We provide IT Staff Augmentation Services!

Sr. Business Analyst Resume

Washington, DC

SUMMARY:

  • Over 6 years of experience as a Systems Analyst/Business Analyst in Healthcare.
  • Health Insurance Background - Specifically related to collecting requirements, documenting and representing the business, Use Cases, Business process improvements, etc.
  • Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
  • Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
  • Extensive experience with the SAS programming and in data step and with various SAS Procedures in Base SAS and SAS/Stat, including thorough knowledge of SAS Macro.
  • Expert in developing Business and System Requirements, Design Documents, working with requirements traceability matrix
  • Experience in writing Request for Proposals (RFP), Statement of Work (SOW) and Standard Operating Procedures (SOP).
  • Worked extensively on Business Requirements Elicitation, Issue List monitoring, Process Modeling, Gap analysis, Risk analysis, SWOT analysis and development of Functional Specifications.
  • Extensive Knowledge about all the phases of Business Analysis Life cycle like Requirements Elicitation, Requirements Analysis, Requirements Documentation and Requirements Management.
  • Very good at writing documents like Business Cases, Vision and Scope Documents, Statements of Purpose andRequests for Proposals.
  • Proficient in MS Office Excel (pivot tables, vlookups, hlookups, macro), Access, PowerPoint, Visio.
  • Extensive experience in writing Use Cases and UML diagrams.
  • Good understanding of Software Development Methodology including RUP and Agile methodologies. Facilitated many JAD sessions and Brain Storming sessions.
  • Experienced in White Box/ Black Box Testing, User Acceptance Testing (UAT), Unit, Integration, Functional and Load testing.
  • Assisted QA team in developing Test Scripts, Test Cases and Test Plans for the User Acceptance testing.
  • 7 20000Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
  • Strong in developing test plans, test strategies, test cases, test data, test checklists, defect tracking & reporting, preparing test summary reports and conducting status meetings.
  • Experience in conducting Backend testing by writing SQL queries and executing them.
  • Ability to multi-task and work smoothly even under extreme pressure. Experienced in creating and enhancing Test Scripts in WinRunner, QTP.
  • Familiar with Load and Stress testing. Experience in Software Quality Metrics
  • Excellent experience managing the whole testing process using Mercury Interactive Test Management tool Mercury Quality Center.

TECHNICAL SKILLS:

Programming Languages: C, C++, C#, VC++, VB, VB.NET, C#.NET, ASP.NET, Java, SQL, PLSQL

Operating Systems: UNIX, Windows 95/98/NT/2000/XP, Linux.

Databases: MS-Access, MySQL, SQL Server, Oracle, Teradata, DB2, Sybase

Application Servers: IBM Web sphere, ATG Dynamo, BEA WebLogic.

Internet: HTML, XML, VBScript, ASP, JavaScript, JSP, J2EE.

Automation Tools: MS Visio, Rational Rose, Rational Clear Case, Rational Requisite Pro, Documentum

Bug Tracking Tools: Mercury Test Director, Rational Clear Quest

Utility Tools: MS Office Suite, MS Project, TOAD, Adobe Photoshop

Reporting Tools: Crystal Reports, SQL Server Reports (SSRS)

Data warehousing Tools: Informatica, Business Objects, Cognos, Erwin

Testing Tools: Quick Test Pro (QTP), Test Director, Win Runner, Load Runner

PROFESSIONAL EXPERIENCE:

Confidential, Washington, DC

Sr. Business Analyst

Responsibilities:

  • Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
  • Consulted with healthcare third-party Administrator Company to develop conversion specifications for member,enrollment, and authorizations.
  • Effectively manage EHR staff by hiring, developing, training, and overseeing personnel to meet the needs of the practice.
  • Customized reports in JIRA for different teams to represent agile board project statuses and key metrics
  • Built and maintained close relationship with all payer provider representatives to insure proper claims processing.
  • Subject matter expert regarding Medicare regulations and operational procedures.
  • Prepare and supervise maintenance of documentation related to EDI.
  • 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.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid 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.
  • Tested different functionality of the application like Medicaid eligibility data, state available funds program, Medicaid claim processing etc.
  • Responsible for testing Medicaid Claims for peach state health plan using MMIS.
  • Understand the overall business model of Medicare Part D products, CMS guidance, and the PBM claim adjudication system.
  • Coordinated EMR/EHR (iHelix Suite) implementation to achieve meaningful use stage 1.
  • Involved in Design, analysis, Implementation, Testing and support of ETL processes for Stage, ODS and Mart.
  • Worked as a part of scrum team, in an agile methodology with sprint cycles, daily stand ups and story implementation, large cross functional project and support teams.
  • Assisted (Acquisition & Contracts) on Federal (CMS) proposals.
  • Served as JIRA executive by setting up workflows, configuring fields, screens, permissions, schemes, etc.
  • Analysis of inbound and outbound interfaces and extensions to Confidential FACETS Claims Processing system.
  • Responsible for evaluating each requirement to see if it can be implemented in EXTOL EDI Mapping Software.
  • Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • Served as interdepartmental liaison for all MA/MAPD/PDP/Cost Medicare Enrollment/Eligibility questions.
  • Project managed all CMS requirements in Enrollment and Billing including Policies and Procedures and Medicare Enrollment Letters.
  • Provide leadership and guidance to the EHR Staff and ensure that the EHR Staff is properly trained.
  • Conducted testing of SQM (Sorian Quality Measure), Siemens' certified EHR portal for Meaningful Use. The initiative propelled SQM to a Natural Language Processing and enhanced its capability to capture "unstructured data".
  • SDLC- Iterative Model & CMMI Level 3 / (ESD) CMS IT Integrated Investment & System Lifecycle.
  • Utilization of CMS technology to identify trends in payments by various types of insurances like Commercial, Federal, Workers Compensation, Managed care.
  • Prepared ETL standards, Naming conventions and wrote ETL flow documentation for Stage, ODS and Mart.
  • Involved in Service Oriented Architecture (SOA) of the claims processing system
  • Worked on broad range of technologies, including business process tools such as Microsoft Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, MicroStrategy Data Warehouse Data Modeling and Design
  • Involved in Scrum development process and prepared Sprint burn down chart, product catalog and sprint backlog contain Business Requirements and supporting documents that contain the essential business elements and definitions as well as the tasks to be completed.
  • Worked in FACETS Reconfiguration of member/subscriber, Data Element Definition and Usage with values and Completed configuring FACETS Applications like Related Entity, Parent Group, Group, and Subgroup using IVSTech Data Toolset.
  • Working with clients to better understand their needs and present solutions using structured SCRUM approach
  • Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
  • Recorded retention stored in Knowledge Link. Ad Hoc reporting, Admin for MS Project 2003, Excel dbase and pivot tables, Clarity and MS Project Server Admin duties.
  • Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
  • Validated, stored and tracked Requirements using CMS DOORs and Quality Center
  • Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
  • Involved in all phases of software development life cycle in RUP framework.
  • Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
  • Developed detailed Developer specification to reflect technical details of the business requirements
  • Performed data analysis by using SQL queries using the DB Artisan tool
  • Extensive experience in using collaborative tools like Mercury Quality Center to facilitate development across disparate teams.
  • Experienced with Rational tools like Rational Req Pro, Clearquest, ClearCase, JIRA, Rational Rose, and FACETS.
  • Facilitated application of technology to create and support business solutions, including implementation of wide-sweeping changes that improved the usefulness of the EMR system and the user experience as a whole.
  • Performed 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.
  • Used Change Data Capture (CDC) to simplify ETL in data warehouse applications .
  • Provided management support to the off-shore End to End Integration / Regression Test Team
  • Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, Cognos, Rational Requisite Pro, MS Office, SQL Server 2005, HTML, DB2, EMR, MS Project, MS FrontPage 2003, MS Access, MS Excel, Business Objects, EDI,TSO/ISPF,UML.

