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Business System Analyst Resume

FL

CAREER SUMMARY:

  • Extensive experience as Business/System Analyst in Planning, Analyzing, Documenting, Designing and Supporting software application implementations with understanding the architecture, scope and functionality.
  • Comprehensive working experience in various sectors of business, with In - depth knowledge of SDLC (System Development Life Cycle) with all phases of Agile - Scrum, & Waterfall.
  • Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the eligibility, billing experience within life and disability in health plans.
  • Hands on experience in Medicare and Medicaid Claim Process.
  • Extensive knowledge of Medicaid Information Technology Architecture (MITA).
  • Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Implementation and knowledge of HIPAA code sets, ICD-10 coding, HL7, HMO, PPO.
  • Experienced working in Facets online modules such as Billing, Provider, Claims and modules.
  • Vast experience in requirement gathering for business and application requirements.
  • Experienced in conducting Joint Application Development (JAD) sessions through interviews and workshops with subject matter experts and business users.
  • Good Understanding of the Quality payment program (QPP) implemented by CMS, which includes Merit based Incentive payment system (MIPS) and alternative payment models (APMs).
  • Extensive experience in handling requirements management, Business Requirements Documents (BRD), Functional Requirements Specification (FRS), System Requirement Specifications (SRS), Use-Case Specifications, and Requirement Traceability Matrix (RTM).
  • Expertise in various Management tools: JIRA, HP ALM/Quality Center, MS Test Manager, TFS.
  • Experience implementing Eligibility System, Facets Data model, Configuration Implementation of FACETS module.
  • Knowledge of different modules within Healthcare Claims Adjudication Process ( process, billing process and enrollment & Claims process).
  • Strong knowledge of Business Intelligence Reporting Tool -Tableau.
  • Experienced in using MS Visio for business process modeling.
  • Expertise with SWOT Analysis, Use Case Diagrams, Activity Diagrams, Sequence Flow Diagrams standards.
  • Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277 and ICD10.
  • Worked on System Changed Requests Issue resolution related to Medicare and Medicaid.
  • Strong Experience in Test Plans development, Test Conditions and Test Cases, test data creation and analysis, interaction with the development team for error detection and correction.
  • Expertise in creating prototypes and mock-ups for user interface designs.
  • Extensive knowledge of reporting tools such as SQL and ACCESS for underlying database tables and resolve data issues.
  • Expertise in RDBMS concepts and running SQL queries.
  • Experienced in conducting Business Process Management and GAP analysis.
  • Excellent working knowledge in Project Life Cycle and clear understanding of Project Management.
  • Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
  • Worked on Data migration, data analysis, data modeling, data conversion, requirement analysis, business modeling and use case development using UML, Structured Query Language (SQL).
  • Experience in Software Verification, Validation, and Testing Methodology extensively involved in UAT testing.
  • Outstanding communication skills, able to successfully build strong working relationships with coworkers and clientele, while ensuring cooperation among company departments.
  • Excellent multitasking skill, able to efficiently plan and prioritize projects. Strong technical and business management skills.

TECHNICAL SKILLS:

Project Methodologies: Agile-SCRUM, Waterfall

Business Modeling Tools: MS Visio

Document Management Tools: Confluence Bug Tracking Tools: JIRA, HP ALM/Quality Center, TFS, MTM

Project Management Tools: MS Project, SharePoint

Operating System: Windows, Mac, UNIX

RDBMS: Oracle, SQL Server, MS Access

BI / Reporting Tool: Tableau

Programming Skills: SQL, HTML, XML

Business Applications: Microsoft Office Suite - MS Word, Excel, PowerPoint, Outlook

PROFESSIONAL SUMMARY:

Confidential, FL

Business System Analyst

Responsibilities:

  • Facilitated various meaningful scrum meetings
  • Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams. Assisted in creation of the Functional Design Document from the Business Requirements Document which was used as the by the development team while preparing the design and held the responsibility of the required data setup for unit testing.
  • Responsible for creating Vision, Epic statement and user stores for Servicing Execution Tool
  • Performed data analysis and data profiling using SQL and SSIS Data Explorer on various sources systems including Oracle.
  • Wrote requirements for data conversion by developing ETL rules, use cases and design specifications.
  • Performed end-to-end System Integration testing which covered the entire business process flow from the initial point of sales through to all the downstream systems and XML output files, including apps/interfaces.
  • Responsible for creating Mockup screens using Wireframes for Mobile and Web Portal.
  • Used Facets to provide seamless transactions between the provider, Group, member and Billing.
  • Used Facets Workflow to route the claims according to the priority.
  • Implemented automated COB processing of Medicare claims into Facets
  • Created and maintained requirement documents for Facets for the different modules like Billing, Member enrollment and Claim adjudication.
  • Worked with ETL to obtain Impact analyses/ Data Analysis of the source files and prepare Implementation plan for the project install.
  • Radiant and Epic Bridges testing, database configuration and management within ConnectR. Troubleshooting RIS Orders from McKesson, Cerner Millennium, Siemens, Syngo Workflow, Epic Orders, and problem resolution of orders on Epic Bridges work queue.
  • Liaised with Clinical and Administrative stakeholders in identifying qualifying initiatives for MACRA Quality Payment Program (QPP). Advised in the effective use of data to monitor KPIs for selected initiatives.
  • Worked on Different Modules like Billings,, Claim and Provider in Facets
  • Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports
  • Involved in extensive data validation by writing several complex SQL queries and Involved in back-end testing and worked with data quality issues.
  • Worked closely with other teams, from Architects and Data Modelers to ETL and DBA resources, to ensure robust, standard and stable Data Model.
  • Created SSIS Packages by using advanced tools (i.e. pivot Transformation, Derived Columns, Condition Split, Term extraction, Aggregations, Multicasting).
  • Performed current state analysis to optimize the Epic Cadence/Prelude modules
  • Responsible for Data mapping testing by writing complex SQL Queries using SQL Server.
  • Performing data conversion by transforming XSD files to sample XML files for customer use.
  • Involved in project using SOAP UI and run request with input XML to receive a response XML for the request sent.
  • Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports
  • Provided the required test data for the developers in order to fix the defects
  • Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals.
  • Demonstrated ability in managing multiple facets of Quality simultaneously while supporting data reporting for totality of the healthcare organization, including GPRO/MIPS reporting to meet requirements of MACRA
  • Was involved in documenting changes to the Benefits Administration, Enrollment Processing and Claims Processing Systems based on the Medicare Plan Changes initiative.
  • Consult and troubleshoot end users issue and Epic work queue HL 7 interface errors.
  • Worked on internet-based application to improve its health insurance claim processing by automating receiving and processing health benefit claims including Medicare.
  • Worked extensively on Extraction, Transformation, loading (ETL) data from Oracle, SQL Server, Access, Excel, Flat Files and XML using SSIS Services.
  • Expertise in the EPIC Medical software application (EMR, HER) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
  • Conducted system to system ETL testing from both upstream and downstream systems.
  • Tested the interface between database and the application.
  • Created and maintained SQL Queries for back-end testing
  • Validated records, structure of tables, Indexes, Triggers in tables after migration.
  • Investigating software bugs and reporting to the developers using HP ALM Defect Module.
  • Analyzed system requirements and developed detailed test plan for testing.
  • Requests/Tickets opened by the developers to validate the code change which was tested and verified in UAT environment before pushing the code in Production.
  • Tracked and reported defects using HP ALM.

Environment: Windows, MS Office Suite, ETL, JAD, BRD, FRD, UAT, JIRA, SQL, SOAP, REST, XML, JSON, Facets.

Confidential, Mountlake Terrace, WA

Business/System Analyst

Responsibilities:

  • Performed GAP analysis on management and claims processing to evaluate the adaptability of the new application with existing processes.
  • Analyzed “TO BE” scenarios based on the data that are currently required to generate reports.
  • Performed detailed business process assessment of the affected business areas.
  • Draft, Evaluate & Finalize Business Case with Possible Milestones and Work Break Down Structures
  • Coordinated in all phases of IT projects based on the Agile Framework and Scrum
  • Organized and facilitated Agile-Scrum meetings, which included Sprint Planning, Daily Scrums or Stand ups, Sprint Check-In, Sprint Review & Retrospective.
  • Designed SSIS Packages to transfer data from various sources like Oracle, DB2, SQL Server, Excel and Access to SQL Server using Business Intelligence Development Studio.
  • Designed various packages for Parallel ETL mechanism using SSIS Control flow and Data Flow components.
  • Responsible for managing the scrum process with the coordination of the scrum team in an Agile methodology.
  • Generated catalogue of letter templates and attachments with detailed specification of validation logic and Error messages as per Business specifications.
  • Designed SSIS Packages to transfer data from various sources like Oracle, DB2, SQL Server, Excel and Access to SQL Server using Business Intelligence Development Studio.
  • Enhanced the Medicaid encounter (837) and enrollment (834) companion guides, enhanced requirements, co-authored test plan, and developed test data via SQL and manual editing (ETL).
  • Wrote User Stories -- Elaborated User Stories and Acceptance Criteria; Reviewed user stories with teams
  • Participated in customization of vendor provided solution to accommodate requirement specific to the business.
  • Analyzed and developed the Use Case Model, Analysis model, Behavior diagrams based on UML Methodology & Business process flow diagrams using Visio.
  • Used SSIS jobs for implementing ETL and importing data from the flat files that brings the data to the application tables.
  • Created data mapping documents mapping Logical Data Elements to Physical Data Elements and Source Data Elements to Destination Data Elements.
  • Documented various Use Case scenarios, Process Flows and other diagrammatic representations in MS Visio.
  • Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches (, Billing, Provider, etc.).
  • Performed the Back-End integration testing to ensure data consistency on front-end by writing and executing SQL statements on the Database.
  • Worked extensively on Extraction, Transformation, loading (ETL) data from Oracle, SQL Server, Access, Excel, Flat Files and XML using SSIS Services.
  • Used SSIS jobs for implementing ETL and importing data from the flat files that brings the data to the application tables
  • Wrote User stories which included the business logic, expected behavior and user acceptance criteria.
  • Tested user stories and sign off on the business functionality completeness.
  • Participated in defect triage/ resolution action items follow up, drive meetings.
  • Set up 834 Dashboard, Translator and Scheduler manually for the test groups and validate members enrolled in the benefits in Facets.
  • Performed Data Mapping to map the EDI 834 data to XML.
  • Validate 834 EDI files, request for batch job to load the files and validate in Facets.
  • Involved in impact analysis of HIPAA and 837P transaction sets on different systems.
  • Create internal reports using Dashboard and basic SQL queries in the tool to track activities of the teams.
  • Facilitated the Meetings with Business owners, SMEs and Business user to gather the requirements. This includes face to face as well as WebEx interaction.
  • Used various SSIS control flow tasks such as Execute SQL task, File system task, for each loop, and sequence containers, send-mail task.
  • Conducted Joint Application Design (JAD) sessions for eliciting data requirements that support the business requirements and documenting data flows.
  • Conducted User Acceptance Testing (UAT) and documented Test Cases.
  • Involved in analysis of requirements for Medicaid and Commercial line of businesses.
  • Scheduled the meetings with domain leads to determine the mapping parameters for each field.
  • Followed agile methodology to gather the Business Requirements and designed Functional specifications.
  • Highly involved in Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system.
  • Identified the crosswalk table schema to persist the mapping of new system to existing system codes.

Environment: Agile-Scrum, SharePoint, MS Visio, Medicaid, Medicare, MS Project, Facets, XML, UML, UAT, Oracle, JAVA, MS SQL Server, MS Office Suite.

Confidential, Hartford, CT

Business/System Analyst

Responsibilities:

  • Create Business Requirement Document (BRD), Functional Requirement Document (FRD), Technical specification Document (TSD).
  • Reviewed, analyzed and created detailed documentation of business systems and user needs, including workflow, program functions and steps required to develop or modify application programs.
  • Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.
  • Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
  • Supported in collecting HIPAA related EDI transactional data from data warehouse.
  • Responsible for conversion of data in Data Mapping and writing transformation rules.
  • Performed in-depth analysis of workflows, data collection, and report details associated with Epic.
  • Monitored contracts and payments and worked with the Billing, Claims, Benefits and Authorization departments and the Managed Care companies to resolve differences and ensure correct reimbursement.
  • Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.
  • Supported in developing the Data Conversion program/projects from legacy system to EPIC implementation (EMR).
  • Met with Senior Management and discussed program and project plans for the whole year.
  • Thoroughly communicated day-to-day status of current projects to stakeholders.
  • Planned, estimated and tracked the progress of portal projects.
  • Used MS Visio for Process Flow and Workflow diagrams.
  • Performed Gap Analysis by matching the requirements for managed care programs.
  • Developing and maintaining business reports which were required to support the various lines of business and specific projects.
  • Consulted with IT Personnel to determine business, functional and technical requirements for specified applications.
  • Developed effective reporting tools for the business unit and completed existing projects from original concept through final implementation.
  • Captured all HIPAA-related EDI data in the repository using Facets.
  • Assisted various projects from start to finish through the SDLC process.
  • Participated in System Testing and UAT followed by production verification, post production testing and support.
  • Was responsible for Medicaid Claims Resolution/Reimbursement for state healthcare plan using Facets.
  • Responsible in testing and analyzing data consolidation, organization, and presentation in Facets.
  • Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834 transactions.
  • Involved in Validation of HIPAA/EDI for 270/271, 276/277, 837, 837i and 835 claims used for professional, Institutional and Dental billings by Writing Test cases, Test Plans.
  • Wrote test scripts and tested claims in Facets.
  • Involved in analysis on 837P and 837I Electronic Data Interchange EDI file to analyze claim lines, amount paid and other secured information on professional claims and Institutional claims.
  • Extensive involvement in data mapping using Facets data model.
  • Extensive use of Facets back end tables and front end application system for data validation purposes.
  • Developed Requirements Traceability Matrix using MS Excel.
  • Defined and analyzed test cases, test scripts, bugs, interacted with QA/ development teams in fixing errors and conducted User Acceptance Test (UAT).
  • Assisted the QA personnel in the creation of Test Cases using HP Quality Center.
  • Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports.
  • Checked the data flow through the frontend to backend and used SQL Queries to extract the data from the database.
  • Maintained and tracked the project plan using MS Project.
  • Assisted the QA team in User Acceptance Testing (UAT).
  • Daily and weekly status reporting to senior management.

Environment: Agile Scrum, HP Quality Center, HIPAA, EDI, Medicaid, Facets, Managed Care, MS Office Suite, MS Visio, MS Project, MS SharePoint, UAT, JAD, BRD, FRD, Windows, Oracle, SQL.

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