- Seven years of experience as a Sr. Business System Analyst.
- Solid understanding of Business Requirement gathering, Business Process flow, Business Process Modeling and Analysis, design documentation .
- Experience in all phases of the Software Development Life Cycle (SDLC) including Requirement gathering , Design, Development , Testing and Deployment.
- Organized Joint Application Development (JAD), workshops and interview sessions.
- Expertise in Documentation, Review of Software and Business/Technical Requirement Documents.
- Efficiently Managed complex business initiatives to achieve quality.
- Excellent knowledge in Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837,270,271,276,277,834,835, NCPDP and ICD9 - ICD10.
- Experience in Medicare , Medicaid and Pharmacy Benefit Management (PBM) projects.
- Exceptional Documentation Skills on writing Use Cases and Functional Requirement Documents.
- Designed and reviewed various documents including the Software Requirement Specifications (SRS), Business Requirements Document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
Operating Systems: Windows 2003/XP/Vista/7, AIX 5.3/4.3, Sun Solaris 8/2.x
Project Mgt Tools: MS Visio, Rational Clear Quest, MS Project
ETL/BI/BPM: Oracle Warehouse Builder, Business Objects, Micro Strategy, SSRS, SharePoint, Salesforce
Bug Tracking/Testing: Quality Center, JIRA, MS Visual Studio
Business Modeling: MS Visio, Rational Requisite Pro, Concept Draw Pro
Project Methodologies: Software Development Life Cycle (SDLC), Agile (Scrum), Waterfall
Oracle 10g/9i, MySQL, MS: Access, Tomcat
Industry Standards: HIPAA 5010, ICD 10, PPACA
Languages/Programming Skills: SQL, PL/SQL, Java
Confidential, Milwaukee, Wisconsin
Sr. Business System Analyst
- Involved in the analysis of the existing credit card processing system, mapping phase according to functionality and data conversion procedure.
- Participated in the identification, definition, documentation of current business process including the customer service model, processing of payments and updates to corporate card features happen in the As-Is world
- Participated in Joint Application Development (JAD) sessions by convening project sponsors, end-user representatives, development team members, subject-matter experts, technical personnel, and different stakeholders to communicate their perspectives with each other to resolve any issues and come to consensus.
- Conducted requirement workshops among all project stakeholders to verify and validate the business requirements.
- Handled the development of business requirement documents (BRD) resulting from JAD sessions.
- Identified Use Cases and wrote Use Case Narratives.
- Supported all QNXT modules initiatives in improving overall efficiency for Quality Standard and Claims.
- Created Use Case Diagrams and Activity Diagrams using Enterprise Architect
- Worked closely with the development team to help them understand Use Case Narratives.
- Reprocessed incorrect paid and denied claim using Facets.
- GatheredBusinessRequirements from users and used Enterprise Architect for documenting the requirements.
- Involved in maintaining Requirements Traceability Matrix (RTM).
- Experienced in creating mapping for loading Benefits in Facets .
- Prepared service offerings, PPTs, Test approach, Road maps, assessment remediation, solution framework for 4010A1 to 5010, ICD10 Conversions.
- Analyzed a wide range of FACETS configuration change requests for the purposes of determining the technical scope of the change and its impact on existing systems configuration.
- Performed analysis in Membership and billing data from Facets .
- Configured Facets for Provider and performed data analysis on subscriber data in Facets.
- Impact analysis, gap analysis, risk identification & estimations for 5010 and ICD-10 compliance.
- Involved in Project plan, Test plan and other pre-sales activities for 5010 and ICD-10 compliance.
- Providing business solutions as a SME for Healthcare-PBM and Medicare Part-D Projects.
- Working with business teams to find out production issues and defects.
- Preparing Daily and weekly status reports and submitting to customers.
- Assisted QA department to write and execute Test plans and Test Cases
- Participated in identifying opportunities and parameters for business process improvements.
- Used the guidelines and artifacts of the Rational Unified Process (RUP) to release multiple iterations of the deliverable over the span of the project lifecycle.
Environment: Enterprise Architect, Microsoft Office Suites (MS Word, PowerPoint, Access, Excel, Outlook, Project, Visio), RUP, Windows, Microsoft SQL Server (2000 & 2005), UML.
Confidential, Phoenix, Arizona
Business Systems Analyst
- Worked as a Senior Business Analyst for the Pharmacy Benefit Management (PBM) operational team which supports day to day group and member enrollments, eligibility, benefits and claims between Confidential and PBM.
- Worked with Managed care Org. (MCO), Rate Management, Spread Pricing, Rebates and Data Exchange.
- Day to day exchange of data with PBM ( Pharmacy Benefit Management ) business system team.
