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Business Analyst Resume

Little Rock, AR

PROFESSIONAL SUMMARY:

  • Expert at assessing business requirements and defining traceable, understandable application requirements
  • Experience with Medicare and Medicaid Claims processing, Membership, and Eligibility Verification
  • Thorough knowledge of Eligibility and membership Affairs for Medicare and Medicaid also knowledge of HIPAA, X12, and HL7 standards, and Medicaid provider best practices
  • Experienced with System Development Methodologies (SDLC), Prototyping, ER Modeling, Functional Hierarchy Diagrams, Data Flow Diagrams, RDBMS, Object Oriented Programming Approach, Design Patterns, UML, Data Warehouse (ETL/OLTP/OLAP), Unix Shell Scripts, Service Oriented Architecture (SOA), SharePoint & BizTalk Messaging.
  • Strong knowledge and experience in healthcare industry working knowledge on HIPPA and Medicare Management Information System (MMIS).
  • Extensive experience in requirements gathering, feasibility analysis and successive documentation in project related artifacts like the User, Functional and System Requirements Specification documents
  • Experienced with Medicare and Healthcare Insurance; as well as Medical Standards (HIPAA and HL7)
  • Extensive experience in Unified Modeling Language (UML) modeling, including Use Cases, Activity diagramming with swim lanes, and Context diagrams using tools such as MS Visio
  • In depth understand & analyzing various 834/837 claims of Inbound & Outbound process of X12 through Xengine until Submission file to State in ETL Process for Various LOB's.
  • Knowledge of EMR/EHR, HMO/PPO/POS, Health Care Reform and Patient Protection and Affordable Care Act PPACA, Medicare Part A, B, C, D, Medicaid, Medicaid Management Information Systems MMIS, Medicaid Information Technology Architecture MITA.
  • Experience testing implemented systems and system changes including liaising with QA teams to develop test cases, test plans, test scenarios, and generating test data; and conducting manual testing (regression, end - to-end, functional)
  • Experience running scripts to check web user interface and Portals for Broken Links, Frame Properties, Table Properties, URL links, Images, Text and prepared Test Metrics to test execution status and results
  • Experience and understanding of Healthcare and Health Insurance business models and operations including Enrollment, Membership Management, Claims Processing, and Client Management

TECHNICAL SKILLS:

Business Modeling Tools: Visual Paradigm, MS Visio, PowerPoint, Rational Rose

Requirements Gathering Tools: Rational RequisitePro, MS Word, MS Excel

Microsoft Tools: MS Office, MS Visio, MS Project

SDLC Methodologies: RUP, Prototyping, RAD, Waterfall

Testing Tools: Mercury Test Director

Programming Languages: PL/SQL,VB.Net, QBasic, HTML,PHP, ASP.Net

Defect Management Tools: Mercury Test Director, Rational ClearQuest

PROFESSIONAL EXPERIENCE:

Confidential, Little Rock, AR

Business Analyst

Responsibilities:

  • Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations and to discuss the different ways and means for migrating data.
  • Gather requirements from the stakeholders and facilitated meeting for a final sign off as well as developing and maintaining business rules.
  • Experience with EMR implementation and post-implementation support.
  • Documented requirements along with a detail data analysis of the systems involved and defined data mapping rules and created source data for the ETL.
  • Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc).
  • Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
  • Document the business processed surrounding Medicaid claims, benefit plans, claims payment cycle, waiver programs, and references.
  • Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling and Utilized JIRA to develop and track agile epics, stories and tasks.
  • Developed business level activity diagram utilizing UML (according to Agile Unified Process) to visualize use cases, identified gaps between the current model and future model.
  • Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system.
  • Maintain and upgrade EMR as needed to new versions and service packs.
  • Worked with CURAM System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 834 and proprietary format files and Reports development.
  • Used Toad for Creating and executing SQL Queries for Data Analysis and extensively involved in Database testing.
  • Setup Procedures to Extract, Transform and Load (ETL) data from Operational and Legacy Systems to the Data Warehouse by Using Informatica.
  • Authored data flow diagrams, sequence diagrams, and business process models that describe how the data is anticipated to flow from one system to another.
  • Experience in writing SQL queries to validate data while performing research/analysis and data modeling.
  • Created Interfaces and writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary, Data Migration and Interface Requirements Documents.
  • In-depth knowledge and experience in full SDLC with Agile/SCRUM and waterfall methodologies.
  • Facilitate all agile ceremonies including daily stand-ups, weekly grooming, retrospective, and review and planning session.
  • Actively participated in status report meetings and interacted with developers to discuss the technical issues.
  • Setup Procedures to Extract, Transform and Load (ETL) data from Operational and Legacy Systems to the Data Warehouse by Using Informatica.
  • Responsible for defect tracking and bug reporting using JIRA; interacted with developers and Business Analysts to discuss and resolve defects.
  • Involved in daily defect review meetings to review the status of defect fixes and upcoming build releases.
  • Verified and validated all the build or release related issues and resolve then through discussion with business analysts with the users approval.

