- Senior Business Analyst/Systems Analyst/Tester with 8 years of experience in Health care industry.
- Expertise in Software Development Life Cycle (SDLC) and Business Process Reengineering in Health Care Sector with prime focus on claims adjudication, provider, eligibility, enrollments, and prior authorization.
- Successful track record of delivering software solutions and process improvements using both Agile and Waterfall Methodologies.
- Extensive knowledge on various modules in Health Insurance and Healthcare Industry.
- Strong knowledge on HIPPA, HITECH, ACA compliances and governance regulations in Insurance industry.
- Good understanding of healthcare interoperability especially in claims management and AR receivables.
- Involved in Project Planning, Project Design, creating Functional specifications and data flow diagrams
- Demonstrated ability to work actively in different phases of Software Development Life Cycle (SDLC) using Waterfall, Agile methodologies like Scrum and Waterfall - Scrum hybrid and extensive knowledge in Rational Unified Process (RUP), Extreme Programming (XP), Scrumban, Kanban and Scaled Agile framework (SAFe).
- Adept in liaising between business and technical stakeholders to gather Functional and Non-functional requirements through various elicitation techniques such as, Document Analysis, Interviews, Focus Groups, Prototyping, Joint Application Development (JAD), Joint Requirements Planning (JRP), Brainstorming, Surveys and Questionnaires.
- Expertise in creating artifacts like Business Requirements Document, Functional Requirements Document, System Requirement Specifications, Use cases, Functional Specification Document, Requirement Traceability Matrix (RTM).
- Experienced in performing Gap Analysis, Risk Analysis, Impact Analysis, SWOT, Pestle, and Cost Benefit Analysis.
- Excellent experience in developing UML diagrams such as Use Case diagrams, Sequence diagrams, Activity diagram, Workflow and Data Flow diagrams using Microsoft Visio, Lucid Charts, Rational Rose and Rational Requisite Pro.
- Extensively used JIRA for creating and maintaining Product Backlog and thereby managing requirements in Agile. Conducted story writing workshops to decompose Epics into User Stories using Vertical and Horizontal slicing.
- Assisted Product Owner in defining MVP, Release Planning & Prioritizing the PBIs using techniques like MOSCOW, Kano.
- Collaborated with the PO and the team to define the Acceptance Criteria and Definition of Done (DoD) for the PSPIs.
- Well versed with architectures such as 3-tier architecture, n-tier architecture and Service Oriented Architecture (SOA).
- Involved in documenting RESTFUL and SOAP APIs in JSON and XML formats using Swagger. Validated and tested APIs using HTTP verbs such as GET, POST, UPDATE, DELETE using Katalon Studio and POSTMAN to connect with webservices.
- Well versed in Creating Data Models such as Conceptual and Logical model. Also, experienced in Online Transactional Processing (OLTP) and Online Analytical Processing (OLAP) operations such as Drill-Down, Roll-Up, Slice, Dice & Pivot.
- Experienced in creating Data Mapping Documents to transfer data from legacy system to target system.
- Extensive knowledge on Data Profiling, Data Transformation, Data modelling, Data migration and Integration. Performed ETL process using Informatica PowerCenter, AWS Glue to load the data into the data warehouse from different sources.
- Working knowledge of MySQL database, SQL Server, Data Warehouse and AWS S3 and EC2 instances.
- Performed SQL queries such as Select, Update, Delete, Joins, Extracts, Unions, Distinct, Stored procedures and Aggregates operations such Min, Max. Avg and Count.
- Created snapshots in reporting tools for data visualizations to track key performance indicators (KPI) to ensure ROI and created Ad-Hoc, Standard static reports, dashboards such as Bar graphs, Pie charts, Maps using Tableau.
- Strong knowledge on Test cases, Test Scripts, Test Scenarios and assisted QA team in performing Unit testing, Integrity testing, SMOKE testing, Functional testing, System testing, Regression testing and Sanity Testing.
- Performed Manual and Automated Testing on Windows platform. Also, conducted User Acceptance Testing (UAT) and documented the defects for further resolution.
- Assisted in preparing UAT plan/scripts and assured in steps for alignment of Operational Quality Checklist.
