- An accomplished Business Analyst with over 7 years of Information Technology experience in the Business Analysis, Business System Analysis and Project management.
- Good knowledge and experience in Software Development Life Cycle (SDLC) and its phases: Requirement gathering, Analysis, Design, Implementing, Testing, Deployment, and Maintenance.
- Used various approaches of SDLC like Agile and Waterfall, Rational Unified Process, and SCRUM software development methodologies.
- Create Functional Specification Documents and Data Mapping Analysis for System Integrations.
- Technical experience in Interfaces, Screen mockups, Data conversion and Data mapping.
- Well versed in Business Process Modeling with expertise in creating User Cases, Sequence Diagrams, Class Diagrams, Activity Diagrams, writing User Stories.
- Having extensive domain knowledge in MMIS, EPIC, EDI X12, HIPAA, System, Medicare and Medicaid, CMS Compliances/Regulations.
- Profound knowledge of EDI X12 standards in healthcare insurance.
- Strong institutional knowledge of Medicaid; including Medicaid Information Technology Architecture (MITA), and Medicaid Management Information Systems (MMIS)
- Development of 820, 834, 837 Claim billing, 276 Status, 834 Enrollment, 835 Claim Payments, 829 and many other healthcare maps.
- Understanding of EDI business practice and the ability to understand the client's needs.
- Strong Experience in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
- Working experience in Health Insurance Exchange (HIX), Health Information Exchange (HIE) and Encounter Data Processing System (EDPS/RAPS).
- Experienced with Federal contracts, X12 transactions, health care act, EDI transactions 270, 271, 834, 835, 837.
- Proficient in managing end - to-end project delivery, system & business analysis, operations & support for various projects.
- Proficient in performing project analysis which entails Requirements Analysis, SWOT Analysis, Data Analysis, Gap Analysis, Process analysis and documentation of the same.
- Expertise in creating artifacts such as Business Requirement Document (BRD), Functional and Non-Functional Requirements Document (FRD and NFRD), Use Cases (UC's), Requirement Traceability Matrix (RTM), User Manuals and Guides. Functional Requirement Specifications (FRS) System Requirement Specification (SRS), and visualizing graphical user interface (GUI) using mockup screens.
- Strong business insight with communication, interpersonal and presentation skills and can work with teams and cross functional departments of an organization. Strong analytical and problem-solving skills, capable of addressing relevant facts and recommending solutions.
- Experience with health care systems: QNXT, Medicare Part A, B, C, D, Medicaid systems, Technical Report Type 3 (TR3) Implementation Guide, and Companion Guide.
- Experience in configuration of claims processing applications, claim adjudication process, claims management process, real time claims adjudication, Electronic Medical Records / Electronic Health Records (EMR/EHR) and Medicaid Management Information System (MMIS), and Medicaid Information Technology System (MITS).
- Have knowledge of HIPAA transaction and code standards and electronic data interchange (EDI) standards like X12 837, 270, 271, 276, 277, 278, 835, 275 and knowledge of claims encounters process.
Confidential, Roseville, CA
- Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically with 837, 835, 834, 270/271, 276/277
- Configure Benefits and Provider Contracts in QNXT for various lines of business.
- Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
- Responsible for validating EDI 837I and 837P claims output files.
- Worked on HIPAA standard/EDI Standard Transactions: 834, 835, 837 to identify the key data set elements to the designated record set.
- Participated in QNXT implementations and conversions of Medicaid-Medicare Health Plans.
- Worked on the requirements pertaining to client requests for changes / modifications required for Medicaid from stakeholders.
- Installed, integrated, and supported QNXT environments for a new line of business.
- Familiar with QNXT’s Q-Connect dental implementation, Claims Adjudication, Coordination of Benefit, Claims Payment and Adjustments,
- Analyzed, revised and created Use Cases according to business requirements.
- Created used cases and Activity Diagrams.
- Supported progressive elaboration of Clarity plan for future project phases being planned.
- Followed the RUP methodology for the entire SDLC.
- Completed QNXT from 5.2 to 5.4 Upgrade project. It was achieved by closely working with Cognizant team on their tasks.
- Installed and upgrade ClaimCheck.
- Worked closely with vendor to upgrade and manage whole project encounter data management for the client.
- Managed project schedule, managed resources, deliverables and key milestone during Project.
- Installed, configured and maintained HIPAASUITE product to load inbound EDI transactions like 834,837 and 277CA.
- Utilized a combination of business knowledge, technical skills, and strategic analysis to provide solutions and creative insights to critical business problems.
- Effective in multitasking and effective management of assignments/deliverables according to work schedules with strong project management orientation.
Environment: RUP, UML, Rational Requisite Pro, SQL, Jira, QNXT, EDI, SharePoint, MS Visio, MS Excel, MS PowerPoint, MS Word, MS Access, HP ALM.
