SUMMARY

• Over 10+ years of Experience as Business Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis, and Joint Application Development JAD sessions with clients and referring to accessible documentation and procedure.
• Functional Knowledge of Medicaid Management Information System MMIS.
• Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Project management, testing and UAT for the data warehouse SSRS and Tableau reporting and analytics portion of the company - wide migration.
• Knowledge in the Member Enrollment and Billing information.
• In dept. knowledge of Software Development Life Cycle SDLC methodology such as Agile, Waterfall and RUP.
• Efficient in writing Business Requirements Document, Use Case Specifications, Functional Specifications and Workflows.
• Supporting all the documents with UML Diagrams such as Use Case Diagrams, Class Diagrams, Activity Diagrams, Data Flow Diagrams, Sequence Diagrams, Process Flows (Business and System) using UML modeling tools such as MS Visio and Rational Rose
• Experience in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
• Proficient in business process modeling, documentation, and testing using Quality Center, irises, Rational Suite, MS Office Suite, MS Visio, MS SharePoint, EDM etc. in combination with UML 2.0 diagramming techniques.
• Proficient with data analysis and processing functions such as pivot tables, statistical analysis, multivariate analysis, data mining, graphs, charts that are used in excel and spreadsheet applications.
• Knowledge of creating ISS, ISE files, documents, and analyses necessary to support electronic submissions in formats.
• Strong Knowledge of UML, FRS, and proficient in creating Use Cases, Sequence Diagrams, and Collaboration diagrams, Activity Diagrams, Class Diagrams etc.
• Highly proficient in preparing Business Requirement documents (BRD), Functional Requirement Documents (FRD), User Requirement Document (URD).
• Extensive experience with process modeling using UML, flow charts, system data flow, task diagrams, sequence, data mapping, and use cases.
• Exceptional documentation skills for writing use cases and functional requirement documents as well as for creating Activity diagrams, State diagrams based on UML Methodology and business process flow diagrams using MS Visio.
• Expertise in developing several Detail, Summary reports including line and pie charts, trend analysis reports and sub-reports according to business requirements using SSRS.
• Skilled at building and deploying multi-valued parameterized reports including matrixes, charts, and gauges in SSRS.
• Experience in generating on-demand and scheduled reports for business analysis or management decision using SSRS.
• Knowledge of various Software Development Life Cycle (SDLC) methodologies like Waterfall Model, Agile (SCRUM, User stories, Sprints) with an in-depth knowledge of RUP's Iterative Software Development Life Cycle process i.e. Inception, Elaboration, Construction and Transition.
• Strong experience on understanding of Business Intelligence and Data Warehousing Concepts with emphasis on ETL architecture.
• Expert in analyzing and reporting using tools like Tableau, IBM Cognos, SSRS.
• Expertise in business requirement elicitation/gathering using techniques like interviewing, questionnaires, brainstorming, and focus groups, conducting JAD sessions, project meetings, customer interviews and coordinating various technical and managerial teams or stakeholders at all levels.
• Knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment) with EDI.
• Having great leadership qualities for handling small/large team with strong analytical and problem-solving skills, multi-tasking abilities.

TECHNICAL SKILLS

Software Tools: Microsoft Office Suite (Word, Excel, PowerPoint, Access), MS Project

Database: SQL Server 2008/2012, MS Access, Oracle 9i

Tools: UML, Share Point, HP Quality Centre, Rational Suite, MS Visio, iRise, JIRA

Project Methodologies: SDLC, Agile/Scrum, Waterfall, Rational Unified Process (RUP)

BI Tools: Tableau, Qlikview, Cognos, Micro Strategy, SSRS, SSIS

Version Control Tools: MS Visual Source Safe (VSS), Team Foundation Server (TFS)

Web Analytics: Google Analytics, Ado

PROFESSIONAL EXPERIENCE

Confidential, Chicago, IL

Sr. Business Analyst/PM

Responsibilities:

• Preparing Business Requirements Documents, Functional Requirement Documents.
• Work with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
• Data mining, data auditing, reports, and table creation within data warehouse via SQL queries
• Responsible for database design as well as data quality, validation, utilization, and improvement within the data warehouse
• Conduct JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.
• Creating GAP analysis report and conducting Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Work with the implementation and ongoing support of the Health Insurance Exchange (HIX) and compliance with Affordable Care Act (ACA) mandate and Health Care Reform Act.
• Using a mix of SDLC Process and Agile Methodology while working on the projects to be able to deliver in a phased approach and meet the deadlines.
• Create configuration files and enabling logging and error handling in SSIS and using user defined variables to dynamically configure packages during runtime in SSIS.
• Working with the project manager to estimate best/worst case scenarios, track progress with weekly estimates of remaining work to do, conducting informal meetings ad hoc and as needed.
• Performing GAP analysis to derive requirements for existing systems enhancements.
• Design and develop Use Cases and Use Case Scenarios using the UML methodologies.
• Synthesize User Interface and Business Process Requirements and translated it into the Business Requirement Document (BRD), to be use as input to the functional design specifications.
• Creating Test Plan, Test Cases, Test Scripts, and Test Procedures as per the requirements.
• Work with upper management of medical management department to identify and brainstorm solutions for bottlenecks and errors of ongoing reports.
• Conducting elicitation meetings gather/refine specifications and design reports that would satisfy business needs.
• Participate in various meetings and discussed Enhancement and Modification Request issues.
• Create Requirements and Software alternatives analysis documents for LMS (Laboratory Management Systems) and EMS (Laboratory Environment Management Systems)
• Work in Claim, Member/Subscriber, Billing, Payer, Provider, Medicare, and Medicaid. Experience with Payer System
• Collaborate with Clinical and IT staff to support HEDIS business requirements and maintain consistency and integrity of data collection and storage.
• Practice agile methodology, lead sprints and prioritize line items based on key business initiatives with respect to the Affordable Care Act (ACA) mandate and Health Care Reform Act.
• Utilize Member module to verify eligibility, benefits and PCP assignment to maintain accuracy.
• Update and analyze Claims 101 edit errors for missing contracts in an accurate and timely manner to avoid penalties.
• Facilitating all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.
• Generate periodic reports based on the statistical analysis of the data from various time frame and division using SQL Server Reporting Services (SSRS)
• Design and develop matrix and tabular reports with drill down, drill through and drop-down menu option using SSRS.
• Creating data mappings to transform the data according to business rules.
• Developing Test Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Preparing various diagrams by using MS Visio.
• Work on creating reports and data analysis using SSRS, and SSIS.
• Use cascading parameters to generate a report from two different data sets in SSRS.
• Scheduled reports for daily, weekly, monthly reports for executives, Business analyst and representatives for various business needs using Subscription in SQL Server Reporting services (SSRS). .
• Conducting project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.
• Recommend cost and performance improvement through documentation and data reporting by using Tableau.
• Visualize results of the analysis over Tableau by making histograms, pie charts.
• Firm understanding of HIPAA regulations and experienced working in all phases of healthcare insurance processing like defining Membership Eligibility and Enrollment and various Medical Claims processing.
• Effective management of clinical data using Electronic Medical Records (EMR) and Electronic Health Records (EHR)
• Creating source to target mapping documents from staging area to Data Warehouse/ Data Mart.
• Experience in using Quick Test Professional (QTP) testing for Client /Server, Web and Database Applications.

