- Sr. Business Systems Analyst professional with 9+ years of expertise in IT and Healthcare domains, featuring a wide body of experience in varied lines of business across multiple platforms, specializing in Business Systems Analysis with strong knowledge of Software Development Life Cycle.
- Experienced in Health Information and Healthcare Services regulatory environment including HIPAA, Medicaid/Medicare, CCHIT, EDI, HL7, FHIR, XML, Quality Measures such as HEDIS, PQRS, and MACRA MIPS, and CMS.
- Proficient in Enterprise Resource Planning system’s operations to manage costs, service and human resources.
- Good understanding of POS System, Medical Claim Processing, Healthcare Plans, HIPAA, Facets, PPO, COPAY, PBM and Retails.
- Expertise in various Business Analysis SDLC Methodologies such as RAD, RUP, JAD, and Spiral Methodologies.
- Designed Use Cases, Activity Diagrams, Sequence Diagrams, Class Diagrams, Swim Lanes, and Data Flow Diagrams using MS Visio. Extensive use of UML/RUP for modeling views in Microsoft Visio.
- Strong Healthcare and Medicaid business configuration experience with focus primarily on claims adjudication, pricing, provider, member, enrollment, and prior authorization.
- Skilled in Project Planning, Project Design, Gathering Requirements, Creating Functional Specifications, and Data/Process Flow Diagrams.
- Conducted/facilitated Focus Groups Sessions, Stakeholder Interviews, Joint Application Development (JAD) and Joint Requirement Planning (JRP) Sessions for effective requirement gathering.
- Created documents such as Feasibility Reports, BI Reports, Systems Request, and Risk Assessments.
- Experienced in implementing Meaningful use (EHR) technology to ensure safety, efficiency, improve quality and reduce health disparities.
- Established documentation for Agile Methodology for implementation with a very water - fall-centric development team.
- In-depth knowledge of TriZetto Facets 4.21/4.31 and TriZetto HIPAA Gateway 4.11 - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature. Experience with TriZetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member Eligibility, Utilization Management.
Sr. Business Analyst/Solution Consultant
- Involved in requirements gathering sessions with the client to capture the expectation from the product.
- Worked with multifunctional team to understand and propose best solution to satisfy the demand of end user.
- Analyzed the sample such as template/letter, inserts and datafile, received from the client.
- Categorized the samples in different folders based on the job nature i.e. mail merge or print on demand.
- Engaged in requirement gathering and documentation for Cognos reporting requiremeents.
- Collaborated with technical team to identify and document Cognos integration requirements.
- Developed reporting mockups for Cognos BI
- Performed the gap analysis and communicated back to the client about the missing files/contents, just to ensure that all the letters, inserts and datafiles are relevant for a specific print job folder and doesn’t missing any crucial information.
- Modified received job samples to reflect the merge fields data in order to make it ready for development team for programming and onboarding the received samples, also for QA team to perform UAT.
- Created user stories and defined acceptance criteria in JIRA for Dev and QA Team.
- Participated in the user story walkthrough with Dev and QA team, answered to their queries and made necessary updates.
- Created product backlog items and refined the stories before and after eack release.
- Involved in product/feature release management in JIRA.
- Created change requests user stories to reflect the requirement changes.
- Participated in requirements gathering sessions with the client advocates to capture the enhancements that are expected in the migration.
- Worked with multifunctional team to understand and propose best solution to satisfy the demand of the end user.
- Captured as-is functionalities of the CIS tool.
- Documented to-be functionalities and enhancements of the CIS tool.
- Created Statement of Requirements (SOR) to include all necessary requirements and information required to complete this migration.
- Worked on the user stories and participated in the walkthrough sessions with Dev and QA team.
- Communicated to client advocate team to ensure all the requirements are current and capture the client expectation.
- Made necessary updates to SOR and user stories when required.
- Worked on documenting change requests as user stories.
- Participated in the DR (disaster recovery) requirements gathering sessions to understand the Print operations in Erlanger facility.
- Collected print requirements that are followed in Erlanger facility.
- Created user stories to reflect necessary requirements and process that are important to complete the print job in Erlanger.
- Participated Dev and QA walkthrough to review and update the user stories periodically.
- Created user stories for new change requests came from both internal and client team.
- Onboarded and documented new jobs/job family with associated details in the internal DCW (Data Collection File).
- Made sure the job data matches between the DCW and Master Job List sent by the client.
- Performed data analysis using SQL queries by pulling data from multiple source data files and then created reports.
- Collaborated with teams to identify and document reporting requirements to be integrated with Cognos BI reporting.
- Communicated and participated in team meetings to understand the task expectations and to answer any questions from business side.
- Used JIRA for team collaboration and task/feature release management.
Environment: Agile, SharePoint, Web services, MS Teams, JIRA, MS Office Suite, MS Visio, MS Excel, CIS Tool, Cognos, User Acceptance Testing (UAT).
