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Business Analyst Resume

Cambridge, MassachusettS

SUMMARY

  • 6 years of extensive experience as a business analyst with strong experience in Pharmaceuticals and Hospital Domains with a solid understanding of Business Process Flows, and Business Analysis. Detail - oriented and good documentation and process management skills
  • Extensive practical knowledge of various SDLC methodologies like Waterfall, Rational Unified Process, Agile and Scrum.
  • Extensive experience in gathering Business and Functional Requirements, performing Gap Analysis and Impact Analysis.
  • Experience in developing UML use case diagrams, Work Flow Diagrams using tools like MS Visio.
  • Excellent Business writing skills in creating Business Requirement Document BRD, Use Case Specifications, Functional Requirement Document FRD, and System Requirements Specifications SRS .
  • Effective problem solving skills - ability to think out of box and give solutions that are feasible under given circumstances.
  • Gained extensive knowledge and understanding of MITA, MMIS, Electronic Medical Health Record EMHR and Pharmacy Benefit Management PBM.
  • Strong Knowledge in Salesforce Administration and Customization, Data Validation, Sales, Marketing, Customer Service and Support Development team.
  • Created tickets for all defects identified and coordinated with development team and business to get the defects resolved using JIRA.
  • Understanding and mapping applicable for tracking of diseases for which diagnostic testing is done in the area of Biochemistry.
  • Created and managed change requests using Change Management Process and conducted feasibility analysis for those changes.
  • Functional experienced in Claim Life Cycle and Health Care Payer domain process along with various line of health insurance system like PPO, HMO, POS.

TECHNICAL SKILLS

Methodologies: Waterfall, RUP, Agile Scrum.

Tool: MS Visio, MS Project, Rational requisite pro, Rational Rose

Language: UML, SQL.

Databases: MySQL, SQL Server, DB2 and ORACLE.

Web Technologies: HTML, XML, MS SharePoint, Health Care/ Pharmaceutical

Domain Knowledge: MMIS, EPIC, EDI X12, HIPAA, HL7 compliant standards, FACETS system, Medicare and Medicaid, Pharmaceutical research and development, PDMA, FDA, and Evidence based practice.

Packages: MS Office Suite

PROFESSIONAL EXPERIENCE

Confidential, Cambridge, Massachusetts

Business Analyst

Responsibilities:

  • The pharmacy system RxConnect is built specifically to support this defined operational process and all 7400 CVS pharmacies have the same defined behavior for receiving and preparing a prescription for a patient.
  • Very good experience interacting with stake holder on requirement gathering.
  • Project with methodology for successful execution with Joint Application Sessions JAD to collect and report requirements, perform data analysis / reconciliation
  • Worked to provide operational problem management to manage Health Insurance Exchange solution application problems as they occur during the Maintenance Operations phase of the project, including issues associated with all system components outlined in this RFP.
  • Formulated Business Requirements using Agile / Scrum methodologies to decompose requirements into Epics and User Stories iteratively
  • Create and execute revenue cycle medication Epic billing data and reports from decision support and billing systems. Analyzed all related medical codes for accuracy to ensure maximum benefit allowed is accurately billed.
  • Reviewed logical design documents and use cases and making sure the enhancements based on the Prescriptive authority changes with business team.
  • Played an important role in launching FDA-approved new product and new sales force into the CRM system by conducting impact analysis and documenting requirements
  • Working on the development of the Environmental Monitoring Program in LIMS. Analyze specifications, design logic and write code for customization of the software using LIMS Basic and SQL.
  • Business analyst subject matter expert for the integration of legacy applications with Model N Revenue Management Enterprise software.
  • Followed NCPDP rules to adjudicate and process the Medicare prescription drug claims.
  • Developed and executed the IQ, OQ, PQ for Waters Empower Software, CDMS CTMS applications
  • Provided ongoing assistance to software developers and testers to resolve defects entered in HP ALM during the testing process.
  • Provided customer support, field study and written case studies on application of Argus Safety Compliance tool and a full future state BRD document.
  • Understanding and assessment of the current Pharmacy Transactions from an NCPDP 5.1 perspective
  • Developed Complex SQL Scripts to help reverse engineering and mapping for various system applications
  • Created User Stories, Acceptance Criteria to express requirements to the development team, and review completed stories using the JIRA Application
  • Implemented and customized Salesforce customer relationship management (CRM) for Marketing, Sales and Case Management also implemented sales cloud and service cloud to improve customer retention and service delivery process improvement.
  • Assisted the implementation in GXP environment to adhere to regulatory and risk management compliance.
  • Microsoft SharePoint, RTM used to manage the project related deliverables to client and maintained internally for the audit purpose.
  • Manage overall coordination, status reporting and stability of complex and cross-functional project oriented work efforts while continuing to evolve the solution delivery lifecycle to encompass multiple methodologies e.g., waterfall, agile .
  • Creating SDLC PMLC documents for Prescriptive authority projects to manage the project.
  • Knowledge on HIPAA- EDI transactions of 270/271, 834, Medicaid/MMIS 820, 276/277, 275, 835, 278 and 837, HIPAA ANSI X12 and PBM
  • Validating requirements test coverage in test strategy, test plan and test scenarios
  • Facilitate meetings with business and IS people, over phone using web conferencing with large number of people
  • Coordination with system, regression and UAT testing team and creating test plan for UAT testing for Prescriptive authority enhancements project.
  • Facilitated workshops between business stakeholders and offshore developers to modify Salesforce.com Merchant CRM platform to conform to Best Practices and to improve performance.
  • Cycle's execution for the latest project and defects tracking and validating the results in QC.
  • Worked on developing and testing functionality for the subgroups module like PBM Pharmacy Benefit

