SUMMARY:

• Over 7 years of diverse experience as a Business/Systems Analyst in developing and implementing innovative business processes.
• In - depth knowledge and experience in full SDLC with RUP, Agile and Waterfall methodologies.
• Functional experience in Health Care Industry with vast knowledge on Medicare and Medicaid.
• Expertise in creating the companion guides on various EDI transactions.
• Specialize in HIPAA 5010 implementation including GAP analysis
• Expertise in impact analysis on the key application systems (claims processing, reporting, payments) and business process of health insurance companies.
• Clear understanding of ICD-9-CM and ICD-10-CM/PCS
• Well versed with ANSI X12, HIPAA and HL7 standards.
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side
• Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
• Extensive experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835, 270/271, 276/277)
• Proficient in all phases of Requirement Management, including gathering, analyzing, detailing, and tracking requirements.
• Expertise in creating test claims in Amisys system to confirm system issues were resolved.
• Excellent experience in Integrated Eligibility Systems (IES), Health Insurance Portability & Accountability Act (HIPAA) 5010 standards, Electronic Data Interchange (EDI), X12, HL7 and ICD-10 coding.
• Expertise in creating various artifacts like BRDs, Functional Specs, Used Cases, UML Diagrams, Data Mapping Documents, Test Plans and Test Strategies, pre and post RTMs and Status Weekly Reports etc.
• Good knowledge of Web Technologies (SOAP, RESTful APIs, XML, JSON, web services, etc.)
• Expertise in creating prototypes and mock-ups for user interface designs.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Experience in Business Requirement and System Specifications Analysis.
• 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.
• Extensive knowledge of reporting tools such as SQL and ACCESS for underlying database tables and resolve data issues.
• Expertise in RDBMS concepts and running SQL queries.

TECHNICAL SKILLS:

Microsoft Technologies: MS Project, Visio, Excel, Word, Outlook, PowerPoint

Requirements Management: Rational Requisite Pro, Jira, Confluence

Business Modeling: Rational Rose, MS Visio

Defect Tracking Tools: HP ALM/ Quality Center, Rational ClearQuest, Jira

Databases/ BI Tools: SQL Server, Oracle, Tableau, SSRS

Languages/Standards: SQL, XML, HTTP, HIPPA 4010/5010, ICD9/10, ANSIX12

Methodologies: Rational Unified Process (RUP), Agile, Waterfall

PROFESSIONAL EXPERIENCE:

Confidential, DC

Business System Analyst

Responsibilities:

• Create Business Requirement Document (BRD), Functional Requirement Document (FRD), Technical specification Document (TSD).
• Reviewed, analyzed and created detailed documentation of business systems and user needs, including workflow, program functions and steps required to develop or modify application programs.
• Played active role during daily scrum meeting and task planning as part of agile methodology
• Consulted with IT Personnel to determine business, functional and technical requirements for specified applications.
• Implemented new benefit plans via auto-load in Amisys.
• Developed effective reporting tools for the business unit and completed existing projects from original concept through final implementation.
• Met with various groups, including business owners, SMEs (subject matter experts) and marketing team, for requirements gathering in definition Stage.
• Specialize in HIPAA 5010 implementation including GAP analysis.
• Capturing and maintaining Functional Requirement Document
• Built Amisys-FACETS interfaces for effective parallel operations.
• Perform and assist with critical path reporting & updating data from internal systems.
• Maintaining DEDs (Data Exchange Document) and S2T (Source to target Document)
• Created Data and Process flow diagram using MS VISIO.
• Compiled requirements obtained from key stakeholders.
• Facilitate review sessions with Business, DEV and PV teams
• Involved in Deployment process with DEV and PV team
• Update and maintained SharePoint
• Waterfall methodology
• Checked the data flow through the frontend to backend and used SQL Queries to extract the data from the database.
• Utilized tools like Soap UI for testing web services to see if they meet acceptance criteria defined by user stories.
• Facilitated One on One discussion to improve morale, trust and performance of the Infrastructure team remote and internal users
• Participate in quality improvement initiatives to develop and improve incoming quality levels
• Performed Web Service testing using SOAP UI.
• Assisted the team members to develop Service Oriented Architecture (SOA), and data warehouse system (EDW) to utilize data mining for data analysis.
• Created Data for XML Requests in SoapUI.
• Work with solutions/delivery teams to implement data quality processes during acquisition, ETL, and delivery stages for Business Intelligence solutions and changes to Data Warehouse.
• Debugging the SQL statements and stored procedures for various business scenarios.
• Set up Enterprise Data Warehouse (EDW) and associated ETL service to generate business reports.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Developed Process flows on End-to-end formulary process and transformation maps to Multi-client Single instance infrastructure approach.
• Maintained and tracked the project plan using MS Project.
• Assisted the QA team in User Acceptance Testing (UAT).
• Daily and weekly status reporting to senior management.

