SUMMARY:

• Qualified professional with over 10 years of extensive experience in the field of Business Systems Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
• Skilled with leading projects based on Waterfall, RUP, RAD, and Agile (Scrum technique) SDLC methodologies.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Experienced as a Business Analyst in using the iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, internet and intranet applications on heterogeneous environments.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• In depth knowledge in the analysis, design, and re-engineering of system applications and business processes, using structured system analysis methodologies, placement of business controls, diagramming data and process mapping, applying Unified Modeling Language (UML), and implementation of performance measures.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Possess analytical and problem solving skills with strong management, leadership, presentation and interpersonal skills.
• Strong knowledge of managed Claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, Medicare and Medicaid Insurance Billing, Hl7 Standards, HIPAA, EDI, HEDIS, NCQA, PPACA (Patient Protection and Affordable Care Act), 834, 835,837, Compliance issues, HL7 Message Validation, ICD9, ICD10, Electronic Health Records, Electronic Medical Records.
• Strong knowledge of Facets and actively involved in end-to-end implementation of Facets Billing, Enrollment, Claim Processing and Subscriber/Member module.
• Experience in using strong communication skill in eliciting and analyzing requirements
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
• Extensive experience with various modules of Facets like membership management, premium billing, enrollment, claims processing & adjudication, coordination of benefits administration.
• Knowledge and experience working with FACETS 4.71 & 5.0 claims processing.
• Proficient in developing Use Case Model, Analysis Model, Design Model, Implementation Model, Use Case Diagrams, Behavior Diagrams (Sequence diagrams, Collaboration diagrams, State chart diagrams, Activity diagrams), Class Diagrams based on UML using Rational Rose
• Knowledge of healthcare standard Health Level Seven (HL7).
• Experienced in preparing Business Process Re-engineering Models
• Familiar with HIPAA EDI transactions such as 835, 820, 837 (P, D, I) 276, 277, 278 etc
• 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.
• Experience in UAT & integration testing. Managed and lead testing teams in formulating test strategy, test plan, test cases, and test summary.
• Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
• Experience in implementing Microsoft Office SharePoint.

TECHNICAL SKILLS:

Programming Languages: C, C++, HTML, XML, SQL, HTML, DHTL, COBOL, Java, J2EE, JavaScript, Python, J2EE, .Net

Data Base: Facets, MS Access, Oracle, DB2, MS Excel

Reporting Tools: Crystal Reports, SAS, Business Objects, MicroStrategy

Operating Systems: Windows, Apple McIntosh, Linux

Software: MS Office Suite (Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes, MS SharePoint, Informatica

Processes/Technologies: Agile, Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2007

Automation Tools: TFS, JIRA, Requisite Pro, QTP/UFT, Quality Center

PROFESSIONAL EXPERIENCE:

Confidential, Louisville, KY

Senior Business System Analyst

Responsibilities:

