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Sr. Business Analyst Resume

VA

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, VA

Sr. Business Analyst

Responsibilities:

  • Extensive experience in Conducting Market Research, Feasibility Studies, Data Analyses, System Analyses, Gap Analyses, and Risks Analyses.
  • Gathering market data including real time and historical price data, financial data, and trading news using financial data source named Bloomberg.
  • Thorough knowledge of EMR . Front end user interface and back end database.
  • Worked in Agile environment allowing teams to deliver project piece-by-piece and make rapid adjustments as needed.
  • Subject matter expert regarding Medicare regulations and operational procedures.
  • Analysis of inbound and outbound interfaces and extensions to Trizetto FACETS Claims Processing system.
  • Acting as a Subject Matter Expert/EDI Analyst implementing Clients on EDI.
  • Created Mapping Documents, Report Mockups and modified existing report mockups as to CMS requirements and finalized for development.
  • Used ETL to extract files for the external vendors and coordinated that effort.
  • Assisted clinicians with EHR chart flow and demographics.
  • Worked as functional Analyst in the software development team for outsourcing Electronic medical records ( EMR ) and paperless office system implementation to the medical facilities.
  • Maintained JIRA team Confluence System Engineering pages that included: Process Flow Management, Team Requirements, Roles and Responsibilities, and COP User Metrics.
  • Responsible for gathering requirements from users in operations group and performing data mapping for the application, confirm and vacillating the requirement at time of BA testing.
  • Solid Experience in developing Scope/Vision Documentation and Project Plan, as well as tracking Project Process, and manage resources to ensure successful delivery
  • Experience with EDI transactions 834,837,999 and 835.
  • Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
  • Deep understanding the Business Flow of Investment Banking, and extensively involved in Portfolio management and analyses, Mutual Funds, Securities trading.
  • Designed new database tables to meet business information needs. Designed Mapping document, which is a guideline to ETL Coding.
  • Troubleshoot EHR malfunctions and providing technical support when appropriate.
  • Good understanding working in Agile and bringing projects to completion.
  • Understand the overall business model of Medicare Part D products, CMS guidance, and the PBM claim adjudication system.
  • Developed test plans with QA team and helped test every scenario using Mercury TestDirector Tool for system testing
  • Efficient use of MS Project for planning and status reporting.
  • Deep understanding of Structured System Development Methodologies
  • Collaborated with External Auditors and documented SOX compliance requirements
  • Assisted Project Management in developing Scope/ Vision Documentation and Project Plan, tracking project process, and developed Risk Mitigation Plan.
  • Assisted QA team by reviewing test cases and clarifying requirements to ensure complete coverage of requirements, worked in Agile environment and was able to bring projects to completion.
  • Extensive success in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) in an SOA environment.
  • Identified gaps and performed gap analysis with respect to CMS requirements.
  • Served as interdepartmental liaison for all MA/MAPD/PDP/Cost Medicare Enrolment/Eligibility questions.
  • Responsible for EMR interface development and implementation. Specialised in Nephrology EMR , Internal medicine EMR , Psychiatry EMR , Oncology EMR , Anaesthesia EMR etc.
  • Researched, Analyzed, designed, developed Java Web Services Service Oriented Architecture (SOA).
  • Worked extensively in Data Analysis, Data Reconciliation and Data Mapping for ETL process
  • Used MS Visio for Process modelling and Business Process flow diagrams.
  • Solely managed our Jira Service Desk, triaging and escalating production issues as needed.
  • 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.
  • Facilitated mini JAD sessions to assess and refine business, functional and system requirements for TANF, Food Stamp and Child Care program enhancements/development
  • Met with stakeholders to identify requirements to modify Federal TANF reporting system.
  • Used SoftTest software with pseudo code to ensure test cases covered all branches of project's code impacting the system. (The system is an IBM mainframe based system that contains the master set of customer information used to bill customers.)
  • Set up market data including zero curves, correlation matrices, dividend curves, etc., and the underlying financial instruments and then set up derivatives pricing parameters and trade capture options that drive the valuation of trades based on the market data to configure and test the system.
  • Involved in requirement gathering and performed ETL Process.
  • Setting up Fee Definition and Fee Calculation in FACETS for QHP Individuals, Grandfathered/ Transitional Small Group, QHP Small Group and Large Groups.
  • Utilized Visio diagrams, data flow diagrams, use case diagrams and process flow diagrams using the CMS-MITA guideline.
  • Monitor EHR output and operations to assure accuracy, efficiency, and productivity.
  • Maintained JIRA team and program management review dashboards
  • Tested the accuracy of iHelix inpatient EMR for Stage 1 meaningful use clinical quality measure calculation by using Cypress tool.
  • Ensured that the data repository was setup in case of emergency or unavailability of data.
  • Solid experience in calculation of the Greeks (Delta, Gamma, Vega, Theta and Rho) in the simulation test of the system.
  • Tested the changes for the front end screens in FACETS related to following modules, test the FACETS batches, Billing, Provider.
  • Project managed all CMS requirements in Enrollment and Billing including Policies and Procedures and Medicare Enrollment Letters.
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • Reviewed high-level design specification, ETL coding and mapping standards.
  • Gap Analysis: Analyzed the clients applications programs to determine the impact of the HIPAA rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
  • Solid Experience in Collection, analyses, and documentation of User Requirements, as well as Organizing interviews, User meetings, workshops, JAD sessions and requirement elicitation sessions
  • Proficient in creating Use Cases, Use Case Diagrams, Activity Diagrams etc.
  • Expertise in development of High level design, Conceptual design, Logical and Physical design for Database, Data warehousing and many Distributed IT systems.
  • Supported the physician applications and ordering module during the initial EMR go-live and provided support to end users during maintenance and optimization activities
  • Involved in the overall Agile process throughout the project.
  • Created common reusable objects for the ETL team and overlook coding standards.
  • Assisted business users in identifying functional gaps, and developed detailed FSD for the gap
  • Developed test plans with QA team and helped to develop test cases for system testing, integration testing and performance testing.
  • Conducted UAT to confirm that all derivative products can successfully processed during the trade life cycle.