Confidential

Business Analyst

Responsibilities:

  • Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
  • Requirement gathering and preparation of business requirement documents BRD.
  • Developed strategy for managing identified utilization patterns for online portal for PBM (Pharmacy Benefit Manager) Implement and perform outcomes analysis for above strategies.
  • Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
  • Evaluated third party JIRA plugins to achieve results not included in standard implementation.
  • Developed data conversion programs for membership, claims, and benefit accumulator data - converted thirteen corporate acquisitions. Developed data field mappings. Provided programming and support for claims processing functions and auto-adjudication.
  • Planned and conducted requirements elicitation meetings with the business to collect functional and non-functional requirements relating to client's Salesforce technology enhancement and initiatives.
  • Configured and updated Argus Safety compliance application for vendor plug-in in a dynamic environment.
  • Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
  • Efficiently handled enrollment, medical-management and workflow processes involved during and for the project given.
  • Developed and maintained all operational and technical flows using Visio and Power point.
  • Responsible writing and maintaining User and System Requirements, Assumptions and Constraints using BluePrint and HP ALM
  • Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models.
  • Documenting IQ, OQ and PQ test scripts for new functionality and modifying existing test scripts, execution and SOP development.
  • Follow 21CFR Part 11 methodologies for validated systems in a structured SDLC environment. Trained in Good Clinical Practices GCP for work with the Clinical Trials area and GXP for work in R D areas
  • Work in partnership with the business unit in order to develop a solid knowledge base of the business line, including the business plan, products, processes and revenue streams.
  • Worked on the team for LabWare LIMS enhancements and Environmental Master Data. Analyzed specifications, designed logic and wrote code for customization of the software, which included configuration in LIMS Basic, Crystal Reports and SQL. Responsible for assigning work to team members, providing weekly status to Project Manager.
  • Troubleshoot and track issues and problems related to Epic ambulatory care solution and inpatient management system. Developed Epic patient billing representative training manual, provided new hire operational and application training.
  • Responsible for the regulatory management process for the services provided by the pharmacy.
  • Conducted gap analysis, identified the potential changes and documented requirements across different systems, including CRM, DI, MDM etc. for a strategic initiative to enable multiple products per sales team.
  • Familiar with SDLC compliance project work streams, Waterfall, Agile, SCRUM. Successfully completed required compliance corporate training initiatives.
  • Led ETL architects in efficient deployment of 4 CSV XLM integrations between Model N legacy systems.
  • Worked on pharmacy benefit management systems (PBM) to make use of our existing web applications that provide pharmacy/Rx related member functionality.
  • Design, build and test maps to translate X.12 EDI to and from transaction formats such as EDIFACT, SAP IDOC, and other multiple formats
  • Creation and maintenance of documents for change request and implemented procedures for testing changes.

Confidential

Business Analyst

Responsibilities:

  • Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
  • Created Master child packages as an ETL strategy to populate dimensions and facts
  • Part of the team developing the business use cases/system use cases using the RUP Methodology and processes for Logical Data Model and Physical data Model.
  • In the analysis and design phase dealt with data architectural team to assist in understanding the functional requirements, technical requirements documentations and design of logical and physical data models.
  • Created highly custom JIRA workflows, field configuration schemes, permissions schemes, screen schemes, security schemes, JQL queries, etc.
  • Worked with subject matter experts and management coordinating business process reviews, developed Visio ‘As Is’ and ‘To Be’ system workflows as part of SDLC methodologies (Agile, Waterfall, RAD) and adherence to 21 CFR Part 11, SOX, GXP, and J&J global web compliance initiatives.
  • Managed implementation of CRM and dropbox and courier management module in a customized LIMS.
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
  • Conducted internal training sessions for business users on Salesforce technology functionalities, especially with respect to reports and dashboards.
  • Involved in testing the Pharmacy Claims adjudication and Billing processing is done through PBM (Health Trans) and Claims Accumulation
  • Authored functional requirements in HP ALM tool and maintain Requirement Traceability Matrix.
  • Accepted E2B cases received through Argus Electronic Submission Module (ESM) as necessary and processed prior to routing
  • Working on the development of the Environmental Monitoring Program in LIMS. Analyze specifications, design logic and write code for customization of the software using LIMS Basic and SQL.
  • Used Tableau to track KPIs and prepared statistical reports for each product (each client) outlining marketing cost vs incoming revenue on a weekly basis.
  • Documented Installation Qualification IQ, Operational Qualifications OQ, and Performance Qualifications PQ documents using standard templates.
  • Worked as Process Analyst at CVS Caremark Silver Script-Pharmacy Benefit Manager for Medicare Part-D
  • Help team as Subject Matter Expert for resolving retail and eligibility issues that got escalated. Provide assistance to plan members about their benefits included in the Medicare Part D Med-D. Update the members about the Med-D enrollment dates and explain them the different plans that are available.
  • Coordinate and assist departments with resolving their charges that are a “Candidate for billing” on a daily basis.
  • Responsible for accepting prescription orders from members for Mail Order Pharmacy and addressing any payment concerns.
  • Creation of a Gap/Impact Analysis Document for changes of the EDI Transactions 837, 835, 276/277, 270/271
  • Creation of a Gap/Impact Analysis Document for changes to Pharmacy Transactions real time and batch based on NCPDP 5.1 to NCPDP D.0, specifically concerning the data elements
  • Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
  • Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest

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