- Proficient working in SDLC methodologies such as Waterfall, Spiral, Agile Scrum and have a fair understanding of industry standard methodologies such as Extreme programming (XP), Scrum - SAFe 4.0 & 4.6, Kanban and Hybrids such as Scrum-ban, Water-Scrum-Fall.
- Familiar with current healthcare industry standards such HHS, CMS and HIPAA guidelines (4010 & 5010) and EDI Transactions like 270,271,276,277,834,835&837,999,997 including MACRA, HITECH, SOX, FDA regulations and GDPR
- Experienced with Facets application groups: claims processing, guided benefit configuration, medical plan, provider, subscriber/member, product billing roles.
- Strong experience in healthcare concepts that Claims Processing, Clinical Trial Management, Electronic Health Record (EHR) Interoperability Application Management.
- Extensive knowledge of Medicaid (MMIS), Medicare, Procedural and Diagnostic codes and Claims Process.
- Integrated various systems with HEDIS and created design for HEDIS and other systems to pull data in HEDIS.
- Worked on the implementation and conversion of ICD-9 to ICD-10 codes with HIPAA 4010 to 5010.
- Experienced in gathering requirements using various elicitation techniques such as Interviews, Questionnaire/surveys, Document Analysis, Brainstorming, Focus Groups, Requirement Workshops, JAD sessions and reverse engineering.
- Spearheaded in analysing and decision making by performing Feasibility study, Root-cause analysis, SWOT Analysis, Cost-Benefit analysis, Impact Analysis, AS-IS and TO-BE business analysis, Pareto analysis, Regression Analysis.
- Specialized in Business and System Analysis, Requirements and Change management, Data Management.
- Proficient in drafting requirement artifacts such as Business Requirement Document (BRD), Functional Requirement Document (FRD), Functional Specification Document (FSD), Software Requirement Specification (SRS), Use Case Specification, Project Charter, Configuration Documents, Requirement Traceability Matrix (RTM) and RACI Matrix.
- Helped PM in creating work breakdown structure (WBS) using MS Project to track schedules and milestones
- Facilitated discussions for decision making and conflict resolution to ensure a good work environment.
- Extensive working knowledge in Scrum Environment. Supported Scrum Master in Scrum Ceremonies, Backlog Refinement Meeting, Sprint planning, Daily Scrum, Sprint Review Meeting and Retrospective Meeting.
- Created User stories, decomposed EPICS into User Stories using slicing technique ensuring INVEST criteria and helped in Prioritization and Estimation of User Stories using estimation techniques such as Planning Poker, Relative Mass Valuation, T-shirt Sizing and Prioritization techniques such as Moscow, Kano, Value Stream Mapping.
- Assisted Product owner in Prioritizing Product Backlog Items and defining the Minimum Viable Product (MVP), Minimum Marketable Feature (MMF), Minimum Releasable Feature (MRF), Definition of Done (DOD), and writing Acceptance criteria for user stories. Worked in Test Driven Development (TDD), Acceptance-Test Driven Development (ATDD), Continuous Integration (CI) and Behaviour-Driven Development (BDD) environments and developed Feature Files with high level description of Test Scenarios and Given-When-Then format (Gherkin format) using Cucumber.
- Created High and Low fidelity Wireframes, Mock-ups for the requirements to get a visual and Graphical User Interface (GUI) understanding of the application using tools like using Balsamiq Tool and MS Visio to assist the clients with better understanding of the outcomes of the project and making it feasible for the PO to define the MVP
- Highly experienced in designing Unified Manipulation Language (UML) diagrams such as Activity diagrams, Use Case diagrams, Sequence diagrams, Business Process Model Notation (BPMN) using Lucid Charts and MS Visio.
- Extensively Proficient in writing SQL queries which includes Inner and Outer joins, SELECT statements, Order by, Group by and Aggregate Functions to extract data for timely Reporting and Validation.
