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Senior Healthcare Business Analyst Resume

Atlanta, GA

PROFILE:

  • Success driven business analyst with 8 years of experience eager to join the team. Proficient in providing analytical support for diverse business projects. Maintaining a record of improving productivity, expert in business cycle management, business data clarification and eliciting project requirements. Driven by low supervision, strong leadership, and high competence, written & verbal communication skills shared with ability to work under pressure to keep up with the deadlines.
  • Over 8 Years industry experience working as a Senior Business Analyst in Healthcare Industry with solid understanding of Business Requirements gathering and business flow.
  • Senior Business Analyst managing projects of all sizes and complexity. Strong analytical and design skills with ability to grasp new processes quickly. Ability to perform rational application of methodologies using solid technical systems background.
  • Extensive knowledge of SDLC methodologies and exposure to Agile, RUP, and Waterfall.
  • Exposure to creation of Business Requirement Documents (BRDs), Functional Specification Documents (FSDs), Use Case Documents, Acceptance Criteria Documents (ACDs), Business Rules Spreadsheets (BRS) and Requirements Traceability Matrix (RTM) across the deliverables of a project.
  • Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277 and ICD - 9 and ICD- 10.
  • Knowledge and Experience on Enrollment, Billing, Claims Payment Processing in relation to HIPAA, EDI, ICD-10 codes 834, 837,835, and 270, 271 transactions.
  • Experience with HIPAA/ Electronic Data Interchange (EDI) transaction sets -- 270/271, 835/837, 276/277 transactions.
  • Extensive knowledge on the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO, HMO, Dental claim and POS.
  • Extensive knowledge using UML diagrams (Use Case, Activity, Sequence) using MS Visio and Rational Rose .
  • Strong knowledge of Software Development Life Cycle (SDLC) including UML, Rational Unified Process (RUP), Waterfall, Agile/Scrum methodologies.
  • Experience in Document processes, procedures, create user guides and guides.
  • Proficient in using Agile Scrum methodologies, performed roles of Scrum Master following sprint/standup sessions and used Excel extensively to write user stories, analyzed the Iteration Burn Down charts and reviewed defects.
  • Strong knowledge of HL7, HIX (Health Insurance Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA) and Facets.
  • In depth in conducting GAP Conducted GAP, Impact, SWOT, Cost benefit analysis, Root cause, Interface Analysis, Feasibility study, ROI Analysis, Impact analysis, Risk Analysis, and As-Is and To-Be business analysis.
  • Proficient in Requirements Analysis working with techniques such as User Stories, Use Cases, Prototypes, Interviews and Storyboards with a strong ability to facilitate JAD sessions.
  • Conducted data analysis using SQL Scripts to answer the questions/ queries by the Subject Matter Experts.
  • Extensive experience in organizing and facilitating interviews and workshop, especially JAD sessions, with subject matter experts SME, users and business stakeholders,
  • Strong knowledge in Data Mapping, Data Modeling, Star/Snowflake Schemas, OLTP/OLAP, and designing E-R Models.
  • Experience using MS Visio, MS Project and MS office tools like MS-Word, PowerPoint, Excel, and Access.
  • Documentation of Test Plans, Test Cases, Test Scripts, Test Procedures based on the Design Document and User Requirement Document for the Black Box, Functional, Usability and User Acceptance Testing (UAT).

TECHNICAL/ DOMAIN EXPERTISE:

Methodologies: Agile, Waterfall, Rational Unified Process(RUP), UML

Business Modeling Tools: MS Visio, Rational Rose, Axure, Adobe Photoshop

IDE Tools: Rational Rose, Rational Clear Quest, Rational Clear Case, MS Visio, UML.

Requirement Management Tools: TFS, Rational RequisitePro, Doors, MS Share point, HP ALM, HP QC

Project Management: MS Project, JIRA

Business Applications: MS Office Suite - MS Word, Excel, PowerPoint, MS Outlook

Testing Tools: Software Application Testing Life Cycle, QTP,QC,HP ALM, Selenium, HP QTP, Load Runner

Reporting Tools: Business Objects

Databases: MY SQL, SQL Server, Oracle, MS Access

Operating Systems: Windows, LINUX/ UNIX

Domain Knowledge: HIPAA, Claims Processing, EDI, HL7, HIX, EMR/HER, PPACA, FACETS, Medicaid, Medicare (Part A, B, C and D), PPO, HMO, Dental claim and POS.

