We provide IT Staff Augmentation Services!

Senior Busiss Analyst Resume

NE

SUMMARY:

  • Over 6 years of Information Technology as Business Analyst with a focus in Healthcare including MMIS, Medicaid, Medicare, FACETS, HIPAA, EDI, and other supporting applications for insurance providers & service providers.
  • Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
  • Experienced as a Business Analyst in using the iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, internet and intranet applications on heterogeneous environments.
  • Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
  • In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
  • Used Query Analyzer, Execution Plan to optimize SQL Queries.
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
  • Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
  • MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
  • Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
  • Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
  • Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
  • In depth knowledge of SDLC and implementation of the Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition.
  • Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
  • Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.

TECHNICAL SKILLS:

Programming Languages: C, C++, HTML, XML, SQL.

Data Base: MS Access, Oracle (SQL Series), DB2

Reporting Tools: Crystal Reports 8.0

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux

Software: MS Office Suite(Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes

Processes/Technologies: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2007

Automation Tools: Requisite Pro, Win runner, QTP, Test Director, Quality Center

PROFESSIONAL EXPERIENCE:

Confidential, NE

Senior Business Analyst

Responsibilities:

  • Expertise in writing SQLQueries using Oracle, SQL Server and Teradata in validating data into Data Warehouse/ETL applications.
  • 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.
  • Facets Conversion files development. Development of the database objects required for the product for each table change in Facets.
  • Experience with Medicare, Medicaid and commercial insurances in HIPAA, ANSI, X12 formats including 270/271, 276,277, 278, 835, 837, 997.
  • Responsible for conducting the overall System Testing to verify operations of key FACETS modules involved in the processing of claims (including benefits), providers and members.
  • Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
  • Built business requirements into the Medicare Advantage (MA) requirements database and created the Project Requirements Document for the three functional areas
  • Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
  • Writing Epics and user stories, managing sprints and backlog grooming, and tracking project progress in JIRA.
  • Analyzed system performance and initiated process improvement measures for mainframe and Web-based applications.
  • Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment
  • Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
  • Used JIRA to perform test management activities and Involved in extraction of data from various sources like flat files, Oracle and SQL Server. Coordinated with the ETL team to come up with processes for ETL involving Oracle/Informatics
  • Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
  • Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.
  • Involved in development of the system for data exchange from EMR, EHR to Electronic Lab Reporting Systems
  • Working knowledge of Medicare, Medicaid and Commercial Insurance benefits eligibility (834s), contracts set up, billing, claim (837s) processing includes remits (835s) and denials.
  • Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High-Level Requirements.
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
  • Worked in an AGILE delivery model involving multiple scrum teams and daily stand-up meetings
  • Implemented and tested the application with Agile Methodology for overall software test strategy and approach, project schedules, issue management, estimations and risk assessment.
  • Participated in meetings to discuss the alignment between the two different software development processes used by Amex (waterfall model) and NAN (agile method).

Confidential, Middletown, NY

Business EDI Analyst

Responsibilities:

  • Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
  • Matched the requirements for programs such as Medicare and Medicaid, which are part of the Social Security Act.
  • 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.
  • Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277, 835, 834 EDI transactions.
  • Generated a streamline process to understand the various steps in the loan lifecycle and desired functionality of the new system by interacting with users, management, SME (Subject Matter Expert), stakeholders, lenders, underwriters.
  • Participated in 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.
  • Worked on the Patient Management System (integrated version of Patient Information System with EMR/EHR)) is intended to remotely communicate with a compatible pulse generator from BSC CRM and transfer data to a central database (HIT EHR).
  • Conducted brainstorming sessions with the business users and SMEs to elicit requirements and worked in the creation of Agile Epics, user stories, Acceptance criteria documents.
  • Extracted data by running SQL queries, and reviewed securities, financial and customer metadata that gets populated on the web application.
  • Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
  • Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
  • Led the development of a training program to train users on a custom web application and a Cognos ad-hoc reporting environment.
  • Trained the team on JIRA tool for Agile/ Scrum Methodologies and Worked with ETL groups and Acquisition team and business analyst for understating mappings for dimensions and facts
  • Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
  • Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations
  • Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
  • Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR
  • Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
  • Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
  • Working knowledge of Medicare, Medicaid and Commercial Insurance benefits eligibility (834s), contracts set up, billing, claim (837s) processing includes remits (835s) and denials.
  • Assisted the database development team in data modeling, data structure and data table layouts required for consolidation of incongruent databases,
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
  • Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
  • Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
  • Reduced operational risk by creating controls, documenting procedures, reviewing and reducing manual processes
  • Facilitated the documenting of test cases and recorded them for the functionality testing in Test Director based on test requirements.
  • Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
  • Worked with the scrum master in getting the estimates for the projects and also user stories and defined the sprint periods using Agile/ Scrum methodology

