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Business System Analyst Resume

Buffalo New, YorK

PROFESSIONAL SUMMARY:

  • 6+ years of IT experience in Data Analyst with extensive usage of SQL, Tableau and HP ALM/QC.
  • Good understanding of SDLC and STLC methodologies including Waterfall, Iterative, Agile and Scrum methodologies.
  • Good experience in data sources, data profiling, data validation, developing low level design patterns based on the business and functional requirements.
  • In a data warehouse environment, designed the staging area based on OLTP concepts, cleansed and profiled before loading into data marts.
  • Efficient in Dimensional Data Modeling for Data Mart design, identifying Facts and Dimensions and Strong understanding of principles of data warehousing, Fact tables, Dimension tables, Slowly Changing Dimensions (SCD) Type I and Type II.
  • Created data Mappings to load data from the target using different transformations and executed workflows for data loads to target systems.
  • Experienced in gathering requirements for HIPPA (Health Insurance Portability and Accountability Act) EDI (Electronic Data Interchange) Transactions 820, 834, 835, 837 (I, P and D), 270, 271, 276, 277, 278, 997 and 999 in various phases of implementation.
  • Strong knowledge of Facets and actively involved in end - to-end implementation of Facets Billing, Enrollment, Claim Processing and Subscriber/Member module.
  • Expertise in creating various artifacts like BRDs, Functional Specs, Used Cases, Data Mapping Documents, Test Plans and Test Strategies, pre and post RTMs and Status Weekly Reports etc.
  • Strong visual modeling and Business Process Modeling (BPM) skills using Rational Unified Process (RUP) with tools like Rational Rose, and MS Visio.
  • Excellent analytical, organizational, communication and documentation skills along with good project management skill to gather requirements to bring out the quality product.
  • Knowledge in Data Modelling, Data Extraction, Transformations and Loading, Mappings Workflows, and Customized Analytics Reports.
  • Created and managed Project Templates, Use Case Project Templates, Requirement Types and Traceability Relationships in Requisite Pro.
  • Excellent written and oral communication skills with the ability to communicate appropriately in business and technical situations at all levels of project management.
  • Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
  • Skilled and managing the breakdown of the Epics in the product backlog into user stories that abide by the invest criteria
  • Extensive experience in Healthcare/Claims and encounters adjudication with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835, 270/271, 276/277).

TECHNICAL SKILLS:

Business Skills: Business Process Analysis & Design, Gap Analysis, Impact Analysis, JAD Sessions, Requirement Gathering, and Use Case Modeling

Languages: SQL, HTML XML

Database: MS SQL Server, Oracle, MS Access

Project Management: Microsoft Project

SDLC Methodologies: Agile Scrum, Waterfall, Hybrid

Operating Systems: Windows, UNIX

Other Tools: MS SharePoint, MS Visio, HP ALM/QC, MS Office, FACETS

PROFESSIONAL EXPERIENCE:

Confidential, Buffalo, New York

Business System Analyst

Responsibilities:

  • Gathering requirements as well as scheduling a daily scrum meeting to elicit, analyze, verify, and manage the needs of the project stakeholders, customers and end users.
  • For Medicare services such as Hospital, Medical insurance, Medicare advantage plan and Prescription drug coverage.
  • Configure Facets Procedure Codes application on Application Support Application by setting up the table and populate the field's name, description, Table name and Columns' name.
  • Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets
  • Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 7 transactions.
  • Conducted Manual testing (Functional, Integration, System, UAT) of the application and provided the Sign-Off on the application deliverables.
  • Configure different applications of Facets such as, Individual user set up, Group set up, Process Control Agent and Duplicate claim rule application on Medicare application, ICD Procedure codes, MDC Codes on Application Support Application.
  • Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
  • Extensively worked with other Business Team / Units to resolve issues. Coordinated with other team members on issues as-needed
  • Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
  • Worked on error of different regions like East, West, and Central regions. Central comprise of Medina and Ashtabula county hospitals. East comprise of Euclid, Lakewood, Marymount Hospitals. West comprise Fairview, Lakewood, Lutheran, Marymount Hospitals
  • Lead person on Customer Service Workflow for New Jersey State Medicaid responsible for enrollment claim related issues, performed detailed processing and research.
  • Quality assures deliverables (documents) being sent to Center of Medicaid and Service by, making sure correct procedures were followed when creating and completing the document.
  • ADT, ORU Delete and Process Reports were tested in all regions. MED Image Reports were also tested in all regions
  • Worked exclusively on Reconcile Reports to match the data in both systems (In EPIC and Invision systems)
  • Logged issues in EPIC defect tracking system called Sherlock and discussed the issues in daily and weekly status meeting
  • Gathered the Requirements for Enhancement of Electronic Lab Reporting Dashboard and implemented the timely status/error messages in the Dashboard
  • Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
  • Created a Data Dictionary Mapping the Reportable Health Conditions with LOINC/SNOMED codes and Master Data Management Documents.
  • Worked on requirements of the 835 HIPAA projects, 276/277, 278, 837, and HIPAA EDI Transactions across enterprise.
  • 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 on developing the business requirements and use cases for FACETS batch processes; automating the billing entity and commission process
  • Setting up Fee Definition and Fee Calculation in FACETS for QHP Individuals, Grandfathered/ Transitional Small Group, QHP Small Group and Large Groups