Confidential, PA

Sr. Business Analyst/ Systems Analyst

Responsibilities:

  • Interacted with business heads to finalize the Business Requirements for the application.
  • Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
  • Used the requirement attributes (priority, effort, and risk) as the basis for negotiating the inclusion of the requirement, to manage the scope of the system efficiently.
  • Customized reports in JIRA for different teams to represent agile board project statuses and key metrics.
  • Involved in Design, analysis, Implementation, Testing and support of ETL processes for Stage, ODS and Mart.
  • Provided business and mapping expertise during a transition of the EDI applications from the GXS Application Integrator (AI) to GIS.
  • Analysis and Design of the Confidential FACETS Data Model to ensure optimal system performance and tuning.
  • Project managed all CMS requirements in Enrollment and Billing including Policies and Procedures and Medicare Enrollment Letters.
  • Conducted testing of SQM (Sorian Quality Measure), Siemens' certified EHR portal for Meaningful Use. The initiative propelled SQM to a Natural Language Processing and enhanced its capability to capture "unstructured data".
  • Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
  • Involved with the QA team to Conceptualize, determine and develop test approaches and methods for Unit testing, Integration and Functional testing, Load and Usability testing according to the application complexity and test requirements.
  • Implemented Data Modeling standards, including element-naming conventions.
  • Wrote complex SQL queries to extract and validate the data from the Facets database.
  • Extensively involved in migration of ETL environment, Informatica, Database objects.
  • 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.
  • Recommend changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
  • Experienced with External claim editing system on frontend system of Facets 4.81.
  • Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
  • Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
  • Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
  • Provide leadership and guidance to the EHR Staff and ensure that the EHR Staff is properly trained.
  • Played active role during daily scrum meeting and task planning as part of agile methodology
  • Worked as an EDI SME at on-site. Project receives 50-70% of Modification/Enhancement work in EDI.
  • Assisted (Acquisition & Contracts) on Federal (CMS) proposals.
  • Prepared and documented System Requirements and workflows for the Content Management Application tool.
  • 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.
  • Troubleshoot any problems found within FACETS and when testing the SQL data database while validating the business rule.
  • Prepared client process maps for the consumer, broker, employer and provider transactions for the Facets process.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid 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.
  • Performed Unit Testing and User Acceptance Testing and documented detailed defects.
  • Wrote Procedure Manuals and was responsible for continuity preparedness.
  • In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors.
  • Produced training material and led training sessions for JIRA, Tempo, and Confluence.
  • Quality assures deliverables (documents) being sent to Center of Medicaid and Medicare Service by, making sure correct procedures were followed when creating and completing the document.
  • Designed High level design, for New process, integrating with legacy and Facets.
  • Analyzed ETL and Report requirements and prepared BRDs, designed patterns in Agile based environment using Cognos report net for HIPAA applications and Creating graphical representations of complex business processes
  • Evaluated testing results for each potential release build using Test Director, Quality Center and Bugzilla reports, listing summarized bug information in priority sequence, recommended viability of release for production.
  • Worked on solving the errors of EDI 834 load to Facets through MMS.
  • Managed various tests, stored test information, reviewed and analyzed test results.
  • Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
  • Created business plans for integration of front end applications to communication with the back end mainframe.
  • 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, Windows XP, NT/2000, HTML, Vignette Content management Tool, J2EE (JSP1.2), XML, XSL, XSLT, HTML, Oracle 9i.

Confidential, El Paso, TX

Sr. Business EDI Analyst

Responsibilities:

