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Business System Analyst Resume

Parsippany, NJ

SUMMARY:

  • To join a team of competent, progressive and task - oriented professionals and to be a part of organizational growth and excellence by working in a challenging environment that welcomes creativity and enhancements of skills possessed.
  • Over 7+ years of diverse experience as a Sr. Business Analyst in developing and implementing innovative business processes with Healthcare industry.
  • Experience in preparing project proposals through all phases and activities of the project life-cycle process (SDLC preferred-AGILE with SPRINTS and SCRUM), project planning documentation.
  • Responsible for day-to-day project team communication and coordinated project meetings.
  • Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them.
  • Contribute toward the establishment and documentation of UX/UI patterns while designing new web product offerings.
  • Produce design deliverables including workflow diagrams, sketches at various levels of fidelity, and wireframes to demonstrate and test the UI and user interactions.
  • Document the results of design related meetings and design deliverables, involvement in user research activities.
  • Conducted JAD sessions, Gap analysis, and prioritized requirements using interviews, document analysis, and requirements workshops.
  • Experienced in documenting requirement using Unified Modeling Language (Use Case and Activity Diagrams) and building business Process Flow Charts.
  • Experience with Facets backend data model tables and frontend application module like Subscriber/Member, Claims processing and providers.
  • Experience in Data Quality and Data integrity.
  • Proficient in Data Warehouse testing like Control Mechanism of batch loads, Error/ rejected records processing, testing of SCD implementations and process dependencies.
  • Expert in organizing and managing all phases of the application testing process using Mercury Quality Center.
  • Strong understanding of test plans, test cases, test scripts and defects tracking/reporting.
  • Extensive knowledge of SQL queries and back end system integration testing.
  • Conducted User Acceptance Testing (UAT) and verification of performance, reliability and fault tolerance issues for web based and client/server applications.
  • Hands on experience working on health information in accordance to Federal Guidelines. Worked on inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
  • Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
  • Worked on audit needs on electronic enrollment process and reconcile data.
  • Extensive experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835, 820,270/271, 276/277).
  • Proficient in all phases of Requirement Management, including gathering, analyzing, detailing, and tracking requirements.
  • Requirements gathering in compliance with HIPAA 4010 and 5010 standard.
  • Experience in gathering and documenting test scenarios and ability to train users to translate technical requirements to a business and have experience in conducting UAT.
  • Worked on MMIS system, HIX, ICD 10 and MITA.
  • Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Enrollment, Provider, Commissions and Billing Modules of Facets.
  • Experience in Business Requirement and System Specifications Analysis.
  • Specialized in creating UML Diagrams like Use Case, Activity and data flow diagrams using Rational Rose and MS-Visio and consistently translate business requirement into IT solutions.
  • Extensive knowledge of reporting tools such as SQL and Access for underlying database tables and resolve data issues.
  • Facilitation of business and IT groups to lead organizational change required for issue resolution.
  • Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements.

TECHNICAL SKILLS:

Requirement Tracking: Rational Requisite Pro, Mercury s Test Director

Defect Management Tools: Quality Center, Rational Clear Quest, Test Director

Operating Systems: MS Windows NT/98/2000/XP, UNIX

Databases: Oracle, MS Access, DB2

Office Tools: MS Word, Excel, MS Project, MS Outlook

Methodologies: SDLC, RUP, UML, RAD, JAD.

UML Diagram Tools: Rational Rose / Microsoft Visio.

Requirement Tools: Rational Requisite pro, Clear Quest.

PROFESSIONAL EXPERIENCE:

Confidential, Parsippany, NJ

Business System Analyst

Responsibilities:

  • Reviewed and analyzed the business requirements document to derive the functional specifications document and assisted in the preparation of System Requirement Specifications.
  • Involved in Planning, Defining and Designing data based on business requirements and provided documentation. Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
  • Assigned tasks among development team, monitored and tracked progress of project following Agile methodology
  • Requisite Pro, Rational Rose, Agile, HL7 Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.
  • Exposed to Agile methodology
  • 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.
  • 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.
  • Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
  • 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, enrolment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • CMS and Medicaid Claims Processing Policies
  • IRS, CMS, HHSC, HEDIS reporting
  • Meets time sensitive deadlines from Medicaid health plans, state agencies, and CMS.
  • Work with Business area to translate CMS, state government regulations, and NCQA requirements
  • 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.
  • Worked with 837, UB92, UB04, CMS 1500 claims and HIPAA 835, 270/271, 276/277, 278 transactions
  • Experience in CMS and MMA Guidelines
  • Extensively worked in the performance tuning of programs, ETL procedures and processes.
  • Tuned the Performance for ETL jobs by tuning the SQL used in Transformations and fine tuning the database.
  • Scheduled the ETL jobs daily. Weekly and monthly based on the business requirement
  • Extensively used ETL to load data from different sources
  • EMR/EHR data knowledge from Epic Clarity, Allscripts, McKesson, Meditech, AthenaHealth or equivalent
  • Lead the analytical-interrogation of their EMR/EHR and/or claims data to perform data quality checks
  • Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
  • Ability to analyze engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production issue and using this as a training opportunity for other team members
  • Maintained Gitlab repositories, JIRA bug tracking system. Created custom JIRA workflows
  • Occupied in Logical, Physical design and Development of the DSR (Data Staging Repository) for the Database and AMS (Asset Management Reporting System) using Erwin.
  • Using FACETS for various health insurance areas such as enrollment, member, Products and other FACETS related modules
  • Analysis of inbound and outbound interfaces and extensions to FACETS claims processing system
  • Analysis and Design of the FACETS data model to ensure optimal system performance and tuning
  • Configured facets modules such as Claims, Membership, Billing, Benefit and plan
  • Worked on the FACETS configuration and tested claims processing modules for medical and dental claims
  • Gathering all system requirements for Business Intelligence, Data Warehouse
  • Interacting with Developers and SME (Subject Matter Experts) about HLD & LLD.
  • Assigned tasks among development team, monitored and tracked progress of project following Agile/Scrum methodology
  • Interacted with the business partners and database administrators to identify the business requirements and data realties.
  • Used SQL queries for Data Validation and Verification.
  • Worked on loading the benefits configuration data into FACETS table.
  • Analyzing the code, data and preparing the spec’s for Developers
  • Analyzing the system performance. Configured SQL mail agent for sending automatic emails when a SSIS package is failed or succeed.
  • Created Drill-through, Drill-down, Cross Tab Reports and Sub-Report using RDL.
  • Generated periodic reports based on the statistical analysis of the data using SQL Server Reporting Services (SSRS) & developed ad-hoc reports using SAS/SQL queries and MS Access and Excel.
  • Wrote Functional Requirement for configuration of Benefits, Provider and Claim processing.
  • Gathered requirements from the users and analyzed the requirements for RQ System, Facets etc.
  • Gathered and documented functional requirements for testing and verification of HIPAA.
  • Web Portal Development - Worked as a Business Analyst gathering requirements to develop a referral portal.
  • Designed, developed and tested data mart prototype (SQL ), ETL process (SSIS) and OLAP cube (SSAS)
  • Translated and transferred requirements from Business Requirements Document (BRD) to Functional Requirements Document (FRD).
  • Designed Activity, Sequence and Process Flow Diagrams using MS Visio to simplify and elaborate certain selection criteria and filter conditions.
  • 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: Facets, MS Visio, MS project, MS Word, MS Excel, UML, Oracle SQL Server, Dental PowerPoint, Rational Requisite.

Confidential, Marlton NJ

Business Analyst

Responsibilities:

  • Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
  • Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
  • Conducted user interviews and documented business and functional requirements.
  • Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
  • Defined, developed specs for federal reporting specific to Medicare Advantage
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
  • Provides interpretation of business rules and requirements for technical system upgrades while tracking progres.
  • Ensured enhanced processes and services are technically, operationally, and legally supported by analyzing and compiling business requirements solidifying successful implementation.
  • Strengthened risk mitigation techniques and improved process efficiencies while meeting stringent regulatory requirements.
  • Developed, coordinated, and implemented methodology and scope for multiple complex projects.
  • Utilized strong analytical and research techniques to identify gaps and inconsistencies within current measurement tools, allowing development of improved and cost-effective business models.
  • Collaborated closely with SMEs to identify and analyze core requirements and key features of the ongoing telecom, media and call center operations projects
  • Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
  • Coordinate changes with customers, vendors and users for EDI..
  • Track tickets related to EDI and provide periodic updates
  • Troubleshoot issues with EDI partners and transaction processes.
  • Work with CMS business owners to define their target goals and propose alternative business solutions
  • Provide technical, business, management expertise, and support the Department of Health and Human Services and Centers for Medicare and Medicaid Services \(CMS\) in building and maintaining a comprehensive enterprise architecture program
  • Experience in CMS and MMA Guidelines.
  • Created test data from claim processing for different FACETS Modules like hospital, medical and dental claims.
  • Experience on working with the Trizetto FACETS 4.31, 4.51, 4.71Data models.
  • Experience working with Health Care Client Server Product TRIZETTO/ERISCO FACETS
  • Maintained pricing configuration in Facets System for Medicaid, Medicare and Dual Eligible Products; creating new and updating existing provider contracts
  • Expertise in the EPIC Medical software application (EMR, HER) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
  • Currently leading, coordinating EMR/EHR (iHelix Suite) implementation to achieve meaningful use stage 1.
  • Performing business analysis, software validation and testing for client/server, multi-tier and web-based applications for EMR and commercial business for managed healthcare plans and Industries
  • Testing the accuracy of iHelix inpatient EMR for Stage 1 meaningful use clinical quality measure calculation by using Cypress tool.
  • Install, configure and maintain JIRA bug tracking system
  • Capture Feature/Function information at varying levels of granularity and document them in a requirements management tool (e.g. Microsoft TFS, JIRA, etc.)
  • Familiarity with a requirements management tool like MS Team Foundation Server, JIRA or the like
  • Helped lead the transition of Requirements Management in the Business Analyst Team to the agile methodology by creating and managing user stories and Requirements Traceability Matrices in the JIRA toolset.
  • Upgraded HMO Medicare EDI and reporting.
  • Completed the documentation of Claims Scenario’s for the source system
  • Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
  • Prepared for GAP Analysis; identified and documented improving areas to meet capital requirement regulations.
  • Documented Medicare claims processing.
  • Designed High level design, for New process, integrating with legacy and Facets
  • Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
  • Organizing JAD sessions, personal interviews and surveys in the process of collecting requirements including that of G.M.’s and other higher management
  • Exposed to Agile methodology.
  • Involved in Service Oriented Architecture (SOA) of the claims processing system
  • Created use case scenarios and documented work flow and business process using Rational Rose
  • Involved in project management using MS Project
  • Collaborated with External Auditors and documented SOX compliance requirements
  • Documented requirements, associated change requests with requirements and connected requirements with Use cases.
  • Wrote test cases and test scripts for the User Acceptance Testing
  • Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
  • Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
  • Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
  • Maintained benchmark controls to policies, company standards and contracts, performed vendor sourcing, pricing and contract negotiation, performed procurement, ensured compliance with service/joint interest contracts.
  • Used Rational Clear case for version control
  • Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
  • Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
  • Served as conduit for managing system requirements between the business and the software development team.
  • Queried database using SQL for backend testing
  • Used Rational clear quest for defect management

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential, Chantilly, VA

Business Systems 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.
  • Wrote functional requirements and use cases for back-end report website system,
  • Worked with web developer in optimizing functionality, labeling and usability of the website.
  • Interacted with client in gathering and managing website content.
  • Worked on various transactions like Claims (837), Healthcare Claim Payment/Advice (835), Benefit Enrollment (834), and healthcare Claim Status Request (276).
  • Worked with graphic designers and wrote text for digital branding guide.
  • Wrote online help text for interactive web pages.
  • Worked on Claims, Membership, Enrollment, Benefits and Data Validation.
  • 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.
  • Created presentations explaining the entire report development process, while drawing a comparison between the legacy & the new report.
  • Experience in analyzing the claims through EDI transaction sets 835, 834, & 837.
  • Identify possible solutions to EDI issues
  • Analyzed EDI X12 - 837I/P, 835 and 834 transactions consistency related to providers, payers, subscribers and other related entities
  • 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.
  • Prepared and maintained EDI maps for different EDI transactions
  • Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange EDI in 4010 and 5010 formats.
  • Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, HL7 Standards, HIPAA, PPACA(Patient Protection and Affordable Care Act), Compliance issues, LO INC and SNOMED Mapping, HL7 Message Validation, ICD 9, Electronic Health Records(EHR), Electronic Medical Record (EMR), Invision to Epic, E-gate Monitoring, Orion Rahposdy.
  • Co-ordinating/Managing ETL Offshore team
  • ETL Architect(Informatica and PL/SQL) /SME
  • Converting the Business rules into Technical Specifications for ETL process
  • Scheduled the ETL jobs daily. Weekly and monthly based on the business requirement
  • 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
  • Served as Healthcare Informatics Analyst for nation's largest touch screen and clipboard vendor with partnerships including various EMRs, GE PACs, GE Centricity, Imagecast Radiology, Meditech, Seimens
  • Report on project status to appropriate project management chain using Jira
  • Participate in projects when assigned infrastructure tasks in Jira
  • Document and track application failures and bugs using tools like Jira and Confluence.
  • 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.
  • Reported defects in Mantis Defect Tracking System.
  • Worked on Report Re-engineering Project and made enhancements to the system flow.
  • Modified System flow diagrams.
  • Tracked the defects in legacy reports as per account managers and end users. Compared the results and tracked the differences in excel.
  • Carried out UAT to make sure that the results were accepted by account managers and users.
  • Worked as a liaison between the Business and Technology Department.
  • Enhanced communication lines between executives, managers, and peers.
  • Conducted competitive analysis of features, functionality and usability of online report websites.

Environment: SQL Server 2000, Windows, Crystal Reports, Siebel, Oracle, Mantis Defect Tracking, UML, MS Office, MS Visio.

Confidential, Austin, TX

Business System Analyst

Responsibilities:

  • Perform a baseline assessment of Hospital-Provider systems and related interfaces, the existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA as well as ICD-10 requirements.
  • Have strong experience in requirements gathering by conducting interviews with end users
  • Actively worked on Data analysis and Report analysis with respect to ICD-10 impact
  • Assisted with training of associates on small enhancement processes; worked with ACES claims data for claims subject area, Enrollment and billing data for membership subject area
  • Conducting business validations covering the following deliverables: Facets Providers, Facets Claims and Facets Membership areas
  • Validated EDI X12 files for Connecture CNX and Center for Medicare System CMS using Ingenix Claredi and manually edited and fixed the errors to make it error free and ready for processing.
  • Thoroughly analyzed EDI raw data for transactions 834 in the 5010 format to verify the changes as per the 5010 format.
  • Worked with IT teams regarding EDI transaction such as 834, 837 as per the guidelines of ANSI ASCX12 5010 implementation guide.
  • Performed Gap Analysis for 5010 enhancement using the TR3 implementation guides and side-by-side HIPAA guides provided by CMS (Centre for Medicare & Medicaid Services)
  • Validated EDI X12 files for Connecture (CNX) and Center for Medicare System (CMS) using Ingenix Claredi and manually edited and fixed the errors to make it error free and ready for processing.
  • Expertise in validation of ETL process by writing SQL queries using complex joins and Analytic functions against Oracle & SQL Server databases. years of strong data warehousing experience using Informatica PowerMart 6.1/5.1/4.7, PowerCenter 8.x/7.x/6.x/5.1/1.7 as ETL tool
  • POC for Liferay,Canvas and Salesforce ETL move
  • Primarily responsible for ETL design, coding and testing strategy
  • Converting business rules into ETL technical specifications
  • Coming up with Design plan and Preparing the ETL Design document
  • Automating the ETL applications using Tidal tool
  • Provide EMR/EHR go-live support
  • Experience in EMR, EHR, and HIE data interfaces and standards
  • Lead the EMR interface project management
  • Technical experience working with EMR/EHR vendors and hospitals within a broad range of healthcare settings
  • Experience with Direct Messaging, HISP, HIE, and HER
  • AthenaOne system knowledge, or similar EHR/EMR
  • Reviewed extensive SQL Queries with complex multi-table joins and nested queries.
  • Experienced with BI Reporting Tools like SAS, Databases like SQL, Oracle.
  • Managed the entire UAT set up & UAT testing effort with the Business users.
  • Participated in weekly status meetings to present status and in corporate any digressions from the original scope.
  • Carried out a thorough target organization assessment and risk analysis.
  • Experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C & D, and FACETS 4.5/4.7 system, Claims Processing, Insurance Pricing and Claim Adjudication. Strong Experience in FEP (Federal Employment Program) and CDA (Clinical Development Analytics) . Healthcare Domain Knowledge with SQL knowledge (in Oracle environment) and 5010, ICD-10 experience.
  • Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS Visio.
  • Designed and implemented basic SQL queries for QA testing and report / data validation.
  • Worked with the clients on the final signing process in the User Acceptance stages.
  • Mapped the collected data with the existing data provided by the hospital departments.
  • Used Word, Excel and Visio as a working tool.
  • Involved in reviewing complex SQL queries, views, functions and stored procedures and spotting issues before/during code migration.
  • Hands-on experience and good understanding of the hospital working system including Registration, Scheduling, Radiology, Laboratory, Pharmacy, Patient Accounting, HIM, Claim Processing etc.
  • Met the deadlines and scheduled day to day meeting sessions

Environment: Facets, Oracle, HIPAA, EDI, Mainframe, XML, SharePoint, MS Word, MS Excel.

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