- Business Systems Analyst with 7+ years of extensive experience, specializing within Health Care.
- Aggressively productive and creative individual with excellent management, administrative, communicative, analytical, and integrative skills; with capabilities to maintain progressive and prosperous working environment.
- Exceptional abilities to build and maintain relationships with Business Users, Stakeholders and Subject Matter Experts (SME), alongside Project Manager / Scrum Master, Business Analyst Team, Development Team, Quality Assurance Team, and Deployment Team.
- Excellent knowledge of the Software Development Life Cycle (SDLC), such as Rational Unified Process (RUP), Waterfall, and Agile (Scrum) methodologies.
- Adept in requirements gathering, documenting, analyzing, detailing, and reporting.
- Expertise in the functional processes of Business Analysis and Data Analysis, such as Business Requirements Documents (BRD), Functional Requirements Specifications (FRS), System Requirements Specifications (SRS), Use Cases (UC), and Requirements Traceability Matrix (RTM).
- Proficient in constructing detailed GAP Analysis, Analysis Models, Activity / Process Models, and Data Flow Diagrams in the forms of Swim Lane Diagrams, Sequence Diagrams, and Wireframes.
- Skillful in preparing User Guides, and performing System Integration Testing (SIT) and User Acceptance Testing (UAT).
- Developed a 3 - tier application using Java Messaging System containing Student Registration & enrollment, Course creation & scheduling, assigning Instructors to courses
- Skillful when utilizing Microsoft SQL for complex queries and in-depth data analysis.
- Highly knowledgeable in utilizing Health Care Integration systems and their respective applications, such as TriZetto Facets, NASCO, HIPAA Gateway, and Informatica HIPAA Validator.
- Experience in web services testing using standards like XML, WSDL, SOAP and Java Message Service.
- Expertise with compliance standards, such as Affordable Care Act (ACA), Health Insurance Portability and Accountability Act (HIPAA), Centers for Medicare and Medicaid Services (CMS), American National Standards Institution X12 (ANSI X12), Electronic Data Interchange (EDI).
- Exceptional understanding of HIPAA Compliance, HIPAA Compliance, EDI Transactions (834, 835, 270, 271, 276, 277, 278, 837, 999).
Methodologies: Rational Unified Process (RUP), Waterfall, Agile (Scrum)
Microsoft Applications / Tools: Microsoft Office Suite, Microsoft Project,, Microsoft FrontPage, Microsoft SharePoint, Microsoft SQL Server
Reporting Applications / Tools: Oracle PeopleSoft Suite,, SAP Business Objects, SAP Crystal Reports
UML Application / Tools: Microsoft Visio, IBM Cognos, IBM Rational Suite
Testing Applications / Tools: Oracle TOAD, HP Application Lifecycle Management (ALM), HP QuickTest Professional (QTP)
Integration Applications / Tools: TriZetto Facets, NASCO, Informatica HIPAA Validator
Languages: UNIX, HTTP, HTML, UML, XML, SQL
Confidential, Parsippany, NJ
Sr. Business Analyst
- Facilitate all agile ceremonies including daily stand-ups, weekly grooming, retrospective, and review and planning session.
- The project dealt with enhancements to the Healthcare Payment EDI transaction set to generate a payer level containing payer specific information.
- Communicated New Business Process Model & Notations (BPMN) with client and suggested best solution to make the changes according to new regulation.
- Executed test scripts in different cycles to get the perfection and logged defects in defect tab of Quality center.
- Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
- Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual for resolution.
- Analysis of functional and non-functional categorized data elements for data profiling and mapping from source to target data environment. Developed working documents to support findings and assign specific tasks
- Claim Transactions and Billing Transactions created flows for adequate matching of claims. Performed data mapping by matching the billing file and EDI claim file record claims received from Medicare and Medicaid agencies.
- Interacted with Subject Matter Experts (SME), Business Owners; Conducted detailed interviews with them, recorded the requirements, and reviewed the gathered requirement by both technical and business people to break down functional requirement and document detailed User Stories.
- Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery
- Perform typical SharePoint administrative activities such as new site creation and managing user/group permissions
- Participate in Change Management related process meetings, advising and consulting across technology for process adoption.
- Used MS Visio to carry out the Business Use Case Modeling and Business Object Modeling effort to develop the business architecture for rapid and controlled application development.
- Developed HL7 messaging for bi-directional case and disease report exchange, in HTML and XML formats, in accordance with HL7 specifications.
- Extensive experience with process modeling using UML, flow charts, system data flow, task diagrams, sequence, data mapping, and use cases.
- Create story board of back log items in Agile and develop item according to business needs.
- Redefined use cases, process flow, and activity diagrams using MS Visio for a clear understanding of the requirements. Reviewed test plan based on Requirement Traceability Matrix (RTM) and defect tracking using Clear Quest.
- Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes EDI 837, 835, 270/271 and others.
- Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
- Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
- Data mapping, logical data modeling, created Class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
- Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
- Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
- Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on the Design Document and User Requirement Document for the Functional, Security, and Performance Testing.
- Responsible for efficient document management using MS SharePoint and to update the document and transmit the information to all stakeholders
Environment: Hybrid Waterfall Agile-Scrum, Informatica, Microsoft SQL, MS Visio, HTML, HL7, XML, JSON, MS Office Suite, MS SQL Server, JIRA, MS Visio, MS Project, MS SharePoint
Confidential, Trenton, NJ
Business System Analyst
- As a System Analyst I supported the Medicaid eligibility by identifying and defining detailed product requirement and acceptance criteria.
- Support existing SharePoint implementation across the enterprise and work on future site development projects
- Was involved in Business Process Management (BPM) activities like Process Design, Process Monitoring and Process Execution
- Led the team of Business Analysts for creation of Business and Functional Requirements for the creation of Electronic Health Records (EHR).
- Experienced in documenting and mapping pricing processes for all rate plans and services. Also experienced in understanding existing legacy structures, systems and processes for pricing, design and help implement future integrated pricing solutions and integration activity
- Involved in preparing test plan, test script and test cases based of functional requirements using Rational Test Manager.
- Assist in the performance of HEDIS related duties, which include maintenance of reports and spreadsheets, gathering information specific to HEDIS measures, and verifying accuracy of reports.
- Analyzed Eligibility for State Welfare Program, Children’s Health Insurance Program (S-CHIP), Food Stamps (SNAP), Child Care and Temporary Assistance to Needy Families (TANF) (CHIP, SNAP, and TANF).
- Identified authoritative data sources; specified business rules for data feeds utilizing HL7 protocol.
- Analyze Reviewed Change Requests & approve changes to ensure all changes conform to Change Management standard as summarized in Change Management grid along with SOX documentation review and scheduling of the change.
- Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications
- Experience with data analysis data mapping and dimensional modeling experience in decision support.
- Dealt with the EDI transaction 835 claims payments and remittance advice, which deals the payment from payer to provider.
- Develop solutions that primarily make use of SharePoint out of the box features but also extend those features through advanced customization, workflows and integration of other technologies with SharePoint
- Participated in functional design sessions, creates and executes SQL test scripts, and aids in the solution of data issues.
- Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, and HL7.
- Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid claims in compliance with HIPAA guidelines.
- Reviewed Test plans, Test cases, Test case execution using specification documents and Rational Test Manager.
- Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
- Worked in Agile environment allowing teams to deliver project piece-by-piece and make rapid adjustments as needed. Good understanding working in Agile and bringing projects to completion.
- Highly proficient in writing User stories, creating Use Cases, Use case diagrams, Workflow Diagrams, Sequence Diagrams, and Class Diagrams etc. Extensively used Rational Rose and MS Visio for UML.
- A major part of the responsibility included interacting with the Users and Business relationship managers and facilitating implementation of changes using ERD diagrams created MS Visio on the database in order to ensure approval from process owners.