Environment: Agile-SCRUM, JIRA, HIPAA, EDI, Medicaid, SQL Server, Tableau, SSRS, SSIS, ICD, SOAP UI, HTML, XML, MS Office Suite(Word, Excel, PowerPoint, SharePoint, Visio, Project, Access), UAT, Windows

Confidential

Business Analyst

Responsibilities:

• Gathered requirements and document the proposed processes to the existing system. Modules included: Claims Processing Files and HIPAA Guidelines adherence across the company.
• Experience in configuration of claims processing applications, claim adjudication process, claims management process, real time claims adjudication, Electronic Medical Records / Electronic Health Records (EMR/EHR) and Medicaid Management Information System (MMIS), and Medicaid Information Technology System (MITS)
• Involved in Generating and designing reports for HEDIS specifications to analyze complex data through internal databases.
• Developed dash boards with rich Graphic visualizations, Drill Down and Drop-down menu options, parameterized using Tableau.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Enhanced applications associated with Claim Numbers so that duplicate Claim Numbers could be allowed in the system. Updated the Electronic Claims, Patient Screen and Sales Administration processes.
• Involved in leading major team projects in regard to the National Committee for Quality Assurance (NCQA) HEDIS measures
• Gathering, Mining and performing statistical Analysis of data with Data mining and visualization tools.
• Involved in Creating Mock-up forms in HTML for better visualization and understanding of the software solution.
• Actively Involved in Claim, Member/Subscriber, Billing, Eligibility, Payer, Provider, Medicare, and Medicaid.
• Medical Claims experience in Process Documentation, Analysis and Implementation in EDI transactions 835/837/867/270/271/ (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Participate in reports layout/content design sessions, standardize BI reports and dashboards
• Extensive experience working with Middleware and messaging tools like BW Adapters, EMS, IBM WMB, MQ, Oracle Fusion.
• Deployed different SSIS packages on test and production servers.
• Scheduled the SSIS jobs using SQL server agent for daily, weekly and monthly loads.
• Implemented Event Handlers and Error Handling in SSIS packages and notified process results to various user environments.
• Upgraded existing packages developed using SSIS 2008 to SSIS 2012 packages.
• Implemented Extraction Transformation and Loading (ETL) process by pulling large volume of data from various data sources using SSIS.
• Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.
• Involved in creating and executing test cases, test plans and test scripts for EDI 837 Claims (I & P) Transactions.
• Maintained proper communication with the developers ensuring that the modifications and requirements were addressed, BI reporting and also monitored the revisions.
• Work in software like Argus, Facets and its modules such as Claim, Member/Subscriber, Billing, Payer, Provider, Medicare, and Medicaid and experienced with several Batches.
• Used JIRA for the issue tracking, bug and defect monitoring. Also used confluence for the sharing various project related documents.
• Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
• The process included importing claims into Facets that had been adjudicated and setting them in a "PAY" status so that a payment cycle could be run to create checks on Facets.
• Performed Data mapping to validate and customize Claims daily load into the system for processing the transactions.
• Created and managed user stories within Version One which was integrated with the EMS for the company
• Validated Inbound and outbound 837 transactions, including but not limited to the loading and correcting any errors with the process of EDI inbound and outbound files
• Generated multiple Enterprise reports using SSRS from SQL Server Database (OLTP) and SQL Server Analysis Services Database (OLAP) and included various reporting features such as group by, drilldowns, drill through, sub-reports, navigation reports (Hyperlink) etc.
• Created different Parameterized Reports (SSRS 2008/2012) which consist of report Criteria in various reports to make minimize the report execution time and to limit the no. of records required. Strong functional expertise in the Healthcare Payer Area- Membership Claims, benefits, eligibility check, ICD 10, HIPAA 5010 standard, CMS, HCPCS
• Generated reports using SQL and MS Excel spreadsheets.

Environment: JIRA, Oracle, MS-Office, MS Visio, MS Word, MS Excel,, Agile methodology, PowerPoint, Quality Center, Rational Requisite Professional, Rational Clear Quest, SQL Server, Tableau, SSRS, SSIS