Environment: Rational Requisite Pro, Clear Quest, Diamond, Facets, ASP.NET, VB.NET, C#, SQL SERVER 2000, IIS, XML, Mainframes TSO, JCL, DB2, MS Visio, Cobol, CICS, MQ Series, Facets, Lotus Notes, SOAP UI,UNIX, Windows 2000, Mercury Quick Test Pro*, Quality Center.

Confidential, Chicago, IL

Business Analyst/Systems Analyst

Responsibilities:

  • Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
  • Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
  • Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
  • Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
  • Interacted with the developers to report and track bugs using Test Director.
  • Played active role during daily scrum meeting and task planning as part of agile methodology
  • Prepared client process maps for the consumer, broker, employer and provider transactions for the Facets process.
  • 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.
  • Coordinated EMR/EHR (iHelix Suite) implementation to achieve meaningful use stage 1
  • Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
  • Enrollment Claims examiner\processor for Medicaid\ Medicare.
  • Provided data modeling support to each logical data model according specifications of EDM.
  • Effectively manage EHR staff by hiring, developing,, and overseeing personnel to meet the needs of the practice
  • Coordinating and Developing QA activities.
  • Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
  • 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
  • Lead person on Customer Service Workflow for New Jersey State Medicaid\ Medicare, responsible for enrollment claim related issues, performed detailed processing and research.
  • Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
  • Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
  • Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
  • Designed High level design, for New process, integrating with legacy and Facets
  • Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest.
  • 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
  • Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
  • Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

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

Confidential

Business analyst

Responsibilities:

  • Worked with the account managers, managements, and report requestors to gather requirements, get report requests.
  • Wrote Business Requirements, analyzed them and tested them.
  • Worked on solving the errors of EDI 834 load to Facets through MMS.
  • 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 .
  • Designed report templates based on the requests by account managers.
  • Analyzed the functionality and came up with test scenarios for split-billing process on FACETS .
  • Designed Functional Specification Documents for the reports.
  • Utilized Agile software development processes.
  • Analyzed trading partner specifications and created EDI mapping guidelines.
  • Managed the systems development and built the business processes to activate Medicare parts A-B-C & D, Special Needs Programs (SNP) and Private Fee For Service (PFFS) plans on FACETS version 4.41 platform.
  • Extensive use of Excel to create Functional Specification Documents & Templates.
  • Facilitate System Integration Testing on FACETS system to verify HIPAA compliance from .
  • Designed the process flow diagrams for flow of information and report creation process.
  • 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.
  • 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.
  • Conducted RAD sessions for the report users, requestors, and the developers.
  • Used MS Project to manage project time lines
  • Prepared Need Analysis Documents of the requirements gathered through JAD sessions.
  • Documented all the changes in the initial templates and was responsible for Release Management.
  • Reviewed Requirements & deliverables for delivery timeline.
  • Used MS Visio to create Flow diagrams and Use Case Diagrams.
  • Created presentations explaining the entire report development process, while drawing a comparison between the legacy & the new report.
  • Worked in iterative Rational Unified Process (RUP methodology
  • Coordinated with the developer, on day-to-day basis, during the development process.
  • Tested the report for its content.
  • Created Test Scripts & Test Scenarios to check report content, layout, and parameters.
  • Worked with business leaders to translate business requirements and processes into test cases according to Facets package requirements and subsequent effective configuration.
  • Worked on Report Re-engineering Project and made enhancements to the system flow.
  • Tracked the defects in legacy reports as per account managers and end users. Compared the results and tracked the differences in excel
  • Reviewed Stored Procedures for reports and wrote test queries against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle).
  • Worked with ETL team during the upload process.
  • Helped with Data Mapping between the data mart and the Source Systems.
  • Worked as a liaison between the Business and Technology Department.
  • Enhanced communication lines between executives, managers, and peers.

