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Sr. Business Analyst Resume

Hartford, CT

SUMMARY:

  • Seven years of Business Analyst experience in the healthcare industry in Medicare and Healthcare Insurance, as well as Medical Standards (HIPAA, HIX, EDI, ACA and HL7).
  • Knowledge of IT Service Management (ITSM) based on ITIL best practices.
  • Experienced in Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
  • Skilled in healthcare standards such as HIPAA 4010, 5010, ICD - 9 and ICD-10.
  • Expertise in HIX and EDI Transactions (270, 271, 277, 820, 834, 835, 837).
  • Worked on solving the errors of EDI 834 load to FACETS.
  • Experience conducting JAD (Joint Application Development) sessions with Stakeholders and Business Partners to resolve issues.
  • Worked on different EDI healthcare transactions like 835-Claim Payment/Remittance Advice, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions.
  • Strong knowledge of Object Oriented Analysis and Design (OOAD) using Unified Modeling Language (UML), Rational Unified Process (RUP), Capability Maturity model (CMM).
  • Sound knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), and Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding, and HL7.
  • Proficient in White Box, Black Box, Unit, Functional, Integration, Back End and System Level Load and Stress Testing for many types of applications including web and client server applications.
  • Good knowledge and understanding of Medical Management Information System (MMIS).
  • Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience with in life and disability in health plans. 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.
  • Extensive experience in reports on SSRS on SQL Server (2000/2005/2008/2008 R2/2012) and sound Experience and understanding of SSAS, OLAP cube and Architecture.

SKILLS :

Methodologies/Processes: Agile, Waterfall, Rational Unified Process, UML, SDLC, Scrum.

Mainframe: COBOL, DB2, JCL, CICS, MVS

Tools: MS Office Suite (Word, Excel, Visio, PowerPoint, Project, Outlook, Access), IBM Rational Rose, IBM Rational Requisitepro, IBM Rational ClearQuest, IBM Rational ClearCase, HP Quality Center, HP WinRunner, HP LoadRunner, QTP, Informatica Power Centre, Adobe PageMaker, Adobe Photoshop, JIRA, Microsoft Team foundation server, Test Director.

Reporting Tools: Crystal Reports 8.0, SSRS, SSAS, SSIS

Technical Knowledge/Systems: Epic Systems, Windows XP/7, Sun Microsystems JRE 1.4.2, Apple JRE 1.4.2 Java Script, Java, JSP, JSON, J2EE, XML, HTML, DHTML, TOAD 7.6, SQL, Unix, Linux, CORBA Services (IONA Orbix), JMS (TIBCO EMS), Oracle 10g, Sybase, PHP, .NET, ASP.NET, SAP ERP

EXPERIENCE:

Sr. Business Analyst

Confidential, Hartford, CT

Responsibilities:

  • Conducted and facilitated JAD meetings with Business Users, Project Managers, Subject Matter Experts (SMEs), and other Business Stakeholders to elicit business requirements.
  • Experience in information security and risk management issues on the Medical Transactions, PHI data protection, and medical data.
  • Worked with Business Analysts and Business Users to collect requirements by conducting interviews and follow up meetings.
  • Experience in transaction sets like 835, 837, 276, 277, 278, and HIPAA version 5010.
  • Designed and implemented HIPAA 835 payment advice transaction, 837 health care claim transaction, 276 and 277 claim status transaction, and 278 medical clearance systems.
  • Populated ICD - 9, ICD-10, HCPC, REV, CPT, NDC Disease code sets per healthcare standards.
  • Bridged gap between "as-is" and "to-be" business process flows, integration of process flow diagrams to show end-to-end business model and process mapping exercise by including swimlanes to distinguish roles and responsibilities.
  • Created UML Diagrams to show business process flows of business requirements like Use Case Diagrams, Class Diagrams, Activity Diagrams, Sequence Diagrams, and Wireframes using MS Visio.
  • Documented database and stored procedure specifications and also defined database constraints.
  • Documented all project change requests for any business requirement changes.
  • Maintained Root Cause Analysis documents and updated service center tickets and work product review documents.
  • Designed and developed SOA processes with the consult of management to manage tasks related to the project while developing all phases of the application.
  • Supported in User Acceptance Testing phases by documenting UAT Test Cases and participated in Regression Testing sessions.
  • Helped in verifying the business scenarios on new developments of requirements to allow further testing by the QA team to ensure the system performed flawlessly.

Environment: Windows, MS Word, MS Excel, MS PowerPoint, MS Visio, MS Project, Web Services, REST API, Rational Requisite Pro, Test Director, CMM, RUP, Rally.

Sr. Business Analyst

Confidential, New York, NY

Responsibilities:

  • Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
  • Designed a claim processing system for the healthcare management client system, which allowed the users to inexpensively capture information regarding patient, summary of medical history, symptoms (ICD - 9 codes), and treatment (CPT).
  • Responsible for gathering the functional requirements for the health benefit claims receiving and processing system.
  • Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD) and the Functional Requirement Document (FRD).
  • Captured process flows by preparing activity and sequence diagrams, pre- and post-conditions, performance requirements, impacted areas, high-level business rules, issues, areas in scope and out of scope, assumptions, etc.
  • Involved in Requirement Scoping and analyzing high priority requirement.
  • Conducted sign-off meetings with IT teams to lock down the requirements
  • Analyzed HIPAA 4010 and 5010 standards for 837I/P and 835 EDI X12 transactions, related to providers, payers, subscribers and other related entities
  • Plan, manage, and execute the integration of new applications and HL7 interfaces into existing network infrastructure, systems and software throughout the enterprise
  • Assisted in development and troubleshooting of HL7 interfaces from Siemens Invision via Openlink to the Laboratory (LIMS), Patient Accounting, Billing (DFT), and Admission/Discharge/Transfer (ADT) modules.
  • Collaborate with technology team members, end users, and stakeholders at every level of the organization
  • Technical writing of HL7 specifications to define best practice
  • Access mirth interface engine to monitor interfaces and troubleshoot HL7 user assessments, requirements documents, current and future state model diagrams
  • HL7 vendor specification review and crosswalk tables
  • Created High-Level Use Cases from Business Requirements and created UML Diagrams like Use Case and Activity Diagrams using MS Visio.
  • Conducted JAD sessions to allow different stakeholders to communicate their perspectives with each other.
  • Tracked stakeholder requested enhancements and changes using Requirement Traceability
  • Matrix (RTM).
  • Reviewed Technical Specification Documents (TSD) with development team, resolved issues and provide Sign Off.
  • Involved with the 837, 835, 270/271,277/275 and 276/277 HIPAA-EDI Transaction Code Sets.
  • Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
  • Involved with the Quality Assurance Team to develop and design Test Plan and Test Cases.
  • Executed Test Cases and Test Scripts for manual and automation testing. Defects were raised in HP Quality Center/HP ALM for logging, tracking and reporting bugs in the application.
  • Conducted User Acceptance Testing (UAT) of the application with the QA team.
  • Performed testing of the health benefit claims receiving and processing system to ensure that the system adheres to project standards, performance criteria, and functional specifications.

Environment: Windows XP (SP-3), Caliber, Toad-11, Toad-Data Modeler, HP Quality Center, MS Excel, MS Word, Visio, MS Power Point, SQL, DB2, SharePoint 2010.

Business Analyst

Confidential, Framingham, MA

Responsibilities:

  • Conducted and facilitated JAD meetings with Business Users, Project Managers, Subject Matter Experts (SMEs), and other Business Stakeholders to elicit business requirements.
  • Participated in information security and risk management issues on the Medical Transactions, PHI Data Protection, and Medical Data.
  • Worked with Business Analysts and Business Users to collect requirements by conducting interviews and follow up meetings.
  • Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction, 276 and 277 Claim Status Transaction, and 278 Medical Clearance Systems.
  • Populated ICD - 9, ICD-10, HCPC, REV, CPT, NDC Disease code sets per healthcare standards.
  • Bridged gap between AS-IS and TO-BE business process flows, integration of process flow diagrams to show end-to-end business model, and process mapping exercise by including Swimlanes to distinguish roles and responsibilities.
  • Created UML Diagrams to show business process flows of business requirements like Use Case Diagrams, Class Diagrams, Activity Diagrams, Sequence Diagrams, and Wireframes using MS Visio.
  • Documented database and stored procedure specifications and also defined database constraints.
  • Documented all Project Change Requests for any Business Requirement Changes, maintained Root Cause Analysis Documents, and updated Service Center Tickets and Work Product Review Documents.
  • Supported in User Acceptance Testing phases by documenting UAT Test Cases and participated in Regression Testing sessions.
  • Helped verify the business scenarios on new developments of requirements to allow further testing by the QA team to ensure the system performed flawlessly.

Environment: CRM 2015, CRM 2011, .Net 3.5, TFS 2013, TFS 2015, JavaScript, JQuery, HTML, CSS, SQL 2012, Windows 7, MS Visio 2010, HUB, Omniture, Google Analytics.

Business Analyst

Confidential, Hingham, MA

Responsibilities:

  • Prepared Business Requirement Document and functional requirement document for the enhancement of existing services.
  • Performed GAP Analysis for HIPAA up gradation and prepared solution documents and project plan.
  • Initiated with a comparison report of migration of HIPAA .
  • Conducted HIPAA requirements gathering sessions for the EDI transaction between providers, payers and employer groups.
  • Coordinated the upgrade of transaction sets of EDI 837 (I/P), 835 and 834 to HIPAA compliance.
  • Involved in testing all the loops, segments and elements within each hierarchical loops for EDI 837I, and 837P.
  • Worked on solving the errors of EDI 834 load to FACETS.
  • Analyzed and documented the requirements for MMIS and CMS.
  • Involved in forward mapping from and backward mapping.
  • Tested EDI transaction like 270, 271, 276, 277, 837, and 835.
  • Designed business process models (BPM) using UML diagrams such as use case model, class diagrams, activity diagram, sequence diagrams and collaboration diagrams in MS Visio.
  • Involved in writing Test Plan, Test cases, and test steps.
  • Mapped the test cases with requirements in test Link.
  • Used SHOVEL as a data - mining tool to mine the test data to execute the test cases.
  • Created Test data sheet and reviewed with testing and development team.
  • Assisted SMEs predetermined Business User to execute UAT testing.
  • Created tickets to log UAT Testing Defects using TRAC as a tool.
  • Involved in Ad Hoc and exploratory Testing with SME's and Business Lead.
  • Provided actual results of UAT testing and reviewed System Testing actual results and reports.
  • Attended daily SCRUM meeting and guided QA and Developer regarding the defects, technical Specification Documents, and Mapping documents.
  • Environment: Mainframe, Microsoft SharePoint, Microsoft Outlook Microsoft Office, test Link, Shovel, TRAC, MS SQL Server

Environment: PL/SQL, Java (J2EE), Waterfall, Test Director, XML, Winrunner, Rational Requisite Pro, MS Office, MS Visio, MS Project, Agile/Scrum, HTML, CSS, RUP, VOIP, UML, CobiT.

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