  • Conducted interviews with the Business Subject Matter Experts to gather, analyze, and document business system requirements
  • Served as interdepartmental liaison for all MA/MAPD/PDP/Cost Medicare Enrollment/Eligibility questions
  • Analyzed impacted programs to identify, understand and document business rules in plain language.
  • Created common reusable objects for the ETL team and overlook coding standards.
  • Worked with Business SME’s and IT staff to identify and translate ICD business rules into system requirements.
  • Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives
  • Generate and revise the EHR Staff work schedule to ensure appropriate staff utilization and coverage.
  • Strong understanding of FACETS and Facets Data Model working on data model and data extracts.
  • Project managed all CMS requirements in Enrollment and Billing including Policies and Procedures and Medicare Enrollment Letters.
  • Supported the physician applications and ordering module during the initial EMR go-live and provided support to end users during maintenance and optimization activities.
  • Created reports and dashboards in JIRA to track hours and project status to report to finance team.
  • Implemented various HIPAA codes (270 and 276) used for Billing and Eligibility purposes of patient records.
  • Reviewed technical impact analysis, identify and segregate relevant application code.
  • Develop detailed specifications of X12 and XML data format standards.
  • Responsible for developing, support and maintenance for the ETL (Extract, Transform and Load) processes using Oracle and Informatica PowerCenter.
  • Lead abstraction of core measure data from EHR and submission of these data to CMS. Data converted to knowledge and wisdom contributed to the establishment of objective measurement, performance transparency, best practice sharing, and standardization.
  • Observed and analyzed corrections-specific workflows to adapt the EMR and optimize provider efficiency and success.
  • Developed and implemented policies and procedures which includes process flows, guide sheet for all important responsibilities as part of development of Medicare Operations Manual.
  • Knowledge of Medicaid Management Information Systems (MMIS).
  • Extensively used Oracle ETL process for address data cleansing.
  • Participated in solving Billing issues from the FACETS Problem Log for Confidential.
  • Supported the CMS Medicare Part B program, Medi-Cal program, and Confidential by providing technical, analytical, testing, and implementation support to existing interfaces.
  • Produced training material and led training sessions for JIRA, Tempo, and Confluence.
  • Articulated and presented business analysis results clearly and concisely to IT staff.
  • Developed requirements traceability matrix to be used in software development and QA testing.
  • Performed 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.
  • Identified required information fields and develop data dictionary.
  • Research Medicaid and Medicare requirements for system automation.
  • Participated in systems development efforts.
  • Worked as a part of scrum team, in an agile methodology with sprint cycles, daily stand ups and story implementation, large cross functional project and support teams.
  • Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Validated Claim and Member enrollment in Facets.
  • Participated is customer weekly JIRA progress updates.
  • Participated in testing, acceptance testing and implementation of information systems, modules and subsystems.
  • Involved in performance testing of Medicaid client server claims processing system, Medicaid MCC / MCO and Medicaid Management Information System (MMIS).
  • Acted as a Medicaid and Medicare SME during discovery analysis.
  • Experienced working in Facets online modules such as Billing, Provider, Claims and Membership modules
  • Establish and conduct monitoring activities centered on key CMS audit findings and best practices including, but not limited to, formulary administration, point of sale edits, coverage, and claim reject reports.
  • Experience with Medicare, Medicaid and commercial insurances in HIPAA, ANSI, X12 formats including 270/271, 276,277, 278, 835, 837, 997.
  • Provided user support during application software implementations.
  • Effectively manage EHR staff by hiring, developing, training, and overseeing personnel to meet the needs of the practice.
  • Used Change Data Capture (CDC) to simplify ETL in data warehouse applications.
  • Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations.
  • Experience with different Facets Modules.
  • Participated in Application Group and business unit meetings.
  • Held training sessions for EPSDT, EDMS and RetroDur.
