Business Analyst Resume Profile

SUMMARY:

Over 7 years of Information Technology as Business Analyst with a focus in Healthcare including MMIS, Medicaid, Medicare, FACETS, HIPAA, EDI, and other supporting applications for insurance providers service providers.

Worked for the team that is responsible for receiving, documenting, processing the claims including the eligibility verification. Responsible for making the system changes if there were any changes needed to be made in the current policies, rules regulations due to the business necessities.

Experienced in Software Development Life Cycle SDLC methodologies Traditional Waterfall Model and iterative approach to software development as per Agile Scrum methodology and Rational Unified Process RUP .

Managed key deliverables through the project lifecycle from requirements gathering to design, development, testing and deployment within allocated timeline and budget.

Executed the project life cycle, including requirements gathering, design, testing, implementation and documentation, as required.

Responsible for converting the programs from 4010 to 5010 version for HIPPA standards, there was also included the NCPDP 5.1 conversion for drug claims.

Involved in claim adjudication process of facets application.

Responsible for migrating the codes from ICD9 to ICD10.

Conducted walkthroughs with the end users and stakeholders to gather the modification requests from the user to upgrade or change the business specification for the product.

Assisted in modeling and documenting the end-user's AS-IS workflow and TO-BE business processes.

Strong writing skills in preparing Business Requirement Documents BRD , System Requirement Specifications SRS , Software Requirement Specifications SRS ,Use Case Specifications, Functional Specifications FSD ,Requirement Traceability Matrix RTM and Technical Design Document TDD .

Strong Data Warehousing, Data Marts, Data Analysis, Data Organization, Metadata and Data Modeling experience in RDBMS databases.

In depth knowledge of RUP's Iterative Software Development Life Cycle process also the experienced in managing project with Agile methodology.

Good experience with XML files and manually created XML files from Excel spreadsheets.

Handled the clinical data to implement to different systems.

Helped the business users to perform the UAT.

Experienced with document management system using FILE NET.

Worked on FACETS up-gradation project.

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst

Confidential is the largest managed health care, for-profit company in the Blue Cross and Blue Shield Association. The main purpose of the project is to provide health care at a reduced cost to its various clients. Well Point have created a variety of PPOs, HMOs and specialty network based dental and health care services that combine the attributes consumers find attractive with effective cost control techniques.

Responsibilities:

Involved in requirements gathering sessions with Business Analysts and Architects to understand requirements in terms of business change.

Actively worked on Business requirement analysis and Data analysis.

Analyzed System Impact including MMIS Tables, Windows, Reports and Interfaces to external entities.

Created Business Rule Comparison BRC documents and Side-By-Side SBS comparison documents using 4010 / 5010 implementation guides for X12 transactions in Excel spreadsheet.

Got hands on experience on analysis of GAP analysis between current HIPAA 4010 and HIPAA 5010 requirements.

Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers and other related entities.

Got exposure of IBM mainframe environment for Medicaid Management Information System impact assessment. Dealt with the EDI transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.

Ensure the UAT test scripts review sessions with business owners to test the application functionality and providing necessary training material.

Analyzed HIPAA 5010 impact on external Data Warehouse and data warehouse extract process and mapping of MMIS database and data warehouse.

Got exposure of EDI, Web Portal, DSS and System documentation.

Analyzed MMIS system impact for Windows and Interfaces.

Excellent writing skills in preparing business requirements documents BRDs , system requirements specifications SRS , system design specification SDS , functional specifications, and defining project plans.

Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.

Gathered all the needed data table names, column names, field names, notes from the Windows and Interfaces documents. Analyzed RRI/Viking Subsystem an external system off the state, dealing with conversion of paper claims to electronic claims and recommended changes for HIPAA 5010.

Elicited business requirements and business needs as part of an Agile Scrum team

Responsible to meet the information demands of business users by delivering timely, accurate, meaningful and standardized data and reporting.

Prepared Test Cases manual/automated and Conducted Tests Integration testing, Regression testing , Black Box/White Box testing, UAT User Acceptance Testing .

Documented analysis, observations and recommendations.

Used Quality Center and ALM for defect tracking and reporting.

Attended daily meetings and dealt with day-to-day deadlines.

Experience in Forward Mapping and Backward mapping analysis of ICD 9 - ICD 10 Conversion for CM Diagnosis Codes and PCS Procedure Codes .