- Expertise in Performance, Stress and Volume Testing of Client/Server and Web based applications using different tools.
- Adept knowledge in Acceptance Test Driven Development (ATDD), Test-Driven Development (TDD). Involved in writing scenarios for Behavior Driven Development (BDD) using Cucumber.
- Experienced in reporting bugs using Bug tracking tools such as HP Quality center and HP ALM.
- Excellent Communication Skills along with verbal and written skills. Exceptional ability to learn new concepts in least time.
- Possess Excellent Professional Skills for working independently and as a team member to deliver the results in the most efficient manner and ensuring a healthy environment among the team members.
SKILLS AND TOOLS:
Healthcare Domain: Medicaid, Medicare, HIPAA, ICD 10 CM, EDI transactions: 270,276,834,835,837.
Software Development Life Cycle: Agile-Scrum, Scrum-Waterfall, Waterfall, XP, RUP, SAFe, Spiral, Kanban, Scrumban
Business Modelling Tools: MS Visio, Lucid Charts and Rational Rose
Project Management Tools: JIRA, HP ALM, MS SharePoint (2010, 2013), Confluence, HP QC, Rational RequisitePro.
BI and Reporting tools: Tableau, MS Office Suite, Informatica PowerCenter , SQL Server Reporting Service (SSRS)
Architecture/Framework: Service Oriented Architecture (SOA), 3-Tier Architecture, n-Tier Architecture
Databases: MySQL Server, HADOOP HDFS, Oracle, SQL, Amazon S3, MS Access
Data Warehousing: Enterprise Datawarehouse, Amazon Redshift
Testing Tools: HP Quality Center, Cucumber
Confidential, Washington, DC
Sr. Business Systems Analyst
- Utilized Agile Software Methodology to deliver the expected solution within the desired schedule.
- Worked with Stakeholders in gathering requirements by performing elicitation techniques such as Brainstorming, Document analysis, Interviews, Introspection and documented the requirements for Claims adjudication, Accounts management, Enrollments, Risks and HIPAA Regulations that are required for the application.
- Performed GAP analysis by analyzing the current system and the scheduled systems there by documented the gap items. Also, worked with the SMEs to various feasibility analysis and cost-benefit analysis. During the initial phase.
- Studied elements of electronic health system and related application changes to execute relevant FDA/HIPAA protocols and GDPR methodologies in the enhanced application.
- Helped Product owner in defining the scope of the project, Minimum viable product (MVP), Acceptance criteria, Definition of Done and Definition of ready. Assisted PO in preparing product backlog and in Prioritizing the PBIs as per MOSCOW model. Also, coordinated with development team in estimating the user stories using Planning poker.
- Provided Epic content expert support by adopting new Epic functionality for process/system improvements with integration/interfaced systems and tracked Epics, User stories and issues in JIRA.
- Created low/high fidelity wire frames and mock-ups using Balsamiq and prepared various UML diagrams such as Activity diagrams, Sequence diagrams, Use cases, Workflows using MS Visio.
- Assisted the Scrum Master to maintain the Sprint/ Release Burn-up and Burn-Down charts in JIRA.
- Actively contributed to Scrum ceremonies- Grooming sessions, Release planning, Sprint planning, Daily Scrum, Sprint Review and Sprint Retrospective meeting.
- Coordinated with Scrum master in addressing the impediments by actively working with stakeholders and End users.
- Worked with development team in identifying the data fields from the claim documents for OCR recognition using Amazon Textract Software and assisted in data mapping with system fields for auto-adjudication.
- Worked with development team in validating the extracted data using AWS lambda validator to check the discrepancy in the claim forms.
- Collected various business rules and Scenarios involved in claim processing and coordinated with development team in automating the adjudication of claims by eliminating the manual steps.
- Worked with Development team in implementation of RESTFUL API between applications, also assisted in API testing and API documentation using POSTMAN Tool.
- Assisted Architect and Developer in revamping the existing web application and worked with development team for in corporation of updated forms and functional features to meet the organizational needs.
- Identified various sources of databases and actively worked with ETL team in Data profiling, Data Extraction, Data transformation and Data loading into AWS Redshift data warehouse using AWS Glue tool.
