Summary

• Over 7 years of extensive experience in Business Analysis, Software Validation and business process re-engineering, with proven ability to articulate business values.
• Experience with HIPAA and HLN7 Industry standards, with the knowledge of MMIS.
• Experience working with HMO's to better understand the healthcare needs.
• Understanding of DRG's Diagnostic Related Groups .
• Experienced with Medicare Advantage Programs, HIPAA 4010 and 5010 EDI transaction codes such as 270/271 Inquire/response health care benefits , 276/277 claim status , 834 Benefits enrolment , 835 Payment , 837 Health care claims .
• Functional experience with concentration on Use Case modeling using UML, Business Process Modeling, Data Modeling, Change Management, Technical Training, Software Development methodologies, QA testing, and Systems Testing of client server and web-based systems.
• Experience in conducting joint application development JAD sessions with end user, expert team, Business intelligence team, IT SMEs and QA team for project meetings, walk through and all stakeholders.
• Strong Business Analysis Skills including In depth knowledge of Software Development Life Cycle SDLC , having thorough understanding of various phases like Requirements, Analysis/Design, Development and Testing and Practical knowledge of Rational Unified Process RUP and Agile.
• Extensive experience with Rational tools such as Clear Case, Clear Quest, Rational Requisite Pro, and Rational Rose
• Excellent Training skills, facilitation, power point presentations, maintaining performance metrics, devising training documentation communicating to users.
• Proficient at creating and transforming business requirements into software requirement specification SRS using Rational Requisite Pro and designing business models using UML diagrams such as use case model, Class Diagrams, Activity Diagrams, Sequence Diagrams and Collaboration Diagrams in Rational Rose and MS Visio.
• Experience in conducting Joint Application Development JAD sessions with end-users, expert team, development and QA team for project meetings, walkthroughs and customer interviews.
• Experience in writing Test Plans, Test Cases, and Test Scenarios and performed various System testing like Regression/Integration/Functional/Black Box/UAT by both manual and automated techniques.
• Effective in cross-functional and global environments to manage multiple tasks assignments concurrently.

Confidential

Sr.Business System Analyst

Confidential is now 5010 complaint. My role in this process was to incorporate the National Provider Identifier, create and modify requirements, modify the MMIS mainframe and reengineer NE Medicaid processes using Agile and Waterfall Methodologies. I was extensively involved in developing and implementing EDI HIPAA transaction 837, 270/271 and 834.

Responsibilities:

• Involved in gathering user requirement and preparing following documents: Functional Requirement Specification FRS , System Requirement Specification SRS , and Business Requirement Document BRD for HIPAA transaction 837, 270/271 834.
• Involved in the development of process and system to support HIPAA compliance and administrative procedures.
• Performed testing of all stages of SDLC.
• Involved in preparing and executing test plans based on user requirement documents.
• Created and modified Medicaid Management Information System screens for Provider and Claims Search Screens.
• Followed scrum development process using Agile Methodology.
• Used Sprint backlog and User stories in creation of various business and technical requirement documents.
• Involved in Medicaid business configuration with focused primarily on claims adjudication, pricing, provider, member, enrollment, prior authorization.
• Provider support during the integration and UAT, Used SQL queries for backend testing.
• Developed training materials for new technology and process improvements.
• Involved in writing Data Mapping Documents for system and involved in documenting the ETL process and writing SQL quires for data validation.
• Assisted BA lead in maintaining SharePoint functionality for consistency and efficiency.

Confidential

Business System Analyst

The Confidential is to establish standards of excellence in management of Medicaid and healthcare services. TMHP is a partner with HHSC and state of Texas to deliver cost effective, customer focused Medicaid and healthcare services through a commitment to continuous improvement, pragmatic technical solution and operational excellence.

Responsibilities:

• Conducted one on one session and team meeting with the team leads and SME's to understand the business requirements.
• Prepared the Charter/BUR and functional design document.
• Updated the functional design document for NPI related change in the Encounters projects.
• Arranged meeting with other teams to gather the functional and system requirement for EPC project.
• Analyzed encounters claims file 837 P, I, D using Spec Builder.
• Created User stories to facilitate conversations with the SME's and other stakeholders.
• Researched and handled the production issues.
• Performed the database testing for service requests.
• Participated in NPI/Encounters project.
• Created and executed the maintenance request from Analysis phase to Deployment.
• Created the test data 837 P, I, D and tested multiple fields for HIPAA validation and business edits.
• Tested the provider interfaces for NPI related changes in the Encounters projects.
• Involved in UAT testing, Sprints to track changing requirements and in Risk analysis.

Confidential

Business Analyst

Confidential is an operating division of Express scripts, they are one of the biggest providers of health insurance, and they provide various insurance plans to over 70 million people across United States. The project aimed at conversion of ICD 9 to ICD 10 and updating the system for auto adjudication of claims process. The project primarily aimed at handling Medicare and Medicaid insurance claims.

Responsibilities:

• Conducted interviews, live Meetings and JAD sessions with business users and subject matter experts to gather information to create Business Requirement Documents.
• Designed and developed Use Cases, Activity Diagrams, Data flow diagrams and Sequence Diagrams using UML.
• Documented, identified, organized and tracked the requirements using Rational RequisitePro.
• Gathered information from reference manuals to understand the changes and differences in ICD 9 and ICD 10 and created requirement documents for the coders.
• Extensively worked on the ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion of HIPAA 4010 to 5010
• Conducted Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.
• Worked on both inbound and outbound transactions, creating requirement for multiple transaction types including EDIX12 837, 834, 835, 270 271
• Gathered requirements of future state processes for HIPAA 5010 transaction processing EDI's 837,834, 835, 270, and 271.
• Created reports from the enterprise data warehouse for the management for quarterly comparison.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Maintained Requirement Traceability Matrix RTM and Utilized Clear Quest for change requests and defect tracking.

Confidential

Business Analyst

Project was geared towards providing retail and composite account clients with regular updates on account performance. The project involved designing an application which obtained data for personal accounts from Caliper, created flat data files and send those to a reporting application. The reporting application was designed to read flat data files, generate PDF reports, graphs based on monthly, quarterly or annual data and send it to the customer. The system also serves as a credit analytics tool that could identify, evaluate and reduce overall business risk using data Management technology.

Responsibilities:

• Analyzed user/business requirements, functional specifications and Use Case System documents.
• Collected requirements for Credit risk calculation Engine.
• Consolidated all the databases from front, back and middle offices and Access to find the Exposure at default EAD
• Used the consolidated Databases from EAD to find the calculated Risk Weight of the bank.
• Conduct Risk Analysis and Credit Risk Estimation Analysis like Regression Analysis.
• Prepared a package of Process flow diagrams to document the existing system.
• Responsible for defining the scope and business rules of the project, gathering business requirements and documenting them textually or using models.
• Voluntary Corporate Actions and SWIFT processing.
• Reconciliation of ACH Wire Transfer/Rejects, SWIFT Rejects, and daily processing files.
• Managed all requirements in DOORS, making them available to all team members.
• Worked on design list and documented requirements to meet industry regulations.
• Interacted with cross functional teams to facilitate gathering of business requirements.
• Conducted user interviews and organized workshops to understand and articulate business requirements and converted requirements into technical specifications.
• Conducted application testing for financial products markup language an industry standard protocol for complex financial products.
• Responsible for writing Functional Requirement and User Requirement Specifications.
• Served as a liaison between clients and technical staff to resolve conflicts.
• Performed GAP analysis to identify mismatch between system functionality and business requirements and segregated those into high/low level Use Cases and Activity Diagrams using Rational Rose.
• Maintained test notes and requirement using DOORS.
• Conducted the FRS and URS reviews and walkthroughs with designers, developers and stakeholders, and performed feasibility and adaptability study.
• Actively involved in User Acceptance Testing UAT and training of the end users.
• Assisted with change, issue, quality and risk management activities, and generated management reports on weekly and monthly basis.
• Worked with the Business Users through interviews and JAD sessions.