PROFESSIONAL EXPERIENCE:

Confidential, Atlanta, GA

Senior Healthcare Business Analyst

Responsibilities:

  • Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.
  • Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from inspection to transition phase.
  • Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/Use Cases.
  • Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, State Diagrams, Activity Diagrams and business process and workflows.
  • Involved in implementing Six Sigma practices to systematically improve processes and standards and by eliminating defects
  • 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 GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 835, and 837 to identify key data set elements for designated record set.
  • Involved in designing & determined 3-tier architecture for the claim processing system. Assisted team lead in developing Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements to test cases.
  • Prepared and executed different Test Cases and Test Scripts.
  • Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing (UAT). Provided analysis and insight to QA Team in defects and bugs tracking.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, Agile, Medicaid, EDI,UAT

Confidential, Dublin, OH

Senior Business Analyst

Responsibilities:

  • Gathered Business Requirements from all the stakeholders and interacting with the providers, managers, developers to develop the business Processes.
  • Conducted Risk Analysis and Impact analysis whenever there is any change in the business requirement and proposed solutions while continually updating the business requirement document.
  • Conducted JAD sessions and ultimately reducing the time spent in moving all the information from stakeholders and other team members.
  • Created and updated data mapping document(s) with to the source for 270/271 (Eligibility & Benefit Inquiry & Response), 276/277 (Claim Status Inquiry & Response) and 837 (Health Care Claim).
  • Conducted Gap Analysis to analyze the client’s applications programs to determine the impact of HIPAA final on EDI transaction set and defined the changes to bring the affected systems into HIPAA compliance.
  • Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
  • Utilize Rational Unified Process (RUP) and build different phases of software developmental cycle.
  • Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD -10 codes and analyzing HIPAA compliance and EDI transaction.
  • Knowledge of the software system and the programs.
  • Developed and executed UAT test cases, UAT test Scenarios using HP ALM/Quality Center and followed-up defects using JIRA.
  • Created architectural styles such as application architecture, enterprise architecture, and service-oriented architecture with the help of Service -Oriented modeling (SOA).
  • Performed Requirement Tractability Matrix (RTM) to track and maintain stakeholders requested requirements and changes.

Environment: MS Project, Requirement Traceability Matrix (RTM), Rational Rose Test, JAD, RUP, MS Visio, Windows OS, MS Office, SharePoint, Server, Quality Center, ETL, SQL Server.

Confidential, Bronx, NY

Senior Business Analyst

Responsibilities:

  • Performed forward and backward mapping between the two standards and documented the required changes.
  • Assist JAD sessions to identify the business flows and determine the EDI X12 Transaction, Code set and Identifier aspects of HIPAA, impacts any current or proposed systems.
  • Validated documentation and validations in compliance with Affordable Care Act (ACA).
  • Develop the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
  • Involved in the processing of the claims and then sharing the test results with the business according to test acceptance criteria during their UAT phase.
  • Independently created Business Requirement Document (BRD) for the whole project.
  • Implemented SDLC which included requirements specifications, design, analysis and testing.
  • Developed non-functional requirements and documented them to be presented to the technical team
  • Worked with the QA team in testing the application using HP QTP.
  • Logged application bugs and was involved in all stages of the bug life cycle.
  • Maintained all the tasks in JIRA and updated status regular basis.
  • Involved in GAP analysis both at the time of requirement gathering and later after development with the Testing team to identify areas and possible scenarios that might have been overlooked.
  • Involved in back end testing using SQL Queries on Microsoft SQL Server.
  • Facilitated collection of functional requirements from system users and preparation of functional specification documents that provided appropriate scope of work for technical team to develop prototype and overall system.
  • Additional responsibilities included mapping the requirements in Caliber to the Test Cases and Scenarios in Quality Center.
  • Involved in identifying dummy data for the testing scenarios for the QA team

Environment: MMIS, UAT, MS office, MS Visio, C, C++, Java, Quality Center, SDLC, Facets, Use Cases.