  • Worked closely with Business Analyst and Developers to discuss test scenarios.
  • Developed and documented test plan, set up test data to execute test steps, attended daily status checkpoint meetings, and also worked on change orders to understand the requirement.
  • Extensively used Captiva to scan the documents and uploaded through Confidential to verify the attachment in EDMS panel through BPEL.
  • Facilitated application of technology to create and support business solutions, including implementation of wide-sweeping changes that improved the usefulness of the EMR system and the user experience as a whole.
  • Worked with claims and configuration departments to resolve and reduce provider issues by analyzing and researching Medicare and Medicaid guidelines, fee schedules, and provider credentialing, contracting and licensing requirements
  • Perform research on Member, Provider, Claims, Authorization, Appeals and Grievances data from Facets back end and front end application system for reporting purposes.
  • Owned the entire reporting process. Interacted with the ETL team, developer(s), management, and account holders to get the requirements, document them, design templates, and write specifications.
  • Served as JIRA executive by setting up workflows, configuring fields, screens, permissions, schemes, etc.
  • Uploaded different files to verify the rejected claim location including Completion new and Completion Verify.
  • Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
  • Worked on EPSDT claims to validate the YTD column, verified letters in viewer and different reports by identifying appropriate recipients.
  • Recommend changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
  • Analysis and Design of the Confidential FACETS Data Model to ensure optimal system performance and tuning.
  • Experience working on RetroDur with different kind of letter, surveys and created interventions.
  • Worked on table change including adding, updating and deleting the field.
  • In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors.
  • Conducted testing of SQM (Sorian Quality Measure), Siemens' certified EHR portal for Meaningful Use. The initiative propelled SQM to a Natural Language Processing and enhanced its capability to capture "unstructured data".
  • Prepared ETL standards, Naming conventions and wrote ETL flow documentation for Stage, ODS and Mart.
  • Modified 271 file for map fix of warnings related message and EVSELIG program to accept a batch of eligibility requests from SACWIS.
  • Experience submitting different kind of claims including LTC, Dental, Hospice, Inpatient, Inpatient crossover, Institutional and also overlapped claims to create EOBs.
  • Customized reports in JIRA for different teams to represent agile board project statuses and key metrics
  • Extensively worked on financial process for submitted claims and created CPAO selection requests, Cost Settlement numbers and generated CPAO report to verify CS03, CS01, CS05 and CS07 calculation.
  • Extensively worked on different form of Patient liability, TPL, RMF, Provider LTC Rates and setting up the data including Nursing facility care and ICFMR.
  • Wrote complex SQL queries to extract and validate the data from the Facets database.
  • Involved in Design, analysis, Implementation, Testing and support of ETL processes for Stage, ODS and Mart.
  • Working with Medicare operational management to monitor, trend and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
  • Worked on Managed Care to add PMP assignments, verified PMP Assignment history panel, Case/Cat/Seq data, Benefit plans and also worked on 1061 and 1062 files to check the error code, descriptions.
  • Created paper claims, XML (Electronic) claims and direct data entry claims for testing purposes
  • Responsible for generating reports for batch processes in mainframe.
  • Interacted with the DST (off shore) teams for QA support and training purposes. Responsible for running test region EDI loads on AS400 Series. Updated records in AS400 before processing for testing purposes.
  • Ran claims batch loads in AS400. Wrote SQL queries to for Data Mining and Data manipulation in MHS. Used Confidential Quality Center for reporting and tracking defects.
  • Provide leadership and guidance to the EHR Staff and ensure that the EHR Staff is properly trained.
  • Research in design methods to create scenarios for adequate test coverage.
  • Extensively involved in migration of ETL environment, Informatica, Database objects.
  • Experienced with External claim editing system on frontend system of Facets 4.81.
  • Performed database validation in the Mainframe to ensure the data entered through the front end reached the database.
  • Created reports using Mercury Interactive Test Director.