Confidential, Plano, TX Juy

Business Analyst

Responsibilities:

  • Conducted JAD sessions with business units and stakeholders to define project scope, to identify the business workflows & task analysis and determine whether any current or proposed systems are impacted by the new development efforts.
  • Working knowledge of Epic Rx /Epic Lab/Epic Care Inpatient/Health Information Management and Chart Tracking.
  • Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications
  • In depth analyzing & testing for 834/835 Inbound & Outbound process of X12 through X-Engine until Submission file to State in ETL Process for Various LOB's.
  • Functional experience in health Care Industry with vast knowledge on Medicare and Medicaid and performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
  • Ability to analyze engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production
  • Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
  • Gained Knowledge of EDI transaction code sets including, 276/277, 834, 835, 837.
  • Tested EDI transactions 270/271, 837, 835, 834(X12) according to the test scenarios.
  • Provided business and mapping expertise during a transition of the EDI applications from the GXS Application Integrator (AI) to GIS.
  • Facilitated problem solving, client interface interaction design, analysis of data flow/data model, and technical leadership with business intelligence teams.
  • 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.
  • Performed User Acceptance testing & End to End testing in interaction with Offshore QA/dev teams for various system releases & pushed them to production
  • Involved in all SDLC stages under Agile process requirement analysis, implementation, testing (functional and use acceptance) and deployment.
  • Involved extensively in writing Agile User Stories and get them reviewed with Business lead and project manager for Sign Off.
  • All work performed in a SOA (Service Oriented Architecture) and using an Agile development methodology.
  • Experience with TriZetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
  • Facets Product Configuration of new products and components including research, testing and trouble shooting in FACETs.
  • Used Facets 4.71 to receive, store and send HIPAA-standard transactions (835, 837, 270, 271, 276, 277) and to administer HIPAA privacy rights.
  • Extensive working experience with HL7, EDI X12 transactions, Facets, claims process, HIPAA, Billing Process etc.
  • Work closely with EDI to ensure accuracy in data transmissions and shared processes. Transaction sets processed (834,835)
  • Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical Specification and documented in Mercury Quality Center.
  • Gathered requirements for making changes to the existing Electronic Medical Records(EMR), Electronic Health Records(EHR) and Ambulatory Services for the existing Epic Interfaces.
  • Always maintained excellent problem-solving and communication skills; and effectively listened, negotiated, debated, discussed, brainstormed, communicated, and collaborated with a variety of individuals and groups

Confidential, Austin, Texas Area

Business Analyst

Responsibilities:

  • Evaluated business process requirements to ensure proper system configuration (i.e. identifying key decisions, process changes, pain points, interface issues, training considerations, etc.)
  • Managing software projects development and delivering custom made solutions based on Service Oriented Architecture SOA.
  • Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team
  • Understood the healthcare plans offered, including Medicaid Managed Plans such as Children and Adolescent Care, Women’s Preventive Care, Maternal Care, Asthma Care, Diabetes Care, Cardiovascular Care, and Mental Health
  • Performed Functionality testing, Integration testing, System and UAT. Documented and logged the results and defects.
  • Gathered requirements for making changes to the existing Electronic Medical Records(EMR), Electronic Health Records(EHR) and Ambulatory Services for the existing Epic Interfaces.
  • Involved in development of the system for data exchange from EMR, EHR to Electronic Lab Reporting Systems.
  • Experience with EPIC user and provider record provisioning, including the development of role-based access, security classes, and user profiles
  • Functional experience in health Care Industry with vast knowledge on Medicare and Medicaid and performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
  • Ability to analyze engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production
  • Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations
  • 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.
  • 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 Enrollment.
  • Facilitated review of Enrollment, Claims, Commissions, and membership portlets’ designs with architects and developers to ensure that the goals of the portal requirements were satisfied
  • Utilized Microsoft SQL 2005 and associated business intelligence tools (SSIS, SSAS, SSRS) to provide focused transaction and task monitoring and error handling on an enterprise level.
  • Produced UML Activity diagrams with defined swim lanes using MS Visio as part of claims process analysis
  • Brought valuable knowledge and solutions to business groups to enhance competitive edge with Facets Extended Enterprise(TM) administrative system implementation
  • Contribute in the build and design of an automated documentation system that met business process needs by providing comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management
  • Analyzed & Tested HIPAA Gateway Application Interface for all inbound and outbound messages (Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 834)
  • Participated in all phases of the Facets Extended Enterprise(TM) administrative system implementation including the planning, designing/building/validation (DBV), testing, and Go-live support phases
  • Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
  • Working knowledge of implementing software development projects using methodologies such as Waterfall, Rational Unified Process, Agile/Scrum.
  • Involved with various aspects of the project’s needs such as the logging, tracking, and resolution of issues, current state workflow assessments, facilitating/presenting DBV sessions, and assist with integration testing
  • Worked on modules related to Providers, Contract & Claims and worked with Claims, Provider attributes, enabling EOB & Remit rules associated with Provider configuration process in Facets.

Confidential, Palo Alto, CA

Business Systems Analyst

Responsibilities:

  • Gathered User and Business Requirements through interviews, surveys, prototyping and observing Stored and modified requirements.
  • Excellent knowledge of E-Commerce, healthcare IT along with HIPAA regulations, EDI transaction Code Sets, and CMS regulations.
  • Accomplished projects and design documents on HIPAA 835 and 837 calculations and EDI transactions, Health Statements and Explanation of Benefits, Healthcare Reform and 5010 CMS occurrence and field expansion for 835 and 837 EDI formats
  • Created Need Analysis Documents of the requirements gathered through JAD and JRP individual elicitation sessions using MS Word.
  • Created User Requirement Specifications (URS), Business Requirement Document (BRD) and Functional Requirement Specifications (FRS) documents.
  • Created Use cases, Use Case Diagrams, Activity Diagrams, Business Flow Diagrams and Business flow diagram using Rational Rose and Rational Requisite Pro.
  • Involved in analysis of the technical specifications of the current system and the infrastructure needs performed Gap analysis.
  • 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.
  • Created complex stored procedures using SQL with multiple table joins and comprehended and isolated areas problems.
  • Gathered requirements for making changes to the existing Electronic Medical Records(EMR), Electronic Health Records(EHR) and Ambulatory Services for the existing Epic Interfaces.
  • Involved in development of the system for data exchange from EMR, EHR to Electronic Lab Reporting Systems.
  • Extensively used SharePoint to document project processes and procedures, communicate requirement and version control them.
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data and Configured the Data mapping between Oracle and SQL Server 2005.
  • Trained the team on JIRA tool for Agile/ Scrum Methodologies and instructed and modeled core Agile principles of collaboration, prioritization, team accountability and visibility, ensured consistent application of SCRUM methodologies across the enterprise
  • Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
  • Collaborated with Quality Assurance Analyst in Rational Clear Quest to track defects and used Rational Clear Case to maintain consistency in the builds.
  • Experienced setting up test scenarios and executing on these scenarios and worked closely with testing team to make sure all the changes made to requirements documents are implemented in there Test Cases
  • Used Agile development methods to promote development iterations, team work, collaboration and process adaptability and strong experience with Scrum
  • Performed felid-by-field mapping of interface between parent EMR system and downstream system.
  • Created User Stories to capture all requirements.
  • Set up definitions and process for test phases including Product test, Integration test, System test and User Acceptance Test (UAT).
  • Conducted GUI testing, Functional Testing, Smoke Testing, Integration Testing, Performance and User Acceptance Testing on the application.
  • Records(EHR) and Ambulatory Services for the existing Epic Interfaces and Involved in development of the system for data exchange from EMR, EHR to Electronic Lab Reporting Systems

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