- Coordinated in performing OLAP queries such as Rollup, Drilldown, Slice and dice. Retrieved and Validated data from the data base by performing SQL queries to confirm the data Integrity and data consistency.
- Identified the risk fields and worked with developers to create validations on the them in the Risk analysis module.
- Tested for Risks involved in the system and ensured the system follows the HIPAA regulations.
- Assisted QA team in developing Test Scripts and conducted manual testing for Functionality and Security. Facilitated Integration testing, System testing, Regression testing and User acceptance testing (UAT).
- Identified and developed Test Scenario’s for various types of claims and user procedures and validated the scripts to make sure they have been executed correctly and meets the scenario description.
- Created happy path scenarios and all the special cases, error cases that the user might encounter.
- Analyzed and documented issues and inconsistencies in JIRA tool and ensured the resolution is meeting the requirements.
- Worked with the team in creating User Manuals and Release notes with the system responsive screen shots.
- Created Ad-hoc report, dashboard reports, Inventory reports, Utilization reports for Daily operations, Sales trend report for Policy administration by using Tableau tool.
Environment: Agile-Scrum, JIRA (v.7.3), Confluence (v.6.4), MS Visio (V.16.0), Balsamiq, KAFKA, JSON, REST Web Services, Textract, AWS SQS, AWS Lambda Validator, AWS SNS, AWS S3, SQL, MS Office, Service Oriented Architecture, POSTMAN (v.7.0), AWS Glue, AWS Redshift, Tableau(v.9.1).
Confidential, St Louis, Missouri
Sr. Business Systems Analyst
- Worked with Senior management, Stakeholders in gathering high level requirements for organizational need.
- Used elicitation techniques of Document Analysis, Interviews and Focus groups with business users and subject matter experts (SME's) to gather functional and nonfunctional requirements.
- Performed System analysis to understand the workflow of the current claims processing system thereby to leverage the new pattern of claims into existing workflow.
- Conducted SWOT analysis, Impact analysis and feasibility studies for EDI transactions as per the HIPAA and PHI guidelines to make sure the rules and regulations are clear and responsive.
- Conducted JAD sessions which helped to synchronize the different stake holders on their objectives and helped the developers on understanding the project.
- Performed Data analysis to identify the networking providers for the past 2 years to finalize the list of networks.
- Worked with Product owner in defining the scope of the project and assisted in converting the requirements into EPICs to user stories by Vertical slicing technique for a product backlog artifact.
- Assisted product owner in Resource planning, Release planning and Definition of Done for the PSPI in each sprint.
- Coordinated with Scrum master in calculating the velocity and capacity of team members. Worked with development team in estimation of user stories meeting INVEST criteria by Planning poker technique.
- Created Interaction diagrams, flow charts, Sequence diagrams using Rational Rose. Prepared low/high fidelity wire frames, mockups, prototypes and shared with stakeholders for better understanding on the process design and requirements.
- Extensively used JIRA for managing, tracking the project and used confluence for accessing the documents.
- Efficiently monitored each sprint and release to ensure that the development of project is in line with requirements.
- Experience in analyzing EDI transactions such as Inbound claims- 837-I/P/D, 835-Remittance advise, 270/271 - Eligibility enquiry/response, 276/277- claims status inquiry/response, EDI 834- Enrollment.
- Identified gaps between HIPAA 4010A/5010 and ensured with the changes updated in the compliances.
- Coordinated with product owner in addressing the requirement change requests and worked with development team in incorporating the changes in next sprint as per priority.
- Worked with ETL team in performing operations such Extraction, Transformation and Loading the data in to Datawarehouse using Informatica power center.
- Examined source data using SQL queries as a part of for extraction of data from database for payment reconciliation reports. Performed CRUD operations on SQL using SELECT and JOIN for slicing, drill down and dicing for reports.
- Assisted QA team in writing test cases, test scenarios and efficiently maintained test plan document. Involved in Unit testing, Integration testing, User acceptance testing, and Regression testing.
- Assisted in integrating Tableau with database for designing dashboards and Static reports, reconciliation reports.
