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Business Systems Analyst Resume

Eden Prairie, MN

SUMMARY:

  • Over 8 Years of experience as Business Analyst in Planning, Analyzing, Documenting, Designing and Supporting software application implementations with understanding the architecture, scope and functionality.
  • Comprehensive working experience in various sectors of business, with In - depth knowledge of SDLC (System Development Life Cycle) with all phases of Agile - Scrum, & Waterfall.
  • Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
  • Hands on experience in Medicare and Medicaid Claim Process.
  • Extensive knowledge of Medicaid Information Technology Architecture (MITA).
  • Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Implementation and knowledge of HIPAA code sets, ICD-10 coding, HL7, HMO, PPO.
  • Experienced working in FACETS online modules such as Billing, Provider, Claims and Membership modules.
  • Vast experience in requirement gathering for business and application requirements.
  • Experienced in conducting Joint Application Development (JAD) sessions through interviews and workshops with subject matter experts and business users.
  • Extensive experience in handling requirements management, Business Requirements Documents (BRD), Functional Requirements Specification (FRS), System Requirement Specifications (SRS), Use-Case Specifications, and Requirement Traceability Matrix (RTM).
  • Expertise in various Management tools: JIRA, HP ALM/Quality Center, MS Test Manager, TFS.
  • Experience implementing Eligibility System, Facets Data model, Configuration Implementation of FACETS module.
  • Knowledge of different modules within Healthcare Claims Adjudication Process (Membership process, billing process and enrollment & Claims process).
  • Strong knowledge of Business Intelligence Reporting Tool -Tableau.
  • Experienced in using MS Visio for business process modeling.
  • Expertise with SWOT Analysis, Use Case Diagrams, Activity Diagrams, Sequence Flow Diagrams standards.
  • 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 ICD10.
  • Worked on System Changed Requests Issue resolution related to Medicare and Medicaid.
  • Strong Experience in Test Plans development, Test Conditions and Test Cases, test data creation and analysis, interaction with the development team for error detection and correction.
  • Expertise in creating prototypes and mock-ups for user interface designs.
  • Extensive knowledge of reporting tools such as SQL and ACCESS for underlying database tables and resolve data issues.
  • Expertise in RDBMS concepts and running SQL queries.
  • Experienced in conducting Business Process Management and GAP analysis.
  • Excellent working knowledge in Project Life Cycle and clear understanding of Project Management.
  • Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
  • Worked on Data migration, data analysis, data modeling, data conversion, requirement analysis, business modeling and use case development using UML, Structured Query Language (SQL).
  • Experience in Software Verification, Validation, and Testing Methodology extensively involved in UAT testing.
  • Outstanding communication skills, able to successfully build strong working relationships with coworkers and clientele, while ensuring cooperation among company departments.
  • Excellent multitasking skill, able to efficiently plan and prioritize projects. Strong technical and business management skills.

TECHNICAL SKILLS:

Project Methodologies: Agile-SCRUM, Waterfall

Business Modeling Tools: MS Visio

Document Management Tools: Confluence, SharePoint

Bug Tracking Tools: JIRA, HP ALM/Quality Center, TFS, MTM

Project Management Tools: MS Project

Operating System: Windows, Mac, UNIX

RDBMS: Oracle, SQL Server, MS Access

BI / Reporting Tool: Tableau

Programming Skills: SQL, HTML, XML

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

PROFESSIONAL EXPERIENCE:

Business Systems Analyst

Confidential - Eden Prairie, MN

Responsibilities:

  • Acted as liaison between stakeholders, end users, subject matter experts, developers, testers and management.
  • Involved in all phases of the iterative approach of the SDLC from Inception to Transition and effectively used Waterfall methodologies for implementation of system requirements gathering.
  • Facilitated Joint Application Development (JAD) sessions with business and technical teams to identify business rules and requirements and then documented them in a format that can be reviewed and understood by both the business people and technical people.
  • Wrote User Stories -- Elaborated User Stories and Acceptance Criteria; Reviewed user stories with teams
  • Organized and facilitated Agile and Scrum meetings, which included Sprint Planning, Daily Scrums or Stand-ups, Sprint Check-In, Sprint Review & Retrospective.
  • Involved in Prioritization of the requirements from the Product Backlog maintained in JIRA.
  • Worked with the Claims Operations Department to develop rules for manual adjudication of claims for Medicare and Medicaid.
  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
  • Worked on electronic Medicaid eligibility verification system and the Medicaid and Medicare intermediary along with their roles in claim processing.
  • Performed testing for Medicare and Medicaid claims for Medicaid Management Information System (MMIS).
  • Extensively used JIRA to document, review and analyze the requirements.
  • Created 'As Is' and 'To Be' BPMN Visio business processes and data mapping to support user requirements.
  • Responsible for writing requirements documents, Business requirements document (BRD), Functional Requirement Document (FRD), Functional Requirement Specifications (FRS) and User Requirement Specification (URS) for Medicaid managed care requirements.
  • Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
  • Used MS Visio for business flow diagrams and defined the workflows.
  • Facilitated weekly meetings lending source system business analysts, SMEs, and data migration analysts to understand system nuances and resolve data issues.
  • Performed GAP analysis and impact analysis on strategies related to resolving migration and post-implementation production issues.
  • Involved in preparing Test Plan and defined the testing approach, resources and timelines.
  • Wrote Test Cases in Excel based on Functional Specifications and upload them.
  • Maintained and supported the daily operation of the Enterprise Data Warehouse (EDWH).
  • Validated the data by writing and executing SQL queries.
  • Created data dashboard, write data stories and performed data visualization using Tableau and Advance Excel by manipulating the data according the need of the business owners.
  • Involved in web services testing using SOAP UI.
  • Performed data mapping from source to target.
  • Worked on SQL Server and MS Access in writing SQL queries to extract data from the database.
  • Performed data validation using SQL queries and run ad-hoc queries to show data to the business users.
  • Conducted User Acceptance Testing (UAT) with the stakeholders & the end-users of the application.
  • Maintained a close and strong working relationship with teammates and management staff to achieve expected results for the project team.
  • Maintained Requirement Traceability Matrix (RTM) to make sure that test plans were cover for all the requirements.
  • Responsible for creating and executing test cases for System, Integration, Regression and End-to-End, User acceptance testing (UAT) of the Application.
  • Reviewed functional requirements documents, high level design documents and finalized the testing in scope and scenarios for testing each assignment.

Environment: Agile/Scrum, JIRA, BPMN, Medicaid, MMIS, MS Visio, MS SharePoint, SQL Server, EDW, ETL, SOAP UI, HTML, XML, Excel (Pivot Table, Macros), MS Office Suite (Word, Excel, PowerPoint, Visio, Outlook), SQL, UAT, MS Access, Windows.

Business / Systems Analyst

Confidential - Chicago, IL

Responsibilities:

  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
  • Handled Child Welfare and Food Stamps (SNAP), Temporary Assistance to Needy Families (TANF) (CHIP, SNAP, TANF).
  • Responsible for requirements analysis, design and developing technical requirements.
  • Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA 5010 EDI transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (Claim status), 834 (Benefit enrolment), 835(Payment/remittance advice), 837(Health care claim).
  • Involved in implementation of AGILE ScrumMethodology to the project.
  • Managed Test results and defects using HP ALM defect tracking tool.
  • Organized and facilitated sprint planning, daily stand-up meetings, reviews, retrospectives, release planning, demos and other Scrum-related meetings.
  • Attending the scrum calls, attending the review meetings, retrofit meetings. Leading a Testing Team, Project Management Activities.
  • Created BRD and FRD for Medicaid managed care requirements and documenting them.
  • Was involved in analysis of complex MMIS System database design, reports and system processes. Supported the implementation and enhancement of state wide MMIS, Web portal, and integration.
  • Was responsible for the HIPAA 5010 compliance lifecycle from gap analysis, mapping, implementation and testing process of Medicaid Claims in the new MMIS system.
  • Organized and facilitated sprint planning, daily stand-up meetings, reviews, retrospectives, release planning, demos and other Scrum-related meetings.
  • Attending the scrum calls, attending the review meetings, retrofit meetings. Leading a Testing Team, Project Management Activities.
  • Used HP ALM/Quality Center for writing/analyzing project vision, goals, specifications and requirements.
  • Involved in the testing of web portal of New MMIS system.
  • Performed Back-end Testing using SQL queries for Database Validation.
  • Maintained bug lists for critical issues using Rally.
  • Managed Test results and defects using Rally defect tracking tool.
  • Performed gap analysis by matching the requirements for managed care programs.
  • Held regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed, and issues were resolved beforehand.
  • Worked with HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
  • Worked with Development Team to resolve issues and clarify Business Requirements from the Business Owners.
  • Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.

Environment: Agile/Scrum, HP ALM/Quality Center, HIPAA, EDI, MMIS, Medicaid, BPMN, SNAP, TANF, Excel (Pivot Table, Macros), SQL Server, SOAP UI, ETL, SQL, MS Office Suite (Word, Excel, PowerPoint, Visio, Outlook), UAT, Windows.

Business System Analyst

Confidential, Tampa, FL

Responsibilities:

  • Have worked in collaboration within the MIS team involving client/stakeholders to review and corroborate test cases created based upon the requirements of the project.
  • Evaluated, documented and achieved all project requirements and changes to requirements all the way through the software development life cycle using Rational Doors.
  • Operated on HIPPA Transactions 270, 271, 276, 277, 834, 835, 837 and 997 as well.
  • Studied customer needs and existing functions in the area of HIPAA transactions to determine feasibility and requirements.
  • Scripted the documents of Functional/Technical data flow of 4010/5010 HIPAA Transactions.
  • Prepared and Designed Test Cases /Test Data according to 5010 Business requirement
  • Prepared Statement of Work (SOW) document for various competences in the initial phase of requirements collecting.
  • Involved in upgradation of HIPAA X12 4010 version to HIPAA X12 5010.
  • Thorough documentating experience in converting business needs to technical documents.
  • Recognized and reviewed high level and thorough requirements in Business Requirement document (BRD).
  • Designed Use Cases and Use Case Description/stories and narratives to be based on the gathered requirements list and the BRD.
  • Transformed partners to exchange X12 4010 files 850, 810, 855, 856 and 846.
  • Designed test plans, cases, scripts and reports on multiple projects in the testing phase of varying size.
  • Carried testing on various software platforms, telecom and reporting systems.
  • Corroborated that user expectations were achieved in the testing phase of the project.
  • Reviewed user requirements documents to certify that requirements were testable.
  • Skilled in using Microsoft SharePoint to centrally store, achieve and access business artifacts and difficulties.
  • Formed Activity and Sequence Diagrams in Unified Modeling Language using Rational Rose and also involved in Creating the Business Process Models.
  • Synchronized activities involved in QA and User Acceptance Testing (UAT) and the developing team.
  • Highly subsidized to the enterprise metadata efforts by implementing the Data Mapping Repository information
  • Dynamically involved in writing project updates, managing project resources, conflict solving and meeting project deadlines.
  • Communicated with business/technology leadership for complete project/program team milestone.
  • Closely observed the production environment and planned to prioritize, communicate, and solve any
  • EDI process or system issues.

Environment: Windows XP, UML, LIMS, SQL, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio 2007), JIRA, Agile.

Business/System Analyst

Confidential, New Castle, DE

Responsibilities:

  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
  • Handled Child Welfare and Food Stamps (SNAP), Temporary Assistance to Needy Families (TANF) (CHIP, SNAP, TANF).
  • Responsible for requirements analysis, design and developing technical requirements.
  • Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA 5010 EDI transaction codes such as 270/271(inquire/response health care benefits),276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice), 837(Health care claim).
  • Involved in implementation of AGILE Methodology &Scrum to the project using Rally with our offshore team.
  • Managed Test results and defects using Rally defect tracking tool.
  • Organized and facilitated sprint planning, daily stand-up meetings, reviews, retrospectives, release planning, demos and other Scrum-related meetings.
  • Attending the scrum calls, attending the review meetings, retrofit meetings. Leading a Testing Team, Project Management Activities.
  • Created BRD and FRD for Medicaid managed care requirements and documenting them.
  • Was involved in analysis of complex MMIS System database design, reports and system processes. Supported the implementation and enhancement of state wide MMIS, Web portal, and integration.
  • Strong experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C & D, and Insurance Claims.
  • Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
  • Determined the requisite ICD10 training for both internal staff and Medicaid provider groups and assisted in the development of training materials.
  • Performed manual testing regarding prior authorization (PA) system use for Medicare Part D Coverage.
  • Billing enhancements to support Medicare Part D .
  • Was responsible for the HIPAA 5010 compliance lifecycle from gap analysis, mapping, implementation and testing process of Medicaid Claims in the new MMIS system.
  • Organized and facilitated sprint planning, daily stand-up meetings, reviews, retrospectives, release planning, demos and other Scrum-related meetings.
  • Attending the scrum calls, attending the review meetings, retrofit meetings. Leading a Testing Team, Project Management Activities.
  • Used JIRA for writing/analyzing project vision, goals, specifications and requirements.
  • Involved in the testing of web portal of New MMIS system.
  • Performed Back-end Testing using SQL queries for Database Validation.
  • Maintained bug lists for critical issues using Rally.
  • Managed Test results and defects using Rally defect tracking tool.
  • Performed gap analysis by matching the requirements for managed care programs.
  • Held regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed and issues were resolved beforehand.
  • Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
  • Worked with Development Team to resolve issues and clarify Business Requirements from the Business Owners.
  • Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.