Confidential

Business Analyst

Confidential offers a broad array of healthcare coverage options to individuals and employee groups. The project had two major tasks, 1 Facilitate the processing of EDI Transactions 270,271,835,837 and to make sure that it follows 5010 of HIPAA standards and 2 Load member's data into the Claim Management System CMS , such as Provider Contracts data, Member Enrollment data, Claims pricing and billing dat

Responsibilities:

Utilized RUP to configure and develop process standards and procedures. Planned all the RUP iterations and documented the artifacts throughout the various phases.

Involved in requirements gathering sessions with SME's Subject Matter Experts , Business Analysts and Architects to understand requirements in terms of business.

Used Rational Unified Process RUP methodology as an iterative approach for software development.

Worked extensively in the Elaboration Phase of RUP and Interacted with stakeholders to get a better understanding of client business processes.

Facilitated requirement workshops to create and define the Business Requirement Document BRD and the Functional Requirement Document FRD .

Conducted and facilitated JAD sessions to allow different stakeholders to communicate their perspectives with each other, to resolve any issues and come to an agreement quickly.

Created Use Cases and prepared the Use Case diagrams, Sequence diagrams by using Rational Rose.

Performed GAP analysis of 4010 and 5010 for EDI transactions 270,271,835,837 and finalized the customization needed for implementation of 5010.

Created RTM in excel for ensuring the full coverage of business requirements.

Recommended changes for system design, and implementation of procedures, policies and work flows affecting Medicare/Medicaid claims processing in compliance with HIPPA.

Worked on Trizetto Facets to validate the membership data and claims data

Performed Impact analysis to find out which system functionality will be impacted by the new 5010 version standards.

Performed GAP Analysis between AS IS HIPAA version 4010 standards and TO BE version 5010 standards.

Assisted QA team in preparing test plans and test scripts, to ensure that all requirements have been covered and tested properly.

Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.

Developed UAT User Acceptance Testing plan to guide a select group of key end-users in testing the user interface and functionality of the application.

Confidential

Business Analyst/Data Analyst

Confidential a fortune 100 Confidential Healthcare company provides consumers directed healthcare products, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans, and medical management capabilities. HAP wanted to decommission its regional data warehouses and consolidate into a single Enterprise Data Warehouse EDW for effective business reporting for CS-90 project. The business subject areas were concentrated in multiple states and were in Mainframe platform. The business users were having issue in consolidating the data and deriving reports from the source system for effective business needs. Data profiling had to be done to clean the existing data and put it in common software - Evoke to move it to the next stage for business reporting. The main challenge was to handle Twenty Three identified business area data analysis and selection. The project was spread over in three major phases.

Responsibilities:

Interaction with operational staff at all levels in gathering business requirements relating to application design.

Produced Gap Analysis documents for HIPAA 5010 and ICD-10.

Wrote Test scenarios and test cases for testing the migration of EDI 4010 to 5010 and the processing of member enrollment and benefits, batch jobs corresponding to the claims 837 .

Interacted with Technical team in understanding Operational and Technical functions of the existing Payment Engine.

Gathered requirement for the facets implementation and performed solution analysis.

Worked with Data Warehouse in the development and execution of data conversion, data cleaning and standardization strategies and plans as several small tables are combined into one single data repository system MDM Master Data Management .

Create and maintain data model/architecture standards, including master data management MDM .

Deployed BI Business Intelligence solution using Business Objects to ensure proper delivery of information to the users and Oracle Projects Suite for proper Project Management.

Utilized corporation developed Agile SDLC methodology. Used Microsoft Office software to perform required job functions.

Extensive use of MS Office tools like MS Access, MS Word, MS Excel, MS PowerPoint MS Project for data migration in to the CI System Knowledge Data Base in MS SharePoint Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams using UML.

Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data dictionary and data analysis.

Configured the Data mapping between Oracle and SQL Server 2005.

Tested HIPAA Gateway Application Interface for all inbound and outbound messages Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 837 and 835 .

Created DTS Packages for migration of data between MS SQL Server database and other databases like MS Access, MS Excel and Flat Files.

Performed customer data analysis to extract, transform and load data to the customer data warehousing system.

Provided technical expertise on the use of Rational Clear Case and Rational clear quest, which were used for Data archiving and Requirements Management.

Dealt with data mapping issues between various source systems and staging area and data-marts.

Involved in coordinating with the database design team and providing inputs in finalizing the data model, report layouts.

Developed the ETL DataStage Mappings for importing data from ODS into subsequent data marts.

Confidential

Business Analyst

Confidential has to comply with Health Insurance Portability and Accountability Act HIPAA and ICD 10 requirements. Purpose of the project is to analyze GAP between current HIPAA 4010 / ICD 9 and compliance HIPAA 5010 / ICD 10 for state Medicaid Management Information System.