SUMMARY

• Business System Analyst with 7 years of experience in business process analysis/modeling, business requirements gathering, database design and development of Web Based, and Client/Server applications, with hands on experience in Healthcare Sectors.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing/Enrollment.
• Strong knowledge of the Software Development Life Cycle methodologies (phases and gates) like Agile and Waterfall models
• Used JIRA and have a clear understanding based on the requirement.
• Extensive experience in testing Facets applications mainly in Provider, Group, Subscriber/Family, membership and billing.
• Expertise in DDL and DML, as well as using Aggregate Functions.
• Extensively worked on MS SQL Server Databases, as well as Microsoft Access
• Experience in writing SQL Queries for Data Validation, Data Integration and testing.
• Experience in developing ETL for Data extraction, Data transformation and loading.
• Good knowledge in building prediction models using simple linear regression, multiple linear regression analysis, and logistic regression analysis techniques.
• Experienced in building Data Integration and Workflow solutions and Extract, Transform, and Load (ETL) solutions for data warehousing using SQL Server Integration Services. SSIS/(Informatica)
• Excellent understanding of Relational Database Systems, Normalization, Logical/Physical Data Modeling and Data Warehousing.
• Good experience working with Claims Processing ITS, Subscriber/Member and Provider applications in FACETS.
• Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD - 9, ICD-10.
• Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Effectively used Rational Requisite Pro to organize, track and change requirements of the system.
• Expertise of UML in visualizing and documenting the artifacts using Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams, Sequence Diagrams using MS Visio.
• Experience in facilitating Joint Application Development (JAD) sessions, Rapid application development (RAD) sessions, conducting user interviews and acting as a liaison between the customers, development team and testing team
• Analytical, methodologcal and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial and system requirements
• Excellent verbal/written communication skills and strong analytical abilities and can perform well both independently and as a team player
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.

TECHNICAL SKILLS

Business Skills: Business Process Analysis & Design, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis and Impact Analysis.

Methodology: RUP, Agile, OOAD and Waterfall.

Standard and Codes: HIPAA, EDI, ICD-10, ICD-9, ANSI X12, HL7, CMM, ISO, CPT and CMS form.

Management Tools: Rational Rose, Requisite Pro, Clear Quest, Clear Case, Serena Team Track and MS Visio, MS Project.

Testing Tools: Test Director, Win Runner, Load Runner and TOAD.

Database: Oracle 8i/9i/10g, DB2, MS SQL Server.

Operating Systems: UNIX, Windows 95/2000/NT/XP.

Office tools: MS Office 2007 (Word, Excel, Power Point, Outlook), MS Visio, MS Project

Data Modelling Tools: R-Studio, SQL, Tablue

PROFESSIONAL EXPERIENCE

Confidential, Phoenix, Arizona

Facets Business Analyst

Responsibilities:

• Evaluate business requirements and prepare the detailed functional and technical specifications that follow project guidelines
• Work closely with Developers and Quality Assurance Analysts to ensure system requirements and design are completely understood
• Communicate design to all stakeholders and varying levels of the organization
• Engaged on the loading EDI 834-file to Facets through Membership module.
• Worked on FACETS Pre-pricing process - Subscriber/member eligibility, Plan benefits, Check
• Mapping of X12 834 Enrollment to EEP, RMB, and MTV for Inbound and Outbound transaction files.
• Mapping of X12 820 Payment for Inbound and Outbound transaction files.
• Worked on Coordination of Benefits - Calculations using Total charges, Facets allowed,
• Conducted business validations, covering the following deliverables: FACETS Providers, Facets Claims and Facets Membership and Operational reports
• Proficient in executing and extracting SQL queries for analysis and validation.
• Act as the liaison between Business and Systems Analysts, Developers and project management groups
• Present and evaluate design solutions objectively and facilitate conflict resolution
• Work closely with business teams to strategize solutions that support long term business objectives
• Ensure IT deliverables align with business requirements with measurable results
• Used SQL Developer to understand the back end tables for data mapping & migration and Informatica for data profiling.
• Collaborate with QA team to ensure testing efforts align with system deliveries and business processes
• Lead and mentor other Systems Analysts Qualifications
• Involved in claim adjudication process of facets application.
• Used SQL queries to the integrity of data by querying the database Interacted with the development team to assure that all the defects are addressed in time.
• Analyzed and designed transaction sets and modified those transaction sets to ensure HIPAA compliance.
• Performed software testing involved Quality Assurance (QA) testing, development of test cases & test scripts, and user acceptance testing (UAT).
• Created UAT plans with several test cases for each project to ensure that the system runs smoothly after the proposed enhancements or changes have been made.
• Conducted UAT; facilitated discussion between business team and QA team on determine the test requirements and pass/fail criteria; documented and reported user feedbacks to management team.

