- IT professional with over 7 years of experience in the areas of IT Healthcare Industry in Business Analysis, Business System Analysis and Project management.
- A hard - working team player with extensive knowledge of Unified Modeling Language (UML), Software Development Life Cycle (SDLC), Object Oriented Analysis and Design (OOAD), Testing Lifecycle, Data Modeling, GAP analysis, risk analysis, cost-benefit analysis, conducting Joint Application Development Sessions (JAD) and various methodologies including Waterfall and SCRUM, Prototyping and Rational Unified Process (RUP).
- Good understanding of Relational Database, Object Oriented Programming, Data Mapping and Data-warehousing
- Proficient in writing SQL queries for testing and data validation.
- Designed and implemented basic SQL queries for testing and report/data validation
- Strong understanding of Business Intelligence tools, database technologies, software development, web-based application design, object-oriented programming and advanced mobile development.
- Strong background in various Data Modeling tools using ERWIN, ER/Studio and Power Designer.
- Extensive experience in Relational Data Modeling, Dimensional Data Modeling, Logical/Physical Design, ER Diagrams, Forward and Reverse Engineering, Publishing Erwin diagrams, analyzing data sources and creating interface documents.
- Worked on report creation skills using Microsoft SQL Reporting Services (SSRS)
- Hand-on experienced in Web Services integration - REST and SOAP
- Design of system requirements, specifications, and design documents of large systems using Object Oriented Modeling Techniques.
- Experience in modeling with both OLTP/OLAP systems and Kimball and Inmon Data warehousing environments.
- Strong understanding of the principles of Data warehousing, Fact Tables, Dimension Tables, star and snowflake schema modeling.
- Adept in various tools including Rational Requisite Pro, Rational ClearQuest, Rational ClearCase, MS Visio, MS Project, Crystal Reports.
- Experienced in FACETS claims management system.
- Familiar with X12 Financial series code set for 820 (Payment order / Remittance advice) and 821 (financial information reporting).
- Strong understanding of HIPAA Transactions & Code Sets Standards like (820- Premium Payment for enrolled health plan members, 837, 834- Enrolment /Disenrollment to a health plan, 835).
- Experienced with Affordable Card Act (ACA) complete implementation.
- Strong background of creating HL7 mapping and translation documents
- Experience in working with frameworks like Spring, Hibernate, JAX-RS and REST API
- Background of documenting HL7 and X12 interface specifications.
- Worked on multiple projects as a project team member, and occasionally as a project team leader.
- Mentored other team members on the development & support of HL7 interfaces for clinical applications.
- Skillfully documented Business Requirements, Use Case Specification, Functional and Non-Functional specification, UML diagrams including Use Case diagram, Activity diagram, Class diagram, Sequence diagram, Data Flow diagram (DFD), Entity-Relationship diagram (ERD), Requirement Traceability Matrix (RTM), Change-Version Control, Training and User Manuals.
- Extensive knowledge of Medical Management Information Systems (MMIS), Health Insurance Portability and Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI) and implementation of HIPAA code sets, ICD-9, ICD-10 and HL7.
- In-depth understanding of the gap between HIPAA 4010 and HIPAA 5010
- Worked on different RDBMS modern database like SQL Server, Oracle and MS Access.
- Thorough understanding and hands-on working experience with standards for medical transactions like 820 (enrollment), 834 (premium payments), 835 (medical claims payments), 837 (medical claims), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), and 277 (claim status response).
- Excellent knowledge of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies, CPT coding, HCFA-1500 and CMS-1500 claim forms and reimbursement forms.
- Experience in White Box, Black Box, Unit, Functional, Integration, Back End and System Level Load and Stress Testing.
- Working experience with PL/SQL, SQL, HTML and MS Access.
Confidential, Irving, TX
Sr. Business Analyst
- Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
- Managed database in IBM Unidata.
- Wrote UNIX commands for database access.
- Responsible for gathering the functional requirements for the health benefit claims receiving and processing system.
- Performed UNIX commands to retrieve the required information.
- Involved in Requirement Scoping and analyzing high priority requirements. Conducted sign-off meetings with clients to ensure the requirements are met.
- Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD) and the Functional Requirement Document (FRD) using Rational Requisite Pro.
- Involved in project status meetings, QA review meetings, and System Test meetings.
- Conducted client call sessions to allow different stakeholders to communicate their needs with each other for project needs.
- Involved with the following list of HIPPA-EDI Transaction Code sets: 837, 835, 270/271,277/275 and 276/277.
- Involved with the Quality Assurance Team to develop and design test plan and test cases.
- Performed testing of the health benefit claims receiving and processing system to ensure that the system adheres to project standards, performance criteria, and functional specifications.
- Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
- Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test using the test cases given by the client before releasing the code.
- Worked in loading ICD-9 and ICD-10 HIPPA codes.
- Troubleshooting production issues with client claims not being paid correctly.
Environment: MS Office Tools, Windows XP, UNIDATA, MS Project, SharePoint 2007, MS-PowerPoint, Agile framework
Confidential, New York City, NY
- Gathered requirements from stakeholders for provider management and member management.
- Worked on Documenting Data Models, logic, coding, testing, changes and corrections.
- Wrote SQL scripts for creating performance evaluation reports
- Coordinated JAD sessions for Requirement Validation with Dept. of Cleveland clinic to gather requirements for the new MMIS.
