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Business Analyst Resume

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Buffalo, NY

SUMMARY:

  • Qualified professional with over 5+ years of extensive experience in the field of Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
  • Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
  • 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.
  • Extensively used rational tools for UML, tracking and reporting and applied the Rational Unified Process in all areas of a software development life cycle.
  • Gathered and documented Non-functional requirements.
  • Experienced in preparing Business Process Re-engineering Models
  • Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
  • 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.
  • Utilized a fusion of industry knowledge and technical programming to provide executive management the development and implementation of interactive busines1s tools, and strategic analysis, vital for use in mission-critical decision-making
  • Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
  • 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.
  • Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)
  • Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
  • Used Rational ClearQuest for tracking and prioritizing defects and for enhancements after base lining the 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

Performance Testing Tools: Virtual User Generator, Load Runner

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, Buffalo, NY

Business Analyst

Responsibilities:

  • Understood the business process that included Sales processes, Rating methodology, different Products, Group Renewals. Eligibility and Enrollment process.
  • Responsible for interacting with client for requirements gathering, analyzing requirements, and creating detailed specifications.
  • Analyzed user and data issues related to Medicaid eligibility determination system.
  • Involved in testing the Member Enrollment, Eligibility Enquiry, Eligibility Response, Claim Status Enquiry, Claim Status Response and conversion of Financial Claims.
  • Very well known to the Subscriber/Member, Claim processing and Provider module in the front-end facets and data model back-end table.
  • Responsible for creating the test plan and designing test cases for the EDI 834 members’ enrollment file loading process into FACETS through HIPAA Gateway.
  • Mocked - up the EDI 834 states file for the system testing purpose and very well known to the loading process of the MMS file into Facets database
  • Actively participated in designing test plans, test cases and test scripts.
  • Extensively worked on Managed Care Provider Enrollment.
  • Responsible for creating business work flows and processes and creating management reports based on the analysis.
  • Maintained pricing configuration in Facets System for Medicaid, Medicare and Dual Eligible Products; creating new and updating existing provider contracts
  • Identified the scenarios based on business requirement and HIPAA compliance for each transaction such as 837(Claim) and 276/277 (Claim Status).
  • Tested various functionality like Membership& Eligibility, Claims Processing and Payment, Provider credentialing and Benefits Packages in Facets.
  • Analyze and manipulate data within the data warehouse based on predefined guidelines using SQL and Excel
  • Gathered business requirements through JAD sessions and one-on-one interviews with the Business Stakeholders
  • Created class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
  • Gathered requirements for enrollment, eligibility and claims side in the NY HIX system.
  • Checked if the Subscriber has active eligibility under NYCDFHP Plan.
  • Worked on EDI transactions: 270, 271, 834, 820, 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.
  • Electronically submitted Enrollment (834) data.
  • Tested and delivered Inbound/Outbound Facets interfaces
  • Validated member eligibility and eligibility inquiry in the facets application to the legacy application in order to confirm the migration successful or not.
  • Defined Functional Test Cases, documented, Executed test script in Facets system.
  • Experience with TriZetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
  • Lead the analytical-interrogation of their EMR/EHR and/or claims data to perform data quality checks
  • Responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records EMR/EHR/PHE/PMR, ASP technology, and full integration tools.
  • Expertise in validation of ETL process by writing SQL queries using complex joins and Analytic functions against Oracle & SQL Server databases. years of strong data warehousing experience using Informatica PowerMart 6.1/5.1/4.7, PowerCenter 8.x/7.x/6.x/5.1/1.7 as ETL tool
  • POC for Liferay,Canvas and Salesforce ETL move
  • Primarily responsible for ETL design, coding and testing strategy
  • Converting business rules into ETL technical specifications
  • Coming up with Design plan and Preparing the ETL Design document
  • Automating the ETL applications using Tidal tool
  • Coordinates and facilitates work sessions with Medicare Operations users and IT development to define projects' scope and requirements and manage project expectations.
  • Participates in driving the success of the software design, implementation, testing, production deployment and post-production phases of the Medicare tool.
  • Develop business process models for projects and demonstrations at the Centers for Medicare and Medicaid (CMS) using business process model notation and enterprise architecture
  • Clear understanding of Medicare (Part A, Part B and Part D) and Medicaid benefits as well as business processing
  • Developed and executed SQL queries on claim records to validate reporting data.
  • Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
  • Responsible for reporting status ensuring accurate coverage of requirements and business rules.

Environment : Windows 2000, MS Word, MS Excel, MS Project, MS Visio, HTML, XML, Informatica (ETL Tool), Java, Oracle.