Environment: SQL Server 2000, Rational Suite, Windows, HL7 v2.X,Crystal Reports, Oracle, UML, MS Office, MS Visio

Confidential, Columbus, OH

Business Analyst

Responsibilities:

  • Gathered Business Requirements, analyzed data/workflows & performed GAP analysis.
  • Met with client groups to determine User Requirements and Goals, thus converting User Requirements into Business.
  • Facilitated collection of Functional Requirements from system users, and prepared Business and Technical Requirement Specification documents.
  • Thorough knowledge of EMR . Front end user interface and back end database.
  • Used ETL to extract files for the external vendors and coordinated that effort.
  • Maintained JIRA team Confluence System Engineering pages that included: Process Flow Management, Team Requirements, Roles and Responsibilities, and COP User Metrics.
  • Worked in Agile environment allowing teams to deliver project piece-by-piece and make rapid adjustments as needed.
  • Subject matter expert regarding Medicare regulations and operational procedures.
  • Assisted clinicians with EHR chart flow and demographics.
  • Analysis of inbound and outbound interfaces and extensions to Trizetto FACETS Claims Processing system.
  • Analyzed business and technical requirements, thus creating the Business Use Case (BUC) and Application Use Case (AUC) documents.
  • Solely managed our Jira Service Desk, triaging and escalating production issues as needed.
  • Worked as functional Analyst in the software development team for outsourcing Electronic medical records ( EMR ) and paperless office system implementation to the medical facilities.
  • Designed new database tables to meet business information needs. Designed Mapping document, which is a guideline to ETL Coding.
  • Troubleshoot EHR malfunctions and providing technical support when appropriate.
  • Assisted QA team by reviewing test cases and clarifying requirements to ensure complete coverage of requirements, worked in Agile environment and was able to bring projects to completion.
  • Utilized RUP to configure and develop processes, standards, and procedures, and to perform System analysis.
  • Assisted in Data File Definitions and Data mapping activities for the data gathered during the process of development and implementation.
  • Responsible for EMR interface development and implementation. Specialised in Nephrology EMR , Internal medicine EMR , Psychiatry EMR , Oncology EMR , Anaesthesia EMR etc.
  • Involved in requirement gathering and performed ETL Process.
  • Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
  • Used MS Visio to carry out the business modeling, data modeling, and object modeling efforts to develop the business architecture for rapid and controlled application development.
  • Involved in the overall Agile process throughout the project.
  • Understand the overall business model of Medicare Part D products, CMS guidance, and the PBM claim adjudication system.
  • Used Rational RequisitePro for overall Requirements Management and to build the Requirements Traceability Matrix.
  • Documented approved change controls to add them into business design.
  • Monitor EHR output and operations to assure accuracy, efficiency, and productivity.
  • Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.
  • Prepared Business Object / Business Process Models that included modeling of all the activities of business from conceptual to procedural level.
  • Tested the accuracy of iHelix inpatient EMR for Stage 1 meaningful use clinical quality measure calculation by using Cypress tool.
  • Maintained JIRA team and program management review dashboards
  • Create story board of back log items in Agile and develop item according to business needs.
  • 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.
  • Developed Data Flow, Work Flow, Process Flow, and Entity Relationship Diagrams in MS Visio, and analyzed them to create “AS IS” and “TO BE” scenarios.
  • Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
  • Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes.
  • Reviewed high-level design specification, ETL coding and mapping standards.
  • Maintained Project Glossary for the entire project team.
  • Followed a structured approach to organize requirements into logical groupings of essential Business Processes, Business Rules, and Information Needs, thus ensuring that Critical Requirements are not missed.
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • Followed the UML based methods using MS Visio to create Use Case, Activity/State Chart, Sequence, and Collaboration Diagrams.
  • 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.
  • Experienced with Rational tools like Rational Req Pro, Clearquest, Clear Case, JIRA, Rational Rose, and FACETS.
  • Conducted JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly.
  • Assist in creating and updating tickets in JIRA, along with implementing improvements in Jira to track and produce metrics for all phases of Intake and Development processes.
  • Worked with the Project Manager on various Project Management activities like Resource Planning, Resource Request, keeping track of Project Status, Deadlines, and Issues, Environment Request, and Compliance Issues.

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

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