Confidential, Chicago, IL
- Analyzed the impacts of HIPPA 5010 project on enrollment, Claims and Benefit.
- Gathered, defined and documented highly complex business requirements for NPI crosswalk implementation.
- As part of validation process for EDI 820, outlined the discrepancies in eligibility reconciliation process and updated the process after discussion with stakeholders.
- Created mapping for EDI transactions, specially 820 and 834. Outlined the updated processes for Payment Reconciliation, Eligibility, and Premium Payment Transactions
- Worked on functionalities such as Premium Payments, Enrollments and Claims.
- Review and understand the claims process and complex requirements for the enhancement of the current system created under the Requirement Specification Documents after conducting interviews with End Users, JAD Sessions and analyzed their current systems.
- Writing the General System Design Documents that demonstrate current and proposed/solution business design and changes to the current Legacy System.
- Documented complex Business requirements and made process flow diagram for the EDI transactions EDI 837, 835, 820, and 834 as per the implementations for the Medicaid claim processing system enhancement.
- Worked on Data Mapping documents explaining flow of data from one-to-another table for the system enhancement purpose required by HIPAA 4010 implementation.
- Worked with technical staff and business users to problem-solve and identify workable solutions.
- 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.
- Maintained Requirements Traceability Matrix (RTM) throughout the project.
- Developed Companion Guides for the business users.
- Wrote test cases, test scenarios, test scripts and prepared test data to conduct the manual testing of EDI files and the online screens.
- Performed manual testing by building 837 claims, converting them into EDI file, uploading them into mainframe region and doing error resolution & testing for 5010 requirements & NPI crosswalks.
- EDI file testing for checking the HIPAA 4010 compliance of the inbound 837 claims.
- Conducted User Acceptance Testing and User for the HIPAA 5010 Project.
- Worked with the users for the enrollment process.
Environment: - Agile Scrum, MS Office, MS Visio, MS Project, JIRA, SharePoint, Rally, UML, SQL
Confidential, Dallas, TX
- Assisted the Project Manager in setting realistic Project expectations and in evaluating the impact of changes on the organization and plans accordingly and conducted Project related presentations.
- Identified internal and external system Requirements, design and configuration set-up.
- Developed strategic partnerships with the Business units to develop a solid knowledge base of the Business line, including the Business Plan, Products, and Process.
- Conducted and managed outcomes of various studies that include analyzing, reviewing, forecasting, trending and presenting information for operational and business planning.
- Developed and implemented effective and strategic business solutions through research and analysis of data and business processes.
- Tested, and maintained functional reports based on user requirements. Mastered the ability to develop innovative reports.
- Translated the Business needs into system Requirements, communicating with the Business on a broader scale and with an in-depth view.
- Analyze and validate quality and accuracy of the production data also analyzing and validating built-in business rules and processes in above data warehouses programs.
- Functioned as the primary liaison between the Business line, operations, and the technical areas throughout the Project Cycle.
- Worked closely with Business users. Interacted with Developers, Project Managers, and members of the QA teams.
- Lead large-scale projects and initiatives, delegated analysis work and provided direction, guidance and support to fellow business analyst.
- Working knowledge of up-to-date web technologies especially social media.
- Helped businesses utilize artificial technologies to generate more revenue by the use of business analytics and social media marketing.
- Tracked the progress of implementation plans and made changes as needed.
- Collaborated with local and regional operational hubs with in Confidential to make sure all client needs were being adhere to.
Environment: - Agile Scrum, MS Office, MS Visio, MS Project, JIRA, SharePoint, Rally, UML, SQL.
- Complete historical, budgeted, forecasted, and competitive analysis for effective budgeting and strategic planning.
- Liaise between business and technical personnel to ensure a mutual understanding of process and application.
- Communicate with business units to gather Requirement and prepare Business requirement document and Function requirement document.
- Collaborate with Developers, Implementation specialists, and Subject matter experts to understand the requirements and tasks required to deliver.
- Research key variables and market trends to create sensitivity analysis.
- Analyze financial reports, making studies or recommendations relative to the accounting for reserves, revenues and assets.
- Translate business requirement to IT team via user stories and workflow diagram.
- Resolving issues and report generation to assure that all aspects of a project are according to business requirements.
- Maintain and expand client relationships through delivery of high-quality work.
- Ability to learn quickly and adapt to fast-moving analytical situations with minimal oversight.
- Ability to identify problems and issues and assist with reporting questions.
- Responsible for basic researching a given number of stocks using a variety of research and investment techniques.
- Strong understanding of finance with excellent Operational analyst background in Fixed-income and equities.
Environment: - MS Office, MS Visio, MS Project, JIRA, SharePoint, SQL.