SUMMARY:

• Sr. Business Systems Analyst with over 8+ years of diverse expertise in investigating and gathering requirements for business processes in functional and technical roles across Healthcare and Healthcare Insurance domain, HEDIS measurement, Salesforce Health Cloud, Application Development, Testing and UX/UI Design.
• Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, Hl7 Standards, HIPAA, PPACA (Patient Protection and Affordable Care Act), Compliance issues, LOINC and SNOMED Mapping, HL7 Message Validation, ICD 9, ICD 10, Electronic Health Records (EHR), EMR.
• Recommend tactics to implement HIPAA 5010 (EDI X12 837, 834, 278, 270, 275, 276, 271) in the new System.
• Facilitated data standardization with Fast Healthcare Interoperability Resources & its affiliated codes for system interoperability.
• Support HL7, EDI interface projects. Interface design and build with Rhapsody interface engine. Rhapsody (ver 4, 5) interface builds using Restful API, HL7, FHIR, ETL, JavaScript, MS - SQL, NoSQL and EDI. Linux, MS, Unix system administration.
• Expertise in Software Development Life Cycle methodologies (SDLC) such as Waterfall and Spiral and Agile Methodologies like Extreme Programming (XP), Rational Unified Process (RUP), Kanban, Scrum, Scaled Agile Framework (SaFE), Large Scaled Scrum (LeSS) and Scrumban and Business Process Re-engineering in Health Care Sector with focusing mainly on Requirements gathering, Documentation, Statistical and Data Analysis, Data Validation and Test Planning and Execution.
• Instrumental in clarifying business requirements, experienced in performing Gap Analysis, Impact Analysis, Risk Analysis, Traceability Matrices, SWOT Analysis, Document analysis, AS-IS & TO-BE analysis and Cost Benefit Analysis
• Excellent facilitation skills in conducting walkthroughs, surveys, questionnaires, one-on-one interview sessions, groups' sessions, prototyping brainstorming, Joint Application Development (JAD) and Joint Requirements Planning (JRP).
• Preparation and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Business document, Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents like Test Analysis Reports and Test Plans
• Acted as a liaison between Business and Technical Stakeholders to elicit various Functional and Non-functional requirements
• Hands-on experience on tools like Rally, JIRA, MS-Project, Greenhopper, Confluence, Zephyr for collaboration and tracking.
• Closely assisted the Product Owner in requirement elaboration and acted as a Proxy Product Owner as and when required.
• Apt in breaking down the Product Backlog from Epics into User stories keeping the INVEST criteria in acceptable limits
• Thorough understanding of preparation of Business Process Modeling Notation (BPMN) to Unified Modeling Language (UML) diagram including Process, Use Case and Sequence Diagram, Data Flow and ER Diagram using MS-Visio, Balsamiq, Axure.
• Tested various functionalities with the help of FACETs. Responsibilities include the Analysis of inbound and outbound interfaces and extensions to FACETS claims processing system and capturing all HIPAA-related EDI data in the repository
• Designed and implemented SQL queries using DDL/DML commands such as distinct, limit, select, joins, unions, outer joins, group by and aggregate functions to extract data from different databases ( Oracle) for timely reporting and Validation.
• Working knowledge of MySQL database, SQL Server, Data Warehouse and Hadoop HDFS, YARN, HIVE and Sqoop.
• Documentation, validation and testing of API (REST, SOAP) using software like SWAGGER, POSTMAN, Apigee, etc.
• Well versed with system architectures such as n-tier architecture and Service Oriented Architecture (SOA)
• Extensive knowledge in Data Warehousing architecture, implementation approaches, schemas and dimensional modeling
• Seasoned in Creating Data Models, such as Conceptual model and Logical model and involved in Online Analytical Processing (OLAP) operations such as Roll-Up, Drill-Down, Slice, Dice & Pivot and Online Transactional Processing (OLTP) operations
• Skilled with Data Analysis concepts of Data Modeling, Data Dictionary and Normalization, Well versed in creating Data Mapping Documents to transfer data from legacy system to target system and to reduce data duplication and redundancy.
• Created and maintained data mapping document(s) in to the HIPAA mandated transactions 837I, 837P and 835.
• Knowledge of Data-Migration, Data Lineage, Data Migration to Cloud, Systems Mapping and Data-Governance Processes.
• Performed ETL using Informatica PowerCenter to load the data into the data warehouse from disparate sources, designing and deploying various reports like Ad-Hoc, Interactive MOLAP and dashboards reports through Tableau, and IBM Cognos.
• Knowledge of Financial and Management Reporting, Business Process Reengineering, Forecasting and Capital Budgeting, KPI reporting, Ad Hoc reports, Dashboards creation and maintenance using Tableau, Micro Strategy and Power BI for the business.
• Understanding of and implementation of Test-Driven Development (TDD), Behavior Driven Development (BDD) and Acceptance Test Driven Development (ATDD) using Cucumber, Zephyr, HP Quality Center and JMock.
• Experienced in creating Test Plan, Test Scripts, Test Scenarios, Test cases, Requirement Traceability Matrix (RTM), User acceptance Testing (UAT), and familiar with software testing as well as Black Box, Smoke, Sanity and Regression testing

