SUMMARY

• Over 6+ years of experience as a Systems Analyst/Business Analyst in Healthcare and Telecom Industry.
• Health Insurance Background - Specifically related to collecting requirements, documenting and representing the business, Use Cases, Business process improvements, etc.
• Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
• Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
• Extensive experience with the SAS programming and in data step and with various SAS Procedures in Base SAS and SAS/Stat, including thorough knowledge of SAS Macro.
• Expert in developing Business and System Requirements, Design Documents, working with requirements traceability matrix
• Experience in writing Request for Proposals (RFP), Statement of Work (SOW) and Standard Operating Procedures (SOP).
• Worked extensively on Business Requirements Elicitation, Issue List monitoring, Process Modeling, Gap analysis, Risk analysis, SWOT analysis and development of Functional Specifications.
• Extensive Knowledge about all the phases of Business Analysis Life cycle like Requirements Elicitation, Requirements Analysis, Requirements Documentation and Requirements Management.
• Very good at writing documents like Business Cases, Vision and Scope Documents, Statements of Purpose and Requests for Proposals.
• Proficient in MS Office Excel (pivot tables, vlookups, hlookups, macro), Access, PowerPoint, Visio.
• Extensive experience in writing Use Cases and UML diagrams.
• Assisted QA team in developing Test Scripts, Test Cases and Test Plans for the User Acceptance testing.
• Strong in developing test plans, test strategies, test cases, test data, test checklists, defect tracking & reporting, preparing test summary reports and conducting status meetings.
• Experience in conducting Backend testing by writing SQL queries and executing them.
• Ability to multi-task and work smoothly even under extreme pressure. Experienced in creating and enhancing Test Scripts in WinRunner, QTP.
• Familiar with Load and Stress testing. Experience in Software Quality Metrics
• Excellent experience managing the whole testing process using Mercury Interactive Test Management tool Mercury Quality Center.

TECHNICAL SKILLS

Programming Languages: C, C++, C#, VC++, VB, VB.NET, C#.NET, ASP.NET, Java, SQL, PLSQL

Operating Systems: UNIX, Windows 95/98/NT/2000/XP, Linux.

Databases: MS-Access, MySQL, SQL Server, Oracle, Teradata, DB2, Sybase

Application Servers: IBM Web sphere, ATG Dynamo, BEA WebLogic.

Internet: HTML, XML, VBScript, ASP, JavaScript, JSP, J2EE.

Automation Tools: MS Visio, Rational Rose, Rational Clear Case, Rational Requisite Pro, Documentum

Bug Tracking Tools: Mercury Test Director, Rational Clear Quest

Utility Tools: MS Office Suite, MS Project, TOAD, Adobe Photoshop

Reporting Tools: Crystal Reports, SQL Server Reports (SSRS)

Data warehousing Tools: Informatica, Business Objects, Cognos, Erwin

Testing Tools: Quick Test Pro (QTP), Test Director, Win Runner, Load Runner

PROFESSIONAL EXPERIENCE

Confidential, NY

Business Systems Analyst

Responsibilities:

• Gathered high level requirements and developed scope of the project for the implementation of Microsoft Office Share Point 2007.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Acted as a Business Analyst for the CDS implementation the backbone for data integration among myriad systems, including ERP, CRM, Portal, Workflow Engine, Payroll and related interface
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance Testing.
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Verified the Business Scenarios on new builds to allow extended testing by the QA team.
• Dedicated a good portion of time with the QA team in front-end, back-end and Regression testing.
• Analyzed the test results from QA teams using Performance Studio Analysis to create various scenarios.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• Involved in Service Oriented Architecture (SOA).
• Extensive success in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) in an SOA environment.
• Involved in Managing Data modeling project from Logical design and implementation of Sybase Database
• Develop Logical and Physical data models that capture current state/future state data elements and data flows usingErwin.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).
• Testing of Epic billing reports (hospital billing and insurance billing) for Epic billing output and interface accuracy.
• Create and execute revenue cycle medication Epic billing data and reports from decision support and billing systems. Analysed all related medical codes for accuracy to ensure maximum benefit allowed is accurately billed.
• Have proven business insight and the technical know-how to implement large-scale EMR and EHR engagements.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Developed schemas for extraction, transaction, and loading (ETL) using Solonde Warehouse Workbench to expedite data integration between systems.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Updated the impacted MS Access tables.
• Worked extensively with MS Excel and MS access
• Generated reports through Business Objects and further analyzed data through Excel Used Pivot tables, Vlookups and Offset functions in order to quickly and effectively generate actionable and insightful analysis
• Tracked and reported on issues and status using report templates and parameter queries via Excel pivot tables.
• Created mainframe DB2 table queries to assist in data analysis and extraction.
• Designed workflows and allocated permissions within SharePoint.
• Performed Unit Testing and User Acceptance testing and documented detailed results.
• Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, Cognos, HTML, Rational Requisite Pro, MS Office, SQL Server, MS Project, MS FrontPage 2003, MS Access, Oracle Pl/SQL, EDI, Documentum 2.0.,UML.

Confidential

EDI Analyst

Responsibilities:

• Assist with creation and maintenance all necessary documentation and training materials for Epic Ambulatory application
• Performed analysis, design, development and maintenance of the Epic Ambulatory applications and other clinical information systems
• 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 hence analyzing and documenting related business processes.
• Interacted with the DST (off shore) teams for QA support and training purposes. Responsible for running test region EDI loads on AS400 Series. Updated records in AS400 before processing for testing purposes.
• EPIC EMR to deliver high quality patient care. As part of the project
• Support testing for EPIC ASAP, Clin Docs and Orders & Results and Optime modules.
• Knowledge of workflows in EPIC Inpatient Modules.
• Responsible for design, build, testing and implementation for Epic Home Health and Hospice Billing and Clinical applications.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
• Experience with EPIC user and provider record provisioning, including the development of role-based access, security classes, and user profiles
• 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.
• Experience in Epic Resolute product implementation and deployment
• Hands on experience with Epic Hospital Billing and Ambulatory
• Full knowledge of application interoperability configurations and managed the implementation tasks of HIE clinical applications.
• 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 Enrolment hence analysing and documenting related business processes
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Experience with Epic Healthcare Information Systems
• Conducted user interviews, gathered requirements, and analysed the requirements.
• Trained thousands of medical providers w/ ten member team on HIE software and insurance proprietary software Managed 1500 medical provider accounts including group practices, large health systems and hospitals
• Worked with the business team to collect the business requirements, security and service level requirements and documented them.
• Analysed set behaviour and contribution to business performance, critical business metrics & tracking underlying business trends using Business Objects.
• Working with different IT & Business groups to understand and determine the Impacts to the Data Warehouse and/or Data Marts for different projects
• Participated in the logical and physical design sessions and developed design documents.
• Designed new process flows for the existing system as well as for the enhanced system.
• Conducted and lead status report meetings with the business and the IT team on a weekly basis.
• Manage Scope and change throughout the life cycle of the product.
• Performed collection, coding, and assessment and reporting of adverse event data using ARISg.
• Worked in the ARISg Implementation of the EHR-Pharmacy Module.
• Supported integrating EDI batch processing and real-time EDI
• Recommend tactic to implement HIPAA 4010 (EDI X12 837,834,278,270) in the new System
• Worked on Electronic health record system as a CRM web based application.
• Working Experience in Electronic Submissions in standard format E2B.
• Knowledge of regulatory issues including State, Federal, AABB, CAP, CLIA, and JCAHO

Environment: Windows 7, MS Project, Microsoft Visio, SQL, Data Warehouse, BI, BO, EPIC, HL7 and Business Objects

Confidential, Chicago, IL

Business Systems Analyst

Responsibilities:

• Analyzed existing reports and defined business requirements and business process flows
• Conducted JAD sessions with PM, SMEs; facilitated interviews with end users and hospital administrators to collect business requirements
• Built a business process model using Rational Rose and Visio.
• Gather detailed business and technical requirements and participate in the definitions of business rules and data standards.
• Facilitated SME interviews and assisted in identifying and analyzing the possible technical solutions.
• Assist DW data analyst in analyzing existing reports and identifying iteration metrics;
• Performed requirement analysis, went through use cases according to the flow of patient data and rules of security sharing.
• Created SAS programs that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros
• Used SAS ODS to create output files in different formats including PDF and RTF
• Formulated logical statements of business requirements researched and evaluated alternative solutions and recommend the most efficient solution for system design.
• Participate in business systems planning for integrated analytic needs; participate in defining approaches and priorities for satisfying needs.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for incorporation in a phased, iterative manner.
• Provide comprehensive support on issues relating to issues with the EMR EPIC system.
• Maintain and upgrade EMR as needed to new versions and service packs.
• Wrote SQL Stored procedures for numerous different KPI Metrics from different modules like Average Length of Stay(Epic Care Inpatient), Patients that left the ED without being seen(ASAP), First Case Late Starts (OpTime),Study Turnaround Time (Cardiant), Barcoding Compliance (Willow Inpatient), Average Daily Revenue (Hospital Billing) etc.
• 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 Analysis on Epic EPM/EMR application.
• Was responsible for Prior Authorization & Treatment Authorization Request forms.
• Assisted in data mart design and prototyping
• Designed and Administered Teradata Scripts, Tables, Indices and Database Objects
• Created test scripts for all the test cases in PL/SQL.
• Involved in creating reports for the end users using Crystal reports from the gathered requirements.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Assisted in mapping the requirements to the source systems, the DW and applicable data marts.
• Assisted in designing and validating source target mappings and transformation logical data model required to support information requirements.
• Assumed DBA roles and responsibilities as needed for DB2 and/or Oracle (mainframe and/or client server) environments.
• Tracked and documented defects and communicated them to the technical developers.
• Used Test Director for bug and defect tracking.
• Assisted the project manager in preparing the project schedules, milestone tracking, resource allocation using Microsoft project.
• Prepared Business Object / Business Process Models that included modeling of all the activities of business from conceptual to procedural level.
• Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance Testing.
• Involved in manual testing and UAT with the development team and QA team.

Environment: MS Office, MS Excel, MS Access, Business Objects, Crystal Reports, TSO/ISPF, XML, Oracle Pl/SQL, HTML, MS Visio, RUP 2002, Rational Rose 2002, Rational Clear Quest 2002, Rational Requisite Pro.