Environment: JAD, BRD, PRD, FSD, Agile-SCRUM, MS Office Suite, MMIS, Rally, SQL, JIRA, UAT, Windows.

Business Analyst

Confidential, Richmond, VA

Responsibilities:

  • Designed a new matrix covering all the conceptual parameters of the new system.
  • Extensive knowledge on relevant cross-industry data and messaging standard organizations and HIPAA/EDI industry-specific organizations to maintain a point of view as to the current applicability and risks associated in implementing standards or new technologies to client environment.
  • Created class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
  • Conducted on-site/web conference presentations, data conversions, system implementations and end user training.
  • Leverage Risk experience and business judgment to plan initiatives and accomplish enterprise- wide goals.
  • Utilization of BPM, as-Is and To-Be modeling processes.
  • Used Microsoft Visio to document Use Cases, ad-hoc reports Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams.
  • Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level.
  • Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports
  • Managed, created and altered Databases, Tables, Views, Indexes and Constraints with business rules using T-SQL.
  • Matched the requirements for programs such as Medicare and Medicaid, which are part of the Social Security Act.
  • Performed daily oversight and analysis and metrics of clinic operations including patient flow, physician / staff and patient scheduling, patient registration, Care Coordination / Care Delivery, referrals, insurance eligibility verifications and pre-certifications (Medicare, Medicaid, and private insurance payers); daily batching and service utilization; resolved employee-related grievances and conflict resolution, reviews and training.
  • Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
  • Checked the data flow through the frontend to backend and used SQL Queries to extract the data from the database.
  • Analyzed the problem domain, specified features, established baseline architecture, developed the Project plan, and risk analysis.
  • Research and Implementation of Web Portal and Content Management Systems
  • Consulting with other departments on the management of content and design of pages.
  • Complying with the consistent development and maintenance of the healthcare industry databases, health care insurance and health care industry related aspects with adherence to HIPAA compliances.
  • Provide reporting to management via excel reports of workload and work completion on a daily, weekly, and monthly basis.
  • Liaison and Coordinated in resolving HIPAA/EDI mapping issues arising from the third-party systems.
  • After successful development and testing of the product, participated in product release and deployment to End-User.
  • Worked closely with the deployment team for roll out the project - external releases, packaging, distributing, installing, user assistance, beta testing, migration of software and data.
  • Conducted User Acceptance Testing (UAT).

Environment: Agile-Scrum, JIRA, SQL, EDI, ETL, UNIX, UAT, MS Office Suite(Word, Excel, PowerPoint, Visio, SharePoint, Project), Windows.

Business Analyst

Confidential, PA

Responsibilities:

  • Followed thoroughly development Life Cycle (SDLC) to create the provider portal, which allows providers to access patient information to increase convenience.
  • Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
  • Managing and Billing Medicare, Commercial HMO/PPO claims daily.
  • Developed test cases and test scripts and assisted Quality Assurance activities, with system integration testing and user acceptance testing (UAT), developing and maintaining quality procedures and ensuring that appropriate documentation is in place.
  • Participated in Business Modeling by documenting the needs of the Business.
  • Prepared Business Requirement Documents (BRDs) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims
  • Involved in testing Facets for Group Information, Enrolling Subscribers, adding members, Related Entities, Class/Plan definition, Premium Rate Tables and all.
  • Worked on HIPAA Transactions 270, 271, 276, 277. 999, 837I/P/D and 835R
  • Involved in claim adjudication process of FACETS application
  • Helped in project testing efforts for doing integration tests, regression tests and user acceptance tests.
  • Assisted the QA personnel in the creation of Test Cases using Quality Center.
  • Used MS Visio, MS Word, MS Excel and MS PowerPoint to develop various project deliverables.
  • Assisted the QA team in User Acceptance Testing (UAT).

Environment: Agile, Waterfall, HP Quality Center, SQL, EDI, FACETS, HIPAA, UAT, MS Office Suite, Windows.

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