Environment: MS Word, Excel, Visio, Access, Sybase, JAD, SQL, Agile Methodology, Enrollment Facets

Confidential, Salt Lake City, Utah

Sr. Business Analyst

Responsibilities:

• Conducted one on one interviews with high level management team and participated in the JAD session with the SME’s.
• Worked on Facets Claims Software System, to convert data from their legacy system (LRSP) and add custom applications to satisfy in-house requirements.
• Used ETL Transformations to copy columns and load data from data sources Oracle, DB2, Flat files to destination data warehouse.
• Used Facets to provide seamless transactions between the provider, Group, member and Billing.
• Worked with Accumulators, Deductibles, Coordination of Benefits, and Overrides of the Claim Line detail and used them for testing various claims scenarios in Facets.
• EDI Claims Processing - documented enhancements to the EDI Claims Processes (EDI 834, 837, 835, 276, 277) to ensure accurate processing of claims of members.
• Proposed FACETS claims adjudication procedures, standards and editing guidelines.
• Involved in implementing HIPAA EDI transactions (837 P/I/D, 835) in the application; also involved in modules: Pre-pricing claims, claims adjudication, claims payment, coordination of benefits (COB) and adjustments. Also, there was implementation of the Enrollment Processing System (EPS) responsible for the automated processing of incoming 834 transitions in HIPAA 5010 format.
• Created database objects including Tables, Views, Stored Procedures, Triggers, Views, User Defined Functions (UDF) and Indexes using T-SQL.
• Worked on performance tuning of SQL, PL/SQL and analyzed Tables.
• Extensive use of OLAP Function as well as complex joins to extract data for reporting purposes
• Created views to make data available on need to know basis.
• Created queries to fetch data from different tables, using derived tables, Sub queries on SQL Server platform.
• Performed numerous SQL queries that were highly tuned using concepts like Explain, Stats and CAST.
• Created Stored Procedure and Views, Indexes, SQL joins and Sub queries.
• Created ETL packages with different data sources (SQL Server, Flat Files, Excel source files, XML files etc.) and then loaded the data into destination tables.
• Created process flow diagrams describing provider and member access to the web portals accesing from Facets system.
• Worked on analysis of FACETS claims processing system and gathered requirements to comply with HIPAA 5010 requirements.
• Worked with all Facets Provider of software development from requirements gathering to testing, configuration and international deployment.
• Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Designed Use Cases using UML and managed the entire functional requirements life cycle using RUP.
• Defined and documented the vision and scope of the project.
• Followed the RUP methodology for the entire SDLC
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes HIPAA 834, 837, 835, and 270/271.
• Worked as a liaison between the business and technical side to convey the business needs to the system architects.
• Used SQL Queries in Oracle to pull out data from the databases for the data validation and routine report generation.
• Worked on claims, Claim adjudication Membership, Eligibility.
• 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.
• Initiated, proposed and implemented critical analytical and technical turnkey solutions extensively increasing the quantitative and qualitative value of the application
• Involved in project planning, coordination and implemented QA methodology.
• Developed the matrix, prioritized and determined QRT impact of all applications.
• Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
• Completed Data Mapping for group and detailed product analysis and report writing.
• Extensive backend testing using SQL queries, generating the reports to ensure the data integrity and validate the business rules.

Environment: FACETS, Rational Requisite Pro, Rational RoseUNIX, Web Services Clear Quest, DB2, Oracle 10G, XML, HTML, DHTML, SQL, PL SQL, Windows NT, Word, Excel, PowerPoint