SUMMARY

• Business System/Data Analyst with around Six years of experience in Healthcare domain and application development with excellent skills in client interfacing, requirement gathering, user support, quality assurance, problem solving and documentation.
• Experienced in writing Use Cases. Proficiency in SDLC life cycle, understands the workflow concept, ability to gather and document the 'As - Is' and 'To-Be' processes
• Experienced in data analysis with solid understanding of Business Requirements Gathering, Data warehousing, Business Intelligence, Data Mapping and Data Modelling.
• Strong experience with different project methodologies including Agile, Waterfall, SDLC, RUP. Good understanding of Relational Database Design, Data Warehouse/OLAP concepts and methodologies.
• Knowledge of various HIPPA EDI transactions which includes 270/271, 834, 835, 837I/P, 276/277. Experience in generating on-demand and scheduled reports for business analysis or management decision using SQL Server Reporting Services. Have good working knowledge in querying salesforce.com database using SOQL & SOSL queries using Force.com Explorer.
• Experience in various phases of Software Development Life Cycle (analysis, gathering requirements, and design) with expertise in documenting various requirement specifications, functional specifications, test plans, source to target mappings, and SQL joins. Experience in conducting JAD Sessions and communicating with Stakeholders, Development team, SMEs, System Analyst, Business Analyst and Project Manager.
• Strong experience and understanding of claims management process Strong experience and understanding of health care industry, claims management process, knowledge of Medicaid and Medicare Services Strong knowledge of EDI Claims, member enrolment, and billing transactions.
• Created data flow diagrams, data mapping from Source to stage and Stage to Target mapping documents indicating the source tables, columns, data types, transformations required and business rules to be applied.
• Experience with FACETS solution for healthcare. Experience in working on Web Applications in Agile (Scrum) methodology. Understanding of HIPAA Standards and Compliance issues, HIPAA Privacy policy, opt in/opt out policy.
• Requirements gathering in compliance with HIPAA standard. Experience web based application development. Writing Use cases and producing Behavioural diagrams (Sequence diagrams, Collaboration diagrams) and Class diagrams based on UML Methodology & creating Business process flow diagrams
• Knowledge of SQL and experience of writing SQL commands. Using project management tools like MS-Project for status reporting and planning.

TECHNICAL SKILLS

• Windows 2003 Server, Windows 8/7/Vista/XP/2000/NT/98
• Rational Requisite Pro, Caliber RM, Blueprint
• MS Visio, Rational Rose, Caliber RDM, Snag IT
• MS Project, SharePoint 2007/ 2010/ 13 , JIRA, Primavera
• HTML, UML, Macromedia Dreamweaver, Wireframe, iRise
• Scrum, Agile, Rational Unified Process (RUP), Waterfall Model
• Oracle, MS SQL Server, MS Access

PROFESSIONAL EXPERIENCE

Confidential, Austin, TX

Sr. Business Analyst

Responsibilities:

• Formulated and defined systems scope and objectives through research, data mining, analytics and fact-finding.
• GAP Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance
• Gathered and documented existing client processes and data using Microsoft Excel in order to perform gap analysis between client’s system and McKesson’s system in order to access client’s readiness.
• Conducted Business validations for different FACETS modules Providers, Claims, enrolment and Membership
• Created ETL documentation such as EDI X12 837(P,I), 834 and 835 Data Mapping, Transformation logic for Main Frame Layout, Updating Meta data documents for new Platform.
• Assisted in managing and billing Medicare, Commercial HMO/PPO claims on a daily basis.
• Worked on project migration of all Healthcare Process (such as EAB, Products, Provider, Claims, Capitation, Voucher, finance etc) for Dental HMO from Legacy system (AREV) to Facets.
• Facilitated User Acceptance Testing (UAT)and test strategies with developers and testers, and participated in manual front-end testing to check all functionalities of different modules
• Used JIRA to perform test management activities and used JIRA tool to track and maintain different versions of the project documentation.
• Strong knowledge of working on JIRA and Utilized it to develop and track agile epics, stories and tasks.
• Extensive experience in manual testing of software applications. Experience writing and executing User Acceptance Testing (UAT) Test scripts.
• Have proven business insight and the technical know-how to implement large-scale EMR and EHR engagements.
• Tracked the day-to-day activities, responsible for new requirements and enhancements associated with EMR/EPIC system.
• Assisted the EDI team in the development and documentation of the test strategies for the EDI transactions which included all standard transactions, auditing and error correction processes, and the creation of the transactions.
• Re-engineered and captured EDI transactions with legacy systems Enrollment -834, Eligibility Transaction (270/271), Claims (837), Claim Status Request and Response (276/277), Remittance (835) .
• Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Analyzing User and Functional requirements to point out gaps between used SQL queries to extract the data from the database.
• Involved in the complete business process redesign and reengineering effort in converting existing process into a strategic web based environment.
• Performed extensive data modeling to differentiate between the OLTP and Data Warehouse data models.
• Worked on Facets Claims Processing for data validation and claims validation. Extensively worked on Claims Inquiry and Dental Claims Processing.
• 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.
• Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
• Master Data Management MDM contract with the Centers for Medicare and Medicaid Services CMS to provide enterprise data services, identity resolution for Medicare and Medicaid beneficiaries and providers to support the agency's information systems.
• Configured and maintained of Facets and other application software products, such as Claim check, Facets
• Expertise in validation of ETL process by writing SQL queries using complex joins and Analytic functions against Oracle & SQL Server databases.
• Strong functional expertise in the Healthcare Payer Area - Membership claims, benefits, eligibility check, ICD10, HIPAA, and CMS HCPCS Exposure to Health Care Industry standards like HIPAA / PHI.
• 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
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using Rational Rose.
• 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
• Planned the UAT testing, test plans, test cases and worked with the business users for UAT test execution in developing the training documentation.

