- Business Analyst with 8 Years of diverse experience as a Business Analyst for Healthcare Insurance domain, and suggest innovative business process and system solutions for various industries.
- Highly motivated individual who applies sound judgment and possesses excellent communication, presentation and interpersonal skills.
- Demonstrated ability to translate complex concepts to peers and business partners
- Demonstrated ability to work in a fast paced and changing environment with short deadlines, interruptions, and multiple tasks/projects occurring at once
- Strong analytical and problem - solving skills and capability to interface with both internal and external stakeholders and in facilitating a healthy communication between the client and IT department
- Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, HL7 Standards, Eligibility, Enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans), Integrated Eligibility System and medical records
- Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
- Experience with TriZetto Facets 4.51/4.71 and TriZetto HIPAA Gateway 4.11 - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
- Worked with HIPAA EDI transactions such as 835, 837, 276, 277, 278, 270, 271 etc.
- Analysis of tools and supporting system programs that enhance the potential for the successful implementation of Medicaid Management Information System (MMIS) software, and Electronic Health Record (EHR) programs.
- Have experience working on Guidewire Billing Center, Policy Center and Claims Center.
- Result oriented, talented professional who combines formal education with experience gained from research and hands-on opportunities
- Facilitated Joint Application Development (JAD) Sessions for requirements gathering and business area analysis to identify business needs and technological improvements
- Have in-depth knowledge of creating Use cases, activity, logical, component and deployment views to extract business process flows and workflows, thereby helping development and quality assurance in understanding requirements.
- Experienced in the use of MS Project, Excel, Word, Power point, Access, Visio and SharePoint
- Experienced in GAP Analysis and System 'As Is' & 'To Be' process and BPR
- Proficient in implementing methodologies such as Agile and Waterfall while working in the Software Development Life Cycle (SDLC)
- Involved in walkthroughs with the development team and QA team and other relevant stakeholders to ensure user requirements are fulfilled.
- Authorized to work in the US for any employer.
- Assisted with the development and execution of detailed system and user acceptance test plans, test cases, and testscripts for manual and automated testing and documented defects using HP QC.
- Extensive exposure to End-to-End testing, Regression testing,Black-Box testing, Smoke testing, and UAT.
- Strong documentation and analytical skills, strong problem-solving skills.
- Organized, goal-oriented and self-starter with the ability to master new technologies and manage multiple tasks.
Languages: SQL, PL/SQL, HTML
Databases: Oracle, MS SQL Server, MS Access, Teradata, DB2 UDB, Informix, Genesis, web services and Mainframe and Salesforce.
Reporting Tools: Business Objects (Supervisor, Designer, Reporter), Cognos, Crystal ReportsTools: TOAD, Win SQL, Teradata SQL Assistant, BTEQ, XML Spy 2008
Operating Systems: Windows, UNIX
Tools: MS-Office suite (Word, Excel, Project and Outlook)
Testing Tools: Mercury (Quality Center, Win Runner, Load Runner, Jira, Quick Test Professional, JMeter, Performance Center, VU Scripting, Business Availability Center) Rational Test Manager, Rational Robot, UML, MS Project, IOS Android, Safari, iPhone, MS Visio & Visual Source Safe
ETL Tools: Informatica (Repository Manager, Designer, Workflow Manager, and Workflow Monitor), Excel Add-in.
Confidential, Houston, TX
- Identified and validated high potential business opportunities for stakeholders.
- Gathered business Requirements, analyze data/workflows. Defined the scope and progressed from problem Statement to well-documented Designs.
- Generated all Medicare claims review and transmit to Medicare
- Utilized Rational Req Pro as a user to analyze the business requirements
- Excellent knowledge of Medicaid Health Insurance Policies and CPT coding.
- Worked on MS CRM Dynamics for handling the customer claim inquiries, Validation and case creation.
- Facilitated with JAD sessions with the management groups, vendors, users and the IT Group for open and pending issues to develop specifications.
- Conducted Functional Walkthroughs as well as User Acceptance Testing (UAT) sessions.
- Developed Use Case diagrams with MS Visio and also created Business Flow Diagrams, Activity/State diagrams, and Sequence diagrams, which enabled developers and other stakeholders to understand the business process
- Created business process workflow diagrams (Activity diagrams) in Rational Rose.
- Worked through Software Development Life Cycle (SDLC) from Requirements, Analysis, Design, and Implementation through Testing.
- Created detailed level test scenarios on HIPAA compliance testing. Gathered business requirements from business users such as Insurance Policy Managers and drafted business requirement document (BRD).
- Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes.
- Managed the Patient Online ecommerce project, utilizing MS Project, medical systems and (Electronic Medical Records) EMR Conducted iterations, communicated results, and milestone achievements to the stakeholders while keeping the developers closely updated on all documented refinements.
- Performed testing for Medicare and Medicaid claims for Medicaid Management Information System (MMIS)
- Created and maintained a project schedule using MS Project showing all target dates for deliverables.
- Created and maintained complete development plans that included functional specifications, requirements engineering, Use Case modeling, risk assessment and mitigation, internal and external workflow.
- Extensively used ETL to Extract, Transform and load data.
- Developed Scripts for Regression Testing and System Testing.
Environment: Windows, UNIX, C++, HTML, XML, Rational Rose, Rational Requisite Pro, SQL, MS-Project, JIRA
Confidential, Parsippany, NJ
Business Systems Analyst
- Identified workflows, Prepared, and documented the UML diagrams- Activity, Sequence, Use Case, Data Flow, and Created page mockups using Balsamiq.