- Explicit insight in Data warehousing and ETL process. Well aware of the Data Warehouse creation process including OLTP, OLAP, Data marts, ODS, Staging, Data sources, Normalization, Dimension tables.
- In Depth understanding of the Star and Snowflake schema, different OLAP operations such as slice, dice, roll-up, drill down and pivot, facts and fact tables, etc. transformation and validation rules. Involved in Data/Dimensional Modelling; Data mapping, Data integration, Data migration, Data Extraction, Transformation & Loading (ETL).
- Aided the Quality Assurance team in creating Test scripts, Test Plans, Test cases, Test Scenario for the purpose of User Acceptance Testing (UAT) using Cucumber, Selenium.
- Generated multiple reports using different BI tools like Tableau and in-house reporting tools.
- Experienced in collaborating with the technical team in Manual Testing, Automation Testing, Graphical User Interface (GUI) Testing and have a fair understanding in Unit Testing, Integration Testing, System Testing, Performance Testing, Smoke Testing, Sanity Testing, Stress/Load Testing and end to end Regression Testing.
- Experienced in Defect tracking, Defect analysis and ability to organize, document and track changes using tools such as Atlassian HP ALM and JIRA with zephyr plug in and created Burndown, Burnup and Velocity Charts.
- Assisted in API testing using SOAPUI and POSTMAN Tools to check the API responses in JSON and XML as defined in the API documentation to determine the workflow and resolve inconsistencies.
Healthcare and Healthcare Insurance Domain: Member Enrollment cycle, Claims Life cycle, Medical Plans like HMO, PPO, POS, EPO, CHIP, Medicaid, Medicare services. (Healthcare Enrollment system, Claims adjudication system, EHR, EMR, Healthcare Data Migration, Health Data mapping,
SDLC Methodologies: Waterfall, Scrum, Kanban, Water-Scrum-Fall (Hybrid Waterfall & Scrum), SAFe, RUP, Xtreme Programming (XP)
Business Skills: Business Requirements Elicitation, Change request Management, Impact Analysis, JAD Sessions, Project planning, Project Scheduling, Issue Management, Information Security Management, Conflict Management, Regression Analysis
Business Modeling tools: MS Visio, Balsamiq Mock-ups, Lucid Chart
Project Management Tools: JIRA, HP ALM, MS Project, MS SharePoint, Confluence
Testing Tools: HP-QC, Cucumber, POSTMAN, SWAGGER, Selenium
BI and Reporting Tools: Tableau, Kibana, Power BI
Architecture/Framework: Service Oriented Architecture (SOA), 3 Tier Architecture, N-Tier ArchitectureTechnologies: Mainframes, UiPath
Databases and ETL Tools: MS SQL Server, My SQL, Informatica Power Center, AWS and Salesforce Cloud
Data warehousing: Data Marts, Data Modeling, ETL
Confidential, Norfolk, VA
Sr. Business Systems Analyst
- Interviewed Subject Matter Experts (SMEs), Conducted Brainstorming sessions and performed extensive document review to develop an in depth understanding of business processes, and got familiarized in RPA implementation, Customer behaviour, and used Prezi Business Presentations to facilitate requirement validation using Joint Application Design (JAD) sessions.
- Analysed the GAP between the systems in the Claims Adjudication Process that caused time lags. Identified the Legacy system involved in the Claims Process and took part in the integration between them.
- Translated the functional requirements to technical requirements in the form of Use Case Diagrams, Process Flows and Prototypes using Scrum Methodology.
- Regularly engaged and participated in Scrum ceremonies, including Backlog Grooming/Refinement, Sprint Planning meeting, Daily Scrum, Sprint Review Meeting and Sprint Retrospective Extensively used Jira for converting the requirements to user stories, assisted the Product Owner in defining the Acceptance criteria and framing the Definition of Done (DOD) for the Potentially Shippable Product Increment (PSPI), participated in PI planning and assisted the product Owner (PO) in Demo Meetings. Documented the addition requirements discussed during review.