• Interacted with stakeholders to understand scope of the project and gathered and documented the requirements by conducting one on one meeting with stakeholders.
• Participated in daily Agile Scrum, Sprint Planning and Retrospective Sessions and update the team on status of upcoming User Stories for the a project of changing the client's software maintenance structure of their various software products.
• Analyzed Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Gathered Requirement from the Client to fulfill the Application need for FACET Implementations.
• Created 837(P, I, D) claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837(P, I, D), 834, 835, 270, and 271.
• Enterprise Provider Search and Member Faced Portals Architecture, Design and analysis
• Worked within project team to identify and interpret state Medicaid and Medicare policies as applicable to customer defined algorithm research as well as assist with internal development of new healthcare analytics.
• Worked with Facets software for maintaining data about the enrollment, billing and health care claims management and to store, send, receive HIPPA transactions and facilitate the administration of HIPAA privacy rights
• Used SQL query to produce data for 270 EDI X12 file, and create 270 files and submit to MEVSNET to check dual snip member for Medicaid benefits eligibility.
• Evaluated Medicare requirements and benefits in Medicare Health Plans for member enrollment and management
• Worked with third party vendor in developing a new Member Portal and Provider Search Portal
• Analyzed Audit and Change Files of 834, 835, 820, 837 PDI, 997, 999, 270 & 271HIPAA EDI Transactions using MS Word, MS Excel.
• Worked on a solution to establish a system that COB teams can use to maintain accurate TPL coverage information in the client's Medicaid Management Information System (MMIS) to trigger appropriate cost-avoidance and recovery activities.
• Worked on enhancing the provider research requests to get accurate results for payment and claims summary.
• Developed Mapping rules, Design specifications and Use Cases for the HIPAA 834i/p/d; 820; 835, 824, 275 and others.
• Created Use Cases and User Stories utilizing JIRA for the Provider Search tool, Member Portal application, as well as various in-flight projects.
• Participated in Ad hock/weekly meetings with external teams to discuss impacts, finalize time lines and share dev and test results.
• Created Models and published packages on Cognos Connection for reporting purposes
• Maintained Traceability matrix throughout the project.
• Extensively worked on MS Access, MS Excel, MS Word, PowerPoint, SQL, MS Project
• Wrote SQL scripts (SQL Server) to find appropriate test data and research data issues with development and test environments.
• Performed data analysis and data profiling using complex SQL on various sources systems including Oracle.
• Participated in all phases of data mining, data collection, data cleaning, developing models, validation, and visualization and performed Gap analysis.
• Conducted performance tuning to primarily focus on writing efficient SQL Queries to generate reports.
• Transformed detailed use cases into test cases in the pre-testing phase.
• Developed Forms using MS Access using Forms and Reports for reporting.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT)

Confidential, Louisville, KY

Lead Facets Business Systems Analyst

Responsibilities:

• Led and managed requirements gathering effort to identify system features needed to support the Fund's budgeting, planning and forecasting needs in Agile Methodology.
• Gathered requirements and developed process flows diagrams in accordance with Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluated the impact of proposed changes.
• Involved in business analysis and project management, coordinating between the team members and addressing budget issues.
• Worked on Data Mapping to map Facets data to outbound eligibility extracts.
• Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Enrollment, Claim Processing and Subscriber/Member module.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center mangers and stakeholders of the project.
• Develop, design & implement department plan to configure new Facets integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
• Involved with the business partners to define requirements, determine solution alternatives, and develop high-level designs and estimates.
• Worked on Unix Platform and experienced in back end testing by executing SQL Queries
• Set claim processing data for different Facets Module.
• Handled the Change Management Process for Release Management Team.
• Met with various groups, including business owners, SMEs (subject matter experts) and marketing team, for requirements gathering in definition Stage.
• Responsible for testing all new and existing ETL data warehouse components.
• Used MS Visio in designing the central Contact Center for data storage.
• Designed the Vision and Scope document for the project including the Major Features and all the associated Functional Requirements.
• Created the IDE (Integrated Development Environment) Collaboration Documents using Version One for all the User Stories.
• Created SQL to test source to target data warehouse transforms, using TOAD.
• Identified all the business requirements of the customer and ensured that all these requirements are traced to the use cases identified.
• Perform Business Process Modelling for increasing process speed, reducing cycle time; increasing quality and reducing costs, such as labor, materials, scrap, or capital costs.
• Involved in identifying and studying the Facets system data and conducting field by field analysis of Facets system for the attribute mapping purpose.
• Assisted in gathering the business requirements, ETL Analysis, ETL test and design of the flow and the logic for the Data warehouse project
• Collaborated with the Clinical SIT and Business teams for generating Test Cases for SIT (System Integration Testing) and UAT (User Acceptance Testing) respectively, using Business Process Modelling workflows and Confidential .
• Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions.
• Worked specifically with EDI 820, 834, 835, 837 (I, P and D), 270, 271, 276, 277 and 999), healthcare provider information specialists, managers, quality review specialists, and service team supervisors.
• Assisted Project Manager in planning the project time-line and scheduled various project deliverable dates according to the various phases of the project.
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases.
• Prepared Project reports for management and assisted the project manager in the development of weekly and monthly status reports, policies, and procedures.
• Devised and prioritized the Product Backlog by conducting requirement churning sessions with various Business / Product Teams.
• Analyzed existing reports in order to respond to Change Requests coming from client side. The change request was in the form of a new business requirement. It involved identification of impacted reports based on CR, number of changes required, and number of hours required for code changes and testing, and creating a document with all these details to be shared with the client.
• Worked on the modification of existing SQL queries in the reports, creating new queries, modification of existing actuate basic code, adding new columns in between the existing columns in the report layout, adding new conditions and addition of a completely new section in the report structure.
• Created Release Tracking Document in order to track the necessary changes.
• Participated in Business Demonstrations and Decisions for the Release of the Sprint Output to Production.