- Responsible for creating and reviewing business requirements, functional/non-functional specifications, project schedules, documentation and Test plans.
- Analyzed Business requirements and segregated them into high level and low-level Use cases, Activity Diagrams, Context Flow Diagrams, Business Process Flow Diagrams thus defining the Data Process models.
- Responsible for keeping track of Action Items, Risks involved, Key decisions and Dependencies in PMG.
- Work with key stakeholders on development of necessary requirements, progress tracking and departmental readiness assessments.
- Responsible for creating UI mockups (wireframes) using Balsamiq.
- Defined Precise and Accurate User Stories fulfilling INVEST criteria, Acceptance Criteria in TFS that were used by developers, automation test frameworks and by Product owner to ensure that product owner intent is effectively captured.
- Documented Requirements Traceability Matrix to keep track of functional requirements mapping to User Stories in TFS.
- Facilitated follow up meetings with the involved systems in the project and documenting the meeting notes.
- Testing Phase - Review test cases and suggest changes to ensure all functional requirements are covered. Perform Scenario testing. co-ordination of e2e/UAT thru to stakeholder sign-off. Analyze and trouble shoot issues and create solutions for the same
- Change Management - Work with Business and IT stakeholders for handling any changes to agreed requirement.
- Other Activities - Requirement prioritization, estimation, providing inputs for requirement scheduling and Project plan, Conduction demos for business, assist and Liaison between Business and Testing Teams during UAT, Performing User Guide updates
Environment: Agile, Java, Oracle Big Machines, MS Office, Visio, UML, SQL
- Worked with the internal e-commerce and web development teams to analyze and design the e-commerce solutions to meet the business objectives.
- Focused to increase the efficiency of the company's online sales by researching and doing cost-benefit analysis.
- Identified and analyzed the e-commerce needs and requirements of the clients as well as Autozones’.
- Project managed scope and prioritization across work streams across customer and R&D teams.
- Worked on business and technical requirements of user interface design to deliver a complete solution for all R&D initiatives.
- Assisted the project manager in project design and project plan using the RUP Methodology, developing timelines for project delivery as well as assessing risks and impact of changes.
- Performed detailed data analysis and process mapping and assisted in building business process analysis model.
- Led requirements elicitation meeting to obtain consensus and feedback on functional requirements and business rules.
- Performed detailed GAP analysis involving the current state and proposed state analysis.
- Worked in conjunction with other team members, technical architects and developers to understand system integration and interface requirements.
- Designed and developed written documentation such as Use Cases, Use Case Diagram, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams
- Extensively used Ms SharePoint for managing content across the organization .
- Conducted highly interactive JAD sessions with project stakeholders to identify and resolve issues.
- Wrote specifications for various reports. Generated canned reports using Business Objects.
- Determined a testing strategy in conjunction with the QA team. Assisted in writing detailed Test Plan, Test Cases and Test Case Scenarios for system testing, integration testing and functional testing.
- Assisted in performing and coordinating unit, performance and functional testing.
- Coordinated User Acceptance Testing (UAT), developed and maintained quality procedures and ensured that appropriate documentation was in place.
- Reported and analyzed all application defects, user issues and resolution status and assisted in deployment and implementation.
Environment: Rational Suite (Rose, Requisite Pro, Doors), Rally, JIRA, Visio, OBIEE, Cognos, Dreamweaver, Sharepoint, Rational Unified Process (RUP), UML, UNIX, MS-Project, MS-Office Suite, Casewise Corporate Modeller, WinRunner
Confidential, Indiana Polis, IN
- Gathered legacy business requirements through interviews Customer Service Representatives (CSRs), Customer Relationship Representatives (CRRs), prepared questionnaires, and identified limitations in the current system and GAPS in the proposed system.
- Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models.
- Used Rational Rose for creating the Use Cases Diagrams, Activity Diagrams, Class Diagrams, and Sequence Diagrams, etc.
- Performed System Testing of the Claims Processing Systems (Pricing Rules, Duplicate/Limits validation, Member Eligibility, Provider Enrolment).
- Responsible for understanding the Business Process and the Functional Specifications of the entire web sales process that included Underwriting, Evaluation, Enrolment, Membership and Billing, and the Vendors Business Processes.
- Reviewed documents/templates to create BRD and implemented the RUP process, identified Gap Analysis and the AS-IS and TO-BE model.
- Met with various HMO, PPO, Medicaid/Medicare, and Tricare/Campus Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
- Created Mapping Documents, Report Mockups and modified existing report mockups and finalized for development.
- Created Use Cases, Activity Report, Logical Components to extract Business Process Flows and workflows involved in the project using Rational Rose, UML and Flow Chart Tools such as MS Visio.
- Collaborated with Project Manager to analyze change requests from business side to determine the change of scope and distribution of tasks between mainframe and Business Process Models (BPM) development teams.
- Prepared Business Process Models (BPM) that included modelling of all the activities of business from conceptual to procedural level.
- Presented the requirements to the Development Team and Management in the form of Mathematical Business Rules, Scenarios and User Stories.
- Created and maintained data model/architecture standards including master data management (MDM).
Environment: UNIX, .NET Framework, UML, Rational Rose, MS Project, MS Access, MS Visio, Sybase, SQL, Oracle, MS Office Suite.