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Sr. Business System Analyst Resume

MO

SUMMARY:

  • A Progressive Business Analyst with 10+years of quality experiences in business process analysis/modeling, business requirements in HealthCare, Insurance, and Pharmaceutical based Industries.
  • Extensive operational knowledge of FACETSenterprise system to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
  • Expertise in Claims, Subscriber/Member, Plan/Product, Provider, Commissions and Billing Modules of Facets.
  • Solid understanding of all phases of SDLC (Software Development Life Cycle), including requirements gathering, analysis, design, development, testing and deployment as well as software engineering/project methodologies like Waterfall, Agile/Scrum and RUP (Rational Unified Process).
  • Extensive experience in developing Functional Requirements Document (FRD), Business Requirements Document (BRD), System Requirement Document (SRD), Functional Specifications & Control Matrix across the deliverables of a project.
  • Sound proficiency in creating Use Cases with Specifications, User Stories, Use Case Diagram, Sequence Diagrams, Activity Diagram, Class Diagram, Data Flow Diagrams and Business Flow Diagram using MS Visio and Rational Rose.
  • Organized many Joint Application Development sessions (JAD), Joint Requirement Planning sessions (JRP), and Rapid Application Development (RAD) sessions with Customer Groups and Project team members.
  • Worked with incorporating Social Media and Siebel / TIBCO CRM for making business a Customer.
  • Understanding of GCP to understand the FDA regulatory process for pharmaceutical clinical trials. Attended seminar & courses to gain more knowledge.
  • Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
  • Excellent knowledge of Microsoft office especially MS Word, MS Excel, MS PowerPoint, and MS Access.
  • Expertise in Tracking and Managing the Requirements using Requirement Traceability Matrix (RTM) that controls numerous artifacts produced by the teams across the deliverables for a project.
  • Facilitated Change Request Management across entire process from Project conceptualization to Testing through Project Delivery, Software Development and Implementation Management in diverse Business and Technical Environments.
  • Develop and maintain MS Access database(s) outlining clinical and administrative HEDIS benchmarks and other targeted performance indicators. Perform data base queries and informational updates.
  • Strong HIPAA EDI 4010 and 5010 with ICD - 9 and ICD-10, analysis & compliance experience from, payers, providers and exchanges perspective, with primary focus on Coordination of benefits
  • Strong Experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases.
  • Proficient in Technical and Business writing, Business Process Flow, Business Process Modeling.
  • Broad knowledge of Medicare, Medicaid, PPO, POS, Diagnostic codes (ICD-9-CM and ICD-10-CM/PCS), claims process, and Electronic Data Management System (EDMS).
  • Results-oriented individual with very strong work ethic and ability to demonstrate excellent leadership & influencing skills in business analysis, communication and problem-solving skills.

TECHNICAL SKILLS:

Microsoft Technologies: MS Project, Visio, Excel, Word, Outlook, PowerPoint

Requirements Management: Rational Requisite Pro

Database: Oracle, MS SQL Server

Business Modeling: Rational Rose, MS Visio

Defect Tracking Tools: HP Quality Center, Rational Clear Quest

Languages/Standards: SQL, XML, HTTP, Java, HIPPA 4010/5010, ICD9/10, ANSIX12

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

PROFESSIONAL EXPERIENCE:

Confidential, MO

Sr. Business System Analyst

Responsibilities:

  • Conducted meetings with the team members to organize and finalize the working hours and resources.
  • Focused analytical algorithms identify low, medium and high risk membership for all HEDIS measures, improving patient care and adherence, while improving HEDIS/STARS.
  • A highly driven, results-oriented professional with broad experience in medical informatics, HEDIS, HEDIS improvement and healthcare analytics
  • Increased reliability and accuracy of HEDIS reporting. Led effort across departments to bring HEDIS reporting process across the board.
  • Coordinated efforts between IT, HEDIS vendor, HEDIS auditor and leadership to ensure a timely and accurate HEDIS submission.
  • Worked on Batch processing, member, subscriber enrollment module of 834, ID card generation processes and Created business process flow to capture the required data in future, define business rules to determine Medicare (Part C and Part D) Member Coordination of Benefit letters as required by CMS, Medicare Secondary Payer for members with Workers Compensation
  • Configured the Payer and Line of Business details into Facets to support claims payment and financial reporting.
  • Prepared a detailed BUR (Business User Requirement) document to explain working of the project to the stakeholders.
  • Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
  • Generated periodic reports to project manager using Report Builder Tools like Microsoft Word, Excel and PowerPoint.
  • Implementation of the new processing system for Benefit Enrolment files (834) and Payer and Claims (837) Eligibility Inquiry and Response (EDI 270/271) along with review, design and reconfigure of the following FACETS functional areas: Enrolment. Claim, Billing, Provider, and Member Information.
  • Provided data for HEDIS reporting (for performance measuring of patient care).
  • Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 et cetera.
  • Extensively used data mapping from source to target and target to source for Sun to Oracle migration of database.
  • Configured the Payer and Line of Business details into Facets to support claims payment and financial reporting.
  • Analyzed, designed, and coded several online subsystems for the Medicaid System.
  • Wrote test cases from the use cases and uploaded the test cases to HP Quality Center.
  • Performed overall project management, analysis, architecture, design, development and implementation of data warehousing / business intelligence initiatives.
  • Analyzed trading partner specifications and created EDI mapping guidelines.
  • Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
  • Wrote Use Cases and design test steps according to the requirements specifications in Excel.
  • Implementation of the new processing system for Benefit Enrolment files (834) and Payer and Claims (837) Eligibility Inquiry and Response (EDI 270/271) along with review, design and reconfigure of the following FACETS functional areas: Enrolment. Claim, Billing, Provider, and Member Information.
  • Worked on Batch processing, member, subscriber enrollment module of 834, ID card generation processes and Created business process flow to capture the required data in future, define business rules to determine Medicare (Part C and Part D) Member Coordination of Benefit letters as required by CMS, Medicare Secondary Payer for members with Workers Compensation.
  • Extensively involved in regression, integration, and UAT testing.
  • Worked in mainframe environment and used SQL to query various reporting databases.
  • Worked on java code with the developers to verify table and column names from the database to be transferred.
  • Involved in the full HIPAA compliance lifecycle from Gap Analysis, mapping, implementation, and testing for processing of Medicaid Claims.
  • Used MS Visio to designed and develop Use Cases Scenarios, Use Cases Models, Activity Diagrams, Sequence Diagrams, State chart diagrams using UML.
  • Actively involved in Requirement Analysis, Business Analysis, Use-Case Analysis Involved and developed comprehensive Test Strategy, Test Plans, Test Case and Test Scripts and documented them in HP Quality Center (QC).
  • Generated periodic reports to project manager using Report Builder Tools like Microsoft Word, Excel and PowerPoint.
  • Developed various reports for user verification like Cross Tab Reports and Sub Reports, various charts and graphs like Bar chart, line graphs, and Pie charts by using Crystal Reports and exported reports into formats like PDF, HTML, Excel, Word and RTF
  • Documented Medicare claims processing.
  • Developed the systems implementation project management plan with milestones and steps from procurement of vendors to project implementation and maintenance.
  • Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
  • Designed and created a mainframe process to automate mass distribution of emails for class registration reminders, class cancellation notification and class offerings for courses listed on individual training plans.

Environment: XML, XSL, SDLC, Agile, ETL, CRM, Cognos, Microsoft Office Professional (Outlook, Word, Excel, Visio, Access, etc.), MS Project, UML, Visual Basic, RUP, Oracle, UAT, DB2, Test Director, XML, SQL, .NET, Clear Case, MS Visio, DB2, SQL, HP Quality Center, MS SharePoint, ORACLE

Confidential, Blue Bell, PA

Senior Business Analyst

Responsibilities:

  • Gathered high-level requirements by conducting meetings and interviews (formal and informal) with functional and business owners and document them in Business Requirement Document (BRD)
  • Elicited and documented requirements for Salesforce.com and Comindware; provided technical requirements support for both applications
  • Used applications to create test data; verified functionality of applications
  • Created BPR charts for “AS IS” and “TO BE” processes of different business functionalities.
  • Documented test results; reviewed issues identified by testers, and documented and managed defects
  • Managed new software information for UAT releases/upgrades, including installation, testing, deployments, and documentation
  • Worked with FACETS to manage all relationships between the payer organization and its members and providers.
  • Wrote Test Cases and design test steps according to the requirements specifications in Excel.
  • Created manual Test Cases in HP QC/HP ALM for various user Stories based on Release and Sprint Plan
  • Held meetings and constantly updated the BRD and FRD as per the changes requested by the stakeholders and approved by the Change Control Board (CCB).
  • Created and maintained Different Requirement documents for Claims (837 EDI Transaction), Membership (834 EDI), and Facets Claim integration. Strong HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10, analysis & compliance experience from, payers, providers and exchanges perspective, with primary focus on Coordination of benefits
  • Executed test cases and test scripts for manual and automation testing. Defects are raised in HP Quality Center/HP ALM for logging, tracking and reporting bugs in application
  • Involved in writing extensive SQL Queries for back end testing oracle database.
  • Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL and Crystal Reports, ETL process, use cases modeling (UML) using MS Office (Word, Excel, Access, Visio) and dashboards
  • Prepared Business Requirement Document (BRD) and then converted the business requirements into Functional Requirements Specification and Technical Specification using Rational RequisitePro.
  • Created and maintained Use Case Narratives including business process workflow diagrams.
  • Led and participated in Joint Application Development (JAD) sessions with technical and business owners team to develop solution design requirements for development team in accordance to Health Care Reform Act.
  • Worked with FACETS to manage all relationships between the payer organization and its members and providers.
  • Participated in Focus Group sessions and interviews with Subject Matter Experts (SMEs) from each work stream/business unit to gather specific information while performing Requirements Analysis and translate information into detail specifications in Functional Requirement Document (FRD).
  • Assisted with FACETS Implementation, such as end to end testing of FACETS Billing and Enrollment Claim Processing.
  • Analyzed payer/submitter specific 4010 claim editing to migrate it to 5010 claim editing system Identify and document transition issues from format
  • Defined scope for Claims Business area and update EDI Transactions with HIPAA 4010 to HIPAA 5010 Changes and participated in full life cycle implementations (SDLC) from project initiation to final deployment.
  • Performed GAP analysis identify changes in 837, 834 and 835 transactions being proposed in upgrade from HIPAA 4010 to HIPAA 5010 and documented required capabilities and changes.
  • Practiced agile methodology, led sprints, and prioritized line items based on key business initiatives
  • Wrote SQL queries to test application for data integrity and verified contents of data table.
  • Worked with senior-level business executives, IT personnel, and business program resources to analyze, gather and execute requirements and manage stakeholder expectations

Environment: Microsoft SharePoint, ETL, MS Visio, Cognos, Oracle, DB2, UML, Team Track, Siebel, AGILE methodology FACETS, Microsoft Office Professional (Outlook, Word, Excel, Visio, Access, etc.), MS Project, UML, Visual Basic, RUP, Oracle, UAT, DB2, Test Director, XML, SQL, .NET, Clear Case

Confidential, Jacksonville, FL

Business Systems Analyst

Responsibilities:

  • Participated in creating Facets data model.
  • Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system).
  • Performed Requirement Gathering by interacting with Business users and documented the requirements.
  • Worked with Business Users and Solution Engineers to solve the capture defects in the MMS system and to effectively solve them.
  • Created and maintained Different Requirement documents for Claims (837 EDI Transaction), Membership (834 EDI), and Facets Claim integration. Strong HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10, analysis & compliance experience from, payers, providers and exchanges perspective, with primary focus on Coordination of benefits
  • Performed Data Mapping to map the EDI 834 data to XML.
  • Used Microsoft Word, Excel, Access and Visio as working tools
  • Worked on solving the errors of EDI 834 load to Facets through MMS.
  • Conducted JAD Sessions, Peer Review sessions with the SMEs, Solution Engineers, developers, Business users.
  • Worked with FACETS to manage all relationships between the payer organization and its members and providers.
  • Analyzed the scope of the project to review it with the customers for different review sessions of the application.
  • Created test data for 837I, 837D, 837P to have Segments/loops information with different combination of Submitter, Receiver, Billing Provider, Pay-To-Provider, Subscriber, Payer, Patient, Claim Information, Physicians, Referring Provider, Service Line Info, Adjudication Information
  • Intensively involved in project testing efforts by doing System Integration Testing, Regression Testing and by helping UAT team in User Acceptance Testing.
  • Used to execute test cases for several transactions such as 837, 835, 820, 834, 277, 278, 270/271.
  • Create SQL queries to read data from databases.
  • Requirements Gathering & Analysis always ensured HIPAA Compliance Auditing.
  • Worked with the Testing team to test the system extensively and log defects.
  • Defined the maps from the existing BizTalk solution and validated it with the client for any changes.
  • Performed data mapping and tracing data from system to system in order to solve a given business or system problem.\

Environment: Agile/waterfall, UAT, GAD (Gap Analysis Document), XML, UML, SQL, Quality Center, Microsoft Office Professional (Outlook, Word, Excel, Visio, Access), Microsoft SharePoint, MS Visio, MS Project, Oracle, DB2

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

  • Gathered Requirements, Developed Process Model and detailed Business Policies.
  • The SDLC Methodology used was Agile or Scrub.
  • Gathered functional business requirements from process owners and developed functional specifications for application enhancements.
  • Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
  • Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 7 transactions.
  • Configured the Payer and Line of Business details into Facets to support claims payment and financial reporting.
  • Worked with development / technical team members to ensure that the enhancements would meet the defined business requirements.
  • Conferred with Business Users to Gather Requirements for the design and development teams.
  • Involved in exporting data from the database to flat files.
  • Facilitated Joint Application Development (JAD) sessions, as well as conducted interviews of appropriate business/technical stakeholders.
  • Microsoft Office (Outlook, Word, Excel, Visio, Access) at various phases of development for documenting the requirements.
  • Analyzed Business Requirements to produce System Requirements for the technical team using MS Visio.
  • Conducted Business meetings for the claims adjudication process and its work flow.
  • Identifying and documenting UML Use Cases with Use Case diagrams.
  • Work with business users to define Business, Process, and Data Models to understand the overall business.
  • Worked with developers to test the iterations of the system under development (SUD) to ensure it met the user’s needs.
  • Written and executed Test cases for the application when in (UAT) Environment.

Environment: MS Office, Visio, SharePoint, SQL, Rational Suite.

Confidential, Baltimore, MD

Business Analyst

Responsibilities:

  • Worked on analysis with the Facets claim processing application in order to gather requirements and comply with HIPAA 5010.
  • Analyzed and documented business requirements and detailed design for full understanding of the business; converted business requirements to functional specifications.
  • Worked with the lead BA to develop structured business requirements and functional specifications.
  • Performed gap analysis and identified the differences between the current product and the expected result.
  • Worked with Data Analysts to create Data Flow Diagram (DFD), Entity Relationship (ER) Diagrams, Use Case Diagrams, and user stories.
  • Worked with the solution architect in order to understand the existing data model and modify the data.
  • Executed SQL Queries for checking duplication in records.
  • Involved in various testing effort including Shakedown, Integration and UAT.
  • Conducted peer reviews and walkthroughs with business analyst, quality analyst, developers, managers and business end users.
  • Monitored client expectations through client involvement and communication throughout the lifecycle of the project, educated clients and stakeholders on the benefits and risks associated with the project.
  • Assisted Project Manager in handling the change control process.
  • Monitored project efficiently to complete on time and within budget with Project Manager.
  • Involved in meetings with the project manager, product manager, onsite teams, and offshore team members to discuss the status of the project.

Environment: Rational RequisitePro, MS SharePoint/Excel/Visio, Oracle SQL Plus, XML.

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