Confidential

Business Analyst

Responsibilities:

  • Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
  • Performed Cost benefit, ROI and ROM studies
  • Conducted user interviews and documented business and functional requirements.
  • Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
  • Provided business and mapping expertise during a transition of the EDI applications from the GXS Application Integrator (AI) to GIS
  • Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
  • Created use case scenarios and documented work flow and business process using Rational Rose
  • Involved in project management using MS Project
  • Documented requirements, associated change requests with requirements and connected requirements with Use cases.
  • Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
  • Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
  • Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
  • Functional Knowledge of Medicaid Management Information System MMIS .
  • Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
  • AthenaOne system knowledge, or similar EHR/EMR
  • Three (3) years’ experience and knowledge in Mirth and/or HL7 messaging standards, structure, and integration techniques. Knowledge of a physician practice management system and EMR or EHR system.
  • EMR/EHR data knowledge from Epic Clarity, Allscripts, McKesson, Meditech, AthenaHealth or equivalent
  • Lead the analytical-interrogation of their EMR/EHR and/or claims data to perform data quality checks
  • Responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records EMR/EHR/PHE/PMR, ASP technology, and full integration tools.
  • Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
  • 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 issue and using this as a training opportunity for other team members
  • Maintained Gitlab repositories, JIRA bug tracking system. Created custom JIRA workflows
  • Install, configure and maintain JIRA bug tracking system
  • Strong functional expertise in the Healthcare Payer Area - Membership claims, benefits, eligibility check, ICD10,HIPAA, CMS HCPCS Exposure to Health Care Industry standards like HIPAA / PHI.
  • Worked with 837, UB92, UB04, CMS 1500 claims and HIPAA 835, 270/271, 276/277, 278 transactions
  • Experience in CMS and MMA Guidelines
  • Work with CMS business owners to define their target goals and propose alternative business solutions
  • Provide technical, business, management expertise, and support the Department of Health and Human Services and Centers for Medicare and Medicaid Services \(CMS\) in building and maintaining a comprehensive enterprise architecture program
  • Used Rational Clear case for version control
  • Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
  • Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
  • Served as conduit for managing system requirements between the business and the software development team.
  • Queried database using SQL for backend testing
  • Used Rational clear quest for defect management

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Cognos, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential, Pennsylvania, PA

Business Analyst / System Analyst

Responsibilities:

  • Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
  • Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
  • Provided support to CMS/ Federal and State stakeholders on objectives relative to PPACA -HIX by performing the following duties in an agile (scrum) SDLC environment.
  • The goal of the project was to create, EDI transaction data maps with its clients and business partners. The outcome was transaction maps were created.
  • Wrote online training manual of EDI transaction maps.
  • Created reports using Microsoft SQL Server 2005 Reporting Services and QNXT 3.4 tables
  • Write SQL scripts for adding, changing or deleting various benefit or contract data to or from QNXT that would take several man hours to complete via the front end software.
  • Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
  • Created detailed Use cases, activity diagrams and flowcharts based on requirements gathering.
  • Involved in configuration of Facets Subscriber/Member Application group
  • Analyzed the member/eligibility information on claim to that in Facets.
  • Created test data for testing in Facets development client.
  • Resolved issues like member duplicated in file, dealing with dependent transaction if subscriber is not found, failures in submissions in QNXT.
  • Maintained Gitlab repositories, JIRA bug tracking system. Created custom JIRA workflows
  • Install, configure and maintain JIRA bug tracking system
  • Capture Feature/Function information at varying levels of granularity and document them in a requirements management tool (e.g. Microsoft TFS, JIRA, etc.)
  • Familiarity with a requirements management tool like MS Team Foundation Server, JIRA or the like
  • Helped lead the transition of Requirements Management in the Business Analyst Team to the agile methodology by creating and managing user stories and Requirements Traceability Matrices in the JIRA toolset.
  • Report on project status to appropriate project management chain using Jira
  • Participate in projects when assigned infrastructure tasks in Jira
  • CMS and Medicaid Claims Processing Policies
  • IRS, CMS, HHSC, HEDIS reporting
  • Meets time sensitive deadlines from Medicaid health plans, state agencies, and CMS.
  • Work with Business area to translate CMS, state government regulations, and NCQA requirements
  • Strong functional expertise in the Healthcare Payer Area - Membership claims, benefits, eligibility check, ICD10,HIPAA, CMS HCPCS Exposure to Health Care Industry standards like HIPAA / PHI.
  • Worked with 837, UB92, UB04, CMS 1500 claims and HIPAA 835, 270/271, 276/277, 278 transactions
  • Experience in CMS and MMA Guidelines
  • Scheduled the ETL jobs daily. Weekly and monthly based on the business requirement
  • Extensively used ETL to load data from different sources
  • Preparation ETL specifications and Creating Mappings in Informatica PowerCenter/PowerMart 5.1.0 for the incoming data.
  • Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
  • Assigned tasks among development team, monitored and tracked progress of project following Agile methodology
  • Requisite Pro, Rational Rose, Agile, HL7 Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.
  • Exposed to Agile methodology
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile
  • Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
  • Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintainace), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/Advice).
  • My role was to assist the Project Management Office (PMO) in the development of an Enterprise-wide, web-based guidelines for Rational Unified Process.
  • Followed the Rational Unified Process (RUP), Agile methodology and Extreme Programming concepts for project development. Analyzed and incorporated User Stories in different release plans for the sprints in Scrum process.
  • Performed GAP analysis to identify AS-IS a process EDI transaction set 834,837 and 835 of 4010A and TO-BE processes of 5010 standard and based on that developed Business Requirement Documents.
  • Worked on Facets to help payers efficiently execute core administrative functions, including claims processing, premium billing and customer service.
  • Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
  • Identified and documented data model processes and system deficiencies for the HIX eligibility & enrollment.
  • Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
  • Worked on Healthcare system implementation including enterprise Electronic Medical Records (EMR) software.
  • HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278.
  • Worked with NASCO teams to get current work flow for detailed business process.
  • Evaluated and analyzed EDI transaction sets 276/277 (Claim Status Request/Response), 270/271 (Eligibility Inquiry/Response), 837 (Claim Transaction) and 278 (Healthcare Service Review Information)
  • Organized local meeting to promote and introduce new environmental products
  • Wrote Test Cases and performed User Acceptance Testing (UAT), documented the in detail defects using the Defect Tracking report.
  • Performed smoke test and Functional testing on the Sprints as and when they were delivered to the QA team
  • Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
  • Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
  • Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.
  • Implemented RUP and followed iterative, Use Case driven process for requirement documentation and deployment.
  • Involved in making Use Case Diagrams, Activity Diagrams, and using analysis and design models tools like MS Visio, Rational Rose through RUP, Agile and Waterfall Model
  • Worked with SME close to understand Claim Adjudication Process setup in Facets.
  • Followed the standards of PMO which included getting approvals for SOX Compliance at various Gates.
  • Responsible for Medicaid Claims Resolution/Reimbursement for state health plans using MMIS.
  • Prepared the Charter/BUR and functional design document.
  • Monitor departmental policies, processes, and procedural compliance for both in-house and client sites to ensure proper adherence to budget and safety standards
  • Experience with Medicare and Medicaid: Claims processing, Membership, and Eligibility Verification and care management.
  • Thorough knowledge of Eligibility and membership Affairs. Also knowledge of HIPAA, X12, and HL7 standards and Medicaid provider best practices.
  • Updated the functional design document for NPI related changes in the Encounters project.
  • Applied Unified Modeling Language (UML) methodologies to design Communication Diagram, Use Case Diagrams, Activity Diagrams, Sequence Diagram, ER diagrams & Data Mapping
  • Analyzed encounters claims file (837 P, I, D) using SpecBuilder.
  • Created SQL queries to check the updates in Oracle database and executed SQL queries in Oracle to check the redundancy of data. Setup runbook for Inbound and Outbound EDI transactions.
  • 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