SKILLS AND TOOLS:

Healthcare Domain: Medicaid, Medicare, Patient Segmentation, HIPAA, ICD 10 CM, Electronic Health Records, Apex EDI, HL7

Software Development Life Cycle: Agile-Scrum, Scrum-Waterfall, Waterfall, XP, RUP, SAFe, Spiral, Kanban, Scrumban

Business Modelling Tools: MS Visio, Lucid Charts, Balsamiq, Axure

Project Management Tools: JIRA (v.7.0, v.7.3), HP ALM (v.11), MS SharePoint (2010, 2013), Confluence (v.6.4), HP QC, Rational RequisitePro, MS TFS

BI and Reporting tools: Tableau (v.9.3), MS Office Suite, Prezi, SQL Server Reporting Service (SSRS)

Architecture/Framework: Service Oriented Architecture (SOA), 3-Tier Architecture, n-Tier Architecture

Technologies: Salesforce Health Cloud, MuleSoft

Databases and ETL Tools: MySQL Server, Informatica PowerCenter (v.9.5, v.9.6), HADOOP HDFS, YARN, Sqoop

Data Warehousing: Enterprise Datawarehouse, Data Marts, ETL

Testing Tools: Selenium (3.0.3), HP Quality Center, Cucumber (v3.0)

PROFESSIONAL EXPERIENCE:

Confidential, Austin, TX

Sr. Business Systems Analyst

Responsibilities:

• Implemented the Web Application Firewall (WAF) to authorize as well as deny certain systems/users to have access to Electronic Health Records (EHR) or Protect Health Information (PHI) for any fraudulent/ unwarranted use.
• Worked on EDI transactions: X12 835, 834 and 837 P.I to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes
• Further stored data in HDFS (Clustered Storage) and performed Analytics through YARN built on HADOOP platform, loading the replicated structured data in Secondary Storage Areas and imported as well as exported data from databases using Sqoop.
• Communicated across all the Stakeholders various aspects Electronic Data Interchange (EDI), Health Level 7 International and HIPAA compliance to keep the health data protected from any users who are unauthorized to have access to the health data
• Interviewed all the stakeholders, performed extensive document analysis and thoroughly reviewed the system and its architecture to develop an in-depth understanding of Business Processes to aid Business Process Improvement (BPI)
• Conducted Brainstorming sessions to perform GAP Analysis by understanding AS-IS business flow and by using Prezi Business Presentations, facilitated TO-BE requirements by means of Joint Application Design (JAD) sessions
• Performed root cause analysis on complex data anomalies and working closely data stewards to define best practice.
• Assisted the PO in determining the Cadence of the Sprint and actively contributed in the Release Planning meeting
• As a part of Collaborative team, sporadically acted as a Proxy Product owner during various Scrum Ceremonies
• Assisted the Scrum Master to create and document deliverables like Information Radiators (Burn-up - Burn-down charts) and Release Burndown Chart to transparently communicate with all the Stakeholders and also track the team progress.
• Helped the PO to populate and refine the Product Backlog, further slicing the Product Backlog Items (PBI) into User Story
• Assisted the Scrum Master in maintaining the Product Backlog Health and reducing requirement churn in the Scrum flow.
• Created Use Cases Diagram using Lucid Chart and assisted the System Architect in developing all the Data Flow Diagrams.
• Worked with testing team for testing the requested web services in JSON format using Apigee and validation of HL7 message via FHIR API using POSTMAN and documented RESTful API and Streaming API with the help of SWAGGER
• Validated the data by performing MySQL/SSRS queries to confirm the data records from the database.
• Data Visualization and Creation of Ad-hoc, standard static, dashboards and technical reports using Tableau.
• Worked with the Validation Analyst to gather requirements, implement enhancements, releases and identify risks for Global Specification System (GSS) and Enterprise Document Management (EDM).
• Assisted in creation of Test Cases, Test Plans and Test Scenarios and created Requirements Traceability Matrix (RTM)
• Conducted User Acceptance Test (UAT) and actively participated and facilitated Smoke Testing and Black Box Testing

Environment: Agile-Scrum environment, JIRA (v.7.3), Confluence (v.6.4), Prezi, Lucid Chart, KAFKA, Hadoop, HDFS, YARN, Sqoop, SQL, SSRS, MS Office, Service Oriented Architecture, Zephyr, Swagger, POSTMAN, Apigee, Axure, Tableau

Confidential, Coppell, TX

Sr. Business Systems Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirement. Involved in GAP analysis, mapping, implementation and testing for Claims processing and made sure that all of the analysis adheres to the HIPAA Compliance
• Assisted Joint Application Development (JAD) sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Created and reviewed ICD-9-CM/ICD-10-PCS comparison document and dealt with DRGs. shift through CMS files.
• Prepared Requirements Traceability Matrix (RTM) and was extensively involved in defining the Entry and Exit criteria.
• Worked on Master Data Management (MDM) implementation, member and provider Data as well as Clinical data for the Healthcare Service Provider (HSP) all line of Business. Prepared business analysis and approach for data warehouse project.
• Documented the Pre-PI, Post-PI and PI Planning summary and the PI Objectives for the upcoming release.
• Assisting the Product Owner in the creation and documentation of the product vision, and value centered roadmap.
• Decomposed the requirement into user stories and conducted a session with all stakeholders to define Definition of Done (DoD)
• Assisted the development team with acceptance criteria and making the user stories ready to be pulled in the sprint backlog.
• Assisted the Scrum Master maintain the capacity plan, iteration board, sprint backlog, velocity & burndown charts.
• Assisting the Product Owner and Dev Team in defining, measuring and evaluating the solution against impact metrics
• Documented ICD9 to ICD 10 mappings one to one/one to Many types of relationship according to the GEM files from Centers for Medicare and Medicaid Services (CMS) with the functional and structural changes related to the data conversion
• Used Informatica for ETL and helped the ETL team to construct Hybrid OLAP queries to process the multi-dimensional data.
• Used different ad-hoc analysis, technical and dashboards Reports in defining business strategy for each customer category.
• Created various reports with the help of Tableau such as billing payment, Billing Grouping Payment and discount reports
• Generated test data using X12 generator for transactions 277/288, 834, 835, 837P/I/D. Conducted Gap Research and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards.
• Participated in testing of Orion Rhapsody Route to receive and process HL7 ORU R01 Version 2.5.1 messages to Webservices.
• Defect Management by using tool HP ALM where all test documentation is stored while report/track all issues and defects.