Environment: HQ Quality Center, SQL, XML, IBM Mainframe, ALM QC, IBM AS400 iSeries, Win 2000/XP, MS Excel, SharePoint, PDS (Project Deliver System), HIPAA.

Confidential, OWINGS MILL, MD

Business Analyst

Responsibilities:

  • Created Business Workflow based on the requirements gathered from the client.
  • Created functional specification documents based on the business requirement documents.
  • Organized JAD Sessions to resolve issues and conflicts, and to arrive at quick agreements regarding the system architecture design.
  • Observed and analyzed corrections-specific workflows to adapt the EMR and optimize provider efficiency and success.
  • Extensively used Oracle ETL process for address data cleansing.
  • Assembled business requirement documents (BRD) and the functional specifications as per the user requirements.
  • Worked with the project manager for planning and organizing the project activities, and in communicating with other business center managers and stakeholders of the project.
  • Participated is customer weekly JIRA progress updates.
  • Supported the physician applications and ordering module during the initial EMR go-live and provided support to end users during maintenance and optimization activities
  • Documented complex Business requirements and made process flow diagram for the 837, 270/271, 276/277 & 835 Remittance transactions as per the 4010 to 5010 implementation for the Medicaid claim processing system enhancement.
  • Developed and conducted statewide HIPAA 5010 and ICD-10 awareness program for staff.
  • Worked with QA to create test plans and test cases based on the business requirements which involved market risk analysis and risk management.
  • Effectively manage EHR staff by hiring, developing, training, and overseeing personnel to meet the needs of the practice.
  • Tested the accuracy of iHelix inpatient EMR for Stage 1 meaningful use clinical quality measure calculation by using Cypress tool.
  • Responsible for developing, support and maintenance for the ETL (Extract, Transform and Load) processes using Oracle and Informatica PowerCenter .
  • Responsible for EMR interface development and implementation. Specialised in Nephrology EMR, Internal medicine EMR, Psychiatry EMR, Oncology EMR, Anaesthesia EMR etc.
  • Participated in solving Billing issues from the FACETS Problem Log for Confidential and Billing Entities.
  • Validated Claim and Member enrollment in Facets
  • Experience with different Facets Modules.
  • Produced training material and led training sessions for JIRA, Tempo, and Confluence.
  • Created common reusable objects for the ETL team and overlook coding standards .
  • Serve as a point of contact for the client’s stakeholders and provided customer support in addition to team building with on and off shore agile teams.
  • Improved and enforced claims handling efficiencies to speed up claims payments and adjust reserves more effectively.
  • Developed and implemented policies and procedures which includes process flows, guide sheet for all important responsibilities as part of development of Medicare Operations Manual.
  • Analysis and Design of the Confidential FACETS Data Model to ensure optimal system performance and tuning.
  • Develop maps in Application Integrator (AI) to translate SAP IDOCs to Edifact for the Supply chain and ebanking business
  • Wrote complex SQL queries to extract and validate the data from the Facets database.
  • Worked on EDI 834, 835,837, 276/277, 278 as per HIPPA guidelines.
  • Experienced with External claim editing system on frontend system of Facets 4.81.
  • Maintained clear understanding of project goals among stakeholders by conducting walkthroughs and meetings involving various leads from BA, Development, QA and Technical Support teams.
  • Reviewed high-level design specification, ETL coding and mapping standards .
  • Interacted with the client and the management teams to understand the requirements and to report the status of the testing efforts on their applications.
  • Lead abstraction of core measure data from EHR and submission of these data to CMS. Data converted to knowledge and wisdom contributed to the establishment of objective measurement, performance transparency, best practice sharing, and standardization.
  • Utilized Visio diagrams, data flow diagrams, use case diagrams and process flow diagrams using the CMS-MITA guideline.
  • Worked as an EDI SME at on-site. Project receives 50-70% of Modification/Enhancement work in EDI.
  • Created reports and dashboards in JIRA to track hours and project status to report to finance team.
  • Generate and revise the EHR Staff work schedule to ensure appropriate staff utilization and coverage.
  • Conducted individual and group joint application development (JAD) sessions with business stakeholders and technical units.
  • Analyzed “AS IS” and “TO BE” scenarios, designed new process flows and documented the business process and various business scenarios.
  • Create story board of back log items in Agile and develop item according to business needs.
  • Worked as functional Analyst in the software development team for outsourcing Electronic medical records ( EMR ) and paperless office system implementation to the medical facilities.
  • Managed scope and deadlines.
  • Participated in various meetings and discussed enhancement and modification request issues.
  • Performed Gap Analysis.
  • Followed the RUP methodology for the entire SDLC.
  • Actively worked with developers as needed to isolate the Root Cause Analysis of defects.
  • Worked with the clients on the final signing process in the User Acceptance stages.

Environment: MS-Visio, MS Word, Excel, PowerPoint, Java, Oracle, Requisite, Web Logic, EMR

Hire Now