Environment: OOAD, UML, RUP, TQM, Facets4.61, Agile / Srum Sprint, Sprint Backlog, Business Modeling and Data Modeling Rational Rose, Agile, Rational Requisite Pro, MS Visio, Clear Case, Clear Quest

Confidential, Jacksonville, FL

Business Analyst

Responsibilities:

  • Analyzed user requirement documents (URD), software requirement specification document (SRS) and prepared System test plan by dividing the application into manageable units.
  • Involved in writing Detailed Test Plan for the Application under Test (AUT).
  • Implemented a modified RUP process for managing requirements
  • Enhanced the Test Cases by analyzing the Specification Documents.
  • Developed and maintained hundreds of programs for the Blood Inventory System to ensure the safety of the blood supply for all regions using our system
  • Requisite Pro, Rational Rose, Agile, HL7 Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.
  • Exposed to Agile methodology
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile
  • 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.
  • Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them.
  • Strong experience in all phases of Software Development Lifecycle (SDLC) using Waterfall, Agile/Scrum, RUP (Rational Unified Process) and Software Testing Life Cycle (STLC).
  • Scheduled the ETL jobs daily. Weekly and monthly based on the business requirement
  • Extensively worked in the performance tuning of programs, ETL procedures and processes.
  • Tuned the Performance for ETL jobs by tuning the SQL used in Transformations and fine tuning the database.
  • Scheduled the ETL jobs daily. Weekly and monthly based on the business requirement
  • Extensively used ETL to load data from different sources
  • Preparation ETL specifications and Creating Mappings in Informatica PowerCenter/PowerMart 5.1.0 for the incoming data.
  • Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers. Worked on ICD 9 codes and gathered future requirements based on ICD 10 codes. Managed creation of sample mappings for the conversion of EDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
  • Prepared and maintained EDI maps for different EDI transactions
  • Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange EDI in 4010 and 5010 formats.
  • Validated EDI X12 files for Connecture CNX and Center for Medicare System CMS using Ingenix Claredi and manually edited and fixed the errors to make it error free and ready for processing.
  • Thoroughly analyzed EDI raw data for transactions 834 in the 5010 format to verify the changes as per the 5010 format.
  • Worked with IT teams regarding EDI transaction such as 834, 837 as per the guidelines of ANSI ASCX12 5010 implementation guide.
  • Collected and processed quantitative and qualitative data analysis.
  • Prepared spreadsheets with the help of MS Office Excel to show like specific geographic regions etc.
  • Analyzed business and technical requirements, thus creating the Business Use Case and Functional Use Case documents.
  • Involved in the User Acceptance Testing to make sure the defects raised by the business users were resolved up to the Management Expectation by the developer group. Prepared documentation using MS Word.
  • Created reports in MS WORD for account processing of each client group.

Environment: MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

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