Environment: HIPAA, SAS, MS Excel, EDI 837I and 837P, Pharmacy, Jira, Web Logic Server, SQL, Share point, Toad, Word, Excel, Magic/app, UNIX/LINUX

Confidential, MD

Business Analyst

Responsibilities:

• Responsible for gaining a good understanding of User needs and accurately representing them in a well-documented software functional specifications document.
• Gathered Business Requirements, Interacted with the Users, Designers and Developers, Project Manager and QA Team to get a better understanding of the Business Processes.
• Extensively involved in testing Trizetto's Facets and mainly involved in enrolment and Eligibility modules.
• Analysed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
• Involved in creating Business Process Documentation. Identified Use Cases from the requirements. Created UML Diagrams including Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams using MS-Visio.
• Helps in conducting Gap Analysis (GAP), User Acceptance Testing (UAT), and System Integration testing (SIT) and SWOT analysis.
• Performed GAP analysis of business rules, business and system flows, user administration and requirements.
• Planned and designed MMIS business processes; assisted in formulating recommendations to improve and support business activities Assisted in analysing and documenting client's MMIS business requirements
• Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
• 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).
• Operating Rules implementation for real time transactions 270/271 and 276/277 using Edifecs XE Connect, XE Server and Xengine for both SOAP and Multipart requests.
• Used Edifecs Transaction Management tool to verify that the batch and real-time files are generated correctly
• For Project management purpose worked on Microsoft Project, used Microsoft Share Point for maintaining the updated Documentation.
• Involved in analysis of HIPAA compliance and EDI Transactions sets and took part in discussions for designing the EDI transactions
• Develop a strong understanding of the commercial healthcare industry, particularly from a payer perspective
• Payers would be BCBSM, FEP, Blue Care Network, Medicare Advantage, Medicare A, B and D, Medicaid, and Commercial (AETNA, HAP etc.)
• Facilitated JAD session to find out the impacted area of functionality of Facets due to upgrade and cooperate with developer to come up with solution.
• Communicate with vendor to regarding new updates on Facets and solution to their existing system
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD (Object oriented Design) using UML.
• Managed change of the requirements and associated requirements to other requirements for traceability using Enterprise Architect.
• Have proven business insight and the technical know-how to implement large-scale EMR and EHR engagements.
• Tracked the day-to-day activities, responsible for new requirements and enhancements associated with EMR EPIC system.
• Prepared test data for positive and negative test scenarios as per application specifications and application requirements and wrote test plans.
• Supported the physician applications and ordering module during the initial EMR go-live and provided support to end users during maintenance and optimization activities
• Observed and analyzed corrections-specific workflows to adapt the EMR and optimize provider efficiency and success.

Environment: MS Office, MS Visio, UML, Rational Clear Quest, Jira, Adobe Acrobat, PL-SQL, Oracle, SDLC, SharePoint

Confidential, Trenton, NJ

Business Analyst

Responsibilities:

• Responsible for developing in-house application comparing data from different sources i.e. EDI, XML and FACETS.
• Perform requirements gathering and analysis; interview the subject matter experts, stakeholders and executive sponsors.
• Interact with the business analysts & business users for design & requirement clarification for external projects & change requests.
• Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD).
• Comprehensive understanding of MMIS subsystem files, screens and integrated workflow processing
• Provided support to the completion of the MMIS Data Dictionary. Evaluated and identified all system problems
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D), 997 and 999 to identify key data set elements for designated record set. Interacted with Claims, Payments and enrolment hence analysing and documenting related business processes.
• Proficient in using Agile Scrum methodologies, performed roles of Scrum Master following sprint/stand-up sessions and used Excel extensively to write user stories, analysed the Iteration Burn Down charts and reviewed defects.
• Worked on FACETS Data tables and created audit reports using queries. Manually loaded data in FACETS and have good knowledge on FACETS business rules.
• Automated and supported HL7 message generation services with message maker and designed and developed HL7 test messages for business users.
• Created data mappings to transform the data according to business rules and Performed Analysis on Data mapping between different data models.
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
• Provided SDLC Methodology for developing EDI applications used by hospitals to completely automate payments posting for Medicare, Medicaid and commercial payers electronic payments files.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop. Documented User Stories and facilitated Story Point discussions to analyse the level of effort on project specifications
• Work on EDI X12 transactions, HIPAA standard transaction codes including 837, 834, 835, 270, 271, 276, and 277 and perform analysis of such transactions.
• Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.

Environment: MS Office Tools, MS Project, MS-PowerPoint, UAT, BPMN, SSIS, SQL Server 2005, XML, HP ALM/Quality Center, Agile