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Senior Business Analyst/ Quality Analyst Resume

Boston, MA

PROFESSIONAL SUMMARY:

  • Conscientious, resourceful, detail oriented and result driven Business Analyst with over 8+ years of experience in Healthcare industry.
  • Possess Excellent interpersonal skills and experience leading cross - functional teams in development and delivery of process innovations driving a realization of business goals and skilled at interdepartmental coordination to maximize business functionality.
  • Over 8+ years of experience as a Sr Business Analyst in developing and implementing innovative business processes in Healthcare & Insurance Industry.
  • Adept knowledge about all the stages in a Software Development Life Cycle (SDLC) including the deliverables at all the stages: proficient with industry standard methodologies like, Waterfall, Agile, Scrum, Waterfall - Scrum Hybrid.
  • Sound knowledge of concepts like Gap Analysis, Risk Analysis, Impact Analysis, SWOT Analysis.
  • Excellent Business writing skills in writing Business Requirements Document (BRD),Functional Specifications Document (FSD), Systems Design Specification (SDS), Software Requirement Specification (SRS)
  • Thorough exposure of conducting JAD sessions and different elicitation techniques like; Brainstorming, Laddering, Surveying interviews with Subject Matter Experts (SME)and the stakeholders to get a clear understand of the business requirements, business process, business rules, and data requirements.
  • Conducted group meetings with the stakeholders and business owners for requirements gathering.
  • Facilitated JAD sessions to understand the business needs and the objectives of the project.
  • Was actively involved in documenting the requirements and converting the requirements into Business Requirements Document (BRD), Functional Requirement Document (FRD), Software Requirement Specification (SRS).
  • 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.
  • Have made Reviews and comments on "As Is" and "To Be" business process work flows.
  • Have experience in conducting requirements gathering sessions/ meetings by facilitating a group of Subject Matter Experts to elicit business requirements.
  • Provided EDI interfaces with Commercial and Government Insurance Payers that included Medicare and Medicaid.
  • Good knowledge in Claims Management Processing, Medicaid, Medicare, Centers for Medicare & Medicaid Services (CMS), Health Assessment Systems, Health Level - 7 Standards, HIPAA, ICD 9, PPACA (Patient Protection and Affordable Care Act), Compliance Issues, HL7 Message Validation, Electronic Health Records (EHR)
  • Well versed with the conversion standards of HIPAA and ICD-9 to ICD-10Codes. Exposure to HIPAA Compliance requirements and HL 7 standards. HIPAA Transaction and Code Sets (EDI 834, 835, 837, 270, 271, 276, 277, ICD-9, ICD-10), Electronic Health Record (EHR)/Electronic Medical Record (EMR).
  • Used MS Office extensively (MS Word, MS Excel, MS Access, MS Visio, MS PowerPoint, MS Outlook, MS Project) for performing calculations, creating graphs, analysis, presentation and documentation throughout the projects.
  • Performed Client handling and manage client requirements and relationship for the project along with Product owner (PO), Project Manager (PM), SME’s, Business Owners, Business Users, and stakeholders.
  • Proactively teamed with the PO to help in Prioritizing the Release Backlog and Product Backlog to achieve maximum Business Value, to vertically slicing the EPICS into user stories using the INVEST criteria
  • Experienced in Project Management i.e. in Designing of the product, Development of the product, Testing of the product and Implementation of the product
  • Domain Expertise in Health Care Insurance industry (Payer). Strong in-depth knowledge on Medicare, Medicaid, Pharmacy Benefits Management PBM, ICD 10 conversion, HIPAA and Healthcare reform initiatives.
  • Proficient in Developing and executing Test Plans, Test Case, FRD, TriZetto Facets 4.x and Medical Billing, Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
  • Efficiently handled projects across various functions in different phases of the Software Development Life Cycle.
  • Worked in Claims processing system for Pharmacy Benefit Management along with review, design and reconfigure of the FACETS in functional areas like , Claims, provider, Enrollment and Service.
  • Extensive knowledge in Data Migration using Data Warehousing basics, Migration from OLTP to OLAP cube using ETL tools such as Informatica Power Center and Data Profiling to design intuitive dashboards for Business Reports
  • Having good experience in writing SQL Queries. Wrote SQL queries using My SQL Workbench, and SAS Clinical SQL.
  • Worked in complete project life cycle of Analysis, Design, Implementation, Integration Testing, and Functional testing including; Unit Testing, Smoke Testing, Integration Testing, System Testing, Sandbox Testing, Black-Box Testing using Load Runner, Cucumber, Selenium, and Unified Functional Testing.
  • Reviewed Clinical Study Protocols, CRF Forms, Data Analysis Plan Documents, clinical applications in the pharmaceuticals, and collaborated with the clinical data management to Annotate the CRF’s and eCRF’s.
  • Has expertise in clinical information systems with experience in various clinical applications like Cerner Power Orders, Cerner Millennium Power Chart.
  • Good understanding of standards specific to Clinical Trials such as CDISC, SDTM, and ADaM, Experience in providing Clinical Study Reports, compliant with FDA guidelines in 21 CFR Part 11 for electronic submissions.
  • Proficient in SAS Macro language. SAS MACROS, SAS/SQL, SAS/BASE, SAS/STAT, SAS/GRAPH, SAS/ODS.
  • Expertise in creating prototypes and mock-ups for user interface designs.

TECHNICAL/ DOMAIN SKILLS:

Requirement Management: JIRA, Rally and Microsoft Office

Defect Tracking: Cucumber, LoadRunner, Selenium, UFT, Postman, Swagger, Test Director, QTP, HPQC

Query and Programming: SQL, HTML

ALM Tools: JIRA, Rally, MS Project, SharePoint

Databases: SQL Server 2008 & 2012, MYSQL, MS Access

Methodologies: Waterfall, Spiral, RUP, Agile (Scrum, SAFe), Scrum-Waterfall Hybrid

Reporting Tools: Tableau, PowerBI, Oracle Business Intelligence Enterprise Edition (OBIEE)

Querying Tools: Toad, Aginity Workbench, SQL Management Studio and Oracle SQL developer

Domain Knowledge: HIPAA, Medicaid, Medicare, Claims Management, HL 7, EDI Transactions, Payer, Data Services, Facets, Claims processing, Claims management etc.

PROFESSIONAL EXPERIENCE:

Confidential, Boston, MA

Senior Business Analyst/ Quality Analyst

Responsibilities:

  • Information regarding the current MMIS system, interfaces, and business processes was elicited during a JAD session. Brainstorming and Laddering sessions were also conducted to elicit specific information.
  • Worked closely with Business Directors, Project Managers in various business areas to gather, analyze and document the requirements and supported the project manager throughout the development lifecycle.
  • Interviewed the stakeholders from different departments to identify their current needs and understand their Current Workflows and Ideal Workflows, to created process diagrams documented As-Is and To-Be business processes.
  • Created Business Requirements Document (BRD), Systems Requirements Specification (SRS), and Requirements Traceability Matrix (RTM) with the assistance from the business group and IT team members.
  • Worked with the system architects in understanding and designing the User Interface as per the stakeholders needs by preparing a systems design document. Helped in Developing Functional and Technical Design Specifications
  • Conducted Impact Analysis when there is any change in requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
  • Experience with Patient Billing, Payer Compliance, Payer Reporting and Analytics.
  • Used Rational Requisite Pro for managing the project requirements comprehensively to promote effective communication amongst the team members and reduce the risk.
  • Created Use Cases to define the role of the users who receive claims, users who process claims, and users who adjudicate claims. Used MS Visio to develop Use Case Diagrams, Activity Diagrams.
  • Performed Gap Analysis for HIPAA P and 835 transactions and HIPAA P and835
  • Conducted Use Case reviews and identified gaps leading to improvements/enhancements in the same
  • Worked with HIPAA Team for the implementation of X12 ANSI 270/271 and 276/277 Companion guides for Pharmacy and Dental claims. Cross-functional team member in the implementation of the ANSI X12 involving 837 HIPAA compliance and 835 Remittance Advice.
  • Wrote Test scenarios and Test Cases for testing the migration of EDI HIPAA and the processing of member enrollment and benefits, batch jobs corresponding to the claims 837 and real time transactions.
  • Recorded Tracking System Defects in Rational Clear Quest. Wrote Test Scenarios, Test Cases and executed them.

Environment: Waterfall - Hybrid, MS Visio, UML 2.0, MS Office Suite, MS SharePoint, FACETS, Test Director, UML, SQL, Rational Requisite Pro, Rational Clear Quest

Confidential, Bethesda, MD

Senior Business Analyst/ Quality Analyst

Responsibilities:

  • Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
  • Used Microsoft Office suit to develop the documents such as Visio for creating wireframes, Word, Excel and PowerPoint for creation of Business Requirement documents.
  • Supported PMO by mentoring specific projects in application of the new SDLC based on the Agile, especially from the project management, requirements and architecture perspectives.
  • Prepared Test plans, Functional Test cases and executed the test cases in Quality Center.
  • Involved in the black-box testing of the Healthcare application and identified the different test cases for regression testing.
  • Involved in Regression testing of each build during the various phases of the application using QTP.
  • Tested and delivered Inbound/Outbound Facets interfaces.
  • Used to execute test cases for several transactions such as 837, 835, 820, 834, 277, 278, 270/271.
  • Created Logical and Physical Test case for Step-Up and Step-Down EDI Transactions for 4010 and 5010.
  • Created EDI Export and Import processes and work with EDI Trading Partners, Payers or Vendors.
  • Reported defects and maintained Test Cases in HP Quality Center.
  • Used HIPAA 5010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDIs 837, 835, and ICD-10 code sets.
  • Recommend on implementation of HIPAA 5010 (EDI X12 837,834, 820, 278,270,999) in the new System.
  • Performed GAP analysis for EDI transactions such as 837, 834 to support state specified X12 5010 file formats.
  • Gathered requirement on FACETS EDI 834 Benefit Enrollment and Maintenance subsystems.
  • Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
  • Executed Test cases manually by composing 270, 276, 837 EDI files and dropped inbound and check response 271, 277, 835 using interleaves and outbound.
  • Used Query Analyzer, Execution Plan to optimize SQL Queries.
  • Ensured that relevant UML diagrams and tools were used in all requirement documents and prepared Use Case Models, Flow Diagrams, Sequential Diagrams in MS Visio.
  • Conducted Requirements & Impact analysis for doing ad-hoc mass changes to data as requested by business.
  • Developed several detail and summary reports including line and pie charts, trend analysis reports and sub-reports according to business requirements using SQL Server Reporting Services (SSRS).
  • 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.

Environment: Hybrid, MS Project, MS Excel, XML, HTML, MS Office, SharePoint, MS Visio, FACETS, EDI, HIPAA, FACETS, Black Box, Regression, UML, SQL, QTP.

Confidential, Columbus, GA

Business Systems Analyst

Responsibilities:

  • Created a relationship with the project team, customer interfacing including Line of Business LOB and interface partners to discuss the As-Is System and develop the To-Be System concept after client interviewing
  • Was responsible for defining the scope and implementing business rules of the project, gathering business requirements, and documentation by eliciting information from the business users and potential stakeholders.
  • Successfully conducted JAD sessions which helped synchronize the different stakeholders, SME’s on their objectives and helped the developers to have a clear understanding of the project and its progress
  • Was responsible for writing the Functional Requirements Document (FSD) and User Requirement Specification URS.
  • Created flow charts and process flow diagrams including Use Case Diagrams, Class Diagrams, Activity Diagrams, to show the interaction of the user with the system in an effective manner using BPMN, and MS Visio
  • Good knowledge of HIPAA ASC X12version 5010Guidelines. Advised changes for the overall system architecture; system design, procedures, and workflows in compliance with HIPAA/EDI formats to the development team
  • Coordinated with the clients, Subject Matter Experts and developers in successfully resolving the action items.
  • Designed and maintained the Requirements Traceability Matrix (RTM), User Story Management using JIRA
  • Successfully maintained and updated SharePoint site with the project documentations based on the progress.
  • Assisted the Web Services team in documenting requests and responses for the REST Web Services in JSON; Worked on Service Oriented Architecture (SOA) mainly on REST Web Services and executed them.
  • Manually tested and executed the Web Services using Postman and helped the Quality Analyst Team in automation of the REST Web Services Testing using Selenium tool. Assisted the Web Services team in documenting API’s
  • Responsible for managing the scrum process with the coordination of the scrum team in an Agile methodology.
  • Gathered and analyzed business requirements for the database systems.
  • Assisted the QA team in creating Test Plans, Test Cases and performed UAT User Acceptance Testing, Functional Testing and logged defects into Defect Tracking Report
  • Conducted presentations of the QA test results to the stakeholders and users and documented modifications and requirements.

Environment: s: Hybrid-Agile, MS Office Suite, SharePoint, MS Visio, MS Project, UML, JIRA, JSON, REST Web Services, XML, SOA, BPMN, Load Runner, Selenium, Postman

Confidential, Stamford, CT

Business Systems Analyst

Responsibilities:

  • Performed gap analysis for HIPAA P and 835 transactions and HIPAA P and 835 transactions.
  • Involved in impact analysis of HIPAA and 837P transaction sets on different systems
  • Defined requirements for Facets configuration modules such as Claim,, Billing, Benefit and plan
  • Work closely with EDI to ensure accuracy in data transmissions and shared processes. Transaction sets processed (837P, 835, 834).Created flow charts and process flow diagrams including Use Case Diagrams, Class Diagrams, Activity Diagrams, to show the interaction of the user with the system in an effective manner using BPMN, and MS Visio
  • Good knowledge of HIPAA ASC X12version 5010Guidelines. Advised changes for the overall system architecture; system design, procedures, and workflows in compliance with HIPAA/EDI formats to the development team
  • Assisted offshore QA team in creating Test Cases, Test Plans and strategies to ensure that business requirements were being addressed and tested.
  • Coordinated user acceptance testing (UAT) and provided biweekly updates to management on progress, issues and actions.
  • Experience in X12 EDI Transactions (834 enrollment, 820 payments, 270/271 eligibility/response, 837I and 837P institutional and professional claims, 835 Healthcare Claim Payment Advice, 277CA Claim Acknowledgement, 999 transactions)
  • Experience with EDI HIPAA conversion
  • Coordinated with the clients, Subject Matter Experts and developers in successfully resolving the action items.
  • Deep knowledge of Healthcare business processes and EDI infrastructures
  • Experience working with EDI standards (e.g., ASC X12, NSF, HL7).
  • Involved several working sessions and much 'offline' research/documentation with the key stakeholders and SME's from the Pharmacy department.
  • Involved in generation and execution of SQL queries to understand the processes used by the pharmacy department.
  • Assisted the QA team in creating Test Plans, Test Cases and performed UAT User Acceptance Testing, Functional Testing and logged defects into Defect Tracking Report
  • Conducted presentations of the QA test results to the stakeholders and users and documented modifications and requirements.

Environment: s: Hybrid-Agile, HIX, MS Office Suite, SharePoint, MS Visio, MS Project, UML, JIRA, JSON, REST Web Services, XML, SOA, BPMN, Load Runner, Selenium, Postman

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