- Accomplished Business Analyst with a proven track record of working on complex IT projects while exceeding expectations.
- Over 8+ years of successful background in Business Analysis, Systems Analysis, Requirement gathering, Communication with SME’s and Stakeholders, Business Process analysis and Technical Documentation.
- Rich experience in Confidential Payer domain in building offerings and collaterals for the Confidential industry.
- Spearheaded projects on Waterfall, Waterfall - RUP, Waterfall-Scrum, and Agile-Scrum.
- Broad experience in Medicaid and Medicare Claims and reimbursement, health insurance plans like indemnity, Managed Care plans (HMO, PPO, POS).
- Extensive knowledge of Medical Management Information System.
- Having comprehensive knowledge of Confidential Industry and processes including current regulatory issues like ACO, Health insurance marketplace (HIX)
- Working Knowledge on Health Insurance Plans - Medicaid, Medicare. Healthcare codes Like Procedure codes, Service Codes HCPCS codes and Diagnostic codes.
- Good Knowledge for Claims Adjudication Process.
- Good Understanding of HIPAA ACT, EDI transaction sets.
- Worked on Claims Management system - Facets and its various Tables and modules.
- Experienced in improving development team motivation, process innovation, SCRUM based emergency procedures, removal of project impediments, working with business/product owner to maximize business value.
- Participate in Sprint Ceremonies (Sprint Planning, Daily Scrum, Sprint Review and Sprint Retrospective) for Agile Scrum Methodology.
- Facilitated backlog refinement sessions with the Agile team.
- Good Understanding of database and SQL quires. Experience in writing select SQL queries to generate reports for analysis.
- Performed hands on business analysis on key specification implementation efforts; functional lead in client requirements gathering sessions, creating Business Requirement Documents (BRDs), Functional Requirement Documents, Technical Documentation, Testing Scenarios, and correlating project implementation tasks as required.
- Business Analysis knowledge for business process, the need to understand all aspects of the company's operations. Identify, analyze and design processes to improve the overall flow of information within the company.
- Good understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirement gathering, analysis, design, data modeling, business process modeling, implementation and deployment).
- Excellent communication, writing as well as presentation skills. Experience working with business users as well as senior management.
- Extensive experience in gathering Business/Functional user requirements and creating Business Process diagrams, Business Requirement Documents (BRDs).
- Serving as a liaison between the programmers and internal business entities in designing and implementing functionalities.
- Interacting with stakeholders, gathering requirements, elicitation techniques like interviewing, questionnaires, brainstorming, focus groups, cost/benefit analysis and risk analysis.
- Skilled in creating logical diagrams like Use Case, Activity, Sequence, Data flow, Business Process flow using MS Visio.
TOOLS: Waterfall, Agile, Waterfall-Scrum, MS Office, SharePoint, JIRA, MS TFS, MS Visio, HP-ALM, HPQC, Tableau, MS SQL Server, Oracle, HIPAA, Advanced Excel, MS Word, MS Project, Medicare/Medicaid, Facets, EDI, XML
Confidential, Tampa, FL
Senior Business Analyst
- Compiled the Vision Document and composed detailed Business Requirements Document (BRD), Use Case Specification Documents.
- Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
- Responsible for defining the scope of the project, gathering business requirements, doing gap analysis and documents them textually or within models.
- Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS) for the Web based application.
- Understand and articulate business requirements from user interviews and then convert requirements into technical specifications.
- Interviewing area experts, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business people and technical people.
- User Rational Rose extensively to created Use Cases, Activity Diagrams, Sequence Diagrams, State chart diagrams, Collaboration diagrams and Class Diagrams.
- Extensively used UML based Methodology to create the Business Object Model.
- Worked as a User\Customer Advocate and negotiated with user as well as with developers and management staff to resolve any requirement conflict to BRIDGE the gaps between IT and Business Client.
- Served as quality assurance/quality control to ensure that the final product met all the clinical protocol requirements. Was responsible for user acceptance testing (UAT) of the final product.
- As a liaison between the Developers and Clients, was instrumental in resolving conflicts between user and technical development teams.
- Designing and reviewing different comprehensive data reports using MS Access and MS Excel.
- Involved in g documenting, implementation throughout the collector development lifecycle.
- Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
- Extensive knowledge in ANSI X12 EDI 834 file format and in Medicare & Medicaid eligibility requirements.
- Worked with Member/Subscriber and HIPAA Privacy Facets application groups.
- Responsible in testing and analyzing data consolidation, organization, and presentation in MMIS.