Environment: MS Office, Visio, Version One, UNIX, SQL, Agile, Scrum, .Net, ALM, Data Warehouse, QTP, TFS, ANSI X12 - EDI, Oracle, Confidential, Facets 4.8, ALM 11, DB2.

Confidential, Owings Mills, MD

Lead Facets System Analyst

Responsibilities:

• Lead strategic and operational IT and business efforts that promote value-added for outsourcing all paper claims and correspondence documents to an outside vendor.
• Defined requirements for receiving 837 claims files and MACESS files into our imaging software and work flow software
• Created Use Case diagrams using UML and Business Process Models using MS-Visio.
• Met with physicians, nurses, billing and administrative personnel. Documented the clinical, financial and administrative business practices, procedures and work-flows.
• Gathered requirement on FACETS EDI 834 Benefit Enrollment and Maintenance subsystems
• Responsible for Business Process Management (BPM) for development of various projects.
• Developed Use Cases, Sequence Diagrams, Activity Diagrams and Class Diagrams.
• Analyzed the impacts of HIPPA 5010 project on inbound 837 claims.
• Gathered requirements and developed process flows diagrams in accordance with Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluated the impact of proposed changes.
• Defined the current clinical and financial business processes and practices.
• Performed manual testing by building 837 claims, converting them into EDI file, uploading them into mainframe region and doing error resolution & testing for 5010 requirements & NPI crosswalk.
• Worked on Data Mapping to map Facets data to outbound eligibility extracts.
• Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Enrollment, Claim Processing and Subscriber/Member module.
• Conducted the Functional, System, Integration, Regression, UAT, performance Tests of the Application.
• Reviewed administrative and clinical practices and procedures: point of care, scheduling, registration, clinical documentation, patient care, and charge entry, medical coding and diagnostic testing procedures associated with multiple business units
• Develop, design & implement department plan to configure new Facets integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
• Analyzed the ICD conversion information provided by the CMS and gained understanding of ICD-9 versus new ICD-10 codes sets.
• Perform Extensive EDI testing on X12/4010 837,835, 270 etc, worked with state vendor to validate inbound /outbound EDI transactions to Facets.
• Researched and resolved pended claims in MACESS.
• Set claim processing data for different Facets Module.
• Verified and Reported of all issues/defects from small to big raised by UAT team
• Built and updated existing Ques using MACESS doc workflow for business migration project.
• EDI file testing for checking the HIPAA 5010 (X12) compliance of the inbound 837 claims.
• Performed Gap Analysis for 5010 enhancement using the TR3 implementation guides and side-by-side HIPAA 4010 to 5010 guides provided by CMS (Center for Medicare & Medicaid Services)
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835, 837 270/271 transactions.
• Performed Smoke (Sanity) testing, Functional testing, SIT, UAT and End to End Testing of API, GUI, Web Applications and Web services.
• Performed Data Mapping to map the EDI 834 data to XML.
• Recommend tactic to implement HIPAA 4010 ( EDI X12 837,834,278,270) in the new System.
• While working on requirements of the 835 HIPAA project, jumped half way in the 820 report project, continued working on 835, 834, 276 / 277 and HIPAA EDI Transactions across enterprise, meanwhile new project initiation of 4010 to 5010 migration began.
• Analyzed System-level requirements and managed changes as they affected test cases and procedures, Worked collaboratively with project team including development, business analyst, and QA resources in Affordable Care Act - Center for Medicare and Medicaid (CMS),Active participant in Eligibility and Enrollment EE modules
• Worked on FACETS claims processing, payment adjustments, claims inquiry, benefits,
• Responsible for Performing Integration Testing, UAT testing.
• Worked on CMS (Centers for Medicare & Medicaid Services) requirements within the project.
• Was responsible for Business Process Management (BPM) for development of various projects.
• Incorporated FDA guidelines (21CFR) and HIPAA (Health Insurance Portability and Accountability Act).
• Involved in System Integration, Compliance and User Acceptance Testing and Validation of Medicaid claims processing and Electronic Data Interchange (EDI) translation in compliance with the 4010A and 5010A Health Insurance Portability and Accountability Act (HIPAA) transactions 837 I/P, 835 and 997 Acknowledgement.
• Worked with various Business Intelligence tools for reporting and decision making.
• Worked with Healthcare Benefits Online (HCBO) to test online portals of different clients and functional testing of Real Time and Batch jobs using EDI.
• Tested the ANSI X12 Version 5010 / EDI transactions (HIPAA) like 837P, 837I, and 837D.
• Developed various reports for user verification like Cross Tab Reports and Sub Reports, various charts and graphs like Bar chart, line graphs, and Pie charts by using Crystal Reports and exported reports into formats like PDF, HTML, Excel, Word and RTF.
• Created product documentation including online help, printed user manual, and training materials.
• Scheduled meetings with developers, Business Analyst's (BA) and testers to identify resource allocation and project completion using MS Project.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, MACESS, Rational Requisite Pro, HL7, MS Office, SQL Server, Agile, MS Project, MS Visio, MS Access, EDI,UML