Environment: Agile- Scrum Environment, MS Project, HL7/FHIR, MS Excel, XML, HTML, SharePoint, MS Visio, FACETS, Python, Regression, SQL, Informatica PowerCenter (v.9.6), HP ALM (v.12), JIRA (v.7.0)

Confidential, Dallas, TX

Business Systems Analyst

Responsibilities:

• Attended meetings with all stake holders and managers regarding process plans, functionality, and business processes
• Negotiate with organizational management to obtain adequate resources with appropriate skills to staff the project team.
• Organized and facilitated Joint Application Development (JAD) sessions to elicit all the requirements and document the client requirements for the customization of the devices and converted the requirements into Business Requirements Document (BRD) and Functional Requirements Documents (FRD) as per the client's requirements.
• Contributed to the GAP Analysis and Technical Feasibility Report with the technical leads and other SMEs.
• Assisted the Project Manager (PM) in creating and documenting the Project Management Plan (PMP)
• Collaborated with team member for requirement analysis and clarifications and recommending changes for known gaps.
• Lead analysis of complex data sources identify trends and patterns in data and make recommendations based on it.
• Translated complex concepts & conclusions in a clear & concise manner in ways that can be understood by audiences.
• Worked on HIPAA Transactions 270, 271, 276, 277, 834, 835 and 997 and Facets Application Groups: Subscriber/Member, Plan/Product, Claims, Provider, Payer, Commissions and Billing Modules of Facets
• Designed and developed various UML diagrams like Use cases, Activity Diagrams, Sequence Diagrams using MS Visio.
• Participated in SCRUM meetings and worked closely with the Subject Matter Expert and the Project Manager.
• Assisted the development team in refining the Epics into Product Backlog Items while maintaining DEEP characteristics.
• Analyzed test results, identified issues and reported it to the developers and project manager through JIRA.
• Defined web service interfaces, specifications and test scenarios for each service that will provide common enterprise functions for key business domains and worked with testing team for testing the requested web services in JSON format in Postman.
• Developed Pseudo codes for 5010 EDI transactions for 837 I/P, 834 and 835 from existing 4010 EDI Production/Test data.
• Extensive data validation on the back end using SQL queries to verify the data has been loaded in the correct tables.
• Generate custom reports summarizing business or clinical data for review by executives, managers and other stakeholders
• Created dashboards of new members adding yearly and those changing their member plans using Tableau.
• Reviewed test cases, test scenario and test data and created & maintained the Requirement Traceability Matrix (RTM)
• Testing of HL7 Message Validation and sending of ADT Messages like ADT A01, ADT A04 and ADT A08.
• Coordinated and participated in Beta Type User Acceptance Testing (UAT) to test the functionality of the application and worked with Quality Assurance (QA) Analyst together to develop test Scenarios and test cases.
• Assisted the Operation and Maintenance team in documenting the Standard Operation Procedures (SOP)
• Created User Manuals and Implementation Notice with detailed list of parameters and system responsive screen shots

Environment: Waterfall - Hybrid, MS Visio, HL7/FHIR, UML 2.0, MS Office Suite, X12, MS SharePoint, FACETS, Python, HP ALM (V11.0), UML, SQL, JIRA, Confluence, Tableau

Confidential

Business Analyst

Responsibilities:

• Interviewed the stakeholders from different departments to identify their current needs and understand their Current Workflows and Ideal Workflows, to created process diagrams documenting As-Is and To-Be business processes.
• Created a relationship with the project team, customer interfacing including Line of Business (LOB) and interface partners to discuss the As-Is System and to develop the To-Be System concept after interviewing the client and other stakeholders.
• Responsible for defining the scope and implementing business rules of the project, gathering functional and non-functional requirements, and documentation by eliciting information from the business users and potential stakeholders.
• Analysis on the technical and functional requirements for FHIR (HL7) conversions to X12 files and electronic payments.
• ANSI X12- EDI schema design, mapping, co-ordination trouble shooting & customizing of application based on customer needs
• Created flow charts and process flow diagrams including Use Case Diagrams, Sequence Diagrams, Class Diagrams, Activity Diagrams, to show the interaction of the user with the system in an effective manner using BPMN and MS Visio
• Assisted in entering and updating Issues (Epics, User Stories, Defects and Tasks) onto JIRA Agile application.
• Assisted the Scrum Master to analysis the feedback from the Product Owner and the other stakeholder in the Scrum Release Planning and update it as a Product Backlog Item (PBI) in the Product Backlog with the consent of the PO,
• Collaborated with the development team in understanding the user scenarios by keeping a user centric approach.
• Manually tested and executed the Web Services using Postman and helped the Quality Analyst Team in automation of the REST Web Services Testing using Selenium tool. Assisted the Web Services team in documenting API's using SWAGGER
• Developed different types of ad-hoc, technical and write back reports using reporting tools of Tableau or Power BI.
• Defined and documented Functional Test Cases and Test Scenarios, Executed test script in Facets system
• Assisted quality assurance team to functional-test the new HL7 interfaces always keeping in mind HL7 and HIPAA guidelines.
• Facilitated the Pre UAT (User Acceptance Testing) and UAT; assisted in testing and maintaining quality procedures such as Black box and Regression testing; created all the relevant documents for appropriate users.

Environment: Scrum-Agile, MS Office Suite, SharePoint, MS Visio, MS Project, Python, UML, JIRA, JSON, REST Web Services, XML, SOA, BPMN, Selenium, Postman

Confidential

Business Analyst

Responsibilities:

• Conducted Document Analysis, Interviews, Focus Groups to elicit the various Functional and Non-Functional requirements
• Acted as a liaison between the business users, business owners and stakeholders & the development team
• Created the Concept Proposal (CP) Document to realize and make a note of high-level Vision and Mission statements
• Assisted the Product Manager in preparing the various management plan reports like Variance Management Plan, Scope Management Plan, Change Management Plan and Risk Management Plan
• Involved in Cost Analysis, feasibility and risk analysis along with Product Manager (PM) and Business Owner (BO)
• Identified the various Goals, Milestones, Scope, Constraints and Documented the Project Charter (PC), created the Work Breakdown Structure (WBS) and the associated Gantt Chart
• Assisted Sr. Business Systems Analyst to create the Requirement Documents such as Business Requirements Document (BRD), Functional Requirements Document (FRD) and Systems Requirements Document (SRS)
• Collaborated with developers and communicated the Data requirements and assisted them to create a Data Requirement Sheet.
• Created a Deployment plan by analyzing the characteristics of the Production environment and saw the project to “Go-Live”
• Single handedly managed Change requests by creating a Change Management Document. Baselined the iterative versions of Change management document by getting an approval from the Change Approval Board (CAB)
• Along with Sr. Business Analyst, maintained and tracked the defect log where all the defect in the system are documented.

Environment: Waterfall, JavaScript, HTML, XML, MS SharePoint 2010, MS Excel, MS PowerPoint, MS Visio (v.15), SQL, User Acceptance Testing (UAT).

Confidential

SQL Developer

Responsibilities:

• Designed and implemented SQL queries using DDL/DML commands such as distinct, limit, select, joins, unions, outer joins, group by and aggregate functions to extract data from different databases ( Oracle) for timely reporting and Validation.
• Designed entities and attributes and established relationship while ensuring their stability, reliability and performance.
• Analyzing the existing SQL queries and code in order to understand the database and improve the performance of the overall system by implementing new queries in the databases.
• Developed different kinds of schemas - Star Schema, Snowflake Schema and Galaxy Schema based on the system requirements.
• Responsible for removing any issues or error related to database performance as well as providing corrective measures.
• Implementing Stored Procedure in the system to reduce network traffic and increasing the execution speed of the queries.
• Responsible for providing authorization and authentication to access and deny users from using the database.

Environment: Waterfall, HTML, CSS, SharePoint 2010, SQL, SWOT, MS Excel, MS PowerPoint, HP QC, MS Visio, Confluence (v.6.2)