- Business System Analyst with 8 years of experience specializing in health information management with experience in range of activities on complete system development life cycle to increase the operational efficiency and success of the projects.
- Competent and Result Oriented professional, accomplished Business Analyst, with experience in managing, planning implementing health care projects with extensive domain knowledge.
- Most of my activities are focused on the techno functional roles including development and architecture of applications particularly with healthcare industry. Experienced in Identification, categorization, defining and analyzing stakeholders and their involvement in the project using both RACI Matrix.
- Expertise in Claims Processing and Claims Scrubbing in HMO, PPO, POS, Medicaid and Medicare.
- Well versed with current healthcare industry standards such as CMS, MMA, HL - 7, ICD9, ICD10, HIPAA 4010/ 5010 EDI X12 standard Transaction sets (835, 837,270/271 and 276/277) HHS, SOX and FDA.
- Experience with Clinical, EMR and EHR projects and assisted in re-engineering the company's core claims adjudication processing following BABOK standards and extensive use of the BABOK guidelines and practices as commissioned.
- Acquired and compared the Healthcare Benefits plans with the HEDIS information which is in turn useful for the subscribers and consumers. Implemented Healthcare Enterprise Core Administration Platforms such as FACETS and Electronic Health Record & Practice Management applications.
- Experienced in Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology and Medicaid Management Information System (MMIS).
- Experienced in waterfall methodology and agile methodologies like Scrum, Scaled Agile Framework (SAFe), hybrid methodologies like Water-scrum-fall methodology. Knowledge of Extreme programming (XP), Spiral, lean- agile, Kanban, Scrum ban and Rational unified process methodologies.
- Worked with the product owner in requirement gathering and product backlog grooming. Involved with scrum teams in retrospective meetings and assisted the team in improving their ways.
- Possess excellent analytical, and interpersonal skills with the ability to communicate with Developers, Architects, Subject Matter Experts (SMEs), Business Stakeholders, Testing team and Senior Executives.
- Designed and documented Business Process Re-engineering, Business Process Modelling, Historical Data Reports Analysis accompanied by conducting and facilitating elicitation sessions such as survey/questionnaires, Interviews sessions, brainstorming sessions, Focus group sessions, Requirement workshops, Interface analysis, Document analysis, and Joint Application Development (JAD) sessions with internal as well as external stakeholders.
- Facilitated prototype workshops with Subject matter experts and validated the requirements.
- Proficient in authoring Business Requirement Documents (BRD), Functional Specifications Documents (FSD), Software Requirement Specification (SRS), Use case Document, and Software Design Specification (SDS).
- Experience in conducting Gap analysis, Impact Analysis, Cost Benefit analysis, SWOT Analysis and ROI Analysis.
- Involved with the project manager in designing the Work breakdown structure, Project scope & Project charter document.
- Built Unified Modelling Language (UML) diagrams including Use Cases, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams. Transformed the requirements gathered into functional specifications focusing on Workflow Analysis and Design, User Interface Design, Data flow, Process flow and ER Diagram.
- Worked along with the product owner in defining the Minimum viable product (MVP), in defining the Acceptance criteria, Definition of ready (DoR) and definition of done (DoD).
- Assisted the testing team in preforming API testing using POSTMAN and maintained the API documentation in SWAGGER. Knowledge and understanding of XML and JSON format.
- Experience in using SOAP web services for transfer of patient data in XML format and validated the data.
- Exposure to Salesforce service and health clouds with good knowledge and understanding of Customer relationship management processes like Sales, Marketing and Customer services.
- Experience in creating process maps (data model) and configuring Salesforce Administrative tasks.
- Extensive experience in retrieving data and data validation using SQL queries like Joins, Views, Sub queries and Aggregate functions like max, min, sum and average with good understanding of Stored Procedures, Functions and Triggers.
- Skilled in Data Warehousing implementation including OLTP, Data Marts, ODS, Staging, Data sources, Normalization and Dimension tables, Data Profiling, Data Integration, Data Migration, Data Organization, Data Conversion, Data Quality and Data Modelling concepts like conceptual model and logical model & ER diagrams.
- Knowledge of the Star and Snowflake Schema, OLAP operations such as Slice, Dice, Rollup, Drill Down and Pivot.
- Created Data Mapping documentation and worked with data analyst in writing the transformation rules.
- Widespread knowledge of extraction of data from source systems, transformation and load process (ETL) for a Data Warehouse using Business Intelligence (BI) tools like Informatica.
- Experience and understanding on reporting tools like Tableau and other BI software/Qlik view, MS Excel .
- Created reports from variety of data sources (EMR, billing files, claim file) using SQL to inform decision making relative to clinical &business opportunities.
- Knowledge of Continuous Integration and Continuous Deployment (CICD) using Jenkins and Bamboo.
- Liaised with Quality Analysis team to design and implement Test plans, Test cases and assisted in performing Black-box Testing, System Testing, Integration Testing, Regression Testing. Performed User Acceptance Testing (UAT), Load/Stress Testing & Performance Testing.
Domain Skills: HIPAA 4010/ 5010, CMS, MMA, HL-7, ICD9, ICD10, EDI X12 standard Transaction sets (834, 835, 837, 270/271 and 276/277) HHS, SOX and FDA, HMO, PPO, POS, Medicaid and Medicare.
SDLC METHODOLOGIES: AGILE-SCRUM, Waterfall, Waterfall-Scrum Hybrid methodologies.
Modeling Tools: MS-VISIO (v14,15,16), Lucid Charts
Business Skills: Process Modeling, Change Management, GAP Analysis (To-be Analysis As-Is Analysis), Impact Analysis, Risk Analysis, Cost-Benefit Analysis, SWOT Analysis
Data Warehousing: Data Modeling, Data Marts, OLTP, OLAP, Data Dimensions, Schemas
Databases: MS SQL (2012,2014)
Productivity Suite: MS Word, MS Excel, MS PowerPoint, SharePoint 2 013, MS Project, MS Visio
Requirement Management: MS Office (2016), JIRA (v7.0)
ETL Tools/Reporting Tools: Informatica, Tableau, MS Excel, Power BI.
Testing Tools/ Defect tracking tools: HP ALM, HP QC(v11,12), JIRA (6.3,7.0)
Confidential, Danville, PA
Sr. Business Systems Analyst
- Operated as a liaison between the end users and the different teams involved in the application development.
- Analyzed the client requirements and processes through document analysis, interviews, workshops, and process maps.
- Held brainstorming sessions with the Subject Matter Experts (SMEs) to clearly define the functionality of the domain and the various processes that it was required to perform.
- Conducted Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
- Created the requirement traceability matrix and kept track of the product backlog, sprint backlog. Converted business requirements to Salesforce technical requirements.
- Assisted the product owner in elaborating the requirements and in writing the acceptance criteria for the user stories.
- Provided guidance to the scrum team in requirement understanding and solution designing along with product owner.
- Performed Gap analysis to identify the features that needs to be introduced in the to be process.
- Performed workflow analysis by visualizing the requirements and the business process by creating Unified Modelling Language (UML) diagrams such as Use Case Diagrams, Activity Diagrams, and Sequence Diagrams prepared process flow charts using MSVISIO.
- Created wireframes and showcased mock-up of the proposed system with a focus on content and user interface design using BALSAMIQ.
- Used Jira to estimate, track and report story points and helped the scrum team to function more efficiently in future sprints.
- Also tracked the defects and the defect life cycle and its status in Jira (v7.0) .
- Lead the software’s UX/UI improvements, focusing on a user centered design reducing the clicks required for workflows.
- Identified the risks involved in the application system and assisted in writing programs to eliminate these risks.
- Assisted the data analyst in performing analytics of real time data by generating adhoc reports and visualized data in different formats maintaining its accuracy and data consistency in TABLEAU.
- Involved in demos and walkthrough whenever required for different aspects of provider model.
- Performed the CRUD operations in SQL to retrieve data from database and to update data into the database.
- Written the reusable data transformation scripts to modify and store the data in the data warehouse and modified existing mappings as per the requirements.
- Assisted in testing and reviewing of ETL mapping and transformation specifications based on the business requirements. Identified and documented various batch processes.
- Assisted the testing team in testing the API in POSTMAN and maintained the XML and JSON REST API’s documentation in SWAGGER.