Environment: Agile-Scrum, MS Excel, XML, HTML, Rational rose (v.7.0), SQL, Informatica PowerCenter (v.9.6), JIRA (v.7.0), Oracle, SQL Server, Windows 2000/XP, HIPAA, Tableau (v.10.3).
Confidential, Richmond, Virginia
Business Systems Analyst
- Adopted Waterfall - Scrum Hybrid methodology and its best practices for the development of web application.
- Analyzed the Insurance Business to understand the customer needs and gathered requirements for the process.
- Worked with Technical team, Architect, Project managers, Subject matter experts and Senior management in collecting Functional and Non-functional requirements by conducting System Analysis, JAD Sessions and Prototyping.
- Worked with Product owner in preparing Business Requirement Document (BRD), System Requirement specifications (SRS), Product Backlog and helped in preparing Project scope document, Project charter.
- Performed GAP analysis and worked on various policy products and associated documents of the policy that are required for business operations. Revised HIPAA and PHI guidelines to ensure the system adheres to Healthcare compliances.
- Prepared low fidelity UI/UX wire frames, mock-ups using MS Visio and shared with stakeholders accordingly.
- Actively involved in all Scrum ceremonies, recorded Minutes of the meeting & maintained detailed project notes.
- Assisted Product owner in preparing User stories and helped in defining Acceptance criteria to meet the requirements. Also, worked with Scrum master in velocity and capacity calculation of team.
- Prioritized the requirements by using MOSCOW technique and efficiently managed the requirements churn.
- Identified Data fields in application system that are mandate for processing and created Data mapping document for the submission of claims and different types of additional information documents to the claim’s adjudication application.
- Worked with Subject matter experts in collecting required questionnaires for medical accident, maternity etc., and with the Development team in incorporating the records into relevant fields of Web portal. Assisted Development team in integrating the physician directory and Pre-authorization request portal into Web application.
- Designed the workflow for integration of data from web application to claims management system.
- Worked with Development team in Implementing RESTFUL API’s for two-way communication between systems.
- Actively participated in API documentation along with Development team and performed API testing using POSTMAN to check the response is in JSON and XML format.
- Generated Use case, Interaction diagrams, Activity diagrams and PowerPoint presentation to depict process flow.
- Worked with QA team in preparing Test plan document, Test cases and Test scripts. Actively participated in Unit testing, Integration testing, regression testing, Monkey testing and performance testing.
- Conducted UAT and documented the defects for further resolution.
- Created User Manuals and Implementation Notice with detailed list of system responsive screen shots.
Environment: Waterfall - Scrum Hybrid, MS Visio (v.16.0), HL7/FHIR, MS Office Suite, SQL, JIRA (v.7.0), Postman (v.5.0)
Business System Analyst
- Adopted Waterfall - Scrum Hybrid Methodology to deliver the expected solution within the desired schedule. Involved in project planning to understand the objective of the project. Assisted in Product owner in creating the Concept Proposal (CP) Document and helped in creating Project charter to indicate scope, objective and stakeholders of the project.
- Gathered requirements for the project using different elicitation techniques like Document analysis, System analysis, Focus groups, Interviews, JAD sessions with various Business owners, branch heads and development team.
- Created UML diagrams like use case diagrams, activity diagrams using Lucid charts to ensure an effective understanding among the stakeholders on the project.
- Actively participated in Scrum ceremonies like Backlog refinement, Sprint planning, Daily scrum, Sprint review, Retrospective meetings and ensured the project is in line with the business requirements.
- Worked with different operational managers and SME’s to understand the required data in the data marts.
- Extensively involved with development team to understand repository objects in the modeling and development of Reporting Data Warehousing System that support the business requirements.
- Experienced in Parsing high-level design specification to simple ETL coding and mapping standards for better understanding.
- Involved in identifying the conceptual and Logical data models to support the Data Marts and the Data Warehouse.
- Assisted ETL team in performing Data profiling, Data mapping, Data analysis and helped in creating OLAP cubes using Informatica power tool.
- Efficiently maintained Mapping, transformation rule document and assisted in data migration from various sources.
- Performed SQL queries like select, Joins, Extract and aggregate functions like Count, Avg, Sum to confirm the data consistency from the data base.
