SUMMARY:

• Around 8 years of Experience as Business System Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis, and Joint Application Development (JAD) sessions with clients and referring to accessible documentation and procedure.
• Experience in Agile (Scrum) and Waterfall SDLC methodology software development.
• Experience in configuration of claims adjudication systems, i.e., Facets.
• Understanding of Trizetto’s core Facets product and knowledge of using Facets Data Dictionary.
• Experience in all phases of software development life cycle (SDLC), including Requirement gathering and documentation, Analysis and Design, Quality Assurance, Testing and End user support working as Business Analyst mainly in Healthcare sector.
• Efficient in writing Business Requirements Document, Use Case Specifications, Functional Specifications and Workflows, and slicing Feature into User stories.
• Extensive Knowledge of Medicare/Medicaid procedural and diagnostic codes.
• Extensive Experience in Functional, Integration, Regression, User Acceptance (UAT), System.
• Knowledgeable working with ETL process (Extract, Transform and Load) of data into (EDW) Enterprise Data Warehouse.
• Contributed analysis of ETL jobs to pull dental historical claims data from EDW into target table in Custom DB
• Experienced in client interaction, deep understanding of business systems functionality and technicality.
• Proficient in Developing and executing Test Plans, Test Case, & Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
• Knowledgeable about preparing RTM documents.
• Experienced in performing Gap analysis by identifying existing technologies, documenting the enhancements to meet the end - state requirements.
• Created maps & layouts for HIPAA as imposed during Electronic Data Interchange (EDI): 837 - Claims and Encounters, 834 - Benefit Enrollment and Maintenance, 835 - Claim Payment/Advice
• Excellent business communication and presentation skills. Adapt at creating, editing, and coordinating extensive communication networks, to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.

TECHNICAL SKILLS:

Business Tools: MS Visio, MS Project, MS Access, MS Office Suite

Business Skills: Business Definition Requirements, Business Process Analysis, Gap Analysis, Use Case Modelling & Analysis

Methodologies: Agile and Waterfall

Testing Tools: HP ALM/Quality Center, JIRA

Databases/Tools: Oracle, Access, MS SQL Server, Teradata, Toad, TFS

EXPERIENCE:

Confidential, Nashville, TN

Business Systems Analyst

Responsibilities:

• Currently working with a fast-paced teams creating Features under Epics, writing User stories, creating Tasks, grooming the stories and mapping S to T documents with multiple Delivery teams.
• Supported Scrum master/ Product owner in sprint planning and prioritize stories in backlog.
• Worked as a Pod Lead to guide and provide updates to Pod Product and Delivery team.
• Proactively participated in system Architecture and Data modeling meetings to understand and advice on Future state, based on existing current state of the system.
• Help communicate business priorities to the organization to effect business solutions
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
• Responsible for testing ITS claim functionality within QNXT for all lines of business.
• Involved in gathering clinical data and supported application development. Data includes patient’s admission status, discharge details and transfers. Also tested claims and diagnosis reports of the patient
• Prepared FSDs and designed new enterprise Source to Target Mapping Document
• Facilitated JAD sessions to capture technical details into the mapping document.
• Performed Data profiling to validate required data with Product and Delivery team
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Tested conversion activities to ensure proper convert of claims and enrollment from legacy system to QNXT.
• Prepared Business Process Models that includes modeling of all the activities of business from the conceptual to procedural level
• Translated and implemented business requirements and project components into the Medicaid Management Information System (MMIS).
• Analyzed and reviewed the claims processing in QNXT and monitor the efficiency, and auditing of the claims and process.
• Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests. Implemented and monitored Individual Development Plans focusing on total performance, including both quality and productivity.
• Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction. Populated ICD EDI X-12 transaction sets 835, 837, 270, 271, 276 and 277 responsible for Claims processing, coordination of benefits and pricing process
• Used Tableau as a Business Intelligence Reporting tool to generate dashboards and ad-hoc reports.
• Documented the Functional Specification for ETL and reporting requirements.
• Wrote Test Cases, performed unit testing and integration testing
• Monitored client expectations through client involvement and communication throughout the lifecycle of the project; educate clients and stakeholders on the benefits and risks associated with the project.
• Worked with the Quality Management team to ensure that requirements documentation can be easily translated into test plans and ensure that the proper testing plans have been completed.
• Tracked and validated use cases in TFS as UAT before the data flows to Production so that application functions as required.

