- Business Analyst with over 6 years of experience, in financial and healthcare industry.
- Experience with healthcare system, Medicaid, claims adjudication, provider, eligibility and prior authorization.
- Extensive exposure to unified modeling language (UML) tools such as MS Visio, Rational Rose and Requirement Management tools such as Rational RequisitePro.
- Significant practical experience using the Rational Unified Process (RUP) methodology - workflow and Implementation.
- Experience in Agile (Scrum/Sprints) and Waterfall.
- Strong at effective facilitation of information flow between the key stakeholders and functional teams engaged on various project deliverables, experienced through roles directly engaging sales and IT teams.
- Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
- Capable of managing multiple projects simultaneously.
- Experience in writing queries/scripts for d Confidential analysis ad QA report testing.
- Experience in User Acceptance Testing, Smoke Testing, Regression Testing Performance Testing and Functional Testing.
- Experience working in Medicare and Medicaid projects.
- Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.
- Working knowledge in financial analysis, financial modeling, Research, Accounting, and Assets, Liabilities, Equities, Fixed Income and Taxation.
- Practical understanding of software development lifecycle in its different facets, methodologies and implication in the industrial (business) scenarios.
- Designed Graphical User Interface using Adobe Photoshop, Knowledge of SQL queries using MS Access and Oracle.
- Synthesized 4010 and 5010 HIPAA implementation guides relate to Claim Testing and Medical Billing.
- Substantiated Object Oriented Analysis and Design representation techniques in UML using Rational Rose, D Confidential flow Process Modeling, and Analysis & Design with Interaction and Class diagrams.
- Scheduled meetings and reinforced business analysis with developers, system analyst and testers to collaborate rescore allocation and project completion using MS Project.
SDLC, Business Analysis, Process Mapping, Systems Analysis, Business Case Development, JAD Facilitation, Requirements Management, Workflow Analysis, Use Case Modeling, Test Management, Communication, Change Management, Problem Root Cause Analysis, Problem Management, Risk Management, Team Building, RUP, Agile (Scrum)
Confidential, Oakland, CA
Business System Analyst
- Implemented the SDLC for the developing life cycle and followed the standards process in the application.
- Translated business requirements into functional requirements and approaches for developers.
- Provided management support to the off-shore End to End integration/ Regression Test Team.
- Workflow documentation and comprehensive to the healthcare clients.
- Analyzed corporate healthcare business processes to develop customized solutions.
- Working with Medicare operational management to monitor, trend and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
- Interacted with healthcare clients to gather requirements, objectives, and input and output requirements.
- Developed test cases and scripts for front end testing.
- Performed execution of test cases manually to verify expected results.
- Ensured the accuracy and consistency of the d Confidential during the d Confidential loading process.
- Developed Use case, Functional, Object diagrams using Rational Rose.
- Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
- Was involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
- Developed a detailed test plan and test cases to cover all the requirements.
- Used rational Rose to create UML diagrams such as use case, activity, sequence, class and component diagrams.
- Developed Flowchart and process diagram using Microsoft Visio.
- Analyzed d Confidential architecture, documented and delivered d Confidential mapping, performed risk analysis.
- Frequently communicated with developers to resolve technical issues.
Confidential, Dallas, TX
- Work closely with the Business owners to gather their financial needs
- Organize information and develop business cases offering recommendations to clients
- Facilitate and gather requirements and create Use Cases by extensive requirement gathering sessions and JAD sessions
- Extensive experience in Oracle Configurator developer - User Interface Design, Rules & Functional Companions
- Use the guidelines and artifacts of the Rational Unified Process (RUP) and Zachman framework to strategize the implementation of Rational Unified Process efforts in different iterations and phases of the Software Development Life Cycle
- Work extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance testing (UAT)
- Work in SQL and Oracle dealing with extraction, analysis and processing of SQL Queries
- Create Use Case specifications, Business Flow diagrams, Activity/state diagram and Sequence diagram using Rational Rose, so the developers and other stakeholders can understand the business process according to their perspective with possible alternate scenarios
- Facilitate in the overall management of the projects including risk analysis and mitigation, status reports, client presentations, defining milestone deliverables and establishing critical success factors
Confidential, Dallas TX
Business Systems Analyst
- Defined scope of the project and developed a vision plan that defined the primary goals and objectives of the project.
- Worked with Rational Unified Process right from the initiation to transition phase.
- Gathered and analyzed business requirements for inbound and outbound files, managing all requirements using Rational Requisite Pro (RRP).
- Assisted Baylor Healthcare in determining the right approach to carry out ICD 10 operations by assessing their business and IT operations
- Conducted brain storming sessions to analyze provider contracts, provider reimbursement, benefit rules, medical policies and medical management rules to see the impact of ICD 10 diagnosis codes.
- Helped Baylor Healthcare in building ICD 9 to ICD 10 crosswalk map by grouping thousands of Codes and ranges in Clinical, Benefits, Financial, Medical policy waves.
- Conducted working sessions to gather and document high level business requirements and detailed level business requirements for different business units impacted by ICD 10 such as EDI Claims Intake, FACETS- Claims Adjudication, Medical Management- Utilization Management, Case management and Provider Reimbursement- Provider Payment.
- Organized impacted systems into high, medium and low impact to help business analyze the level of effort for remediation activities and ease resource allocation work
- Prepared use cases and d Confidential flow diagrams to analyze the impact of ICD 10 diagnosis codes embedded in different systems and applications
- Defined and prioritized the critical functionality required by the users (What-if analysis, Need analysis).
- Conducted Impact analysis and gap analysis
- Assisted in Risk-Management analysis.
- Designed and developed all Use Cases and UML models.
- Developed business requirement specification documents as well as high-level project plan.
- Manually tested the interfaces and functionalities.
- Involved in drawing process flow diagrams and work flow diagrams in all phases of the SDLC.
- Involved in preparing Software Requirement Specifications (SRS) and User Interface Design.
- Also assisted Technical team in designing of Application Architecture.
- Evaluated the Design Quality (Physical design checks, Standards, Security).
- Conducted functional walkthroughs, User Acceptance Testing (UAT)
- Assisted the project manager with risk lists, action items etc.
- Made presentations to the senior management executives several times during the course of the project
Confidential, IRVING, TX
- Translated business needs into actionable programming and process steps for developers
- Provided client implementation best practices and ongoing technical support
- Assisted in development of ongoing technical processes and procedures
- Responsible for analysis, modification and execution of routine tasks related to change management
- Supported the project delivery team during design, development, testing and participated in UAT
- Project leadership for new initiatives and present improvement plans to IT senior management
- Documented processes and procedures for EDI implementations
- Implemented HIPAA EDI messaging for health insurance industry (payers), including health plan administration, claims processing and transaction codes.