Confidential, Columbus, OH

Business System Analyst

Responsibilities:

• Under general direction, gathered, defined and documented highly complex business requirements for NPI crosswalk.
• Review and understand the claims process and complex requirements for the enhancement of the current system created under the Requirement Specification Documents after conducting interviews with End Users, JAD Sessions and analyzed their current systems.
• Conducted JAD/RAD sessions and elicited customer requirements by organizing interviews with internal/external stakeholders and subject matter experts (SMEs) to create subject specific questionnaires for clinical trials.
• Involved in identifying and studying the Facets system data and conducting field by field analysis of Facets system for the attribute mapping purpose.
• Analyzed EDI -X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Tested EDI transaction 834 and 820
• Analyzed the data in the Facets source system to map into the correct field and attribute in the target storage.
• Writing the General System Design Documents that demonstrate current and proposed/solution business design and changes to the current Legacy System.
• Analysis and Design of existing EDI transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases.
• Participated as a core team member of a Clinical Development initiative to create an architectural business end-to-end solution for clinical trials as a standard for all Merck remote data capturing clinical trials.
• Involved with the management to improve and to enhance the future processes for HIPAA5010 transaction sets of EDI including 837, 835, 834 and 820.
• Worked out to get the correct count on number of Members, their Eligibility status and their Demographic information to set Groups/Subgroups/Subscribers/Members accurately in Facets.
• Did gap analysis between ICD 9 and ICD 10.
• Developed business case, objectives, cost analysis and budget for implementation clinical and financial business systems.
• Worked with user to define user acceptance test cases. Involved in UAT testing (User Acceptance Testing) and Implementation.
• 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.
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases.
• Identifying the requirements for accommodating HIPAA 4010 and 5010 standards for EDI X12 transactions and capture these requirements for mapping purposes
• 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.
• Worked on Data Mapping documents explaining flow of data from one-to-another table for the system enhancement purpose required by HIPAA 5010 implementation.
• Facilitate and participate in the meeting and discussions held with the business users, Business analysts and Technical analysts.
• Analyzed HIPAA 4010 and 5010 standards for 837I/P EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• Worked with EDI Team for 837, 835, 834, 820, 270, 271 transactions.
• Facilitated various brainstorming, requirement gathering sessions, and provided training on HIPAA Compliance, HIPAA Standard transactions and current version of X12 HIPAA 4010A1.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Conducted meeting and facilitate Joint Application Development (JAD) sessions with different users and internal stakeholders for defining business requirements and User Acceptance Testing (UAT) standards.
• Developed Companion Guides for the business users and managed User Acceptance Test (UAT) for business users to explain Mainframe CICS screens for claim processing.
• Answer questions and inquiries about system functionality and provide user support, including training, help and instructions for the Trading Partner Application used by Nebraska Medicaid.
• Worked on As-Is To-Be analysis of ICD 9 for the new qualifiers used in the 837 claims for the diagnosis and procedure/HCPCS codes.

