We provide IT Staff Augmentation Services!

Sr. Business Analyst Resume

Tampa, FL

SUMMARY:

  • 6+ years of IT experience as a Business Analyst and Product Consultant with analytical and technical skills to leverage experience in business analytics, requirement gathering and project co - ordination in the Commercial Banking, Investment, Marketing and Healthcare Industries
  • Strong communication skills in engaging business stakeholders, and users in gathering the intricate flows of the business processes.
  • Extensive knowledge of Software Development Life Cycle (SDLC) through all the four phases including Inception, Elaboration, Construction, Transition, and employing Agile and waterfall software methodologies.
  • Hands on experience in scripting Business Requirement Documents (BRDs), Functional Requirement Document (FRD), Systems Requirements Specification (SRS) Technical Requirement Documents (TRD’s).
  • Proficient in conducting Rapid Application Development (RAD) with Business Users, Joint Application Development (JAD) with developers, Joint Application Review (JAR) sessions with technical team including developers to develop and agree upon a system focusing on Business Requirements.
  • Experience in analyzing Business and Technical specifications, developing Use-Case diagrams, Activity Diagrams, Class Diagrams, Data Modeling, Data Mapping and Work-flow Diagrams to test requirements and procedures and formulate robust Business Model using Unified Modeling Language (UML) Techniques, Visio and Rose tools.
  • Worked extensively with QA Team in understanding Test Cases, Test Plans, User Acceptance Testing (UAT) and ensuring that the software meets the system requirements.
  • Expertise in working with Office Suite including MS Word, MS PowerPoint, MS Excel, MS Access
  • Experienced with production of documentation using templates, following writing standards for documentation, use cases using Rational Unified Process (RUP), Rational Rose, Requisite Pro, Rational Clear Case and Clear Quest.
  • Working knowledge and experienced in GUI design/prototyping including web interfaces.

TECHNICAL SKILLS:

Methodologies: UML, RUP, Agile, Waterfall, SDLC.

ERP: SAP BW, CRM.

Business Processing Tools: Requisite Pro, Clear Quest, Clear Case, DOORS.

QA Tools: Test Director, Load Runner, QTP, Rational Test Manager.

Tools: and Technologies: MS Office,Autosays Front page, Dream Weaver, Adobe Acrobat.

Business Intelligence Tools: Crystal Reports, Reporting Services, Business Objects.

Platforms: IBM Web Sphere, Windows Series, UNIX, DOS.

PROFESSIONAL EXPERIENCE:

Confidential, Tampa, FL

Sr. Business Analyst

Responsibilities:

  • Performed GAP analysis as pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process
  • Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation & Verification process.
  • Followed Agile (Scrum) SDLC methodology software development
  • Developed Test Plans and Test Cases to test the GUI and workflow for Quality Assurance.
  • Used Quality Center to plan tests, manages test assets, create and run manual and external scripts to check GUI and functional features of the AUT
  • Involved with requirement gathering and analysis for the data marts focusing on data analysis, data quality, data mapping between ODS, staging tables and data warehouses/data
  • Experienced in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
  • Involved in developing and maintaining Test Matrix and Traceability Matrix, and performing Gap Analysis.
  • Maintaining knowledge of Medicare and Medicaid rules and regulations and evaluating the impact of proposed changes in rules and regulations.
  • Scheduled the ETL jobs daily. Weekly and monthly based on the business requirement
  • Co-ordinating/Managing ETL Offshore team
  • Testing the accuracy of iHelix inpatient EMR for Stage 1 meaningful use clinical quality measure calculation by using Cypress tool.
  • Created Process Work Flows and responsible for preparing Functional Requirement Specifications Involved in gathering and prioritizing requirements using 1 to 1 interviews, job shadowing, brainstorming & developing questionnaires
  • Efficiently worked alongside Project Manager and Lead Business Analyst to determine the Scope and utilized Rational Unified Process (RUP) and Agile (Scrum) System Development Life Cycle (SDLC) methodologies to coordinate and strategize concise solutions within a constricted timeframe involving multiple interfaces.
  • Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data dictionary and data analysis.
  • Developed, designed & implemented department plan to configure new Facets integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
  • Translated business requirements into functional specifications and documented the work processes and information flows of the organization
  • Track tickets related to EDI and provide periodic updates
  • Troubleshoot issues with EDI partners and transaction processes.
  • Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
  • 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
  • Worked extensively through Agile development methodology by dividing the application into iterations
  • Configured Process Models and Data Flow Diagrams by means of Swim Lane Diagrams, Sequence Diagrams, and Wireframes compliant to HIPAA 5010 standards for Electronic Data Interchange (EDI) Transactions 834 (Membership Enrollment), 835 (Enrollment of Benefits),270 (Benefits Inquiry), 271 (Benefits Responses), 276 (Claims Status Requests), 277 (Claims Status Notification), and 837 (Claims Processing) via Microsoft Visio.
  • Used HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions
  • Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I, P, D) and 820) standards
  • Responsible for configuration/ compatibility and BA testing with the help of Facets, SharePoint and Tidal scheduler
  • Contributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management
  • Converting the Business rules into Technical Specifications for ETL process
  • ETL Architect(Informatica and PL/SQL) /SME
  • Currently leading, coordinating EMR/EHR (iHelix Suite) implementation to achieve meaningful use stage
  • Involved in Up-gradation of HIPAA X12 4010 transactions to HIPAA X12 5010 and ICD-9-CM to ICD-10.
  • Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers. Worked on ICD 9 codes and gathered future requirements based on ICD 10 codes. Managed creation of sample mappings for the conversion of EDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
  • Report on project status to appropriate project management chain using Jira
  • Document and track application failures and bugs using tools like Jira and Confluence
  • Participated in changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
  • Analyzed EDI X12 - 837I/P, 835 and 834 transactions consistency related to providers, payers, subscribers and other related entities
  • Analyzed the data in the Facets source system to map into the correct field and attribute in the target storage
  • Owner of the business rules document, which documented the business rules across different systems.
  • 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
  • Led and managed the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that the HIPAA regulation are met across all the modules
  • Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan.
  • Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying
  • Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
  • Executed advanced level SQL queries to verify data integrity of the databases.
  • Used Microsoft Word, Excel, Access and Visio as working tools.
  • Involved in the development of Test Plans, Test Cases and Expected Results, and coordinated the tests with the QA team to verify implementation of new features and enhancements.
  • Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports.
  • Performed Data Analysis, Data profiling and Data validation by writing SQL queries using TOAD
  • Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehous
  • Prepared and maintained EDI maps for different EDI transactions
  • Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc).
  • Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
  • Strong knowledge of Facets and actively involved in end-to-end implementation of Facets Billing, Enrolment, Claim Processing and Subscriber/Member module.
  • Worked on analysis of FACETS claims processing system and gathered requirements to comply with HIPAA
  • Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS - enrolment and benefits.
  • Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
  • Expertise in ICD-9 to ICD-10 Conversion
  • As Interface Architect designed and developed Admission, Scheduling Charge messages flow and transformations for 50 applications such as Dietary, Oncology, Radiology, Professional Billing, Operating Room, materials management, HIM Coding, Lab, External Partner EMRs additional Hospital Billing Systems, and HIEs
  • Worked with 837, UB92, UB04, CMS 1500 claims and HIPAA 835, 270/271, 276/277, 278 transactions
  • Experience in CMS and MMA Guidelines
  • 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)
  • Strong functional expertise in the Healthcare Payer Area - Membership claims, benefits, eligibility check, ICD10,HIPAA, CMS HCPCS Exposure to Health Care Industry standards like HIPAA / PHI Resolved data issues and updates for multiple applications using SQL queries/scripts
  • Responsible for unit testing and working with System/Integration testing team in debugging/resolving any issues raised during testing.
  • Created Data Flow Diagrams and Process flow diagrams for various load components like FTP Load, SQL Loader Load, ETL process and various other processes that required transformation.
  • Conducted user training pertaining to old and new Affinity Provider ID appearing on documents providers receive from Affinity (mainly occur with EOPs, capitation rosters, PCP membership rosters, provider directory listings and some system generated letters)

Environment: Rational Unified Process (RUP), Agile (Scrum), HIPAA (5010), EDI X12 (834, 835, 270, 271, 276, 277, 837), ICD-10, Microsoft Project, Java, IBM Cognos, IBM Rational Suite, MS Visio, Word, Excel, PowerPoint, UML, XML, Microsoft Visio, Atlassian JIRA, Microsoft SQL, Microsoft Access, Facets.\

Confidential

Sr. Business Analyst

Responsibilities:

  • Gathered high level requirements and developed scope of the project for the implementation of Microsoft Office Share Point 2007.
  • Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
  • Performed frontend configurations for Facets profiles in room type profile configuration build
  • Gathered requirements
  • Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)-Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analysing and documenting related business processes.
  • After Executive confirmation did Gap analysis to assess needs that could not be met by core EHR.
  • HIPAA EDI transactions such as 834, 837 (P, D, I) 276, 277, 278.
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile
  • Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
  • Working knowledge of implementing software development projects using methodologies such as Waterfall, Rational Unified Process, Agile/Scrum.
  • Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them.
  • 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.
  • Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
  • Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
  • Collaborated with management and senior-level engineers to develop code for new features used within a Health Information Exchange(HIE).
  • Designed and implemented basic SQL queries for QA Testing and Report / Data Validation.
  • Analyzed, designed, and coded several online subsystems for the Medicaid System.
  • Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions
  • Worked on data modeling and produced data mapping and data definition documentation by interacting with ETL programmers and ensured the implementation of the business requirements.
  • Validated the following: 834 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
  • Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
  • Used SQL to test various reports and ETL load jobs in development, QA and production environment
  • Analyzed the changes made to different EDI ANSI X12 transactions (834, 837 I and P, 278, 270 and 271) under HIPAA 5010.
  • Created Source to target data mapping documents identifying key data elements and prepared Data Flow Diagrams
  • Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
  • Involved in analyzing activities for a variety of major projects including Medicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.
  • Experience in implementing and managing the implementation of software, hardware and hybrid solutions to enable Electronic Health Records (EHR) and Health Information Exchanges (HIE).

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, Cognos, Agile, Rational Requisite Pro, MS Office, SQL Server 2005, Cobol, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0.,UML.

Confidential, MD

EDI Analyst

Responsibilities:

  • Assist with creation and maintenance all necessary documentation and training materials for Epic Ambulatory application
  • Performed analysis, design, development and maintenance of the Epic Ambulatory applications and other clinical information systems
  • Expert knowledge in developing and configuring Facets Extensions (Embedded, XCOM, XSQL) using C#, VB .NET, SQL, and VB
  • Expert knowledge in design and implementation of custom Interfaces, Extensions, Data Extracts on Facets platform.
  • Extensive experience in Facets version upgrades projects.
  • Strong knowledge of Claims In and processing flow within Facets platform.
  • Possess strong knowledge in ITS Home & Host implementation on Facets platform
  • Performed impact analysis of Facets version upgrade changes.
  • Provided Facets system solution and technical design, for business problems.
  • Analyzed the Facets billing configuration and designed the Refund letters process for Consumer billing project.
  • Developed and implemented policies and procedures which includes process flows, guide sheet for all important responsibilities as part of development of Medicare Operations Manual.
  • Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
  • Interacted with the DST (off shore) teams for QA support and training purposes. Responsible for running test region EDI loads on AS400 Series. Updated records in AS400 before processing for testing purposes.
  • 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.
  • Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
  • Experience with EPIC user and provider record provisioning, including the development of role-based access, security classes, and user profiles
  • 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.
  • Experience in Epic Resolute product implementation and deployment
  • Hands on experience with Epic Hospital Billing and Ambulatory
  • Full knowledge of application interoperability configurations and managed the implementation tasks of HIE clinical applications.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analysing and documenting related business processes
  • Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
  • Experience with Epic Healthcare Information Systems
  • Conducted user interviews, gathered requirements, and analysed the requirements.
  • Trained thousands of medical providers w/ ten member team on HIE software and insurance proprietary software Managed 1500 medical provider accounts including group practices, large health systems and hospitals
  • Worked with the business team to collect the business requirements, security and service level requirements and documented them.
  • Analysed set behaviour and contribution to business performance, critical business metrics & tracking underlying business trends using Business Objects.
  • Working with different IT & Business groups to understand and determine the Impacts to the Data Warehouse and/or Data Marts for different projects
  • Participated in the logical and physical design sessions and developed design documents.
  • Designed new process flows for the existing system as well as for the enhanced system.
  • Conducted and lead status report meetings with the business and the IT team on a weekly basis.
  • Manage Scope and change throughout the life cycle of the product.
  • Performed collection, coding, and assessment and reporting of adverse event data using ARISg.
  • Worked in the ARISg Implementation of the EHR-Pharmacy Module.
  • Supported integrating EDI batch processing and real-time EDI
  • Recommend tactic to implement HIPAA 4010 (EDI X12 837,834,278,270) in the new System
  • Worked on Electronic health record system as a CRM web based application.
  • Working Experience in Electronic Submissions in standard format E2B.
  • Knowledge of regulatory issues including State, Federal, AABB, CAP, CLIA, and JCAHO

Environment: Windows 7, MS Project, Microsoft Visio, SQL, Data Warehouse, BI, BO, EPIC, HL7 and Business Objects

Hire Now