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Healthcare Business Analyst Resume

Philadelphia, PA

SUMMARY:

7+ years of experience as a Business Analyst in Healthcare/Life science industry that accepts the responsibilities to support both external clients and internal management. Broad understanding of healthcare data like Claims, Clinical data, Lab results data, Provider data, Pharmacy drug/ prescribers' data, FDA AHFS Drugs details, quality metrics and health outcomes. Capable of analyzing problems and designing recommendations including workflows processes and procedures.

SKILL:

Project Management: MS Project, Excel spread sheets

Project Methodologies: Waterfall, Agile, RUP, V Model

Business Modeling Tools: MS Visio

Business Models: Class Diagrams, Use case Diagrams, State Transition, Diagrams, Sequence

Diagrams, Activity Diagrams:

Desktop software: MSOffice, MS Word, Power point, Adobe Acrobat, MS Project

Requirement Management Tools: Caliber RDM, Caliber RM, SharePoint

Web Tools: Front Page, Photoshop.

RDBMS: MS SQL Server 2000

Defect Tracking Tools: JIRA, HP QC - ALM

Operating Systems: Microsoft Windows XP, vista7, Mac OS X

Databases: MS SQL Server

Test Tools: HP QC, Bugzilla, and Mantis

WORK EXPEREINCE:

Confidential, Philadelphia, PA

Healthcare Business Analyst

Responsibilities:

  • Played an active and lead role in gathering, analyzing, and writing business requirements
  • Project was implemented in phases, enabling system to deliver as many business requirements as early as possible
  • Involved in Requirement Scoping and analysis of high priority requirements for implementation
  • Involved in HIPAA EDI transactions such as 270, 271, 837 (P, D, I), 276, 277, 834, 820, 278, 999/TA1, and 277 CA
  • Evaluated Medicare requirements and benefits in Medicare Health Plans for member enrollment and management
  • Coordinated, implemented and provided on-going support of the Quality Performer as outlined in the Specifications
  • Manual for Well Care Inpatient Quality Measures Centers for Medicare & Medicaid Services (CMS)
  • Used HP Quality Center for writing Test plans and Test Cases
  • Worked on documenting business rules to be defined in the business rules management engine (IBM ODM
  • Participated in requirements meetings, writing requirements and converting requirements from Caliber RM to HP Quality Center
  • Working knowledge of implementing software development projects using methodologies such as Waterfall, RUP, and Agile Scrum
  • Used HIPAA guidelines and regulations to keep track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment
  • Worked closely with business team, and identified, analyzed the core requirements and key features of the ongoing project. Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD)
  • Developed Software Requirement Specification (SRS) document using Visio and MS Office
  • Loaded the defects on to HP Quality Center and maintained a track record of the updates on the defects from the development team
  • Executed Test Cases Manually, once the application is stable and documented the successful or unsuccessful completion of each test case in HP Quality Center (QC) for End-to-End Scenario based testing
  • Worked on Agile SDLC during the project phase, performed the role of Product Owner and Team member in Scrum Meetings
  • Participated in agile process - planned iterations, created tasks, assigned tasks to quality assurance team based on the priorities and estimated capabilities of quality assurance team for every iteration
  • Involved in Scrum development process and prepared Sprint burn down chart, product catalog and sprint backlog contain Business Requirements and supporting documents that contain the essential business elements and definitions as well as the tasks to be completed
  • Responded to billing inquiries from patients and payers

Confidential, Nashville, TN

Healthcare Business Analyst

Responsibilities:

  • Interacted with business users and performed Gap Analysis of Client requirements
  • Provided Support to business both in Person and Remote via Jabber.
  • Worked in the agile methodology and participated in the daily scrum meetings.
  • Worked under Agile methodology attending daily standup calls with 2- week sprint timeline which were tracked with JIRA.
  • Coached and developed a distributed team of business managers and technical professionals regarding Agile roles, routines and responsibilities resulting
  • Involved in gathering requirements for developing custom features and components within MetaVance
  • Gave access to end-users for Acceptance Testing and sent defect reports to developers.
  • Completed the documentation of Claims Scenario's for the source system. Analyzed the existing claims process and specific business rule logic
  • Implemented Agile Scrum methodology guidelines to build artifacts in different sprints and phases of the application development process.
  • Identified and eliminating redundancies within the business workflow processes.
  • Identified system/application data sources, data integration and data flow processes
  • Worked under Agile methodology attending daily standup calls with 2- week sprint timeline which were tracked with JIRA.
  • Manual for Inpatient Quality Measures Centers for Medicare & Medicaid Services (CMS)
  • Provided data integrity strategies and solutions to eliminate any disruption of business and to move changes into a production environment.
  • Prioritization of customer value streams based on scaled agile principles of shared software services, continuous integration, and continuous delivery.
  • Educated and reinforce Scrum methodology and Agile framework to team members and key stakeholders when needed.
  • Performed UAT User acceptance Testing, ATDD Acceptance test driven development
  • Conducted several levels of testing including functional regression user acceptance integration and performance to verify the client needs are met.

Confidential

Jr. Business System Analyst

Responsibilities:

  • Performed a BSA role in Healthcare Informatics and Prescription Drug Management (PBM/Life Science) for Chronic Disease Care Management, Chronic Disease Risk Adjustment, Interventional Care-Management Module, Invasive Cardiology Care Management and Antidepressant, Antipsychotic, Antibiotic Prescription drugs.
  • Created Utilization reports (Life science) for Antidepressant, Antipsychotic and Antibiotic Prescription drugs with frequencies of Monthly, Weekly and Quarterly based on NCQA DUR specifications.
  • Involved in conducting Root Cause Analysis and GAP Analysis - Invasive Cardiology, statins & Sovaldi Drug cost analysis. In details to see why Insurance company have sudden spike in HEP C class drugs payments. Also compared their medical and pharmacy cost to see the trend of patient cure vs cost investment for 4 quarters.
  • Strongly involved in researching details and developing Work flow Diagram, Process flow diagram and Data flow diagram using MS Visio specific for the medical device which helps to reduce inpatient hospital stay for the cardiac patient. Strongly conducted this project with FDA approved medical device manufacturer in Canada to bring this device in USA market to identify their pros and cons. Conducted this team to IBC place for their presentation & explored the vision of purpose to the IBC's higher organization.
  • Created Software Development Lifecycle (SDLC) deliverables Business Requirement Document (BRD), Functional Requirement Document (FRD) and Requirements Traceability Matrix (RTM), during pharmacy claims data migration from HMK to IBC database systems.
  • Executed Server Query Language (SQL) queries on SAS for data extraction from Active Enterprise Data Warehouse (AEDW) healthcare database for HealthCare Analytics purposes. Mostly worked with pharmacy department for supporting drugs cost analysis, high cost marketed drug analysis, specific therapeutic class (AHFS for HIV, Migraine, Statins) analysis.
  • Created System documents for developers to create java-based web, i-pad, and smart phone application (Lab Alert Rx) development.
  • Also involved in creating presentations for project meetings based on real information, including PMPM Cost model, Health care Database, Claims, etc

Confidential

Intern Dentist/ President

Responsibilities:

  • Performed data-driven analysis to help implement the program that reduced the wait times of patients in the OPD.
  • Collaborated with the administrative department to implement al programs that promote evidence-based treatment modality and system compliance.
  • Acted as a patient navigator by promoting patient in relation to various treatment interventions.
  • Organized Live-in Concerts, International, National and Celebrity sport events and several fund-raising events.
  • Drafted Grants to generate funds through donations from corporate and political sectors to expand the institution’s revenue.

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