Environment: Agile/Scrum, ETL, TOAD, Service Now, SQL,ETL,SOAP UI, JSON,MS Visio, Excel, Word, Outlook, UAT

Confidential, Virginia Beach

Business System Analyst

Responsibilities:

• As Business Analyst, analyzed and created a quality report targeted for senior-level management.
• Assisted director with creation of daily and weekly reports
• Worked on Agile environment, which included breaking tasks into user stories and prioritizing those user stories and breaking then into sprints.
• Conducted Agile Ceremonies-Sprint Kick off, Sprint Planning, Sprint Review, Retrospectives meetings.
• Collaborated with Product Owners, Developers, Testers, and Business Analysts to ensure smooth functioning of Agile teams, ensuring transparency, facilitating discussion, resolving conflicts, thereby driving a viable solution.
• Analyzed data obtained from different groups and created various reports and presentations using MS Excel.
• Configured new provider affiliations and update service definitions in Amisys.
• Analyzed and prioritized user and business requirements as system requirements that must be included while developing the software.
• Responsible for consistently and effectively turning large quantities of data into meaningful and useful information
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements of the to-be-migrated client.
• Worked on large scale and enterprise level Data Warehouse and Analytic projects providing status, risk, and issue identification and mitigation, as well as functional specific tasks
• Provided Production support to Tableau users and Wrote Custom SQL to support business requirements.
• Performed source to target mapping documentation including the handoff to the development team
• Delivered data and system analysis documentation that in corporate the business and data requirements including technical requirements
• Provided the link between the technical and business views and requirements of the system by ensuring that the technical solutions being developed will satisfy the needs of the business
• Worked on data mapping to bring data from one system and reside in another system
• Responsible for Data Profiling to determine data integrity for transformation of Data from Source to Target.
• Interacted with the project stakeholders to gather requirements & business needs
• Analyzing large data sets to develop custom models and algorithms to drive business solutions.
• Extracting and transforming data into report interface working with relational databases and querying tools.
• Worked on Mass unsuspended and claim reduction on Daily, weekly and monthly basis.
• Responsible for consistently and effectively turning large quantities of data into meaningful and useful information.
• Responsible for communicating with development and sales teams and generating customized reports as needed.
• Created charts on excel for claims reduction report weekly
• Point of contact for all the report regarding information
• Administrated SharePoint for the team

Environment: Agile/Scrum, HP ALM, MS Visio, MS Project, MS SharePoint, MS SQL Server, HTML, XML, SOAP UI, MS Office (Word, Excel, PowerPoint, Outlook), UAT, Windows

Confidential, Rochester, NY

Business Systems Analyst

Responsibilities:

• Assisted the project manager in the creation of the project charter & vision document during the inception phase of the project.
• Worked as a Business Process Analyst in agile methodology to do requirements gathering, analysis and planning, development & testing.
• Performed requirements gathering, analysis and planning, development & testing in Agile methodology.
• Performed GAP analysis as it pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process.
• Produced Activity diagrams with defined swim lanes as part of the claims process analysis.
• Involved in gathering and prioritizing requirements using 1 to 1 interviews, brainstorming & developing questionnaires.
• Attended daily scrum meetings.
• Worked with Product Manager to define the Business requirements and create user stories in JIRA to address them.
• Created and maintained requirements using Jira/Confluence.
• Worked various Claims Processing modules in Facets.
• Worked on different Facets backend tables.
• Prepared FRDs that help drive the design of infrastructure necessary for organization to meet new reporting requirements.
• Translated business requirements into functional specifications and documented the work processes and information flows of the organization.
• Performed extensive data modeling to differentiate between the OLTP and Data Warehouse data models.
• Conducted and automated the ETL operations to Extract data from multiple data sources, transform inconsistent and missing data to consistent and reliable data and finally load it into the Multi-dimensional data warehouse.
• Used TriZetto HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions.
• Extensively used SQL statements to query the SQL Database for Data Validation and Data Integrity.
• Created SQL queries for data validation.
• Performed manual Back-End testing on the application by writing complex SQL queries.
• Inserted different types of Verification points to capture and store information about the objects.
• Maintained Test matrix and Traceability matrix and also performed Gap Analysis.
• Participated in meetings with the developers on a regular basis to update the test documents.
• Tested user stories and sign off on the business functionality completeness.
• Organized and facilitated Agile and Scrum meetings, which included Sprint Planning, Daily Scrums or Standups, Sprint Check-In, Sprint Review & Retrospective.
• Wrote SQL Queries to perform Back-End Testing for data verification.
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I, P, D) standards.
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases.
• Involved with various aspects of the project's needs such as the logging, tracking, and resolution of issues, current state workflow assessments.
• Involved with the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that HIPAA regulations are met across all the modules
• Assisted the Quality Analyst (QA) in creating test plans, test data and conducted manual testing to validate functionality.
• Conducted Infrastructure testing. teaming up with the Enterprise Infrastructure to validate High Availability of new hardware
• Logged the defects and track the defects using JIRA.
• Clarified to claims personnel the new Affinity payments and Explanation for payments (EOPs) for same claim processing cycle.
• Clear understanding of Medicare (Part A, Part B and Part D) and Medicaid benefits.

