- Over 6+ years of IT experience, client - focused, detail-oriented, skilled professional seeks a challenging position within a team oriented environment in an organization that welcomes experience, initiative and innovation.
- Excellent ability to understand the client’s business needs using strong communication skills to elicit, document, analyze and validate business processes, systems, and solution requirements.
- Aptitude to consult with business management and personnel to identify and document business needs and objectives, current operational procedures, problems, input and output requirements, data scope, usage, formatting, and security requirements.
- Ability to define timelines and set milestones for prioritizing work requests.
- Expertise in conducting “AS IS”-“TO BE” GAP Analysis, and eliciting high-level business requirements.
- Involvement in defining scope, project plan, and Requirement Traceability Matrix (RTM) on the on-going projects.
- Good understanding of State & Federal funded health plans such as Medicaid & Medicare.
- In depth exposure to healthcare industry compliance HIPAA 5010/4010 & ICD10/ICD9.
- Expertise in developing analytical reports such as Risk Analysis, Impact Analysis, Feasibility Study.
- Have a wide range of experience as a healthcare business analyst in Hospitals, Third party Billing companies, and Bio-Medical companies.
- Knowledgeable in HIPAA, Joint Commission and ISO Standards.
- Experience with healthcare fraud and abuse problem and solution development.
- Have strong knowledge of Rational Unified Process (RUP) and Agile (Scrum) methods of SDLC.
- Strong knowledge of requirement Elicitation Techniques like Joint Application Development sessions (JAD), Interviewing, Questionnaires, Brainstorming, and Surveys for enhancing features of the Application.
- Strong Management Skills, demonstrated proficiency in leading and mentoring individuals to maximize levels of productivity, while forming cohesive team environments.
- Highly motivated, organized and results and detail oriented with excellent interpersonal, communication and presentation skills. Proven capability of adapting to new and fast changing technologies
- Creative and aggressive self-starter with integrative thinking skills, capable of forming and maintaining positive and productive working relationships in internal, external, independent, and team environments
Requirement Management Tools: Requisite Pro, Enterprise Architect, iRise
Quality & Change Management Tools: Rational Clear Quest, HP Mercury Quality Center
Databases: MS SQL Server, Oracle, DB2, MS Access
Business Modeling Tools: Enterprise Architect, MS Visio
Operating Systems: Windows 7/2000/XP
Business Management Tools: MS Project, MS Office
Other Tools: MS SharePoint, iRise, Telelogic DOORS, Rational Suite (RequisitePro, ClearQuest, ClearCase), Rational Rose, Blueprint, Siebel eClinical, Remedy, Noetix, LiveLink, CaliberRM, Enterprise Architect, Team Foundation Server, Cognos, Business Objects
Methodologies: RUP, Agile, SCRUM, RAD, Waterfall
Confidential, Jacksonville, FL
Business Systems Analyst
- Conducted brain storming sessions to analyze provider contracts, provider reimbursement, benefit rules, medical policies and medical management rules to see the impact of ICD 10 diagnosis codes.
- Participated with migration HIPAA 4010 version to HIPAA 5010 for all the EDI Transactions (270/271, 276/277, 278, 837P/I, 835)
- Part of team to elicit, validate, organize, and document required functionality and constraints by engaging in iterative requirements gathering sessions with the various business users in the projects, including company employees, business partners, testers and analysts.
- Facilitated requirements meeting, JAR/JAD discussions with business users and subject matter experts (SME) to elicit requirements.
- Functioned as the primary liaison between the business line, operations, and the technical areas especially with the stakeholder’s team, which provided the web-based underwriting solution.
- Worked with different business users and analysts by conducting interviews to collect requirements and business process information.
- Applications were developed in Risk Based SDLC.
- Agile, RUP and NexMo methodology.
- Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction, 276/277 Claim Status Transaction, 270/271 Eligibility and Benefits Transaction, 278 Medical Clearance.
- Populated ICD-9, ICD-10, CPT, HCPC, REV, NDC Disease code sets as per the standards.
- Experience with transaction sets 835, 837, 270, 271, 276, 277, 278 and HIPAA 5010.
- Gathered Business requirements.
- Interacted with the End users, Designers and Developers, Project Manager to get a better understanding of the Business Processes.
- Involved in Project Management by preparing Working Break down Structure (WBS) in Gantt chart. Used Rational Portfolio for project plans, process templates and work products.
