to develop and track Agile epics, stories and tasks.
  • Work with CMS business owners to define their target goals and propose alternative business solutions
  • Created GUI specifications with Page flows, page business actions and screen mock-ups
  • 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.
  • Responsible for establishing new requirements for administrative transactions to improve the utility of the existing HIPAA transactions and reduce administrative costs.
  • Experience in Claims Processing per Confidential Management Information Systems (MMIS) 42 CFR 433.
  • Created RUP activity diagrams and sequence diagrams to analyze the requirements and recommend solutions.
  • Develop Logical and Physical data models that capture current state/future state data elements and data flows using Erwin.
  • Performed testing for Confidential, Confidential and X-Over claims for Confidential Management Information System (MMIS)
  • Worked extensively with MS Excel and MS access
  • Prepared scenarios, Use Cases & UML State Diagram for scenarios using Rational Rose.
  • Prepare presentation slides in MS Project, which was extensively used in different JAD sessions and to track progress.
  • Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
  • Prepared and documented System Requirements and workflows for the Content Management Application tool.
  • Aware of the various Operating rule mandates along with the EFT and ERA operating rules as per Section 1104.
  • Involved in generating various reports using the SQL Server Reporting Services (SSRS).
  • Used Test Director, PL/SQL for testing the application
  • Worked with 837, UB92, UB04, CMS 1500 claims and HIPAA 835, 270/271, 276/277, 278 transactions.
  • The Addenda version of the ANSI ASC X12 834 transaction set was selected as the HIPAA-mandated format for electronic enrolment and disenrollment in a Health Plan.
  • Understand the Business/Technical requirement and prepare high level Design document for various projects in Child care enhancements like Benefit Calculation, Eligibility Determination rules, Cash Programs, MMIS etc.
  • Assisted JAD sessions to identify the business flows and determine whether the EDI X12 Transaction, Code set and Identifier aspects of HIPAA, impacts any current or proposed systems.
  • Involved in the project for implementing Best Practices for Business Analysis in the organization and instrumental in the transition plan for Agile Development methodology using SCRUM.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Confidential Claims.
  • Tested HIPAA Gateway Application Interface for all inbound and outbound messages
  • Participated in the bug review meetings, updated requirement document as per business user feedback and changes in the functionality of the application.
  • Clarified QA team issues and reviewed test plans and test scripts developed by QA team to make sure that all requirements will be covered in scripts and tested properly.
  • Organized meetings to discuss outstanding issues with QA and developers.
  • Wrote test scripts for User Acceptance Testing (UAT).

Environment: Rational Suite (Rose, Requisite Pro), Dreamweaver, Rational Unified Process (RUP), Windows NT/XP/2000, UML, UNIX, MS-Project, MS-Office Suite, Case wise Corporate Modeler, Win Runner, Test Director

Confidential, Fairfax, VA

Business Analyst

Responsibilities:

  • Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects of both ETL jobs and Reporting jobs.
  • Responsible for installation and configuration of the SharePoint Server 2007 along with Office 2007 and worked on Site designing using SharePoint Designer 2007.
  • Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
  • Using FACETS for various health insurance areas such as enrollment, member, Products and other FACETS related modules
  • Utilized Agile Methodologies to configure and develop process, standards and procedures.
  • Organized and facilitated Agile and Scrum meetings, which included Sprint Planning, Daily Scrums or Stand-ups, Sprint Check-In, Sprint Review & Retrospective.
  • Analysis of inbound and outbound interfaces and extensions to FACETS claims processing system
  • 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
  • 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
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Confidential Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
  • Assisted the database development team in data modeling, data structure and data table layouts required for consolidation of incongruent databases,
  • Tested claims adjudication and group and enrollment in Amisys for New Confidential advantage members
  • Created Use-Cases and Business Use-Case Model after accessing the status and scope of the project and understanding the business processes.
  • Interacted with the stakeholders to get a better understanding of client business processes and gather business requirements.
  • Prepared questionnaire based on the System Analysis Performed for all entities.
  • Linked business processes to organizational objectives, perform critical path analysis, and identify opportunities for business process improvement.
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
  • Responsible for attaining HIPAA EDI validation from Confidential, Confidential and other payers of government carriers
  • Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP
  • Gathered and validated requirements, resulting in detailed business rules, functional requirements and process design.
  • Used MS Sharepoint for the purpose of managing documents and for hosting websites which was used to access shared work spaces and documents.
  • Developed test plans with QA team and helped test every scenario using Mercury TestDirector Tool for system testing
  • 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.
  • Participated in the support of BI applications with IT applications and technical staff.
  • Performed Unit Testing and User Acceptance testing and documented detailed results.
  • Involved in Logical & Physical Data Modeling. Database Schema design and modification of Triggers, Scripts, Stored Procedures in Sybase Database Servers.
  • Configured the Data mapping between Oracle and SQL Server 2005.

Environment: Ascential DataStage 7.5, (Designer, Director, Manager, Parallel Extender) Debugger, MS Word, Excel, Visio, Access, and Project, Star Schema, UNIX, Mercury TestDirector Agile, Waterfall

Confidential, Pottstown, PA

Business Analyst

Responsibilities:

  • Interacted with business heads to finalize the Business Requirements for the application.
  • Worked with the business users and with different levels of management to identify requirements, use cases and to develop functional specifications.
  • Worked on AGILE Environment with daily scrum meetings, grooming sessions, planning and sprint cycles.
  • Identified, researched, investigated, analyzed, defined and documented business processes
  • Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
  • Documenting business requirements for re-engineering the Customer Profile System to accommodate the new employee benefit trust account infrastructure.
  • Configured facets modules such as Claims, Membership, Billing, Benefit and plan
  • Worked on the FACETS configuration and tested claims processing modules for medical and dental claims
  • Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
  • 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.
  • 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.
  • Assisted with development of strategy for managing SharePoint permissions in conjunction with Active Directory and future implementation of Identity Lifecycle Management functionality
  • Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
  • Managed changing requirements which included establishing a baseline, keeping track of the history, determining dependencies that are important to trace, tracing relationship between related requirements and maintaining version control.
  • Helped in writing Training manuals and helped business with the Training on a one to one sessions.
  • Employed Rational Clear Quest for effective Change Management (Requirements Creep) and bug tracking during the testing lifecycle.

Environment: Rational Rose and Requisite Pro, MS Visio, MS Project, UML, XML, Star Schema, Windows XP, NT/2000, HTML, Vignette Content management Tool, J2EE (JSP1.2), XML, XSL, XSLT, HTML, Oracle 9i.

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