Confidential, NJ

Business System Analyst

Responsibilities:

  • Provided full life cycle support for company’s Facets enhancement to Facets e2 Workflow and Network Management Suite with Pricing Modeler and Network Modeler application--including Business Requirement gathering, Functional Design, Technical Design, and Production Support documentation for multiple outgoing interfaces.
  • Documented the user Stories, Functional Specifications Documents and also Designed Data Flow Diagrams using MS-Visio.
  • Knowledge on HIPAA Compliance EDI Transaction Sets 834, 837 and Good understanding of the EDI transaction sets 834, 837
  • Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.
  • Writing Epics and user stories, managing sprints and backlog grooming, and tracking project progress in JIRA.
  • Worked with 837, UB92, UB04, CMS 1500 claims and HIPAA 835, 270/271, 276/277, 278 transactions.
  • Experience in CMS and MMA Guidelines.
  • Published detailed guide describing data file content and structure for business partners; created quick reference guide for HIPAA EDI ASC X12 834 transaction set for Medicaid enrollment.
  • Coordinated testing for contract set-up, enrollment and claims processing for four new managed care contracts for Medicaid mental and physical health providers.
  • Involved in intensive system level testing of analyzing the HL7 messages coming out and in of EPIC Bridges.
  • Responsible for the mainframes that receive the HL7 message in pre-approved format from the middleware as disclosed in the documentation.
  • Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
  • Studied existing business application and processes, current source system, collected end user requirements and suggested the improvised business process model
  • Use HL7 implementation methodology to create specifications, assist with unit testing, and perform integrated testing for messaging between the state Departments of Health and the location office
  • Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS VISIO.
  • Used JIRA tool to track and maintain different versions of the project documentation.
  • Working knowledge of inpatient and outpatient claims processing including ICD-9, ICD 10-CM, ICD-10 and set up system related components to ensure accurate claims adjudication by health systems
  • Designed a claim processing system for the healthcare management client system. It allowed the user to inexpensively capture information regarding patient, summary of medical history, symptoms (ICD-9, ICD-10 codes), and treatment (CPT).
  • Involved in reviewing complex SQL queries, views, functions and stored procedures and spotting issues before/during code migration.
  • Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834 transactions.
  • Used JIRA tool to track and maintain different versions of the project documentation.
  • Designed wireframe mockups for claim processing EDI transactions 837 and 835.
  • Extensive backend testing using SQL queries, generating the reports to ensure the data integrity and validated the business rules.

Confidential, North Brunswick, NJ

Business Analyst

Responsibilities:

  • Developed SQL queries /scripts to validate the data such as checking duplicates, null values, truncated values, ensuring
  • 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.
  • Responsible for developing business process diagram as per BPMN standard.
  • To perform Gap Analysis on the existing system with an idea of figuring out the necessary mapping steps towards the new "Target" system.
  • Used JIRA tool to track and maintain different versions of the project documentation.
  • 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.
  • 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.
  • Performing business analysis, software validation and testing for client/server, multi-tier and web-based applications for EMR and commercial business for managed healthcare plans and Industries
  • Testing the accuracy of iHelix inpatient EMR for Stage 1 meaningful use clinical quality measure calculation by using Cypress tool.
  • 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 analyzing and documenting related business processes.
  • Gathered requirements for making changes to the existing Electronic Medical Records (EMR), Electronic Health Records (EHR) and Ambulatory Services for the existing Epic Interfaces.
  • Performed SQL queries for retrieving, organizing the database with general commands like select, create, update, and joins.
  • Developed Test Cases and prepared test scripts using SQL to test transformation logic in the data and Executed UNIX shell scripts for data loading, job scheduling and SQL script execution.
  • Extensive work experience in analyzing the data from various sources in data warehousing/ mining environment; analyze and determine the gaps; hands-on experience in designing the ETL processes/ procedures.
  • 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).
  • To analyze and resolve the ongoing issues with the Data Warehouse and the ETL processes/ upstream and downstream applications.
  • Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR
  • 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.

Confidential, Louisville, KY

Business/Data Analyst

Responsibilities:

  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
  • In-depth knowledge and experience in full SDLC with Agile/SCRUM and waterfall methodologies.
  • Facilitate all agile ceremonies including daily stand-ups, weekly grooming, retrospective, and review and planning session.
  • Performed workflow analysis toward automated disability claims process. Detailed comparison of two competing proposals, including HR interfaces. Facilitated requirements definition for new system.
  • Introduced Agile to the product team and organized releases into SCRUM sprints, incorporated elements of XP
  • 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.
  • 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.
  • Experience with Medicare, Medicaid and commercial insurances in HIPAA, ANSI, X12 formats including 270/271, 276,277, 278, 835, 837, 997.
  • Used Rational Clear Quest to track required changes and Rational Clear Case to maintain different versions of the project documentation
  • Performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
  • 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
  • Gathered requirements for making changes to the existing Electronic Medical Records (EMR), Electronic Health Records(EHR) and Ambulatory Services for the existing Epic Interfaces.
  • Modeled Business requirements into workflows to depict various scenarios of system to request RFI and RFP responses from major vendors.
  • Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
  • Responsible for developing in-house application comparing data from different sources i.e. EDI, XML and FACETS.
  • Intricately involved in Business Process Flow development, Business Process Modeling, and ad hoc Analysis

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