Environment: Windows XP Professional, Oracle9i, MS Access, HL7, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case, Agile, Rational Clear Quest, MS Office suite, MS Visio 2003.

Confidential, Baton Rouge, LA

Business Analyst

Responsibilities:

• Gathered business requirements through discussion with stakeholders and SME’s.
• Managed SDLC process of custom application development and COTS implementation projects.
• Performed Gap Analysis for HIPAA 5010.
• Involved in activities to make sure proper documentation and standards are being followed.
• Wrote Business Requirement Document after collecting requirements through conducting interviews, JAD sessions and brainstorming sessions.
• Created Use Case diagrams by analyzing the business process followed by Activity diagrams using MS-Visio and participate in production of HIPAA 5010 EDI Test data.
• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions related to providers, payers, subscribers and other related entities.
• Developed use case Designed process flow diagrams using MS-Visio and also Business Context Diagrams.
• Created Data Mapping to document to migrate data from the existing system to the new system.
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system).
• Work directly with Center for Medicare and Medicaid Services (CMS) and providers to get requirements for the project.
• Strong Documentation and Report Generation skill and experience by Use case approach.
• Participated in software upgrades for claims workflow and EDI transactions (835, 278) upgraded from Version 4010 to 5010.
• Involved in claim adjudication process of facets application.
• Worked extensively on EDI transactions 837 and 835 Involved in writing test cases for different LOB’s (ITS, FEP and Regular) for SIT, Parallel and UAT.
• Worked on 270,271 Eligibility request and Eligibility response and on 276,277 Claim status request and response.
• Performed Integration, System, Regression, Functionality, Security, Performance, Positive, Negative and User Acceptance testing on Payment Eligibility Screen, CMS ICD Screens and Center for Medicare and Medicaid Services (CMS) Eligibility Screens.
• Used Agile testing methodology for achieving deadlines in UAT testing.
• Validated that the 270/271 generated is in accordance with the 5010 implementation guide.
• Assisted developers in troubleshooting and resolving EDI issues by collaborating with internal and external business partners to define business processes and information requirements by building on intermodal industry best practices and ANSI X12 EDI standards.
• Setup, co-ordinate & conduct system & UAT testing with Business Analysts and end-field users
• Used FACETS: Subscriber/Member, Medical Plan to validate the Eligibility benefits received in the 271 response.
• Performed parallel testing for the 83x transactions to ensure comparable results between 4010 and 5010 transaction processing with the help of XC file comparisons, Keyword file comparisons, and other significant file structures with end-to-end testing cycle Analyzed and provided ‘compare results’ for production XC’s (External Claims) and test XC’s for all LOB’s after every build to validate if the defect were fixed.
• Make presentations to the end client during UAT.
• Constantly involved in review meetings and made sure testing is done based on the QA master plan and deadlines are met.
• Used FACETS to provide seamless transactions between the provider, members and the plan.
• Used SQL Queries to verify the data from the Sybase database.
• Creating and consolidating SIT Test Cases and UAT test Cases using MS Excel or Quality Center.
• Was involved in working with the offshore testing team to co-ordinate Regression Testing.
• Preparing sample Test Data and executing Test cases using Quality center.
• Provide support to end users while execution of UAT with proper test scenarios & test data.
• Monitored RTM to close the defects/cases as and when developers resolved the defects
• Communicated with developers and Business Analysts through all phases of testing to prioritize defect resolution.
• Reporting the Test Execution status to the project manager on daily basis.
• Good understanding of 5010 conversion initiative
• Actively involved in weekly walkthrough meetings and Daily Defect calls to verify the status of the testing efforts meeting the deadlines & mid-term targets