- Involved in project plan, captured high level plans and SIT plan in Microsoft Project Standard (MPP) as per client's requirement.
- Identified and validated business rules and data elements.
- Involved in Object-Oriented Programming which was used to implement Rational Unified Process methodology
- Gathered DEV and QA Effort Estimates and created project plans using Microsoft Project Planner (MPP)
- Prepare integrated workflows, obtain approvals across systems and validate before hand-off to Development team - SOAP, REST, SQL, Oracle and Splunk
- Created 837(P, I, D) claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837(P, I, D), 835, 270/271, 276/277 and 278.
- Modeled the 'as-is' process flow and the 'to-be' process flow and analyzed the gap and developed the action steps to fill the gaps.
- Worked within project team to identify and interpret state Medicaid policies as applicable to customer defined algorithm research as well as assist with internal development of new healthcare analytics.
- Extensive knowledge of Patient Protection and Affordable Care Act (PPACA).
- Extensive knowledge of Medicaid Information Technology Architecture (MITA).
- Analyzed Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
- Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
- Analyzed Audit and Change Files of 834, 835, 820, 837 PDI, 270 & 271HIPAA EDI Transactions using MS Word, MS Excel, MS Access and Facets PROD & PPMO
- Created functional requirement specification documents such as UML diagram, use case diagram, scenarios, activity diagrams and mapping.
- Have utilized Requisite Pro to import word and excel documents in different extension formats.
- Proficient in RDBMS concepts and also in database testing using PL/SQL tools.
- Have utilized Clear Quest to repair and detect errors in a program.
- Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
- Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
- Examine the system design deliverables & validating it against the SLA.
- Maintained and tracked the project plans using MS Project.
Environment: MS Office 2007 to 365, Windows, .NET, Agile, MS Visio, MS SharePoint, TFS, MS Project, MS Access 2007, Web Services, MS Visio, SQL, Oracle, SOA, HTML, REST.
Confidential, Eden Prairie, MN
- Facilitated JAD sessions to collect requirements from system users and prepared business and functional requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
- Designed and Developed data models for multiple different subject areas such as Membership, Claims, etc.
- Involved in solution and architecture meetings, to plan out the design for data model.
- Performed data mining using SQL to map fields of IMS database to the DB2 (RDBMS) database
- Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
- Identified processes for developing and documenting detailed business requirements. Data was collected from end-users, and analysts.
- Created Use-Cases and Requirements documents to document business needs.
- Requirements were gathered through interactions and meetings and periodic walkthroughs.
- Involved in Writing use case based on HIPAA standards.
- Gathered Requirement from the Client to fulfill the Application need for FACET Implementation.
- Created and maintained the Requirements Traceability Matrix (RTM).
- Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
- Refined the requirements (use-cases) and Business Process Models to detailed level appropriate for technical analysis and system design.
- Extensive Analysis of HIPAA rules to incorporate in the Development of Utility applications which are not HIPAA compliant.
- Was responsible for tracking issues that are detected and updating the status of existing issues based on the daily meetings with the off-shore team.
- Identified and analyzed the data requirements for the various site teams and made sure that the required data is available in the testing environment.
- Worked directly with software engineers to ensure clear communications on requirements and defect reports.
- Involved in Analyzing the data in flat files, excel sheets, access, other RDBMS databases and providing suggestions that help in making better business decisions.
- Designed and developed scenarios based on business requirements.
- Developed requirements integrating E-R diagrams and designed the testing process flows.
- Worked on 276/277 HIPAA Transactions and Code Sets and validation.
- Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test using the test cases given by the client before releasing the application.
- Interacting with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.
- Validated the scripts to make sure they have been executed correctly and meets the scenario description.
- Involved in project status meetings, QA review meeting, and System Test meeting.
- Wrote test cases and test scripts for the User Acceptance testing.
Environment: Oracle, Windows XP, Rational Rose, REST, Rational Requisite Pro, UML, MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint)
Confidential, Franklin Lakes, NJ
- Conducted interviews, live meetings and JAD sessions with business users and Subject Matter Experts (SME's) to understand the As-Is system and gather requirements for the To-Be system.
- Performed Data mapping, logical data modelling, created Class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
- Created, Updated and administered a relational database using RDBMS to access the database using Structured Query Language (SQL).
- Analyzed the pre-existing documents to have a better understanding of the present system.
- Incorporated Rational Unified Process (RUP) andanalyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS)using Requisite Pro, Rational Rose and MS Visio.
- Did Presentations for Stakeholders explaining the gaps in the system and how the changes would affect different modules w.r.t. Medicare.
- Performed Gap analysis to understand the best way of incorporating the changes in the system with respect to POS.
- Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and End to End Scenarios using UML.
- Organized daily scrum calls to keep the team on track and the stakeholders updated.
- Documented, organized and tracked the requirements using Rational RequisitePro.
- Worked on changes regarding new CMS directives and proposed changes to be made in the current system.
- Analyzed Claims adjudication related transactions like 835, 837, 270, 271, 276 and 277 transactions (both inbound and outbound).
- Worked with Source System Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped.
- Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
- Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
- Assisted in writing test case scenarios for regression testing and end-to-end testing.
- Involved with Medicaid claims testing.
- Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
- Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.
Environment: SQL Server, Windows XP, Rational Rose, Rational Requisite Pro, REST, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint)