PROFESSIONAL SUMMARY:

• 7 years of experience as Service - oriented Senior Business / Eligibility Analyst with an extensive background in identifying business with State and Healthcare clients.
• Hands on experience with US health and welfare administration.
• Experience in Business Requirements Gathering, Application Design, Data Modeling, Development, Implementation and Testing of Client/Server applications, with a sound working knowledge in Data Warehousing/Business Intelligence Systems Health Care domain
• In depth understanding on handling every aspects of the project from requirement gathering, documentation to working with development team and test plan execution.
• Experience in ETL tools like Informatica 8.6.1 (Designer, Workflow Manager, Workflow Monitor).
• Strong experience in Data Analysis, Data Migration, Data Cleansing, Transformation, Integration, Data Import, and Data Export through the use of multiple ETL tools such as Ab Initio and Informatica.
• Experience in testing and writing SQL Queries, Stored Procedures, Functions, Triggers and packages.
• Extensive experience in Healthcare and well versed with HIPPA compliance, HL7 standards, CMS HCPCS.
• Worked on EDI 837, 835, 275, 270, 271, and ICD 9 and 10.
• Thorough understanding of healthcare industry including Eligibility, Enrollment, Benefits, Claims, Medicare, Medicaid and implementation of HIPAA key EDI (ANSI X12) transactions
• Experience in EDI transactions like 270/271, 834, 837 P, 835 and conversion of and ICD- 9 and ICD- 10.
• Experience with FACETS solution for healthcare and strong understanding of Managed Care such as HMO, PPO, & Long-Term Care.
• Well versed with HIPAA, FACETS claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Good Knowledge in Health Care Transaction, EDI HIPAA X12 transactions (837,835,834,270/271,276/277) Inbound and Outbound 837 Institutional, Professional, Dental and Pharmacy Claims.
• Experience in developers and advising technical groups on reporting best practices.
• Proficient in Requirement Management, including gathering, analyzing, detailing and tracking requirements.
• Specialist in developing User Interface (UI) design and ware framing.
• Extensive expertise in the writing and interpretation of Story Card, User Stories, Use Cases, Functional Requirements, Screen Specs, and Data Mapping Documents
• Experience in Laboratory Information Systems (LIMS), functional, integration, regression and user acceptance (UAT), system load and black box testing.
• Strong knowledge of the Software Development Life Cycle (SDLC) methodologies such as Water Fall, Agile, Scrum and RUP.
• Proficiency in orchestrating Joint Application Development sessions that bring all elements of the project together in an effort to maximize efficiency and outline vision.
• Proficiency in MS Visio in creating, analyzing and implementing business workflow diagrams including use case diagrams, activity diagrams, state diagrams, sequence diagrams, collaboration diagrams and deployment diagrams.
• In depth knowledge in SDLC involved in all stages from defining, designing, to developing, debugging and deployment of application.
• Expert in creating all sorts of business artifacts such as Business Requirement Document (BRD), Functional Requirement Document (FRD), Use Cases, UML diagrams, Data Mapping Documentation, Requirement Traceability Matrix (RTM)

TECHNICAL SKILLS:

Methodologies: Waterfall, RUP, Agile (Scrum and XP)

Project Management Tool: Microsoft Project 2008 and MS SharePoint, FACETS

Requirement Tools: UML IBM Rational Requisite Pro, Power Designer

Database Management: SQL, SAS, CRM, Suite, Tableau, MS Access, Informatica 8.6.1

QA Testing Tools: Quality Center, QTP, JIRA, ALM

Business Modeling Tools: MS Visio, Smart Draw, MS PowerPoint

PROFESSIONAL EXPERIENCE:

Confidential, Lincoln, NE

Sr. Business System Analyst

Responsibilities:

• Gathered Business Requirements from the Subject Matter Experts (SMEs) and documenting the requirements in the BRD.
• Interfaced with and interviewed cross-functional stakeholders to generate requirements.
• Analyzed, resolved and tracked discrepancies in the eligibility reconciliation process for multiple stakeholders.
• Help create and updated data mapping document (s) with to the source for 270/271 (Eligibility & Benefit Inquiry & Response).
• Responsible for the successful migration of eligibility data as well as taking a lead role on the testing and implementation of a new Electronic Eligibility file processing system.
• Updated EDI transactions like EDI 837, 835, 277 and 276.
• Tested new ICD 10 procedure and Diagnosis code in EDI 837 and file format.
• Conducted analysis of the HL7 transactions for accommodating changes made in the system so that HL7 transactions accommodate the gaps in the system.
• Created Wire Frames for the Nebraska Medicaid Eligibility System/portal used for checking member eligibility.
• Optimized process flow for NMES subsystem by using Business Process Management (BMP) techniques and create requirements for the IVR system for recipient eligibility.
• Worked alongside Testing Team to create test documents and strategic testing scenarios for User Acceptance testing and System testing for MPS1 (Provider Eligibility), NMES IVR and RFS6 Sub systems.
• Documented Current State vs. Future State for a Referral Web Portal. Create process flow diagrams describing provider and member access to the web portals.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and the performance of the application from various dimensions.
• Maintained Traceability Matrix Table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked.
• Coordinated and participated in daily scrum meeting to discuss any roadblocks or impediments in the project path
• Involved in sprint planning session to identify the features and functionalities that should be achieved by the new application
• Experience in relational databases such as SQL and MS Access.
• Documented the UAT Plan for the project and working with the UAT Team to ensure every acceptance criterion for the requirements has been included in the UAT task plan.
• Worked closely with the business team, development team and the quality assurance team to ensure that desired functionalities will be achieved by the application

Environment: Agile, JAD, MS Visio, MS PowerPoint, Excel, RTM, JIRA, SharePoint, MS SQL, MS Suite, SQL, Java.

Confidential, Ewing, NJ

Business Systems Analyst

Responsibilities:

• Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
• Organized and facilitated JAD sessions with the Business Stakeholders and the Users to define the Scope of the project and gather requirements
• Documented the requirements in the form of User Stories for the Provider Contracting and Credentialing side of the project implementation.
• Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.
• Assist in the requirements gathering of 837 Claims, 270/271 and testing of 837 (PID).
• Develop documentation of business requirements, technical specifications and implementation of various ETL standards in the mappings.
• Worked on Mapping documentation by using Implementation Guide for (LIMS), EDI HIPAA 834, 835, 837 (D, P, I), 277/278, HL7, and other Health Care Transactions.
• Worked on analysis of FACETS claims processing system and to gathered requirements to comply with HIPAA 5010 requirements.
• Worked on Data Mapping to map FACETS data to outbound eligibility extracts
• Coordinated the implementation of multiple front-end tools including PowerPivot, Excel interface for SSAS cubes, SSRS Reports and MicroStrategy.
• Performed Data Analysis and Data validation by writing SQL queries
• Documented the inputs from Gap analysis review and proposed solution for the future EDW and Reporting needs.
• Worked on HIPAA 5010, ICD9 / ICD 10 and EDIX12 transactions (837, 834, 835, 270/271, 276/277)
• Configured all the enquire types and response type benefits for 270/271 project in FACETS
• Involved in compliance with (LIMS), HIPAA 5010, HL7 and ANSI X12 format regulations to assure the privacy of individuals insured under the various policies.
• Actively involved in conducting meetings with the business to review and validate the User Stories and to modify the User Stories based on new business decisions and State compliance requirements.
• Worked closely with the development team to answer and clarify the understanding of the User Stories and in creating of the TRDs for PDMS (Provider Data Management System)
• Worked with UAT team to create Test cases for the Medical Management side in the different track areas- Referrals, Enrollment, Continuity of Care, Transitions, IDT/Appeals and Disenrollment
• Documented the Test Cases using Excel Spreadsheet and worked with the business users to validate and make modifications to the test cases as required
• Actively involved in data mining activities for the collection and verification of data integrity
• Worked closely with the UAT testing team and business users in the execution of the Test Cases for Medical Management.
• Worked in ClearQuest to log defects and for defect tracking, management and resolution.