- Assisted project managers with the development of project schedules, JAR/JAD Sessions, Project Presentations and manage scope using MS Project and MS Excel.
- Experience in working with application developers, Technical Architects, Enterprise Architects, DBAs, QA Testers and User Acceptance Testers.
- Responsible for creating UML modeling plans, Sequence Diagrams, Activity Diagrams, Use cases, process flows, Wire Frames and business requirements documentation using MS Visio.
- Analyzed and modeled the system using Data flow Diagrams, Functional Diagram and Process Diagram.
- Proposed an object change management system to support object-oriented system design.
- Analyzed business requirements from user interviews and then convert requirements into Technical specifications using Rational Requisite Pro.
- Analyzed XML, Java Scripts, and Pipe delimited format transactions, EDI Transactions to identify input and output data in Web Services.
- Systems Documentation included Business Process Document (BPD), Functional Requirements Document (FRD), Functional Design Document (FDD), Software Architect Document (SAD), Technical Design Document (TDD), Proof of Concept (POC), Mapping Documents, Meeting Minutes Document and test plans using MS Word, MS Excel.
- Bridged the gap between AS-IS and TO-BE business process flows, Integration of process flow diagrams to show one end-to-end business model and process mapping exercise including swim lanes.
- Created the HIPPA segments using Edifecs and conducted review sessions as required.
- Opened the Issues in MSPEM and assigned to stake holders to do research and generate the business requirements out of the existing issue which leads to the solution of the issue.
- Documented Database/Stored procedures specifications and defined the database constraints.
- Consulted with management and designed and developed several SOA processes and data management tasks related to the project, whilst developing all phases of the application.
- Documented Maintained all the Project Changes Request (PCR), Route Cause Analysis Documents, Service Center Tickets and Work Product Review (WPR) documents and updated them accordingly.
- Participated in all the phases of testing, documented the “User Acceptance Test” scripts and participated in Regression testing sessions, verified the Business Scenarios on new builds to allow extended testing by the QA team once the system was in testing environment.
Environment: Windows XP, RUP, MS SharePoint, Quality Center, .Net, SQL Server, Clear Quest, MS Office, MS Visio
Confidential, Hartford, CT
Business Systems Anal yst
- Collaborated with project managers and project sponsors to determine project scope and vision.
- Developed and utilize standard templates to accurately write requirement specifications by conducting interviews and product analysis to gather user requirements via workshops, questionnaires, surveys, site visits, workflow storyboards, use cases, scenarios, and/or other methods.
- Managed the expectations of the customer with regard to solution functionality and deployment process
- Developed deep relationships within the client organization and build effective cross-functional teams across diverse stake holder groups including client business and technical organizations
- Managed and track the status of requirements throughout the project lifecycle; enforce and redefine as necessary by communicating enhancements and/or modifications verbally or through written documentation.
- Researched, reviewed, and analyzed the effectiveness and efficiency of existing requirements-gathering processes and develop strategies for enhancing or further leveraging these processes.
- Interacted with the Subject Matter Expert (SME), Operational/Technical Managers and Stakeholders to get a better understanding of Business rules/processes and gather core Business Requirements.
- Worked on designing processes & sub-processes & confirming it against the functional requirements.
- Worked as a liaison between the business and technical side to convey the business needs to the system architects.
- Participated in weekly status meetings to present status and incorporate any digressions from the original scope.
- Designed Use Cases using UML and managed the entire functional requirements life cycle using SDLC.
- Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
- Carried out a thorough target data model assessment and risk analysis.
- Involved in cross-functional teams, developing new ways to boost efficiency and delivering results in a fast changing environment to achieve company goals.
- Participated in the walkthroughs and meetings specifically for Claims and Membership modules.
- Worked with the clients on the verification process for the requirement phase documents
- Implemented Standardized process throughout the Software Development Life Cycle (SDLC).
- Provided professional and prompt technical support to customers, partnering with other internal departments to provide two way communications and customer impacts.
- Prepared Risk Assessment artifacts for the different deliverables of the project WBS.
- Create monthly/weekly status reports to update the project schedules & deliverable plan.
Environment: Windows, MS Visio 2007, RequsitePro, MS SQL Server 2008, DB2, MS Project Professional, Business Objects, Quality Center
Confidential, Santa Clara, CA
- Worked in different types of Projects at Confidential such as CTMS (Clinical Trial Management System) and CDC (Clinical Document Control).