Confidential, Tampa, FL

Business Systems Analyst

Responsibilities:

• Assisted in writing Business Requirements Document and Use Case Specifications, writing Functional Specifications and Workflows, and slicing Feature into User stories
• Created use-case scenarios and storyboards in MS Word and MS PowerPoint for better visualization of applications as well as developed Traceability Matrix in Excel
• Proactively participated in SIPOCR, BRD, FSD, CR Work sessions, Quality Analysis and User Acceptance Testing
• Developed and delivered Data mapping, logical data modeling, created class diagrams and ER diagrams, and use SQL queries to analyze data
• Worked closely with Business Intelligence team Developers in analyzing and understanding the current state of systems so that desired state is met as per business requirements
• Facilitated JAD sessions with business and technical stakeholders to fine tune, prioritize and detail requirements and, as a Scribe, prepared MAR (Meeting Action Record) for takeaways and follow-ups.
• Facilitated working sessions with Lead Developers from multiple teams (IBR, BI, EDI) so that clean data transferred Source system through Target systems as per the business requirement
• Provided pseudo code and business rules to Lead Developers as requested by the Provider Portal business/end users and validated SOAP request and response in XML format using SOAP UI
• Analyzed and validated inbound/outbound EDI (X12) 837, 834, 820, 835, 276, 277 transactions from multiple sources to generate internal and externals reports as defined by business rules
• Worked closely with Data Warehouse Lead Developers to evaluate impact on current implementation, redesign of numerous ETL logic
• Used SQL Queries in MS SQL and TOAD for Data validation, extraction, Ad hoc data analysis, test various reports and ETL load jobs in DEV, QA and PROD environments
• Participated in the bug review and defect meetings, updated requirement document as per business user feedback and changes in the functionality of the application.
• Worked with testing team to create the testing scenarios, Queries and helping them to understand the logic
• Involved in generating Test Plans and Test Specifications as per Business requirements
• Provided support and worked closely in UAT and used SQL to test various reports and ETL load jobs in development, QA and production environment

Confidential, Dayton, OH

Technical Business Analyst

Responsibilities:

• Worked in Agile (Scrum) SDLC methodology software development
• Prepared Technical User stories based on User Requirement specifications and delivered to the project team on TFS (Team Foundation Service) user story board. Understand and articulate business requirements from user interviews and then convert requirements in to technical specifications.
• Analyzed and understood the Business/end-user requirement, created Intake/Incident Ticket and filled the team’s TFS Feature Backlog.
• Further analyzed the Feature in the Backlog and sliced it into numerous stories with all the needed technical details for each story.
• Responsible for gaining a good understanding of User needs and accurately representing them in a well-documented software functional Story Document.
• Interacted with the “End-Users” by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process.
• Facilitated JAD sessions with business and technical units to fine tune prioritize and detail requirements
• Participated in system designing with Developers and System engineer to increase efficiency when migrating Providers data into team’s Custom database and then eventually to Facets.
• Heavily involved with Developers in Georgia Providers data validation and create a footprint design to auto-assign Members to appropriate PCP (Primary Care Physician)
• Conducted Grooming Sessions to provide technical details of system requirement to the team.
• Analyzed and optimized the process, Prepared Business Requirement Document and managed requirements using Rational Requisite pro.
• Performed data analysis of Provider Extract, conducted root cause analysis and corresponded to the vendor (Scion). Import and ingest flat file into the database for data analysis with SQL queries.
• Knowledgeable working with ETL process (Extract, Transform and Load) of data from (EDW) Enterprise Data Warehouse into table in Custom Database.
• Managed RTM (Requirement Traceability Matrix) to track the process flow.
• Managed change of the requirements and associated requirements to other requirements for traceability using Enterprise Architect.
• Worked on Provider data validation and member attribution to respective provider. Extensively worked on Claims Inquiry and Dental Claims Processing.
• Created attribute level File Specification for flat file to be ingested into Database per business requirement
• Organized meetings to discuss outstanding issues with QA team and developers.
• Involved in User Acceptance Testing.

Confidential, Carmel, IN

System Analyst

Responsibilities:

• Studied existing business application and processes, current source system, collected end user requirements and suggested the improvised business process model.
• Acted as a liaison between client and payer/intermediary.
• Analyzed and developed business and functional requirements-BRD, FRD for the Financial Client Reporting website including Medicare part D Banking Payment Option for the members & Clients in the Company Home Page.
• Tested SOAP request and response in XML format using SOAP UI.
• Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS VISIO.
• Gathered requirements during inception phase, documented and delivered functional specification documents, and assisted architecture analysis and design using UML and Rational tools.
• Involved in creating an on-line Transaction Processing & Work Flow Document and tutorials for the system.
• Follow and implement SDLC methodology and keep aligned all aspects of the Project.
• Prepared user instruction manuals and used case to conduct User acceptance testing.
• Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Involved in the development of Business and Technical Requirements Document (BTRD) for the project.
• Participated in the JAD session with the SME’s and project team members.
• Wrote SQL queries for data validation, analysis and manipulation, and maintaining the integrity of the database.