- Applied Unified Modeling Language (UML) methodologies to design Use Case Diagrams, Activity Diagrams, Sequence Diagram, ER diagrams & Data Mapping Defined the change management approval procedures to control the scope of the order management requirements. Actively engaged various partners from the client team to monitor and control the risk associated with Changing Scope
- Involved in performance testing of Medicaid client server claims processing system, Medicaid MCC / MCO and Medicaid Management Information System (MMIS).
- Created UML Diagrams like Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
- Understand the Business/Technical requirement and prepare high level Design document for various projects in Child care enhancements like Benefit Calculation, Eligibility Determination rules, Cash Programs, MMIS etc.
- Responsible for conducting ALM training sessions for the Business Users. To give them a walk through over the tool. And to show them how to write test case, logging defects etc.
Environment: Agile/SCRUM, Rational Clear Quest, BPM, TFS, HP ALM, ANSI X12, HTML, XML, JSON, HIPAA, EDI, UML, MS Office, Windows XP/2000, SQL, UAT.
- Responsible for developing in-house application comparing data from different sources i.e. EDI, XML and FACETS.
- Perform requirements gathering and analysis; interview the subject matter experts, stakeholders and executive sponsors.
- Interact with the business analysts & business users for design & requirement clarification for external projects & change requests.
- Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD).
- Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D), 997 and 999 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
- Proficient in using Agile Scrum methodologies, performed roles of Scrum Master following sprint/standup sessions and used Excel extensively to write user stories, analyzed the Iteration Burn Down charts and reviewed defects.
- Worked on FACETS Data tables and created audit reports using queries. Manually loaded data in FACETS and have good knowledge on FACETS business rules.
- Automated and supported HL7 message generation services with message maker and designed and developed HL7 test messages for business users.
- Created data mappings to transform the data according to business rules and Performed Analysis on Data mapping between different data models.
- Working automated requirements capture tools, e.g. Requisite Pro, DOORS, JIRA, and Rally Dev etc.
- Facilitated Change Management across entire process from project initialization to testing through project delivery, Software Development & Implementation Management in diverse business & technical environments in accordance to the Agile Methodology
- Provided SDLC Methodology for developing EDI applications used by hospitals to completely automate payments posting for Medicare, Medicaid and commercial payers electronic payments files.
- Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop. Documented User Stories and facilitated Story Point discussions to analyze the level of effort on project specifications
- Work on EDI X12 transactions, HIPAA standard transaction codes including 837, 834, 835, 270, 271, 276, and 277 and perform analysis of such transactions.
- Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
Environment: MS Office Tools, MS Project, MS-PowerPoint, UAT, BPMN, SSIS, SQL Server 2005, XML, HP ALM/Quality Center, Agile framework, Crystal Reports.
Confidential, Bloomfield , CT
- Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
- Conduced Joint Application Development (JAD) sessions and walk in interview with the business users to gather requirements.
- Participate in the design, implementation and documentation of current and new mainframe infrastructure utilizing "Best Practices" technologies and methodologies.
- Developed a detailed test plan and test cases to cover all the requirements and scripts for front end testing.
- Writing Epics and user stories, managing sprints and backlog grooming, and tracking project progress in JIRA.
- Used the guidelines and artifacts of the Agile Methodology to strategize the Implementation of Change Management in different iterations and phases of SDLC
- Extensive working experience with HL7, EDI X12 transactions, Facets, claims process, HIPAA, Billing Process etc.
- Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in Rational Rose for the Business Use Case and System Use Case.
- Validated the test data in DB2 database on Mainframes using SQL queries.
- Analyzed the existing reports of the reporting system in the database. Checked the consistency of the data after ETL process using SQL queries.
- Analyzed data architecture, documented and delivered data mapping, performed risk analysis.
- Developed HL7 messaging for bi-directional case and disease report exchange, in text and XML formats, in accordance with HL7 specifications.
- Developed the business anomalies workarounds and described them in documentation and presented the matter to the upper management for review.
- Recommend changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
- Developed non-functional requirements and documented them as Business Rules, Quality attributes and constraint documents.
- Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release
Environment: s: UML, Rational Requisite Pro, Rational Rose, Facets, Rational ClearQuest, Excel, SQL, HP Quality Center, UAT, Windows.