- Worked with requirement gathering of Noetix reporting tool by interacting with the various SMEs of Abbott & the Noetix corp. through interviews and prototyping.
- Responsible for conducting Joint Application Development (JAD) sessions with the Noetix Corporation & Project managers of Confidential for the requirement gathering of CTMS-Noetix integration project.
- Responsible for finalizing the requirement document for the customization of the Noetix reporting tool.
- Took an active part in sizing of the CTMS project.
- Responsible for preparing the RFP (Request for Proposal) according to the guideline for the vendor selection purpose.
- Responsible for the development of Business Context diagram along with the SME for the integration project using Microsoft Visio.
- Completed the BRD along with the other Business analyst.
- Prepared the Functional Design Document with Use cases and Activity diagram covering all the business needs.
- Responsible for creating & maintaining Requirement Traceability Matrix in order to track the development and QA process.
- Closely involved with the QA team & assisted them to develop quality Test cases by referring the Use cases.
- Assisted the QA team to complete the performance testing of the integration project.
- Assisted with the Project Manager to define project milestones, schedules, monitoring progress and updating plans using MS Project.
- Responsible for documenting the Confidential Siebel eClinical installation user manual for the development and QA team.
- Played an active role in the UAT and the release of CTMS integration project.
Environment: Scrum, Noetix, UML, Siebel eClinical, TOAD, MS Visio, Remedy (Bug tracking tool).
Confidential, Wellesley, MA
Business Systems Analyst
- Prepared the Business requirement Document (BRD) and system requirement document (SRD) for the enhancement of the existing services.
- Created workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the system.
- Provided report analysis that differentiates both existing Medigap plans as well as the newly modernized Medigap plans.
- Differentiated enrolment between legacy plans and CPSS plans for enrolment and finance.
- Developed an automated approach for capturing all 837 data received that supports claim utilization and reporting.
- Did gap analysis and impact analysis for the new Medicare PPO product.
- Developed business requirements for online pricing tool for Medigap product.
- Developed business requirement for online web form for capturing application information
- Requirements Gathering & Analysis always ensured HIPAA Compliance Auditing.
- Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
- Created, executed and translated manual test cases and scenarios into automated test scripts in order to validate functional requirements using HP Quality stage.
- Extensively worked Claims, Enrollment, Eligibility verification for Members and Providers, benefits setup, and backend payment cycle.
- Worked with 276/277 transactions where exchange is used.
- Coordinated the upgrade of Transaction Sets 270, 271, 276, 277, 837, 835 to HIPAA compliance
- Conducted Risk Analysis to identify the risks associated with developing the patches, and formulated a Mitigation Plan to eliminate or reduce risks of high severity and any major effects.
- Conducted JAD sessions with business SMEs and developer.
- Collaborated with Quality Assurance Analyst in testing.
- Developed test cases and performed UAT testing for all the files and reports
Environment: Windows, SQL Advantage, MS Visio, MS Word, ClearCase, ClearQuest, RUP
Confidential, Jersey City, NJ
Health Information Management (HIM) Supervisor
- Oversaw and managed a staff of 12 to reduce backlogs during early stages of EPF implementation.
- Coordinated and assisted with implementation and maintenance activities of HIM Document Imaging System.
- Monitored staff productivity by maintaining records on spreadsheets highlighting against performance standards. Redesign productivity record-keeping forms accordingly.
- Assisted HIM Project Director in development of policies and procedures for HIM redesign processes and Document Imaging system.
- Used workflows to document pre and post imaging processes.
- Lead in deployment of project plans as suited to needs of internal and external departments relating to their individual processes.
- Interacted with physicians to explain and facilitate assignments, chart completion and documentation issues and deficiencies.
- Prepared reports and statistics on incomplete and delinquent numbers. Interact with department administrators and chairmen to reduce and troubleshoot delinquent status and numbers.
- Conducted orientation and training sessions on use of various HIM Systems and processes and provide support as needed. Consult with HIM Managers in development of operational monitoring tools for respective functional units.
- Provided training and resources for hospital staff to enable them to conduct training for their Personnel "train the trainer".
- Led in forms control process with forms vendor to assure Information Management committee approves all forms.
- Maintained documentation of forms inventory and imaging specifications. Monitor forms for adherence to imaging requirements.
- Determined, identified, and developed team skills (based on business need) by facilitating and providing feedback to team members on customer service and communication skills, therefore enhancing quality of support and customer.