Sr. Business Systems Analyst
- Interacted with Stakeholders and Subject Matter Experts to ensure that business requirements were captured, documented, maintained and met throughout the life of the program.
- Established constant communication with the Project Manager and development team during different stages of the development life cycle.
- Prioritized the requirements using JIRA and also segregated them in terms of Functional and Non-Functional Requirements.
- Created product backlog items and refined them in each feature release.
- Inovolved in change and release management of the product/feature using JIRA.
- Conducted research, gathered data and analyzed the data to define the project scope.
- Investigated potential solutions for the Business Problems by analyzing healthcare data using SQL.
- Documented the Business Requirements and Functional Specifications.
- Presented the documented information to the Stakeholders and other Business Members.
- Worked with the technical development team and communicated the requirements and specifications.
- Performed business requirements testing in various environments like Development, Test, QA and Production.
- Interacted with claims processing tool PowerMHS to test and validate claims data.
- Used EHR tool such as Epic to manage patient record and maintain data safety.
- Performed audit to validate and match data/information in all phases to ensure consistency of the different benefit plans.
- Analyzed impacts of proposed solutions to the communication with key stakeholders.
- Collaborated with the QA/testing team in preparing test data for positive and negative test scenarios as per application specifications and writing test plans.
- Analyzed and evaluated the performance of the application from various dimensions and conducted User Acceptance Testing (UAT) for successful implementation using HP Quality Center.
- Provided support during development, testing and post-deployment.
Environment: MS Office suite, MS Project, MS Visio, Rally, JIRA, SharePoint 2010, SQL Server, Waterfall, PowerMHS, HP Quality Center, RUP, Windows.
Sr. Business Analyst
- Collaborated in project’s Planning, Design, Validation, Monitoring and Completion phase, following entire Software Development Life Cycle (SDLC) methodology.
- Analyzed existing artefacts to document manual ‘AS-IS’ workflow to identify existing issues, pain-points.
- Designed ‘TO-BE’ process flow using MS Visio to present possible solution.
- Performed GAP Analysis and Impact Analysis by conducting ‘AS-IS’ and ‘TO-BE’ process flow analysis using MS Excel.
- Designed both high level and detailed process flow to help the Stakeholders get in depth understanding of the path/work flow of the solution and its benefit.
- Conducted frequent one-on-one meetings and JAD sessions to gather and validate requirements.
- Presented multiple process flows to the business stakeholders to ensure and validate their expectations from the designed solution.
- Documented high-level business requirements in BRD with key stakeholder needs in focus.
- Documented Functional Requirements Document (FRD) to hand over the business requirements to development team.
- Designed Use Cases using MS Visio to get better understanding of the interaction between the user, the database and the system and again identified gap.
- Designed mock up screen using wireframe and prototyping tool such as Balsamic mock plus to capture what business wants to see after logging in to the system and after validating, passed to the development team to design the screen accordingly.
- Extensively used EHR system such as Epic to ensure patient data safety. Analyzed Epic security templates to create user access model.
- Strictly followed HL7 standard guidelines and XML wrapper while performing electronic data interchange.
- Worked closely with the Project Manager to build and execute the project plan in Envision’s performance logic.
- Assigned to set up SFTP for the purpose of smooth and secured transaction of pending patient data from vendor’s site to Envision’s internal site.
- Documented and prepared user manual/help guide for both task manager for quality reporting and SFTP set up for transfer of pending documents for training and assistance purpose.
- Created Test Plan and Test Scripts for User Acceptance Testing.
- Worked as a liaison between business and IT development team.
Environment: MS Excel, MS SharePoint, MS PowerPoint, MS Word, TFS, MS Outlook (One Note), SDLC, UML, Balsamic Mockplus, Rational Rose, Requisite Pro, Clear Case, HP Quality Center, MS Visio.
Sr. Business Analyst
Confidential, Miami, FL
- Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validated the needs of the business stakeholders.
- Performed Cost Benefit, ROI, and ROM studies.
- Conducted user interviews and documented Business/Functional Requirements.
- Performed Requirement Analysis, and developed Use Cases&Activity Diagrams using Rational Rose.
- Defined and developed specifications for federal reporting specific to Medicare Advantage.
- Intricately involved in Business Process Flow Development, Business Process Modeling, and Ad Hoc Analysis.
- Studied standards for MSP best practices to implement identity authentication.
- Developed outline for identity authentication policies for outsourcing.
- Completed documentation of Claims Scenario’s for the source system.
- Prepared for GAP Analysis; identified and documented areas of improvement to meet capital requirement regulations.
- Conducted interviews, meetings, and JAD sessions during the process of requirement gathering.
- Designed high level design for new process, integrating with Legacy and Facets.
- Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
- Created requirements documentation for user Epic acces based on Active Directory group membership.
- Efficiently used Epic EHR system to safely handle patient medical data and track patient service records.
- Followed HL7 standard guidelines while performing data interchange.
