- 8+ years of experience as a Business Analyst in Healthcare.
- Expertise in all phases of Software Development Life Cycle (SDLC) methodology - requirement analysis, design, data modeling, implementation and deployment.
- In-depth knowledge of Rational Unified Process (RUP); data modeling and mapping, and design using UML (Unified Modeling Language), Rational Rose and Visio.
- Experience in gathering Business and Functional user requirements, creating Use Cases, Activity, Class, and Sequence diagrams.
- Good knowledge of Oracle and SQL; SQL queries for data analysis and report testing.
- Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
- Gathered good knowledge of Medical and Healthcare Standards and Regulatory vehicles such as HIPAA, FDA, ICD, MMIS, EDI, HL7.
- Capable of managing multiple projects simultaneously.
- Exceptional problem solving and sound decision making capabilities.
- Experience in writing Experience working in Medicare and Medicaid projects.
- Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.
- Created Requirements Traceability Matrix for forward and backward traceability.
- Strong expertise in Health Insurance Claim process.
- Extensive experience in conducting Joint Application Development (JAD) sessions.
- Extensive experience in working in a Customer - oriented environment.
- Broad knowledge of Test plans, Test cases and test scripts.
- Experience in User Acceptance Testing, Smoke Testing, Regression Testing Performance Testing and Functional Testing.
- Knowledge of various RDBMS like DB2, Oracle, MS-Access and MySQL Server.
- Knowledge of ISO, Six Sigma and CMM standards.
- Organized, goal-oriented, and flexibility in adaption to a wide range of work environments Excellent communication skills, writing skills as well as presentation skills.
Databases: MS SQL, MS Access, Oracle
Languages: SQL, Visual Basic
Methodologies: SDLC, Agile methodology, RUP, UML, CMM Testing
Tools: Test Director, Quality Center
Project Management: MS Office Suite, MS Project Change Management, Rational ClearQuest
Business Modeling Tools: MS Visio, Rational Rose.
Confidential, New Hudson, MI
- Converted the Business Requirements (BRD) into Technical Requirements (TRD) for the IT Department.
- Participated in analysis workshops for ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances
- Worked as liaison between business users and stakeholders and organized JAD seasons as well as performed GAP analysis.
- Worked on improvement of Claims Reimbursement User Interface for a better experience and in corporate changes as per HIPAA 4010/5010 guidelines using the gap analysis.
- Developed an implementation guide for Partners for HIPAA 5010EDI X12 transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claim status response), 820 (enrollment), and 834 (premium payments).
- Conducted claim validation and end/denied claims analysis for the health plans Medicaid programs.
- Worked extensively through agile development methodology by dividing the application’s requirements into iterations.
- Participated and contributed in daily scrums, Sprint meeting and Sprint review meetings.
- Coordinated daily activities with the IT Developers, QA and Product teams along with the project management group.
- Maintained and tracked Stake holder’s requested enhancements and changes using Requirement Traceability Matrix (RTM).
- Worked on modeling UI wireframes, mockups and documenting the end-user's AS-IS workflow and TO-BE business processes.
- Worked on web-based application development which includes New Account opening, view their Existing Statements Online, and Pay the bills Online, Account Maintenance and upgrades.
- Assigned problems to the appropriate software development team for fixes.
Environment: Agile/Scrum, VersionOne, UML, HP ALM, Rational Rose, Windows, MS Office, HTML, Windows
Confidential . Nashville, TN
- Work closely with Business Owners and Stakeholders to outline Business Requirements.
- Work with System analyst and IS teams to understand the flow of data.
- Validated 835 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
- Identified gaps and performed gap analysis
- Created Mapping Documents, Report Mockups
- Researched and evaluated alternative solutions and recommended the most efficient solution for system design.
- Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows.
- Work with Compliance and Regulatory operations to follow and monitor different IT process bound by CMS Regulations.
Environment: Windows XP, Business Objects, MS Excel, Word, Visio, power point, SQL, DB2, SAS database
Confidential, Princeton, NJ
- Gathered Business Requirements, Interacted with the Users, Project Manager and SMEs to understand the Business Processes.
- Used Rational Unified Process (RUP) as the Software Methodology.
- Analyzed business process, Prepared Business Requirement Document (BRD) and converted the business requirements into Functional Requirements Specification.
- Performed Feasibility, Adaptability and Risk Analysis to identify the business critical and high-risk areas of the application.
- Participated in test review meetings.
- Used Rational ClearQuest to maintain and track the Stakeholders requested enhancements and changes.
- Used Rational ClearCase to maintain different builds of the application.
- Developed and implemented automated test scripts using Rational Robot.
- Conducted regression testing and interacted with developers to resolve the issues.
Environment: Rational Rose, ClearCase, ClearQuest, Visio, MS Project, Visual Studio .NET, SQL Server 2000.
Healthcare Business Analyst
- Proposed strategies to implement HIPAA 4010 and move to HIPAA 5010
- Created BRD Document
- Coordinate with stakeholders and project manager to gather functional and non-functional requirements during JAD sessions.
- Performed a High-level analysis of the requirements from a business perspective to determine the feasibility of constructing the new application.
- Conducted gap analysis for changing old MMIS to new MMIS.
Environment: RUP, SQL, MS Office, MMIS, MS Visio, SharePoint, Lotus Notes, Rally. Rational Tools