SUMMARY:

• Seasoned Healthcare Business Systems Analyst and Project Delivery Specialist with over 6 years of diverse experience spanning across the areas of Member Enrollments, Claims and Bill Review Process including EDI transactions (837), ICD 9 and ICD 10 structures, differences and conversations and HIPAA rules and regulations.
• Integral part of Healthcare Government Programs with an extensive project/program management experience - highly recognized for designing, developing and implementing innovative business processes and providing system solutions using new approaches.
• Implement Healthcare claim processing application for payers and providers
• HIPAA 4010 - 5010 conversion (adhering to the implementation/ companion guide for respective 837 EDI’s
• ICD 9- CM, ICD 10-CM structures and differences
• Model User Interface - creating user-friendly interfaces and creation of prototypes
• UML modeling, drawing Use Cases Diagrams and Activity diagrams (Microsoft Visio)
• SQL Query: Analysis, Research and Data extraction
• MS-Office (Word, Excel, PowerPoint, Access, Visio, Project)
• SharePoint
• HP ALM (Quality Center for Requirements Traceability Alignment and Defect Tracking)

PROFESSIONAL EXPERIENCE:

Sr. Business Systems Analyst

Confidential, Orange, CA

Responsibilities:

• Lead and managed the development effort of creating Workflows for complex business processes defining the end-to-end flow of information and data exchange between applications along with appropriate ownership.
• Created Business Rewuirement Document (BRD) andvFunctional Requirement Specifications (FRS) by gathering requirement from business users, project charter and based on User Requirement Specification URS. Understand and articulate business requirements from user interviews and then convert requirements into technical specifications.
• Analyzed Client/Business Requirements and Documented Functional Requirements and Use Cases as part of the Functional Specifications Document
• Identified process impacts and opportunities for optimization of the CORE UI around User Plan Changes - produced documentations and proposals outlining deficiencies including options for remediation: removal of redundant flag attributes and enhanced user dialog messages.
• Researched, tracked and communicated on areas that caused slowness throughout the application and improved the disbursement processing speed by over 20% than actual for the CORE UI.
• Assisted in planning and managing various project initiatives to assure goals and objectives accomplished within prescribed timeframe - Identified project constraints through planning and established appropriate goals for project accomplishment.
• Maintained the Project/Product Backlog for user requirements and user stories, reviewed the functional specifications deliverable drafts created by Business Analysts team and assisted/shadowed them to produce and analyze data by making clean data facts available to the development team for testing and migration
• Enact change & continuous improvement to increase the productivity of the team and quality of deliverables.
• Lead the effort to discuss and document the Business Need and Vision Scope - interviewed Business Stakeholders and performed Brainstorming sessions by documenting the related scope of development and other enhancements per aggregated prioritization.
• Worked closely with the Business and IT collaborates for project execution; served as a liaison between IT Partners and Business Stakeholders (collaborates) through the project life cycle. Partnered with Plan and Build Project Managers to estimate and scope development needs for the project.
• Empowered teams to self-organize and grow cross-functionally
• Coached business team in the set up and conduct of UAT, review test scripts, and report out on UAT results including defects for resolution and enhancements for future roadmap. Facilitated Business Sign-Off on UAT results.
• Responsible for development of testing strategy, preparation and execution of test scripts. Produced and provided reports on testing progress, scheduling issues and project risks at review meetings and escalate issues if necessary.
• Executed the test scenarios/cases for functional and User testing from the test plan. Responsible for development of testing strategy, preparation and execution of test scripts. Regression testing to ensure that the product functions as expected.
• Report on testing progress, scheduling issues and project risks at review meetings and escalate issues if necessary.

Sr. Business Systems Analyst

Confidential, Irvine, CA

Responsibilities:

• Lead the effort of gathering the Functional Requirements by understanding and articulating business requirements by conducting interviews with the Stakeholders and documenting the same in the Functional Specification (FRS) based on User Requirements Specifications (URS) - translating them to technical specifications thereafter for the development team.
• Conducted weekly FSD Status meetings with a team of 8 business analysts, to track the progress and address any issues the team members may be facing while working on their respective FSDs.
• Facilitated JAD sessions, which focused on the definition of Business Requirements, security access groups and third party insurance companies associated. Prepared Use Case views for a clear understanding of the vision document and stakeholders’ requests along with visual aids such as Use Case Diagrams, Activity Diagrams and Data Flow Diagrams (DFDs).
• Collaborated with the development and Quality Assurance team to make sure they understand the documented requirements and helped in the creation of Test Plan and Test Cases. Assisted in User Acceptance Testing (UAT) throughout the life cycle of the project.
• Documented Change Requests, Patch fixes and Production Support tickets for ongoing production issues with multiple SW clients. Developed weekly status reports describing the overall health of the project, project progress, problems the team came up with, and potential unidentified risks.
• Assisted in system validation and defects logging to ensure quality product delivery. Performed Backend Database Validations and Front-end User Validations before releasing the patch into production.

Business Systems Analyst

Confidential, Jacksonville, FL

Responsibilities:

• Interacted with the SMEs and stakeholders to get a better understanding of client business processes and gather business requirements. Worked with HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims. Knows how to read 837 files and submitting them manually.
• Performed crosswalk for understanding major changes from ICD-9 to ICD-10. Drafted the major changes that would appear in ICD-10 version and verified the EDI raw data as per 5010 format.
• Worked on COB (Coordination of Benefits) for Medicare claims processing; Mapped ICD09 codes to ICD10 codes - both Primary/Principal codes and Non Primary.
• Performed Gap Analysis ICD9-CM and ICD10-CM E-codes - analyzed complex business issues related to ICD 9 and ICD 10 crosswalks mapping by abstracting medical records with ICD 9, CPT and DRG coding.
• Created BRS documents and identifying the rules and benefits that should apply to both ICD09 and ICD10 codes after the mandatory date.
• Wrote SQL queries to check the contents of the SQL Server tables of the application - worked closely with developers and testers in retrieving data using the developed SQL Queries
• Worked on Pricing Edit in in terms of testing the Re-Pricing of system. Created BRD on process of changing bill charges to allowed charges that helped creating test cases on Claim Edit and Pricing Edit rules in system of claim adjudication
• Involved in designing the Test plans, creating and running the automated and manual test on the HP platform - wrote test cases and executed them manually from HP Quality Center to test the application for its functionality and system integration.
• Participated in the walkthrough for the evaluation of the test plans with QA Lead and the development team and conducted review meetings with the development team to set a hard-freeze date and gather input for creating the Test Plans and Test Specifications.
• Involved in developing Test Plans and Test cases for the transactions 834,835, 837,270/271, and 276/277. - Performed System, Integration, Functional, User Acceptance and Back End testing. Interacted with the developers on various technical issues and resolved the reported bugs.
• Collected test metrics weekly from the test director database that reflected the current status of the test execution and the state of the defects
• Followed the UML based methods using Rational Rose for Business Modeling