SUMMARY

• Over 6 + years of experience in Healthcare domain as a Business Systems Analyst.
• Comprehensive knowledge and experience acting as a liaison between business and technology in phases of Software Development Life Cycle (SDLC) methodologies like Agile, RUP and Waterfall.
• Excellent experience in documenting the Business Requirements Document (BRD), developing the UAT Plan, maintaining the Requirement Traceability Matrix and assisting in Post implementation activities.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims.
• Experience in developing ETL for Data extraction, Data transformation and loading.
• Expert in translating business requirements & user expectations into detailed Functional Requirements Specifications (FRS) by employing Unified Modeling Language (UML).
• Experienced in building Data Integration and Workflow solutions and Extract, Transform, and Load (ETL) solutions for data warehousing using SQL Server Integration Services. SSIS/(Informatica)
• Highly experienced in performing Feasibility Studies, Impact analysis, GAP analysis and Risk Analysis.
• Experience with FACETS, Claims Processing, Subscriber/Member, Care Management, and Utilization Management (UM).
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835, 837 270/271 transactions.
• Organized Joint Application Developments (JAD), Interviews, workshops and requirement elicitation sessions with end - user/clients/stake holders .
• Well versed for creating User stories based on Agile methodology.
• Proficient in using UML in behavioral, structural and architectural modeling - in creating Use Case, Class Diagrams, Sequence Flows, and Activity diagrams using Microsoft Visio.
• Exposure to testing methods, such as Regression, Performance, Load, Functionality, Smoke, and Usability Testing for web and Client/Server application.
• Well versed in ETL processes , performance based systems, and ETL process flow and standards.
• Good knowledge of System Testing and Integration Testing.
• Responsible for writing Test Plans and Test Cases for (UAT).
• Expertise in Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Experience in the Analysis, design, testing and Implementation of ETL & Business Intelligence solutions using Data Warehouse/Data Mart Design, ETL, OLAP.
• Knowledge of HIPAA-ready membership enrollment, claims and plan administration.
• Worked on inbound and outbound EDI’s such as 834,270,271,837,276,277,835.
• Worked with the components of Data Warehousing like components model, ETL.
• Good knowledge on HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10, analysis & compliance experience from, payers, providers and exchanges perspective, with primary focus on Coordination of benefits.
• Worked on Data migration, Reports Implementation, letters, Inbound/outbound Interfaces and Facets Extensions.
• Used diverse techniques to better capture and communicate the requirements with IT team employing State charts, Process modeling, Decision tree analysis, and Data flow diagrams.
• Proficient in creating reports using various BI tools and communicating the findings.
• Excellent presentation and communication skills combined with a proficiency in problem abstraction, business modeling, interpersonal, leadership skills, and ability to work in a cross functional team.
• Familiar with Affordable Care Act (ACA).
• Extensively worked on Patient Encounter in order to validate Claims and membership data in Facets. Performed forward and backward data mapping between fields in Mainframe and Facets.

TECHNICAL SKILLS

Operating System: Win 95/98/NT/2000/XP, UNIX

Languages: SQL, HTML, Java, XML, Visual Basic, Python

Software Development Methodologies: SDLC, Waterfall, RUP, Agile

Requirements Management Tools: MS Visio, iRise, DOORS, Rational Requisite Pro, SharePoint, MS Word, Power Point, Excel

Quality Assurance Tools: HP ALM, LoadRunner, HP Quality Center, Quick Test Pro (QTP), JIRA

Change Management Tools: Rational Clear Quest, Rational Clear Case

Business Intelligent Tools: COGNOS, Crystal Report, QlikView

Database: MS-Access, Oracle PL/SQL, ASP.NET, SQL Server, DB2, Mainframe, MS SharePoint, MS Excel

Statistical Software: SAS, SPSS, Advanced Excel with Pivot tables and V-Lookup

Claim Management Tools: FACETS, QNXT, CRT, CBM

PROFESSIONAL EXPERIENCE

Confidential, Chicago, IL

Sr. Business System Analyst

Responsibilities:

• Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the BRD.
• Responsible for testing all new and existing ETL data warehouse components. We were also working for Facets
• Involved in developing Test Plans, Developed Test Cases, Test Scripts and Prepared Test Data for Extract transform and Load through ETL. migration/conversion from one version of facets to another higher version and from one environment to another environment.
• Supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
• Gathered and documented functional requirements for testing and verification of HIPAA.
• Web Portal Development - Worked as a Business Analyst gathering requirements to develop a referral portal.
• Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
• Responsible for developing in-house application comparing data from different sources i.e. EDI, XML and FACETS.
• Worked on FACETS Data tables and created audit reports using queries. Manually loaded data in FACETS and have good knowledge on FACETS business rules.
• Extensively worked on validating data loads during ETL process.
• Created process flow diagrams describing provider and member access to the web portals.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and the performance of the application from various dimensions.
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application
• Created Business Requirement Documents as a result of meetings with the Business Areas. Obtained business sign offs on the documents after reviewing the final documents with them.
• Involved in developing Test Plans, Developed Test Cases, Test Scripts and Prepared Test Data for Extract transform and Load through ETL
• Assisted in creation of the Functional Design Document from the Business Requirements Document which was used as the reference by the development team while preparing the design and held the responsibility of the required data setup for unit testing.
• Change Control Process - Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
• Maintained the Traceability Matrix Table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked.
• Involved in developing Test Plans, Developed Test Cases, Test Scripts and Prepared Test Data for Extract transform and Load through ETL.
• Involved in daily scrum meeting to discuss any roadblocks or impediments in the project path.
• Involved in sprint planning session to identify the features and functionalities that should be achieved by the new application.
• Followed Workgroup for Facets Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines. Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintenance), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/Advice).
• Identified various points of integration among the new and existing applications and required integration with other IT components.
• Worked closely with the business team, development team and the quality assurance team to ensure that desired functionalities will be achieved by the application.
• Provided business and technical suggestions and recommendations during the project life cycle.

Environment: SharePoint, MS Visio, Word, Excel, UML, PowerPoint, Rational Requisite, JIRA, MS Project, MS SharePoint

Confidential, Walnut Creek, PA

Business Systems Analyst

Responsibilities:

• Facilitate all agile ceremonies including daily stand-ups, weekly grooming, retrospective, and review and planning session.
• The project dealt with enhancements to the Healthcare Payment EDI transaction set to generate a payer level containing payer specific information.
• Communicated New Business Process Model & Notations (BPMN) with client and suggested best solution to make the changes according to new regulation.
• Executed test scripts in different cycles to get the perfection and logged defects in defect tab of Quality center.
• Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
• Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual for resolution.
• Analysis of functional and non-functional categorized data elements for data profiling and mapping from source to target data environment. Developed working documents to support findings and assign specific tasks
• Claim Transactions and Billing Transactions created flows for adequate matching of claims. Performed data mapping by matching the billing file and EDI claim file record claims received from Medicare and Medicaid agencies.
• Interacted with Subject Matter Experts (SME), Business Owners; Conducted detailed interviews with them, recorded the requirements, and reviewed the gathered requirement by both technical and business people to break down functional requirement and document detailed User Stories.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery
• Perform typical SharePoint administrative activities such as new site creation and managing user/group permissions
• Participate in Change Management related process meetings, advising and consulting across technology for process adoption.
• Used MS Visio to carry out the Business Use Case Modeling and Business Object Modeling effort to develop the business architecture for rapid and controlled application development.
• Extensive experience with process modeling using UML, flow charts, system data flow, task diagrams, sequence, data mapping, and use cases.
• Create story board of back log items in Agile and develop item according to business needs.
• Redefined use cases, process flow, and activity diagrams using MS Visio for a clear understanding of the requirements. Reviewed test plan based on Requirement Traceability Matrix (RTM) and defect tracking using Clear Quest.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes EDI 837, 835, 270/271 and others.
• Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
• Data mapping, logical data modeling, created Class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
• Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on the Design Document and User Requirement Document for the Functional, Security, and Performance Testing.
• Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Responsible for efficient document management using MS SharePoint and to update the document and transmit the information to all stakeholders