Environment: MS Visio, Microsoft SQL Server 2005, Quality Center, Sybase, Facets, MS Word and MS Excel.

Confidential, Dayton, OH

Business Analyst

Responsibilities:

• Business Lead for provisioning automation of all manual functions.
• Prepared the Business requirement Document (BRD) and Functional requirement document (FRD) for the enhancement of the existing services.
• Conducted JAD sessions with business units and stakeholders to define project scope.
• Created workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.
• Tested the ANSI X12 Version 5010 / EDI transactions (HIPAA) mainly on 837 Professional and Institutional Claims
• Performed Smoke (Sanity) testing, Functional testing, SIT, UAT and End to End Testing of API, GUI, Web Applications and Web services.
• Involved in claim adjudication process of facets application.
• Performed User Acceptance Testing (UAT), documented in details the defects using Quality Center.
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system).
• Did gap analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
• Involved in Integration Testing, Functional Testing, and UAT.
• Utilized Agile Methodology to configure and develop process, standards and procedures.
• Did GAP analysis and Impact analysis for the facets up gradation system.
• Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.

Environment: Requisite Pro, Rational Rose, Agile, HL7 Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, UML

Confidential, St. Louis, MO

Sr. Business System Analyst/ Sr. Facets Analyst

Responsibilities:

• Identified the scope, business objective and documented the functional requirements for each release.
• Directly involved in process improvement Plans and implementing business change.
• Identified and analyzed user business requirements, procedures and problems to improve existing processes and workflow in AMISYS Advance and surrounding systems and applications.
• Documented requirements and workflows for AMISYS Advance modules/subsets including Provider, Member, Claims and Benefits.
• Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions
• Extensively worked with Member/Subscriber and HIPAA Privacy Facets application groups.
• Involved in creating documents and diagrams for Membership Enrollment according to the HIPAA 834 Compliance Standards for Membership Enrollment.
• Worked on eligibility files with the Claims dept. ensuring all the data and enrollments were correct and updated in AMISYS Advance.
• Gathered requirements and developed process flows diagrams in accordance with care and Medicaid rules and regulations pertaining to the Facets configuration and evaluated the impact of proposed changes.
• Worked on Data Mapping to map Facets data to outbound eligibility extracts.
• Facilitated, documented and oversaw the provider set-up and contract configuration in AMISYS Advance.
• Created use cases specifications, use case diagrams, swim lane diagrams, component diagram and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
• Conducted and Participated JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions.
• Held regular meetings with the Business users and SME’S to priorities the business Requirements.
• Facilitated the resolution of project-related issues, identified risks and mitigation steps to manage risk using PLSQL in RDBMS.
• Used Rational Requisite Pro for overall Requirements Management and to build the Requirements Traceability Matrix.
• Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business work flow of applications.

Environment: Windows XP, RUP, UML, SQL, Rational Tools, MS Visio, AMISYS, Informatica, XML, MS Word, Excel, PowerPoint, Access