- Worked on 4010- 5010 Transactions (837I,837P,837D,835,834,270,271,271) through which claims being processed including Coordination of Benefits (COB) payments and analysed related business processes to ensure compliance.
- Meticulously documented the various elements of claims which includes ICD, Procedure Codes, CPT, HCPC’s, Diagnosis Codes, Taxonomy Codes and categories of Claims both Professional Claims or Institutional Claims and ensuring all Claims are Compliant to of The Medicare Access and CHIP Reauthorization Act (MACRA) with MIPS and Alternative Payment Method for provider payments through Quality Payment Program (QPP).
- Worked on Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare using Facets.
- Created Mock-Ups, High Fidelity, and Low Fidelity Wireframes using Balsamiq and MS Visio.
- Developed User Stories through the Agile Lifecycle. Also created UML Diagrams such as Activity Diagrams, Use Case Diagrams, Entity Relationship (ER) Diagrams using MS Visio.
- Developed the Requirement Traceability Matrix (RTM) for future references and tracking the progress.
- Maintained defects by prioritizing them against the backlog items and tracked them till completion using JIRA.
- Worked on automating the claims process flow which includes receiving, eligibility and benefit level determination, apply pricing claim edits, apply proprietary claim edits, complete adjudication, generate EOB (explanation of Benefits) and send payment
- Assisted in implementing UiPath as a Robotic process Automation (RPA) Tool to automate the claims process to take over 8 0% of the FNOL process, including data entry in the company’s claim filing system, creating, archiving and streamline the claims process by speeding up data processing and simultaneously reducing the number of errors.
- Designed and implemented SQL queries and stored procedures. Used functions like joins, unions, outer joins, group by, order by and aggregate functions to extract data for timely reporting and validation.
- Involved in designing and developing Data Models and Data Marts that support the BI Data Warehouse.
- Extensively involved in mapping data from various sources to the target database tables using Informatica. Worked in creating the Enterprise Data Warehouse (EDW) and ETL of data into DWH.
- Performed API testing using Postman and SoapUI to check if the API’s are returning the data in JSON, XML format as defined in the API documentation using Swagger tool and required by workflow.
- Worked with Development, QA, and Production Support teams to communicate, verify, and test the desired functionality changes. Helped the Testing team in creating Test Plans, Test Scenarios, Test Cases and collected Test Data for successful completion of Integration Testing and Functional Testing.
- Performed Manual testing using, Integration testing, System testing, User Acceptance Testing with UAT cases and resolved issues with the users.
- Created various charts, graphs, reports for business analysis using Tableau Business Intelligence tool. Report extractions to various formats, Snapshots, Dashboards, and Email generation according to application requirements in UiPath.
Environment: Scrum-SAFe, Service Oriented Architecture (SOA), MS Visio, JIRA, Tableau, Swagger, Robotic Process Automation (RPA), UiPath, Informatica, UML, and UAT Testing.
Confidential, Bloomberg, PA
Sr. Business Systems Analyst
- Elicited business requirements by conducting JAD sessions, interviews with stakeholders, and business owners. Performed extensive document analysis Also, collaborated with Subject Matter Experts (SMEs) for Pre-Analysis of the system, Captained GAP Analysis by understanding the AS-IS business process, and TO-BE business process.
- Creating and maintaining business process flows (AS-IS, TO-BE), Use Cases, Activity diagrams (UML diagrams) using MS Visio and also created high fidelity Wireframes using Balsamiq to gain insights from the stakeholders.
- Assisted the PO in Translating the functional requirements and User Interface (UI) into EPICS and breaking them down into User stories and helped manage the Defect lifecycle using JIRA and scheduled automated testing with Zephyr
- Developed Business Modelling through understanding the needs of the business and developed a conceptual Matrix such that the business needs can be tracked to the new business processes satisfying the needs.