- Track, analyze and solve any day to day issues that occurs due to files and message queue (MQ) jobs (EDI) exchanges between Confidential and PBM for member’s enrollment & eligibility, Medical and Pharmacy claims.
- Participated in various JAD sessions involving various business and technical teams.
- Documented various Use Case scenarios, Process Flows and other diagrammatic representations in MS Visio pertaining to various provisions of HCR.
- Performed Gap analysis for various existing product lines and operations with respect to HCR.
- Worked extensively on all the mandated first phase of provisions of Health Care Reform.
- Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
- Extensively used Requisite Pro and other Rational tools for Requirements Management and their traceability.
- Gained extensive experience related to various product lines and impact on the respective products due to HCR.
- Worked on the modification of Pricing Modeler of the various systems.
- Gained extensive experience with medical codes and the change of benefits regarding various products.
- Gained extensive experience regarding all phases of Requirements Management and Change Control for various projects.
- Ensured legal compliance of the corporation in regard to the mandates of the Federal and State regulations.
- Worked with Customer Care department to document the User Guides and Corporate Communications regarding policies and products.
- Attended training sessions for the latest versions of existing Rational tools such as Rational Requisite Pro 7.1.1, Rational Quality Manager and Rational ClearQuest 7.1.1.
- Analyzed the structural and operational impact of ICD-10 on the current systems.
- Worked for Provider & Quote to Bill team for requirements gathering and documentation phase.
- Interacted with various departments and application admin regarding the impact of ICD 10 into the system.
Environment: MS Office, Rational ReqPro, Rational Quality Manager, DB2, Rational rose, Unix, J2ee, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP
Confidential, El Segundo, CA
- Gathered requirement through workshops and JAD sessions.
- Developed documents like BRD, FRD, Data specification document, technical specification documents, file transfer document, Data mapping document etc.
- Participated in analysis workshops for ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
- Developed Use case diagrams, activity diagram and system design diagrams.
- Validated CPT , HCPC, ICD 9 code sets from Data Flat files to support configured benefit plan building.
- Managed global administration and support of the Documented based Regulatory Electronic Document Information System (EDMS).
- Facilitated Electronic Data Interchange (EDI) and storage in the ICD-10.
- Worked on HIPAA Transaction Sets 837P and 837I Standards according to the test scenarios.
- Created Test Conditions from business requirement document and functional requirement document.
- Processed Medicaid claims and worked on X12 format of EDI 837 and EDI 835 for Medicaid claims.
- Accessed Diagnosis Master File and Crosswalk Mapping file to use ICD Diagnosis and Surgical Procedure Codes.
- Performed GAP Analysis to make sure that all requirements were covered by test cases.
- Prepared and submitted weekly test status reports to QA Lead.
- Analyzed the System Impact including MMIS Tables , Windows, Reports, and Interfaces on external entities.
- Tested the Members, Provider, and Claims Products in Facets.
- Involved in testing Claims, Financial management in Facets.
- Worked on EDI 834 to validate new enrollment and dismiss the enrollment.
- Accepted and validated messages in EDI 999 form like accepted, rejected, and accepted with error.
- Coordinated System and Regression testing schedules and completed the same.
- Ensured the functionality meets business requirements as defined in test results logged in RQM.
- Developed Test Cases to test the functionality of the system based on the test conditions.
- Extensively used Rational Quality Manager to monitor the progress of assignment of testing activities and Reported executed results.
- Logged the defects in Clear Quest tool, assigned the right severity level and managed the defects through it.
- Performed parallel testing comparing unmatched fields from the ND MMIS Enterprise subsystem and the Legacy subsystem and analyzing why the fields were unmatched by looking up unmatched reasons on the Enterprise subsystem and business rules.
- Performed CR tracing by matching the use cases related to the CR’s, CTC’s , Test Plan, Test Case diagrams to the location on the Final DSD using Rational Clear Quest.
- Analyzed several defects related to Edits & Audits functional area along with the help of a SME.
- Conducted KT sessions for Member, Provider and Service Authorization.
Environment: MS Office, Rational ClearQuest, Oracle database, Windows 7, Environment 63, Citrix.
- Involved in designing and publishing the packages in Framework Manager.
- Involved in designing the dimensional database for faster recovery of data and efficient performance.
- Involved in creating Ad - Hoc reports.
- Involved in creating reports in query studio for analysis of data.
- Extensively involved in creating complex reports and scheduling them.
- Extensively worked with List Reports and various formats of report generation e.g., PDF, Xl etc.
- Worked extensively with prompt - based reporting.
- Wrote PL/SQL Stored Procedures based on the Requirements.