- Played a key role in the planning User Acceptance Testing and Implementation of data conversions.
- Created various dashboards in Tableau for reporting needs like Heat maps, geographical maps and bar graphs.
Environment: Waterfall-Scrum hybrid, MS Office Suite, Lucid charts, SOA, Informatica (v.9.6), Tableau (v.9.2)
Junior Business Analyst
- Analyzed current business process flow by understanding present business rules and conditions.
- Involved in project planning and assisted project manager in preparing different business artifacts like Project Vision document, Business requirement specification, Functional requirement Specification, Use case specification.
- Worked as a liaison among stakeholders in order to elicit, analyze, communicate and validate requirements for changes to business processes, policies and information systems.
- Used elicitation techniques like System analysis, Document analysis, Interviews and JAD sessions with stake holders in gathering requirements.
- Performed GAP analysis to identify the areas of differences between HIPAAX12 4010 transaction to X12 5010.
- Contributed in implementation of transition in accordance with HIPAA standards.
- Developed documentation of current business flow and definition of future EDI business information flow well experienced with EDI files - 837-I/P/D claim submission, 835-Remittance advise, 270/271 - Eligibility enquiry/response, 276/277- claims status inquiry/response, EDI 834- Enrollment file formats.
- Facilitated meetings to ensure common understanding between the non-technical team and the development team on requirements during Design, Development, Testing and Implementation phase.
- Created Use Case diagrams by analyzing the business process followed by Activity diagrams using MS-Visio and participated in production of HIPAA 5010 EDI Test data.
- Identified and developed Test Scenario’s for various types of claims submissions and user procedures. Involved in reviews, meetings with client and participated in test closure activities.
- Actively monitored the enhancements, change requests and effectively maintained the requirement churn. Prepared and executed test scenarios in HP QC, based on the functional document received.
- Validated the Data in database by performing basic SQL queries such as Select, Update and Delete.
Environment: Waterfall, HTML, CSS, SQL, MS Office, MS PowerPoint, HP QC (v.11), MS Visio, Confluence (v.5.0).
- Adopted Waterfall Methodology to deliver the expected solution within the desired schedule and actively involved in all stages of Software development life cycle from Initiation to deployment.
- Involved in Project planning and assisted Project manager in creating the Project Vision Document.
- Assisted project manager in preparing the business artifacts like Business Requirement Document (BRD), Functional Requirement Specification (FRS), System Requirement Specification, Use case Specification.
- Used elicitation techniques like Document analysis, System Analysis, Interview and Brainstorming sessions for gathering the Business Requirements from the stakeholders.
- Facilitated JAD sessions with the development team and the business owners to review business requirements for clear understanding on the requirements of the project.
- Assisted design and development team in creating the System Design documents and ensured it is in line with the business requirements of the project.
- Created UML diagrams - Flow charts, Activity diagrams accordingly using MS Visio.
- Efficiently utilized lean management for elimination of unwanted steps to enhance the process for automation.
- Assisted QA team in writing test scenarios, test plans, test scripts and was involved in performing Unit testing, Integration testing, Regression testing and Performance testing to ensure the product developed meets the requirements. Effectively tracked the defects in HP Quality center and diligently worked with the development team until their closure.
- Involved in UAT testing and validated the result. Also, created user manuals and implementation plan document.
- Performed SQL queries in retrieving data from customer profiles stored in the system.
- Participated in team meetings to understand client requirements and prepared different test cases to identify the bugs in the program.
- Responsible for specific testing phase (Performance) and mitigated business risks through timely and precise execution of test scripts.
- Used HP Quality Center to store all testing results, metrics and Reporting.
- Produced test results/screenshots & uploaded to Test Director/Quality Centre.
- Performed functional and technical test execution activities in line with the business requirements of the project.
- Document software product defects as per the defect life cycle and track it to closure.
- Developed test cases and conducted customized walkthroughs. Participated in unit testing and performance testing.
- Implemented testing in more levels of regression, negative, error/bug retesting and usability testing.
- Assisted the QA team in manual testing and UAT for defect tracking prior to release of company's new software
- Delivered thorough QA testing reports that determined product quality and release readiness.