- Results - driven, versatile consultant with over 5+ years’ experience as a Business Analyst.
- Specialized in Healthcare, Insurance, Risk and Compliance, Document management.
- Good knowledge of Business Analysis methodologies, Iterative and Incremental Software Development Life Cycle (SDLC) using Rational Unified Process (RUP).
- Proficient in gathering business and technical requirements from both formal and informal sessions through interviews, NetMeeting, questionnaire, video conferencing, JAD sessions and conference calls.
- Strong knowledge of Use Cases, Sequence Diagrams, Collaboration Diagrams, Activity Diagrams, and Class Diagrams.
- Extensive hands-on and HealthCare management experience in a variety of projects involving the customization, design, development, implementation, and testing of automated systems to support the Medicaid Management Information System (MMIS) as well as day-to-day business operations.
- Hands on knowledge of various Health Care standards/requirements like HL7, CCHIT, Meaningful Use & Stimulus Program, HITSP, PQRI, HIE, CQM, DICOM, ISO, IEEE.
- Experience in developing Test Plan and Test Cases as per the business process requirements to match the functionality requirements and UML diagrams.
- Possess very good organizational skills, with the ability to multi-task and deal with shifting priorities.
- Experience in Claims Processing, Claim encounters and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
- Experience in EDI (270,271,835,834,837) transactions.
- High-level understanding of a health care claims processing system such as MMIS.
- Sound analytical and problem solving abilities.
- Worked on healthcare standards such as HIPPA 4010, 5010, DICOMM, CPT, ICD-9 and SOAP.
- Expertise in ICD-9 to ICD-10 Conversion.
- Working knowledge of healthcare Technology standards such as HL7, ANSI ASC X12, IHE XDS/XDM, HITSP, CCR (continuity of Care Record), CCD (Continuity of Care Document), NCPDP Script 8.1, ELINCS, and CDA.
- Worked on various Professional billing and Hospital billing products.
- Experience in working with HHS, CMS or Medicaid Programs, RHIOs, IHDNs.
- Knowledge on medical necessities, software validation and healthcare compliance auditing.
Methodologies: RUP, Agile, CMMI, CMM, Six Sigma, OOAD, UML, Business Modelling, Process Modelling and Data Modelling.
Office Tools: MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, MS Outlook, Lotus Notes.
Process/Modelling: MS Visio, Rational Rose, Rational Requisite Pro, Smart Draw, Clear Case, Clear Quest.
Testing Tools: Test Director, Quality Centre, Win Runner and Selenium
Operating Systems: Windows 7, Vista, NT/2000/2003/ XP/98
Quality Management: HIPAA, CMMI, CMM, Six Sigma, TQM
Languages: C/C++, Java, SQL, PL/SQL, HTML, XML
Database: MS Access, SQL Server 2000, Oracle 9i & 10g, Teradata
Other Tools: Macromedia Dream Weaver, Macromedia Flash and Adobe Photoshop.
Sr. Business Analyst
- Extensive experience in Conducting Market Research, Feasibility Studies, Data Analyses, System Analyses, Gap Analyses, and Risks Analyses.
- Gathering market data including real time and historical price data, financial data, and trading news using financial data source named Bloomberg.
- Responsible for gathering requirements from users in operations group and performing data mapping for the application, confirm and vacillating the requirement at time of BA testing.
- Solid Experience in developing Scope/Vision Documentation and Project Plan, as well as tracking Project Process, and manage resources to ensure successful delivery
- Deep understanding the Business Flow of Investment Banking, and extensively involved in Portfolio management and analyses, Mutual Funds, Securities trading.
- Developed test plans with QA team and helped test every scenario using Mercury TestDirector Tool for system testing
- Efficient use of MS Project for planning and status reporting.
- Deep understanding of Structured System Development Methodologies
- Collaborated with External Auditors and documented SOX compliance requirements
- Assisted Project Management in developing Scope/ Vision Documentation and Project Plan, tracking project process, and developed Risk Mitigation Plan
- Extensive success in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) in an SOA environment.
- Researched, Analyzed, designed, developed Java Web Services Service Oriented Architecture (SOA).
- Worked extensively in Data Analysis, Data Reconciliation and Data Mapping for ETL process
- Used MS Visio for Process modelling and Business Process flow diagrams.
- Facilitated mini JAD sessions to assess and refine business, functional and system requirements for TANF, Food Stamp and Child Care program enhancements/development
- Met with stakeholders to identify requirements to modify Federal TANF reporting system.
- Used SoftTest software with pseudo code to ensure test cases covered all branches of project's code impacting the system. (The system is an IBM mainframe based system that contains the master set of customer information used to bill customers.)
- Set up market data including zero curves, correlation matrices, dividend curves, etc., and the underlying financial instruments and then set up derivatives pricing parameters and trade capture options that drive the valuation of trades based on the market data to configure and test the system
- Ensured that the Reference data repository was setup in case of emergency or unavailability of data.
- Solid experience in calculation of the Greeks (Delta, Gamma, Vega, Theta and Rho) in the simulation test of the system.
- Solid Experience in Collection, analyses, and documentation of User Requirements, as well as Organizing interviews, User meetings, workshops, JAD sessions and requirement elicitation sessions
- Proficient in creating Use Cases, Use Case Diagrams, Activity Diagrams etc.
- Expertise in development of High level design, Conceptual design, Logical and Physical design for Database, Data warehousing and many Distributed IT systems
- Assisted business users in identifying functional gaps, and developed detailed FSD for the gap
- Developed test plans with QA team and helped to develop test cases for system testing, integration testing and performance testing.
- Conducted UAT to confirm that all derivative products can successfully processed during the trade life cycle
Environment: Rational Requisite Pro, Clear Quest, Diamond, Facets, ASP.NET, VB.NET, C#, SQL SERVER 2000, IIS, XML, Mainframes TSO, JCL, DB2, MS Visio, Cobol, CICS, MQ Series, Facets, Lotus Notes, SOAP UI,UNIX, Windows 2000, Mercury Quick Test Pro*, Quality Center.
Confidential, Atlanta, GA
Business System Analyst
- Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
- Prepared the Business Requirement Document (BRD) and System Requirement Document (SRD).
- Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
- Manage the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios. Modeling of the business and application using Rational Unified Processing (RUP) and Unified Modeling Language (UML).
- Performed Gap analysis and assessed risks of the project.
- Gathered Requirements through interviews and JAD sessions with business owners.
- Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives
- Facilitated Provider Enrollment, Setting up Provider profile & Trading Partner Agreement.
- Set up Provider's Access to the System. (Security Setup).
- Helped creating Provider Reports i.e. Financial, Claims processing.
- Prepared the Business requirement Document for the enhancement of the existing services.
- Wrote FRDs for the defects and enhancements and got approval from business for the developers.
- Worked on Technical Design Documentation (TDD) of the claims processing system.
- Used Microsoft Word, Excel, Access, Project and Visio as working tools.
- Performed task estimations and documentation of procedures.
- Designed, prepared and implemented test cases for system testing as well as for User Acceptance testing.
- Involved in the testing of web portal of New MMIS system.
- Conducted integration testing and regression testing with developers in development and QA, also conducted user acceptance testing with UAT team. Safety reporting on system-based projects, acted as a liaison, writing documentation and increased project coordination.
- Analyzed and documented system release/deployment issues according to version management, backward compatibility, load balancing of components in production environment.
- Did impact analysis for changing requirements and coordinated with business users for prioritizing the testing/release of the changes.
- Maintained a very close interaction between business users and developers to avoid any gaps in understanding or implementation of requirements.
- Performed SQL Backup and Restore tasks on Various SQL Servers.
- Ensured different internal & external systems exchanged data according to the specification to transform data from enterprise data warehouse to SQL Server & load data to fact tables.
- Deployed Reports for Internal, Departmental & Executive Reporting based on the requirements using SQL Server Reporting Services.
- Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
- Performed Risk Analysis based on defect severity and priority.
- Tested User Interface inconsistency and application functionality.
- Developed Reports and Graphs to present the Stress Test results to the management.
- Created BPR charts for AS IS and TO BE processes of different business functionalities.
Environment: Windows XP, SQL, MS Visio, MS project, MS Word, MS Excel, Rational Rose, Requisite Pro, Clear Quest, UML, Axure, Java, Agile.
- 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
- 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