- Used previous domain knowledge to gain an understanding of the relevant Regulatory Information Management and developed processes and reviewed them in accordance with the HIPAA and Electronic Data Interchange (EDI) in context with the PHI data levels of security and standardization with HL7 protocols and access provided by the patients.
- Spearheaded in prioritizing the User stories and created Acceptance criteria for each of them using the Gherkins Format and cucumber.
- Cooperated in defining EHR interoperability on AWS EC2 instances and integration with each addition of new data to amazon S3 (Simple storage service) and used AWS RDS as a database.
- Created and updated data extensions, filtered data extensions and wrote SQL queries with various functions inside of individualized Data bases to import or export data between data extensions
- Assisted in identifying the clinical data and creating specialty EHR registries for diseases and disorders being treated, procedures performed, medication and their codes according to compliances for communication among pharmacy, providers and another EHR system to help Decision Support System and fast health interoperability resources (FHIR) exchange.
- Performed XML and JSON RESTful API documentation using Swagger and tested APIs using SOAPUI in compliance with FHIR draft guidance conforming to the standards of HL7 v2 and HL7 v3
- Assisted the QA team in designing Test plans and Test Cases for Manual testing and User Acceptance Testing (UAT) using Selenium, Cucumber, HP ALM. Assisted Manual testing of System, Integration, Regression, User Acceptance Testing (UAT), Load/Stress Test, and Performance Test.
- Performed business analysis and created various reports, charts, dashboards and graphs using Tableau and implemented highly interactive graphs and charts to track trends with patients.
Environment: Agile/Scrum, Service Oriented Architecture (SOA), AWS EC2, Amazon S3, MS Visio, JIRA, Tableau, Swagger, Informatica, UML, UAT Testing, Selenium, Cucumber, HP ALM
Confidential, Austin, TX
Business Systems Analyst
- Identified key stakeholders to elicit the business requirements using various elicitation techniques such as interviews, Surveys and JAD sessions and translated them to User Stories.
- Created enterprise Business Process Modeling (BPM), mapping of importing salesforce contacts, centralized technical documentation at one place to drive transparency and defining process timeline with lucid charts.
- Assisted Product Owner in prioritizing the backlog using different techniques such as Moscow and Kano.
- Advised the Product owner in defining the Definition of Done (DOD) in the sprint review meeting for the respective demos.
- Gained Knowledge in the relevant technologies to participate in the design, development, testing, and implementation of SalesForce Marketing Cloud, Health Cloud and Community cloud.
- Extensively involved in gaining knowledge in Patient and protocol compliance in clinical Trials. FDA guidelines and ensuring 21 CFR part 11 compliant and capable of capturing detailed audit trail of user activity on the system.
- Reviewed and analyzed the Regulatory frameworks including PhRMA, HIPAA compliance, SNOMED CT, PHI, EHR, IRB/EC approval, LOINC and RxNORM guidelines
- Assisted in designing and deploying workflows, validation rules, approval process and auto-response rule for automating business logic with health cloud on Salesforce
- Identified Disparate systems to be seamlessly connected using MuleSoft Anypoint Platform to connect EHR, facilities and procedures, environmental information, credit and claim information of patients.
- Helped Admin in using Einstein Analytics that is built-in to provide predictive analytics and operational reporting. Marketing Cloud makes it easier to recruit and enroll patients, while Community Cloud lets patients and investigators share information and collaborate within a secure, authenticated portal
- Facilitated meetings with Salesforce developers in presence of Sales and Marketing team to discuss about the data that needs to be ingested into Health cloud and Marketing cloud.
- Created and updated data extensions, filtered data extensions and, wrote SQL queries inside of SFMC to import or export data between data extension and email campaigns. Generated reports based on the Salesforce application platform for evaluation.
- Enabled salesforce to provide 360-degree view of the patient at a single point of view for better forecast and analysis.