- Worked extensively in Medicaid eligibility and Medicaid Management Information Systems.
- Involved with Quality Assurance team to focus on Web based enterprise applications.
- Extensively worked with EDI transaction 837 (Professional & Institutional) following the HIPAA compliance EDI standard format of x12.
- Involved end to end analysis of FACETS enhancement project Billing, Claim Processing and Subscriber/Member module.
Confidential, Tampa, FL
Senior Business Analyst
- Assisted in identifying project scope, to confirm to the regulatory compliance related to X12 837 (I/P) and 835.
- Worked on trouble-shooting of claim processing issues with the providers and hospitals.
- Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system.
- Followed Workgroup for Facets Electronic Data Interchange (EDI) standards for testing that need to comply with the HIPAA guidelines.
- Hands on experience with daily claims processing and uploading 837 files into database.
- Worked extensively on analyzing and testing the 837 institutional and professional EDI transactions.
- Worked on requirements of 837 & 835 transactions across enterprises
- Worked as a liaison among stakeholders both business and IT side in order to elicit, analyze, communicate and validate requirements for changes to business processes.
- Involved in various Facets batch jobs for Claims, Membership, Payment, Billing.
- Involved in creating Reports and Documents like Requirements, Documents, and Management Plan, Issue/Alternatives documents, Project Summary and Plans with formats like PDF, HTML, Excel and Word.
- Worked with FACETS Team for HIPAA Claims Validation and Verification Process.
- Involved with reviewing defects reported from UAT efforts and analyzed for root cause and took actions based on the findings.
- Used extensively of HP Quality Center for Test Scripts, Test plans and defect management.
- Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
- Conducted Business Process (As Is/To Be) sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.
Confidential, San Francisco, CA
IT Project System Analyst
- Gathered Business and Functional Requirements based on Waterfall SDLC methodology.
- Worked on project documentation that defines the process requirements required to implement Facets.
- Facilitated JRP sessions, JAD session, written Status Reports, Oral Presentations, Emails and coordinating extensive communication network through in
- Led Requirement Gathering session (RSG), Joint Application Development (JAD), and Rapid Application Development (RAD) sessions.
- Configured Facets modules such as Finance, Membership, Billing, Groups/Benefits and Plans.
- Responsible for validating claim processing transaction of MMIS.
- Interviews with end users, physicians, Tech team and other non-technical team members.
- Experience in implementation of HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system.
- Facilitated Functional Requirement gathering from system users and authored Business Requirement Documents (BRD).
- Worked with the team on FACETS claims processing system and gathered requirements to comply with HIPAA.
- Created 837 P, I, D claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837 P, I, D, 834, 835, and 270/271.
- Converted Business Requirements into Functional Requirements Specification Document and Technical Specifications.
- Troubleshoot any problems found within FACETS and when testing the SQL data database while validating the business rule.
- Provided assistance in developing Test Plans, Test Cases, Test Reports, and bug tracking using Mercury Quality Center
- Created Work Breakdown Structures (WBS), Project Schedule and Project Timelines using MS Project
- Maintained the Requirements Traceability Matrix (RTM)
- Involved in Medicare writing Test Cases, executed Test Cases and defect reports.
Confidential, Louisville, KY
- Followed a systematic approach to elicit, organize, and document requirements of the system.
- Interacted with client and the technical team for the requirement gathering and translation of Business Requirement to Technical specifications.
- Wrote SQL queries to obtain entity relationship between the databases.
- Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
- 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.
- Conducted weekly meetings to decide the policies and procedures to be followed while constructing new sites.
- Prepared Business Cases understanding the Business functions of a new system and enhancements to the current system.
- Analyzed and translated business requirements into system specifications utilizing UML Diagrams.
- Prepared Functional Design Specifications employing Use case scenarios, sequence diagrams, Class, Activity and Collaboration diagrams to better visualization of the project by various teams.
- Documented the Traceability Matrix to trace the Test Cases and requirements related to them and assisted the QA Team with the Test Plan.
- Worked closely with project Manager during the Project Development and Change management, User trainings during the new system implementation.
- Created use cases that defined the role of customers, medical practitioners, clearing house Administrators and healthcare plans such as: Medicare, Medicaid insurance plan.
- Prepared and proposed Mock-ups of UI changes for internal or consumer facing users of the application website using visualization software.
- Prepared and maintained User Documents, User Manuals and Demos on SharePoint to get new approvals from the Therapist and Nursing divisions.
- Prepared and provided user training, documented user guide and User Manual, documented detailed results.