- Wrote SQL queries for Data Integration, Mining and Data Manipulation in MHS.
- Created Use Case Scenarios and documented workflow and business process using Rational Rose.
- Wrote Test Cases and Test Scripts for the User Acceptance Testing.
- Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
- Utilized SSRS for query report generation.
- Performed extensive data modeling to differentiate between the OLTP and Data Warehouse data models.
- Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
- Created Test Scenarios and scripting Test Cases using testing tools and defect management for Policy Management Systems, Payables/Receivables, and Claims Processing.
- Involved with all the phases of Software Development Life Cycle (SDLC) Methodologies throughout the project life cycle.
- Served as a conduit for managing system requirements between the business and the software development team.
Environment: Oracle9i, MS Access, MS Excel, MS Project, MS PowerPoint, SAP ERP, RUP, UNIX, Oracle Pl/SQL, UML, Rational Rose, Requisite Pro, Clear Case, Rational Clear Quest 2002, MS Office suite, MS Visio.
Business Systems Analyst
- Interacted with business heads to finalize business requirements for the application.
- Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
- Used the required attributes (priority, effort, and risk) as the basis for negotiating the inclusion of the requirement to manage the scope of the system efficiently.
- Developed UML Use Cases using Rational Rose and AutoCad and developed a detailed project plan with emphasis on deliverables.
- Successfully conducted JAD sessions, which helped synchronize different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
- Used SDLC (System Development Life Cycle) Methodologies like RUP and Waterfall.
- Understood the “as-is” system and develop the “to-be” system concept and also prepare the System Process Maps.
- Managed changing requirements which included establishing a baseline, keeping track of the history, determining dependencies that are important to trace, tracing relationship between related requirements, and maintaining version control.
- Prepared and documented System Requirements and workflows for the Content Management Application tool.
- Responsible for integrating with Facets for claims processing and benefit configuration. Designed test scripts for testing of Claims in Development, Integration, and Production environment.
- Involved in interactions with Subject Matter Experts, Project Manager, Developers, and the end-users.
- Performed analysis of integration method for the purpose of integrating with PeopleSoft.
- Performed data analysis of existing ERP system.
- Performed Unit Testing and User Acceptance Testing, and documented detailed defects.
- Wrote Procedure Manuals and was responsible for continuity preparedness.
- Managed various tests, stored test information, reviewed and analyzed test results.
- Conducted presentations of the Q/A test results with analysis to the stakeholders and users, and documented modifications and requirements.
- Helped in writing training manuals and helped the business with trainings on one-to-one sessions.
- Employed Rational Clear Quest for effective Change Management (Requirements Creep) and bug tracking during the testing lifecycle.
Environment: Rational Rose and Requisite Pro, AutoCad, MS Visio, MS Project, UML, XML, Rational Clear Quest, Rational Clear Case, RUP, Microsoft Excel, PeopleSoft, Microsoft Word, Microsoft Power Point.
- Gathered Business Requirements through brainstorming sessions on global calls.
- Documented business logic and associated validation logic.
- Used Agile methodology and worked in all of the phases like Inception, Elaboration, Construction and Transition using JIRA.
- Used open source integration tool to ease of the operation.
- Met with various HMO, PPO, Medicaid/Medicare, and Tricare/Champus Representatives and discuss benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
- Worked with Data Extraction, Transformation, and Loading using HL7 guidelines. Metadata architecture was also providedfor the purposes of query enhancement and clarification of data relationships. Also performed data integration to pull data from various sources and built the foundation for process implementation in MS-SQL.
- Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
- Responsible for architecting integrated HIPAA, Medicare Solutions, and Facets.
- Duties included maintenance of existing and development of new Unix Korn and C shell scripts for sales/marketing EDI data extraction and uploading to Excel spreadsheets and MS Project files.
- Created Requirements Specification Document that translated business requirements into Technical Specificationsincluding business and validation logic for ease of understanding to the development team.
- Analyzed and translated business requirements into system specifications utilizing UML and RUP Methodology.
- Ensured that all Lines of Business specifications were consistent in form and function to the Diamond Base System.
- Led Business Intelligence (BI) reports development efforts by working closely with MicroStrategy, Teradata, and ETL teams.
- Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD.
- Generated wireframes and prototypes for the GUI.
- Reviewed Test Scripts and made sure that the Test Scripts covered all scenarios of the requirements.
- Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.
- Checked the schema of Oracle database manually or using TOAD after every upgrade.
- Ran stress testing using HP LoadRunner. Interacted with the users and logged any defects&enhancements from the UAT.
- Worked with the Training Group to build training materials as well provided any suggestions/tool tips to assist in User Training.
Environment: Rational Rose and Requisite Pro, AutoCad, MS Visio, MS Access, MS Project, MS SharePoint, Mockplus, UML, Windows XP, NT/2000, HTML, HP LoadRunner, MicroStrategy, J2EE (JSP1.2), XML, XSL, XSLT, HTML, Oracle 9i.