Environment: Hybrid Waterfall Agile-Scrum, Informatica, Microsoft SQL, MS Visio, HTML, XML, JSON, MS Office Suite, MS SQL Server, JIRA, MS Visio, MS Project, MS SharePoint

Confidential, Norfolk,VA

Business Analyst

Responsibilities:

• Worked as a liaison between database analysts and developers and assisted by creating data mapping documents.
• Gathered business requirements, analyzed data sources, workflows by conducting interviews and meetings.
• Created and maintained data mapping document(s) in reference to the HIPAA mandated transactions 837I, 837P, and 835.
• Created business process models, flow diagrams, activity diagrams, use cases and wrote Business Requirement Documents (BRDs) and Functional Requirement Documents (FRDs) using tools and applications such as MS Word, MS Excel, and MS Visio.
• Debugged SQL queries as a reengineering process to any problems or errors found.
• Worked database validation during ETL processes by identifying key requirements and testing.
• Assisted in JAD sessions by creating minutes of meeting, and facilitating BRD and FRD creation
• Implemented the suggested changes and finalized the design to be presented to the developers.
• Held meetings and constantly updated the BRD and FRD as per the changes requested by the stakeholders and approved by the Change Control Board (CCB).
• Followed the Waterfall methodology for all the modules throughout the entire SDLC.
• Coordinated the testing process while working with the QA team by helping them setup the test environment and users.
• Actively participated throughout the User Acceptance Testing (UAT) process and helped coordinate the application deployment process.
• Worked independently with minimal supervision throughout the project.
• Adhered to HIPAA for health insurance & Medicare claims, responsibility included from functional requirement specification to testing the claims for HIPAA-compliant format and also to ensure all NCPDP formatting standards.
• Reviewed and implemented the change requests from Center for Medicare Services.
• Analyzed Healthcare transaction flow for HIPAA Healthcare Transactions like 834, 835, 270, 271, 276, 277, and 278.
• Created process work flows and was responsible for preparing Software Requirement Specifications (SRS) and Functional Specification Document (FSD).
• Participated in developing test plans, test procedure templates and guidelines to be used by the project team with detailed screen layouts.
• Performed Defect Tracking using Rational Clear Quest.
• Worked with QA team to design test plan and test cases for User Acceptance Testing (UAT).

Environment: MS Project, MS Office, Quality Center, JAD SharePoint, MS Visio, Word, Excel, UML, PowerPoint, Facets, HTML, Rational Requisite.

Confidential, Augusta, GA

Business Analyst

Responsibilities:

• Elicited and documented business, user, functional and non-functional requirements.
• Developed, communicated, and validated requirements package with business and developers.
• Engaged with clients to understand business processes and determine their specific requirements.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations
• Identified processes for developing and documenting detailed business requirements.
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Made regular status presentations to senior management.
• Worked collaboratively with business analysts, developers, testers to perform a gap analysis of the company’s existing system functionalities.
• Worked directly with software engineers to ensure clear communications on requirements and defect reports.
• Validate EDI Claim Process according to HIPAA compliance.
• Tested HIPAA regulations in Facets HIPAA privacy module.
• Conducting business validations, covering the following deliverables: FACETS Providers, Facets Claims and Facets Membership and Operational reports.
• Tested the HIPPA EDI, 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data with Facets on different modules.
• Designed and developed scenarios based on business requirements.
• Followed RUP methodology for the entire SDLC.
• Identifies, logs, and tracks defects found during test execution phase using JIRA.
• Interacting with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.
• Validated the scripts to make sure they have been executed correctly and meets the scenario description.
• Extensively worked on all kind of joins and operators to fetch data from multiple tables.
• Created and maintained SQL Scripts to perform back-end testing on the oracle database.
• Connected to SQL plus in UNIX and created and executed complex SQL queries.
• Wrote complex SQL queries to perform the Back End Testing of the Oracle database using SQL and UNIX.
• Assisted in implementation plans related to new/revised applications/services.
• Worked with the client to create and execute the acceptance test strategy.
• Obtained signoff from project stakeholders on tasks completion

Environment: MS Project, MS Office, Quality Center, UML, JAD, SQL, SDLC, Agile, JIRA, HIPPA, Facets, HTML