Environment: Agile-Scrum, SQL,TFS, HP ALM, ANSI X12, ETL, HTML, MS Office Suite (Word, Excel, PowerPoint, SharePoint, Project), Windows, UAT.

Confidential, Raleigh, NC

Business Systems Analyst

Responsibilities:

• Conduct gap analysis between the current system and new requirements to be implemented thereby mapping the business requirements to the application
• Involved in training and test session on HIPAA Privacy policy.
• Prepared high level and detailed system requirements documents for the application.
• Actively participated in daily Stand Up meetings and Sprint Planning meetings
• Worked with internal stakeholders creating, prioritizing, and monitoring application feature/issue backlog.
• Created and maintained user stories using Jira.
• Analyzed HIPAA 5010 standards for 837P transactions, related to providers, payers, subscribers and other related entities
• Identified the requirements for accommodating HIPAA 5010 standards for 837P transactions and captured these requirements to develop new GUI for the internet-based application
• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Studied in-house requirements for the Data warehouse to be developed.
• Responsible for managing the Data Warehouse and Business Intelligence functions.
• Used SQL, Data Warehousing and Data Cleansing for the arrangement of customer data. Used Data mapping for collecting the data.
• Involved HIPAA regulations in Facets HIPAA privacy module.
• Involved in daily Scrums to determine the status of the project and impediments, if any
• Involved in sprint planning meeting to identify the tasks for the sprint and getting team members acceptance/commitment for the assigned tasks.
• Involved in Sprint review meeting with the team and stakeholders to review the achievements from the sprint and get approvals
• Identified the requirements that go in each sprint, collect them in the sprint backlog and collecting and managing the requirements that are not part of the current sprint into the product backlog
• Designed the Internet based application and managed the business and design specifications in the business specific wikis
• Write high-level and low-level business requirements and design mock-up screens for the application
• Analyzed the existing data model and provided suggestions and recommendations
• Translated the requirements prepared for SDLC methodology to User Stories and implementing Agile methodology as a standard for the ongoing project
• Wrote user stories and acceptance criteria for the requirements of the project
• Involved 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
• Preparing Requirements Traceability Matrix and Test cases to insure the desired functionalities are present
• Assisted in performing body testing as a part of Regression Test using SOAP UI.
• Inspected and worked on HTTP web services application and on SOAP APIs.
• Identified various points of integration among the new and existing applications and required integration with other IT components
• Worked closely with the business team, development team and the quality assurance team to ensure that desired functionalities will be achieved by the application
• Provided business and technical suggestions and recommendations during the project life cycle

Environment: Agile-Scrum, XML, HIPAA, ETL, Enterprise Data Warehouse, MS Office, MS Visio, MS Project, SQL, SOAP UI, UAT, Windows.

Confidential - Denver, CO

Business Systems Analyst

Responsibilities:

• Participated in the research and gathering business requirements through conducting surveys, interviews and JAD sessions.
• Used Scrum practices like documenting User Stories, facilitating Story Point discussions to analyse the level of effort on project specifications.
• Contributed to the definition of scope, preparation of work plans and definition of business requirements.
• Involved in Claims Processing, Enrollment (834), Group and Individual Member billings.
• Performed Data Mapping to map the EDI 834 data to XML.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation, and testing for Medicaid Claims.
• Performing regression testing.
• Performed testing for Medicare and Medicaid claims for Medicaid Management Information System (MMIS)
• Involved in Agile methodologies to do requirements gathering, analysis and planning, development & testing.
• Used SQL queries for testing and report/data validation.
• Documented business requirements and communicated the requirements with the development team for design and implementation of business solutions.
• Responsible for using best practice PMO methodology to develop project plans to fit the stakeholder’s/sponsor's needs and deliver on desired outcomes.
• Provide a full range of health care services to business clients, enrolling and assisting with applications and regulations for the Affordable Care Act.
• Created Data mapping documents between various data elements, XML files, flat files, excel files, HIPAA EDI files X12 834, 837, 270/271, 276, 277/276, 999, 835 and 5010 and web services, to perform verification and validation.
• Performs Business analysis from multiple data sources and ability to build reports, Excel- PowerPoint slides.
• Trouble shooted file transmission problems and assisted customers with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides (837P, 837I, 837D, 270/271)
• Provided EDI interfaces with Commercial and Government Insurance Payers that included Medicare and Medicaid.
• Conducted Requirement Gathering Sessions with the stakeholders. Incorporated stakeholder feedback throughout the project lifecycle to ensure project quality and customer satisfaction.
• Conducted review sessions on test case and regression test scripts in with Business team
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Created AS-IS and TO-BE business process flow diagrams, integrate process flow diagrams to show one end-to-end business model. Responsible for creating business flow diagrams (using MS-Visio).
• Prepared the guides for UAT
• Used MS Project to manage schedules, deadlines and resources and collaborate on the project.
• Developed SQL Queries to fetch complex data from different tables in remote databases using Joins, Database Links and Bulk Collects.
• 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 EDI's 837, 835, and 834 and ICD 10 code sets.
• Worked on EDI (X12) 820, 835, 837, 834, 820, 835, 999, 276, 277 Transactions. Worked on X12 validations and validated the EDI transaction.
• Involved in monitoring and reporting defects by using JIRA.
• Provided EDI interfaces with Commercial and Government Insurance Payers that included Medicare and Medicaid.
• Incorporated User Stories in different release plans for the sprints.
• Assisted Project Managers in the development of weekly and monthly status reports.
• Designed the business requirement collection approach based on the project scope and SDLC Methodology.
• Conducted Gap Analysis during the review of the compliance items for improved future audits.
• Created Data Mapping Documents and wrote transformation rules.
• Worked closely on 837 I/P transaction code for Health care claims and was involved in Validation of HIPAA for 270/271 (health care benefits and eligibility), 276/277 (Claims).
• Worked with VLOOKUP's, Pivot Tables and VBA's in Excel.
• Used JIRA for project tracking, bug tracking, and reporting.
• Worked specifically with EDI 820, 834, 835, 837 (I, P and D), 270, 271, 276, 277 and 999.
• Responsible for identifying and documenting business rules, conducted User Acceptance Testing (UAT) in terms of training the end users.
• Involved in creating detailed test plans and testing strategies and ensure these are executed extensively, which includes executing SQL queries to retrieve data and test
• Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271 to identify key data set elements for designated record set.
• Worked on EDI transactions: X12, 835, and 837 P.I to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analysing and documenting related business processes
• Worked with providers & Medicaid entities to validate EDI transaction sets.
• Served the healthcare community by adhering to professional standards, hospital policies, federal state and local requirements.

Environment: Agile/Waterfall, MS Office, Visio, Version One, SQL, Agile, SDLC, Scrum, MS Excel, SOAP UI, HP ALM,HL7, TFS, ALM, SQL Server

Confidential, Buffalo, NY

Business Systems Analyst

Responsibilities:

• Analyzed system requirements and developed detailed Test Plan.
• Performed Manual Testing for the EDI transactions.
• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Performed Data mapping on the extracted data, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Document technical issues while agent deployment and facilitate resolving the issue by conducting working sessions with technical lead.
• Documented requirements for numerous groups globally for scanning of assets after the agent is deployed on their assets and communicated across various project teams.
• Document and communicate with multiple leadership teams on weekly basis regarding project updates.
• Responsible for creating test case scenarios, creating test data plan and writing test scripts for the UAT using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Conducted GAP analysis and filling gap according to the format set by HIPAA.
• Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Elicit requirement to be able to generate the tools and info needed to process the ICD-10.
• Tested the HIPPA EDI 834, 270/271, 837/835 transactions according to test scenarios and verify the data on different modules.
• Performed Back-End Testing to check database integrity by writing SQL queries.
• Set claim processing data for different FACETS Modules.
• Tested HIPAA regulations in FACETS HIPAA privacy module.
• Wrote test cases in Quality Center derived from the Design documents and generated a Traceability Matrix for testing purposes.
• Created Traceability Matrix to ensure implementation of all functionalities, identify all test conditions and test data needs.
• Uploaded the diagnosis codes, procedure codes to the related tables in test environment to verify the changes related to ICD9 - ICD-10 changes.
• Used Quality Center to record documenting information useful in debugging process, evaluating test data.
• Extensively worked on any requirement upgrade and/or change request while doing UAT.
• Worked closely with development team to ensure the application performance and stability and, also ensure the application completes the whole end-to-end process.
• Participated in weekly status meeting with Development and Management Teams.

Environment: Agile/Waterfall, XML, Quality Center, MS SQL Server, MS Visio, MS Project, MS SharePoint, SQL, HTML, XML, SOAP UI, MS Office (Word, Excel, PowerPoint, Outlook), UAT, Windows.