- Service cloud was used to improve the patient experience embedding the customer support in the application through live chat, screen sharing features and addressing their issues by generating cases and I was involved with the team in integrating the cases created in salesforce to JIRA (v7.0) .
- Involved in integration of salesforce service cloud features into the application.
- Simplified process for admin and developers by ascertaining requirements accordingly.
- Involved in identifying, planning and implementing new Salesforce.com features and functions new screens, workflow, force.com objects, reports, apex code to meet business requirements.
- Expertise in Data management for SFDC Standard objects , Custom objects. Used different data tools -Data Loader, Import Wizard, and Workbench.
- Experienced in sandbox management such as refreshing sandbox, migrating code from one sandbox to the other with change set.
- Designed process which needed to build custom Visual force pages with various functionalities which involved communications with SME’s and business stakeholders and the developers.
- Performed requirement walkthroughs with the development and QA teams with the aim to develop Testing Strategies and Test Plans such that Test Cases reflecting the user needs.
- Involved in the test preparation and test execution. Assisted the QA team in writing test plan, test cases, test scenarios.
- Assisted the technical members to creating test cases for unit testing.
- Created and documented the test plans and test cases associated with the requirements and the defects in HP ALM (v.11.5) and tracked and reported project related tasks.
- Performed the User acceptance testing and identified the bugs and tracked the progress of the bugs in JIRA (v7.0). Assisted the team in assessing the existing the defects and discovering its impact on the project and what steps to be taken to minimize them.
Environment: Agile- Scrum, JAVA, My SQL Server, JIRA (v7.0), MS VISIO (v.16), HP ALM (v.11.5), TABLEAU (v.10.1), Salesforce service cloud, Informatica Power Center (v.9.6.1).
Confidential, Chicago, IL
Sr. Business System Analyst
- Worked along with the product owner to interact with key stakeholders in defining requirements to enable informed business decisions and service level improvements.
- Communicated with other team members to give a better understanding of the requirements and ensured that they worked accordingly. Assisted the product owner in defining the acceptance criteria & prioritization of user stories.
- Planed stories for sprint work in agile methodology. Developed user stories and to be process flows to support design and development of salesforce solutions for the users.
- Used techniques such as interviews, JAD sessions to gather and finalized the requirements.
- Traced the requirements and managed changing requirements, there effects and prioritized them.
- Tracked and Managed sprints, requirements, translated functional requirements to user stories and estimated them assisted in verifying the velocity and re-prioritized issues using the JIRA (v7.0).
- Involved in walkthrough of Requirement's, Functional and Technical Specifications.
- Carried out Gap Analysis ('as-is' and 'to-be' model) on performance, productivity to understand KPI and areas of improvements.
- Built use cases, activity diagram, sequence diagrams and collaboration diagrams that include functional and non-functional specifications to convey to the development teams adopting using Lucid Chart.
- Ensured that the claims transfer to the trading partners who used the FACETS to verify the claims was meeting the compliance standards.
- Helped developers with following list of HIPAA transaction code sets (, 276/277).
- Assisted the technical team in integrating the claim management system data to the salesforce health cloud.
- Documented the REST API’s involved in the integration of the system to salesforce.
- Used HIPAA guidelines and regulations to keep track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment
- Responsible for gap analysis in changing old MMIS to new MMIS and analyzed the workflow towards the adjudication system.
- Involved in scrum meetings with technical/non-technical team, data analysis and sharing with XML patterns, SME's to clarify business rules & solve impediments, rectifying the regulatory issues with SME's and translated Functional requirements into User stories using JIRA (v7.0).
- Assisted the testing team in preparing the test data for positive and negative scenarios as per the requirements.
- Used SQL queries to filter the data within the database tables. Applied the SQL scripts to the test database and executed the scripts on the database and data marts.
- Assisted the testing team in communicating the requirements to be tested and planning the test strategy.
- Created and tested scripts for the premium calculations and Claims limits and deductibles.
Environment: Agile- Scrum, Python 3.5, MS SQL Server, JIRA (V7.0), Confluence, Lucid Chart, Salesforce health cloud.
Confidential, Fairfield, NJ
Business System Analyst
- Used techniques such as interviews, JAD sessions to gather and finalize the requirements.