Environment: Agile, JAD, MS Visio, MS Excel, MS Word, MS PowerPoint, SQL, ClearQuest

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Developed and implemented tactical DR documentation, including Application Profiles, Validation Test Scripts, and DR Runbooks, used to recover Epic, the client’s core ERP; these tools will be used to build DR documentation for their remaining SEV-1 applications and systems
• Extensively used Agile Methodology in the process of the project management based on SDLC.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, Object Oriented Design (OOD) using UML
• Performed Gap analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements
• Developed test cases and test scripts and assisted Quality Assurance activities, with system integration testing and user acceptance testing (UAT), developing and maintaining quality procedures and ensuring that appropriate documentation is in place
• Responsible for identifying and documenting business rules and creating detailed Use Cases
• Participated in the process of internal and external auditing activities and developed timelines for project delivery, and managed projects and resources to successful completion
• Involved in data dictionary management, extraction, transformation and loading (ETL) of data from various sources. Participated in ETL requirements process during data transition from source systems to target systems
• Developed DR testing documentation, such as a Master DR Runbook and a DR Test Timeline, for a live production role-swap DR Test
• Involved in Data Analysis & Mapping to track all data elements used in the application from the user interface through different interfaces to the target databases in which they are stored.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting
• Established Inner Join, Outer Join and created Indexes whenever necessary
• Writing Complex SQL queries and optimizing SQL Queries
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting
• Participated in creating logical and physical data models, their enhancement. Based on the data models, worked with business architect, to create the software solution models.
• Helped in creating of Data-Mapping best practices document including visual processes and trained team members on Data Mapping process and tools
• Worked with business users to generate sample reports using PL/SQL and Oracle Reports conforming to NCQA HEDIS industry specifications.

Environment: EDI, Java, MS Visio, MS SharePoint, MS PowerPoint, MS SQL Server, HP ALM, XML, MS Project.

Confidential, Philadelphia, PA

Business Analyst

Responsibilities:

• Developed project scope statements, business requirements document and functional specifications for all the projects.
• Determined eligibility benefits for customers with EDI Health Care Eligibility/Benefit Inquiry (270).
• Developed test plans to validate required functionality. Test plans were written with both positive and negative data to verify that only valid data was moved according to business rules.
• Extensively used ETL methodology for supporting data extraction, transformations and loading processing, in a complex EDW using Informatica.
• Worked on SQL statements against the Teradata tables in order to analyze data during the requirements phase. Also worked with data modelers to ensure new requirements worked into the physical and logical data models for the AEDW.
• Conducted data mapping from source files to AEDW tables to ensure data was mapped correctly. Worked with the data acquisition team to ensure data feeds (flat files) are interrogated and analyzed.
• Studded the issues of failing in the production or not working properly, explored the root cause and fix issues.
• Developed stored procedures for new FACETS interfaces and outputs.
• Created new and update FACETS security profiles as per the template provided by the clients.
• Analyzed the code changes for migration purpose. Also analyzed the effort and impact of merging the new code from changes done in production environment to the migrated environment.
• Contacted with Client to accommodate any new change in requirements as well to discuss the project status.
• Coordinated between the project group and the operations group. Helped design scope document and the request for proposal after extensive analysis and coordinated with top management for the approval process.
• Facilitated the customer in defining the high-level functional requirements and needs.
• Gathered the Requirements, Develop Process Model and detailed Business Policies and modified the business requirement document.
• Responsibilities involved product direction, including new platform, architecture enhancements and customizations.

Environment: Quality Center, SQL, MS Visio, FACETS, ClearQuest

Confidential, New York, NY

Junior Business Analyst

Responsibilities:

• Facilitated requirements gathering interviews with stakeholders.
• Analyzed and translated collected business requirements into detailed functional specifications
• Created Use Case, State Transition and Activity diagrams using UML modeling techniques
• Documented functional specifications including use cases, business rules, and screen specifications
• Analyzed required data-flow and created Data Dictionary catalog
• Collaborated with Graphic Designers and Medical Writers to create Story boards
• Coordinated UATs with Business Users for all releases, production defects and application enhancements
• Resolved and documented change requests and production issues
• Worked with the Quality Assurance team to design test plans and test cases that enabled the completion of highly effective product
• Created documentation for user manuals

Environment: MS-Visio, Excel, Access, MS Power Point, SQL, ClearQuest