- Over 8 years of professional experience as a Business Analyst in the Health Care domain.
- Extensive experience in analyzing and requirements gathering and writing system functional specifications including use cases.
- Strong knowledge on the Systems Development Life Cycle (SDLC), Rational Unified Process Methodology (RUP), RAD, SWOT, and CRM.
- Strong skills in creating UML Diagrams and Data Models including Use Case Diagrams, Activity Diagrams, Deployment Diagrams, Data Flow Diagrams (DFD) and Entity - Relationship diagrams using Rational Rose and MS Visio.
- Experience in Clinical Data Management and Clinical Trial Management.
- Strong knowledge of Project management skills includes time estimation, task identification, and scope management.
- Proficient in designing Data Models (logical and physical) for Oracle, DB2 and SQL Server databases.
- Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
- Organized Joint Application developments (JAD), Joint Application Requirements sessions (JAR), Interviews and Requirement Elicitation sessions.
- Experience in preparing Systems Proposal Reports and performing GAP analysis.
- Experience and skills in creating design models and Extensive use of UML/RUP for modeling views using tools like Microsoft Visio.
- Understanding of BEA WebLogic Portal to simplify the production and management of custom-fit portals, allowing a shared services environment to roll out changes with minimal complexity and effort.
- Hands-on experience on EDI transactions such as 270, 277, 278, 834, 835, 837 (P, I, D) for Health Care Industry.
- Hands-on experience using FACETS 4.3, FACETS 4.5, DB2, Oracle Packages, Stored Procedures and Database Triggers, Forms 9i, Reports 9i, PL/SQL, SQL.
- Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
- Conducted requirement analysis techniques such as Business Process Automation, BusinessProcess Improvement, and Business Process re-engineering.
- Motivated self-starter with exceptional team building, leadership, and verba skills.
- Possess strong technical skills and business knowledge coupled with product knowledge in Oracle E- Business Suite.
- In depth knowledge Rational Unified Process (RUP) methodology, Use Cases, Software Development Life Cycle (SDLC) processes, Object Oriented Analysis and Design (OOA/D).
- Competent in Creating Unified Modeling Language (UML) diagrams such as Use Case Diagrams, Activity Diagrams, Class Diagrams and Sequence Diagrams.
- Extensive experience in developing Use Cases, creating Screen Mockups, conducting Gap Analysis and Impact Analysis, SWOT analysis, Cost Benefit Analysis, Risk Analysis.
- MS Visio, MS Project, ClearCase, Quality Center, MS Excel, MS Powerpoint, MS Word, MS Access;
- Waterfall and Agile, and concepts such as: Data warehousing (Informatica)/Reporting (Cognos), Data modeling.
- SQL, Java, XML, HTML, Unix, C++, Apache Pig Scripts
Sr. Business Analyst
- Performed SWOT and Gap analysis for the new functionality requirements
- Worked with HIPPA rules and regulations to draft business rules and claim processes.
- Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.
- Responsible for validating claim processing transaction of MMIS.
- Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
- Worked on different types of insurances such as, Group health insurance, individual health insurance, dental insurance, vision insurance, etc.
- Hosted the application online using Microsoft SharePoint excluding some functionality those were developed to use by employees only.
- Identified and documented the dependencies between the business processes.
- Created and executed Use cases for product and benefits testing for Medical and Dental.
- Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for a clear understanding of the requirements by the development team.
- Responsible for Medicaid Claims Resolution/Reimbursement for state health plan using MMIS.
- Conducted JAD sessions and Data modelling.
- Determine member benefits and priced claims according to individual provider's contract under Medicare CMS guidelines and Dental benefits
- Facilitated daily scrum, sprint planning and sprint retrospectives meeting.
- Diverse experience in Information Technology with focus on Business Analysis, Business Modeling, Requirement Gathering, Documenting Requirements (BRDs/FRDs/Use Cases), and Software Validation.
- Worked with Medicare operational management to monitor, trend, and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
- Responsible in testing and analyzing data consolidation, organization, and presentation in MMIS.
- Create and maintain Use Cases, visual models including activity diagrams, logical Business process models, and sequence diagrams using UML.
- Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
- Documented all the aspects of Systems validation lifecycle in accordance with the FDA regulations, including Validation Plan and Protocol, Installation Qualification (IQ) Specifications, Operation Qualification (OQ) Specifications, Performance Qualification (PQ) Specification.
- Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology)
- Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products.
- Responsible for teaching sessions for end user to tell how to use tools.
- Used MS Project for various planning and budgeting activities.
Environment: MS Office Tools, Windows XP, MS Project, SDLC, Agile, Facets, MMIS, Clear Case, MS PowerPoint, MS-SharePoint, MS-Word, MS-Excel, Business Objects, XML, XSLT, Oracle, SQL Serve
Sr. Business Analyst
- Facilitatedaily scrums, manage issue escalation and resolution.
- Work closely with users to ensure the project meets business needs.
- Work on EDI 270/271, 276/277, 835 & 837 for claims department and interact with customer's compliance.
- Work with the vendor, who was contracted to send letters on customer's behalf on quarterly basis.
- Created data mapping documents based on clientspecifications which involved working with Facet claims, membership & plan data model.
- Extensively used SQL queriesto fetch data from different claim & membership table.
- Interacted with Provider's medicalmanagement, customer service &intake team for authorization.
- Designed screen mockups and layouts based on the customer need.
- Designed the look & feel of the CDRS front end (auth grid search screen).
- Validated HCPCS & CPT codes in Facets, worked with configuration analyst for configuring missing HCPCS&CPT codes in Facet.
- Developed mapping documents based on Clearing House's specs & CAQH core operating rules.
- Mapped clearing house provided service codes to Facet by developing crosswalk tables.
- Worked with plan data model in Facet front end & backend.
- Responsible for planning the risk and manage the risk for any occurrences.
- Documented claims extraction process and worked with provider relation & membership department.
- Provide LOE - for the Business Solutions Analyst effort.
- Performed root cause analysis for errors found in facet for membership and claims status.
- Facilitated issue resolution and created RFC's presenting in CAB (change advisory board) meetings.
- Performed workflow analysis to understand the inefficiencies in the AS - IS system and documented them accordingly.
- Documented Current State vs. Future State for a Referral Web Portal.
- Created process flow diagrams describing provider and member access to the web portals
- Created BRD by gathering Business Requirements from the Subject Matter Experts (SMEs).
- Obtained business sign offs on the documents after thorough review.
- Assisted in creation of the Functional Design Document from the Business Requirements Document which was used as the reference by the development team while preparing the design and held the responsibility of the required data setup for unit testing.
- Scheduled scrum meeting using Agile and using Jira keep track of work.
- Led the Change Control Process for changes submitted for the BRD after initial sign off with all stakeholders.
- Worked with HIX and gathered requirements for new plans in HIX and integrated them with existing system.
- Created tabular, matrix reports and created graphical charts such as pie, bar and column reports and displayed to users.
- Experience with Affordable care Act and migrated rules to HIX products.
- Created a UAT Plan in conjunction with the UAT Team to ensure all acceptance criteria has been included.
- Created and maintained training documentation for end users.
- Maintained a Traceability Matrix to uniquely trace and ensure all requirements requested have been addressed, developed, and tested in the project.