- Assisted Quality Analyst to write Test Plan, Test Case, Test Scenario and created and updated the Requirement Traceability Matrix (RTM). Performed User Acceptance Test, actively participated and facilitated testing of the system during Smoke Testing, integration Testing, Black Box Testing and Regression Testing
- Performed API documentation using SWAGGER and completed the API testing using POSTMAN.
Environment: Agile-Scrum environment, Salesforce Health Cloud, MuleSoft. Salesforce Marketing cloud, SaaS, PaaS, JIRA, Lucid Charts, SQL, HTML, XML, Swagger, Balsamiq, MS Office, Tableau, Confluence
- Established a Waterfall-Scrum hybrid analysis and development methodology. Conducted user interviews, gathering requirements, analysing the requirements using Requisite pro.
- Ensured compliance of HIPAA, ACA, ICD-10-CM and ICD-10-PCS compliance requirements, EDI HIPAA X12N-5010, HIX. Conducted analysis of HIPAA compliance and took part in discussions for designing the healthcare transactions system and data warehouse to be HIPAA 5010 compliant.
- Identified/documented data sources and transformation rules required to populate and maintain data warehouse content. Responsible for indexing of the tables in the data warehouse.
- Wrote multiple SQL queries using functions such as joins, aggregate, order by, union, group by, like, triggers. Created stored procedure for frequently used queries.
- Data mapping, logical data modelling, created class diagrams and ER diagrams and used SQL queries to filter data within the database.
- Performed source system analysis, data transformation, loading, validation for data marts, operational data store and data warehouse.
- Played a key role in the planning, testing, and implementation of system enhancements & conversions. Developed the ETL Informatica Mappings for importing data from ODS.
- Coordinated with the data modelers and data architects regarding the architecture and schema (Star schema or snowflake schema).
- Performed analysis on enterprise data/report integration & provided functional specification to the development team to build Enterprise Reporting Systems. Assisted in presenting reports and analysis to help guide the management. Generated multiple reports for analysis and testing of the EDI conversion using Tableau.
- Tested the ETL Informatica mappings and other ETL Processes (Data Warehouse Testing). Involved in setting up different configuration environments for compatibility testing and manual testing. Prepared Test Plans for each release, wrote Test Cases and executed them as part of Functional Testing. Prepared Test Reports and Deliverables and submitted for version releases.
- Evaluated testing results for each potential release build using HP Quality Center and Bugzilla reports, listing summarized bug information in priority sequence, recommended viability of release for production.
- Developed various reports, graphs, charts, dashboards for business analysis using Tableau.
Environment: Waterfall-Scrum, SharePoint, XML, Rational Requisite Pro, MS Office Suite, MS Project, MS Visio, HTML, MS Windows, HP Quality Centre, Bugzilla Tableau.
Jr. Business Analyst
- Led product implementations and business requirements sessions with clients to understand available instruments, tests, test procedures, and associated standard codes and regulations in the form of Interviews and JAD sessions
- Analysed the GAP between standard operating procedure (SOP) and actual procedure followed for routine and batch lab testing from work order through sample tracking to loading reports.
- Created the business requirement document (BRD), system requirement specification (SRS) documents and developed timelines for project delivery, and managed projects and resources to successful completion.
- Represented the system to stakeholders using a use case diagram and activity diagram using Lucid Charts.
- Developed low-fidelity mock-ups and wireframes with the UI designer and lab analysts using Balsamiq.
- Maintained quality procedures to ensure documentation is in place with Good Documentation Practices (GDP).
- Performed Data mapping, logical data modelling, created class diagrams and ER diagrams, used SQL queries to filter data and produced data mapping and data definition documentation.
- Developed XML schema for data retrieval and processing to improve system flow through metrics.
- Assisted to develop the test plan, test cases and test scenarios for testing based on business requirements, technical specifications, and product knowledge and performed user acceptance testing (UAT).
Environment: Waterfall, MS Office, MS Visio, Informatica Power center, Tableau