Confidential, Huston, TX

Business Analyst

Responsibilities:

  • Requirements gathering from Subject Matter Experts, project stakeholders and Business users so as to obtain maximum details of requirements and involved in documenting Business Requirement Documents (BRD).
  • Liaison between the Business needs (business users and sponsor) and the Technical team (development and testing staff), ensuring technical solutions satisfied business requirements.
  • Conducted JAD sessions involving the management, development and user teams for clarifying requirements and facilitating better communication.
  • Careful documentation of business requirements ensured that they are aligned with UI from the initial stage itself.
  • Worked in Healthcare Claims Administration - Healthcare Claims.
  • Processing (837/835) includes facility claims and professional claims.
  • Did data analysis, created data mapping documents and kept the documents updated with changes in requirements and functional speci cations.
  • Business analyst for collaborating requirements from CA, MT and NY state Medicaid system used JIRA as a tool to manage the requirements.
  • Worked with EDI Team for Data Mapping and Building 837 Maps.
  • Participated in entering, tracking system defects in Rational Clear quest.
  • Apply UML notations and methodology in developing models that accurately represent the business process and workflows and clearly communicate them to the stakeholders.
  • Analyze EDI data elements captured by the existing system to validate it against the data elements required for new system.
  • Was also involved in the configuration set up of provider reimbursement, benefit package,, and pricing in FACETS.
  • Used Microsoft SharePoint as the version tracking tool for managing the requirements documentation.
  • Ensured that the claims processing is strictly under the HIPAA compliance regulatory document to safe guard patient information.

Environment: Claims, Rational Clear Quest, HIPAA, MS Visio, MS SharePoint, UML Use Cases, SQL Server, Use Case Documentation.

Confidential

Business Analyst

Responsibilities:

  • Engaged with project teams to integrate change management activities into the overall project.
  • Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
  • Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
  • Gathered requirements and prepared business requirement documents (BRD).
  • Created Use Cases, FAD’s and Solution Requirement Document based on the business requirements.
  • Analyzed the defects with QA and Development teams.
  • Conducted face to face meeting, webinars and JAD session to gain process & modeling understanding
  • Written multiple Use Cases for multiple transactions include 837I(Health care claim Institutional), 835(Payment/Remittance advice), 276/277 (Claims status), 270/271(inquire/response health care eligibility and benefits; both inbound and outbound).
  • Extensively involved in planning efforts for the Digital team including mobile app.
  • Worked with the Project Manager (PM) on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
  • Worked closely with project manager and other users and created work flow diagrams using MS Visio/UML.
  • Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
  • Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance
  • Test using the test cases given by the client before releasing the application.
  • Involved in project status meetings, QA review meeting, and System Test meeting.
  • Created test cases and test scripts for the User Acceptance testing (UAT).

Environment: MS- Visio, HP ALM Quality Center, HP QTP, SQL Server, MS Office, Agile, Web Services.

Confidential

Business Analyst

Responsibilities:

  • Requirements gathering from Subject Matter Experts, project stakeholders and Business users so as to obtain maximum details of requirements and involved in documenting Business Requirement Documents.
  • Liaison between the Business needs (business users and sponsor) and the Technical team (development and testing staff), ensuring technical solutions satisfied business requirements.
  • Conducted JAD sessions involving the management, development and user teams for clarifying requirements and facilitating better communication.
  • Careful documentation of business requirements ensured that they are aligned with UI from the initial stage itself.
  • Experience in Medicare advantage and dual advantage.
  • Participated daily standup meetings with the Developers.
  • Facilitated user interviews and workshops to gather requirements.
  • Involved in GAP Analysis and Technical Feasibility study with the technical leads and other SMEs.
  • Created process flow diagrams in MS Visio.
  • Worked with other team members for requirement analysis and clarifications and recommending changes for the gaps identified.

Environment: MS Office Suite (Word, PowerPoint, Access, Excel, Outlook), Windows 2000, MS Visio, MS Project, Claim, JAD, EDI and UML Use Case.

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