Confidential, Bismarck, ND

Business Analyst

Responsibilities:

  • Interacted with Informatica developers for designing and developing complex web intelligence, Business intelligence, Client and ad hoc reports for corporate data.
  • Successfully designed and implemented statistical reporting processes for regular data collection and clinical data analysis. Analyzed safety and efficacy data from Phase II and III clinical trials.
  • Met with physicians, nurses, billing and administrative personnel. Documented the clinical, financial and administrative business practices, procedures and workflows.
  • Defined the current clinical and financial business processes and practices.
  • Applied guidelines, standards and regulations such as HL7 CDA, CDISC, MedDRA, Code of Federal Regulations (CRFs) to clinical data modeling.
  • Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
  • Worked with SME’s in Finance, Investment, Commercial and Personal banking to collect the Business process requirements, documented them in Business Requirement Document (BRD) and performed Business Process Re-engineering.
  • Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
  • Analyzed data flow requirements and developed a scalable architecture for staging and loading data and translated business rules and functionality requirements into ETL procedures.
  • Analyzed business requirements and implemented technical solutions and assisted with local WAN, LAN, Server, desktop and other technologies.
  • Developed test plans, test scenarios, test cases, test data to be used in testing based on business and user requirements, technical specifications.
  • Expertise in writing SQLQueries using Oracle, SQL Server and Teradata in validating data into Data Warehouse/ETL applications.
  • 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.
  • Facets Conversion files development. Development of the database objects required for the product for each table change in Facets.
  • Experience with Medicare, Medicaid and commercial insurances in HIPAA, ANSI, X12 formats including 270/271, 276,277, 278, 835, 837, 997.
  • Responsible for conducting the overall System Testing to verify operations of key FACETS modules involved in the processing of claims (including benefits), providers and members.
  • Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
  • Built business requirements into the Medicare Advantage (MA) requirements database and created the Project Requirements Document for the three functional areas
  • Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
  • Writing Epics and user stories, managing sprints and backlog grooming, and tracking project progress in JIRA.
  • Analyzed system performance and initiated process improvement measures for mainframe and Web-based applications.
  • Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment
  • Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
  • Interacted with line of business managers and coordinated the transition into the security database to assure business compliance with SOX.
  • Used JIRA to perform test management activities and Involved in extraction of data from various sources like flat files, Oracle and SQL Server. Coordinated with the ETL team to come up with processes for ETL involving Oracle/Informatics

Confidential, Hartford, CT

Business Analyst

Responsibilities:

  • Instructed and modeled core Agile principles of collaboration, prioritization, team accountability and visibility, ensured consistent application of SCRUM methodologies across the enterprise
  • Extensive involvement in performing Data-Analysis of the Backend Systems and existing Web Services to define the solution.
  • Performed analysis, design, development and maintenance of the Epic Ambulatory applications and other clinical information systems
  • Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
  • Strong experience in all phases of Software Development Lifecycle (SDLC) using Waterfall, Agile/Scrum, RUP (Rational Unified Process) and Software Testing Life Cycle (STLC).
  • Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
  • Experience with EPIC user and provider record provisioning, including the development of role-based access, security classes, and user profiles
  • Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
  • Assisted 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.
  • Experience in Epic Resolute product implementation and deployment
  • Worked on FACET modules such as pricing, payer, eligibility under claims processing system.
  • The project dealt with enhancements to the Healthcare Payment EDI transaction set to generate a payer level containing payer specific information.
  • Full knowledge of application interoperability configurations and managed the implementation tasks of HIE clinical applications.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. 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 Enrolment hence analyzing and documenting related business processes
  • Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
  • Involved extensively in writing Agile User Stories and get them reviewed with Business lead and project manager for Sign Off.
  • Worked on AGILE Environment with daily scrum meetings, grooming sessions, planning and sprint cycles.

Hire Now