- Organized and prioritized the requirements and traced the relationship between them and played a role in designing and loading the data warehouse (ETL).
- Assisted the Product Owner in writing user stories and acceptance criteria.
- Based on the requirements created upgraded strategy and stored procedure transformations to populate the targets.
- Tracked and Managed sprints, estimated the user stories, adjusted the sprint scope, assisted in verifying the velocity and re-prioritized issues using the JIRA (v.6.3).
- Analyzed the inefficiencies in the system by using MS VISIO to visualize the process flows.
- Created wireframes and mock-ups in BALSAMIQ and created digital sketches of the product before initiating with the development. Assisted the developers in designing the prototype.
- Integrated PowerBI for data evaluations, manipulation and visualizing features through graphs, dashboards and co relate between the data sources.
- Scripted the SQL database views that would be available to users as data sources.
- Performed an impact assessment against the Information Security Management Systems ISO 27001.
- Managed requirements traceability information and track requirements status throughout the project. Managed changes to requirements through effective use of change control processes and tools.
- Mapped the data elements being loaded to the SQL database by identifying the primary keys in data.
- Assisted data analyst in establishing the transformation logic to calculate the service data elements and to configure the process. Worked with them in performing OLAP operations.
- Involved in dimensional modelling and designed the star schema, identified the various facts and dimensions.
- Created Data Mapping documentation and performed data profiling and analyzed the source data by writing SQL queries.
- Supported and coordinated with the technical team in designing and developing ETL (extraction, transformation & loading) strategy and designing Informatica mapping by translating the business requirements.
- Worked on EDI transaction sets to identify key data set elements for recorded data.
- Implemented the ICD-9 & ICD-10 mapping and crosswalk analysis and monitored the revenue cycle process.
- Assisted the team in resolving data mapping issues between various source systems, logical data modelling
Environment: Agile-Scrum, Python (3.5), MS SQL Server, Informatica Power Center (v.9.6.1), JIRA (v 6.3), MS VISIO (v.16), BALSAMIQ, PowerBI
Confidential, Indianapolis, IN
- Conducted JAD sessions with business units and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts.
- Prepared Business Requirement Documents after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype of system.
- Interacted with clients to understand and document new requirements for the benefits configuration application. Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio (v.16).
- Managed the clinical team members and assisted in clinical configuration of the device, documented the configurations; device end-to-end workflow demonstrations and deployment.
- Assisted the technical team in managing the integration of device with Electronic Medical Records.
- Assisted the development team in effectively communicating the requirements.
- Collaborated and communicated using tools such as SharePoint and Microsoft teams.
- Conducted complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.
- Responsible for Change Management Processes and efficiently managed changes and analyzed the impact on the project.
- Worked along with testing team and assisted them by providing requirements to be tested.
Environment: Waterfall -Scrum Hybrid methodology, JIRA (v7.0), MS Visio (v.16), SharePoint, MS Office2013
- Worked with the project manager and analyzed the Project Scope. Designed Business requirements documents.
- Conducted multiple interviews with the Stakeholders to understand the as-is process & to be processes and gathered business requirements and communicated them to team.
- Set up brain storming sessions with functional and technical teams.
- Facilitated JAD sessions for assessing needs and thereby quantify objectives for requirements.
- Primary responsibilities included analyzing, validating various processes.
- Worked with the technical team in development and testing of the system.
- Managed the team and tasks as well as schedules using MS Project.
Environment: Waterfall, MS SQL, MS Office (MS Word, MS-Project, MS Excel).
- Performed the feasibility study for the project and researched on the technical challenges associated with operating the dental clinic.
- Gathered the requirements from the client and converted them to technical requirements.
- Performed the gap analysis to bridge the gap between the existing and the proposed system.
- Constructed the workflow charts and diagram studying system capabilities writing specifications.
- Written medical equipment specifications, evaluations, tendering processes & procurements.
Environment: Waterfall methodology, MS Office (MS Word, MS-Project, MS Excel).
- Performed standard dental practices, including preventive and corrective services.
- Endodontic treatment and oral surgeries.
- Pediatric and Geriatric dentistry.
- Records Management.
- Used Radiographic equipment.