CAREER SYNOPSIS

• A competent professional with 8 years of extensive experience in business analysis in the Healthcare Insurance domain. Expert in clarifying business requirements, performing gap analysis between goals and existing procedures/skill sets, and designing process and system improvements to increase productivity and reduce costs. Strong business analysis skills and an understanding of the Software Development Life Cycle SDLC utilizing Rational Unified Process RUP . Experienced in working on Medicare and Medicaid benefits in accordance with Federal Regulations.
• Good understanding of gap analysis, requirements management, risk analysis and project plans. Adept in creating and updating Business Requirement Documents and Functional Requirement Documents. Lead JAD sessions and act as the lead facilitator for various projects from start to finish through the SDLC. Strong interpersonal skills, highly adept at diplomatically facilitating discussions and negotiations with stakeholders.

KEY SKILLS

• Extensive success in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language UML .
• Proficient in gathering business and technical requirements from both formal and informal sessions utilizing a variety of software tools including, use cases and RUP.
• Supported FMEAs Failure, Mode, Effect and Analysis sessions
• Performed gap analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Proficiency in creating Business Process Modeling including Use Cases, Activity Diagrams, Data flow diagrams and sequence diagrams using UML, in MS Visio and Rational Rose
• Expert in claims reporting claims processing lifecycle, insurer's unique identifier number to subject matter expert SME for the claims reports and other statistics reports as well as the Facets application system.
• Extensive knowledge of NASCO, FACET, and HIPPA healthcare applications.
• Experience in working with the FACETS development, application and configuration team.
• Lead the impact analysis, scope lockdown, and requirements gathering phases of the company's transition from ICD - 9 to ICD-10 and development phase management of transition from HIPPA 4010 to HIPPA 5010. Experience in implementation of ICD- 9 and ICD-10 in accordance to HIPAA compliance.
• Experience with HIPAA versions 4010 and 5010 and the impact on backend and front end systems and applications as well as ANSI X12 Health Insurance Transactions 837/835/834/ 820/270/271/276/277/997/999 .
• Knowledge on Prime Dental and Prime Pharma in claims processing system.
• Knowledge on NCPDP provider identification number.
• Strong knowledge of applied principle of the iterative methodologies of SDLC including Requirements Analysis/Design and Development as per the Rational Unified Process RUP . Documented Business Requirements, Functional Specifications and Detail Design of the Application.
• Extensive knowledge in implementing new MMIS compared to old MMIS.
• Good knowledge on desktop intelligence DESKI, web intelligence WEBI and business objects tools.
• Solid technical knowledge on data warehousing, operational systems optimization with online transaction processing OLTP and database normalization, entity relationship, reporting and online analytical processing OLAP .
• Solid understanding of use cases, sequence diagrams, collaboration diagrams, activity diagrams, and class diagrams.

EMPLOYMENT HISTORY

Confidential

Sr. Business System Analyst,

Project Description:

Clearing house is fully automated, real-time claims processing system for complete, on-line mediation of medical, dental, vision, and disability claims following HIPAA guidelines. The system facilitates the efficient and timely management of all health care insurance relevant data- clinical, financial, and administrative throughout the organization enabling the sharing of health information between the sub systems.

Responsibilities:

• Analyzed Business Requirements, developed, tracked and enhanced them into functional requirements using Rational Requisite Pro as a requirements tool.
• Extensively worked on Agile methodology in software development life cycle, Oracle as backend end Java as front end in web application development.
• Presented client requirement to project team members through clear project plan presentation.
• Worked on FACETS software up gradation 5.0 platform with integrated applications and configuration.
• Worked as a FACETS analyst with Benefits, Claim processing and Enrollment departments.
• Worked on Health Insurance HIPAA transaction codes specifically on EDI 277 and 834 to in corporate enhancements to existing efforts on capturing and mapping.
• Extensively worked in implementation of ICD- 9 and ICD-10 in accordance to HIPAA compliance.
• Worked on MMIS integrated group of procedures and computer processing operations subsystems developed at the general design level to meet principal objectives. Extensively worked on program control and administrative costs service to recipients, providers and inquiries operations of claims control and computer capabilities and management reporting for planning and control.
• Interacted with the ICD-10 transition team and participated in JAD/JAR sessions.
• Provided business and technical consulting services for ICD-10 remediation and other concurrent business requirements as a result of the ICD-10 implementation that are mandated by the centers of by Browse to Save >Medicare and Medicaid services.
• Worked with NASCO implementation and claim processing team.
• Analyzed the business requirement as per the HIPAA rules and regulations to follow in creating business requirement documents.
• Worked with FMLA and disability Claims department, determined the direction of LTD and STD claims and analyzed a variety of criteria to determine eligibility of benefits. Evaluating claimant's degree of physical/mental limitation based on medical records and clinical review recommendations. Coordinated with clients like insured's, doctors, hospitals, attorneys and other individuals as required.
• Worked on Clinical Document Architecture CDA based on XML, the Extensible Markup Language with HL7's Reference Information Model, Electronic Medical Record EMR and Electronic Health Record EHR software system.
• Develop and maintain risk management policies and procedures to maintain regulatory compliance while minimizing and stabilizing the total cost of risk.
• Researched, evaluated and make recommendations regarding current and state-of-the-art trends in risk management/safety/loss prevention, risk financing and claims management.
• Assisted in review of potential acquisitions to identify significant risk management and insurance issues and make recommendations.
• Prepared Case Status Documents on process and on data interchange billing process.
• Continuous supervision of project and analyze implementation of client requirement through Requirement Traceability Matrix RTM .
• Documented the meeting minutes from the JAD's and stored the artifacts in the appropriate place holders and SharePoint for both the teams to review.
• Developed business required documents BRD on the basis of JAD sessions for project.
• Worked in GAP analysis to understand the difference between both the billing systems and documented the GAPs in GAP analysis spreadsheet.
• Used UML and RUP best practice methodologies along with supporting toolset including Rational Ross.
• Created Used Case Diagram and Activity Diagram to provide better understanding of process to developers and other team members.
• Worked on Crystal reports and Fidelis.
• Developed Change Request Form to satisfy client requirement changes and created.
• Documented the business requirements into functional requirements document.
• Gathered requirements and transformed them into high-level Process-Flow

Confidential

Business Analyst

This project dealt with developing and implementing new web based system at the dental hospital and integrating it with the stand alone medical information system at the hospital. The project was about developing new application so as to comply with HIPPA 5010 and EDI 837 with ICD-9 codes. Also, it involved dealing with the billing and registration system.

Responsibilities:

• Interacted with the business user and IT team for understanding the requirements.
• Worked with business representatives to understand data requirements and priorities and ensure that IT work is appropriately aligned
• Created Business Requirements and converted them into System Requirement Specifications.
• Worked on SCRUM Project Management and Agile Methodologies for Software Development Life Cycle
• Played an active and lead role in gathering, analyzing and documenting the Business Requirements and worked on capturing various client specific requirements as well as CMS Compliance and HCR Regulatory requirements.
• Gathered and documented Technical Requirements from the Business Group and the Technical Group.
• Conducted JAD sessions with business users, stakeholders to understand the requirements in more detail
• Generated various SQL queries as and whenever required.
• Drafted Physical Data Mapping document for the data flow from Facets to the data warehouse.
• Participated in Design walk-through with end users to baseline the business architecture.
• Performed GAP analysis on the existing solution and its transition into the new HIPAA 5010.
• Worked on Prime Dental in claims processing and reporting
• Used Rational Rose to carry out the business modeling and object modeling effort.
• Managed the requirements change requests with ITIL framework.
• Created data flow and sequence diagrams to describe how EDI Healthcare Transaction set 837 was used to submit health care billing information.
• Involved in preparing a simple and detailed User manual for the application, for an intended user.

Confidential

Business Analyst

Project Description: The project involved Replacement of VAS with VISTA reports system that integrates reports of all the products of Confidential

Responsibilities:

• Worked closely with designers and developers, and determined solutions by balancing the business needs and technical aspects.
• Worked on Agile development.
• Analyzed and designed business process flow diagrams and network architecture.
• Worked on Health Insurance HIPAA transaction codes.
• Worked on implementation of ICD- 9 in accordance to HIPAA compliance.
• Facilitated the definition of project scope through the use of scooping deliverables and ensured traceability of all future deliverables back to scooping
• Proactively identified needs by interviewing, asking questions, probing at potential gaps in the requirements.
• Captured and defined high level and detailed business requirements.
• Redefined data into programmable form, and prototyped elements, process and systems.
• Created and analyzed concept level blue prints for the technical feasibility of business concepts.
• Modeled functional requirements, converted business requirements into technical specifications using sequence and activity flow diagrams in MS Visio and MS Project.
• Formulated and tested queries with SQL, created and documented test plans and cases efficiently.
• Developed test cases for selected modules, manually tested application modules and used TestDirector for generating reports, tracking defects and testing performance.
• Participated in the testing phases including development of test conditions, scenarios, test plans, expected results and testing execution.
• Modified and refurbished Data Requirement Impact Analysis to make it applicable and compatible for the designers architect as well as end users.

PREVIOUS EXPERIENCE

Confidential

Business Analyst