Confidential, Lincoln, NE

System Analyst

Responsibilities:

• Identified the business functions and processes and prepare system scope and objectives based on user needs and industry regulations.
• Defined terms, conducted stakeholder analysis, elicited business needs, conducted business process modeling work, facilitated work sessions (JAD), elicited requirements, wrote requirements and use cases, analyzed requirements, validate & prioritize requirements, trace requirements to related project documentation (process models, designs, test scenarios & scripts).
• Communicated with developers and other staff concerning program policy aspects for Medical Assistance (MA), TANF and SNAP to resolve software defects and clarify requirements.
• Gathered requirements by using interviews, observation, JAD, brainstorming sessions, and documents analysis.
• Determined user/business/functional requirements. Created Business vision, scope, and Use Case documents; Business Process Models, Use Case diagrams, Activity Diagrams, and Sequence Diagrams using MS Visio to clearly define the data process model, and the business process model.
• Used Agile software development methodology in defining the problem, gathering requirements, writing functional and technical specifications, business system modeling.
• Involved in testing the XML files and checked whether data is parsed and loaded to staging tables.
• Created 837 I & 837 P claims using macro enabled claim spreadsheets.
• Identified testing scenarios and defined Test Cases for detailed functional testing.
• Created and maintained data mapping document(s) in reference to the HIPAA transactions: 270/271, 276/277, 837, and 835.
• Work closely with the team members to identify any bugs, fixes, any issues regarding the development and designing.
• Worked with the ETL tool like Informatica for data integration and data quality services.
• Developed a Schedule and identified project milestones.
• Analyzed business scenarios to track possible business outcomes for the functions which could be incorporated into more detailed test scripts.
• Identified risk and project impact and performed risk assessment and mitigation.
• Reviewed various Re-engineering techniques with Technical Experts to finalize the Approach. Reviewed functional test cases to confirm the expected outcome and behavior.

Confidential, Phoenix, AZ

Business System Analyst

Responsibilities:

• Proficiency in the use of supporting technologies such as workflow management system and case management software.
• Analyzed EDI ANSI X12 file mapping and reported in analysis spreadsheet.
• Appliance of knowledge in triage, research, collaboration, and technical skills to resolve transaction and processing issues.
• Participated in an agile environment by creating stories that communicated the needs of the business.
• Analyzed the member/eligibility information on claim to that in Facets.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup and backend payment cycle in FACETS.
• Worked on MMIS system for different Medicare and Medicaid plans.
• Worked on Member Management, Benefits, Eligibility, Claims, and Billing modules.
• Conduct JAD sessions to gather and document requirements that enhance a wide range of functionalities including claims processing, eligibility and enrollment, provider networks, and electronic data interchange for our Facets core application.
• Analysis of discrepancies in the eligibility reconciliation process for multiple stakeholders and continuous process improvement of the reconciliation process.
• Provide content to and for collaboration with training staff on training stakeholders on the transactions and the reconciliation process.
• Provision of training on transactions and on the reconciliation process.
• Participation in all phases of testing.
• Worked with the technical and development to resolve identified issues in a timely manner.
• Reviewed documented training material for accuracy and assisted in end user training and support.

Confidential, Wilmington, DE

Business Analyst

Responsibilities:

• Studied existing business application and processes, current source system, collected end user requirements and suggested the improvised business process model.
• Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS VISIO.
• Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Followed all the phases in the project management life cycle.
• Acted as a liaison between the business users and technical teams to build applications based on the business requirements - provided a single point of contact for user communication (managed issue tracking, prioritization and resolution).
• Created BRD and FRD for Medicaid managed care requirements and documenting them.
• The company owns, operates, and administers Medicaid managed care plans and related businesses.
• Developed the scope and vision document that defines the primary goals and objectives.
• Worked closely with the business users to gather the functional requirements for the investment banking application.
• Responsible for validating claim processing transaction of MMIS
• Involved in performance testing of Medicaid client server claims processing system, Medicaid and Medicaid Management Information System (MMIS).
• Responsible for Medicaid Claims Resolution/Reimbursement for state health plan using MMIS.
• Refined the requirements (use-cases) and Business Process Models to detailed level appropriate for technical analysis and system design.
• Coordinated with the project team and testing team to revise project artifacts (such as use-case specifications, test scripts, and so on) to reflect requirement changes.
• Worked independently with minimum supervision as part of a dynamic IT team.
• Participated in weekly meeting with the management team and walkthroughs.