- Have 9+ years of expertise in Business Analysis and Testing with hands on experience in Healthcare, Insurance and Financial domain
- Experience in understanding and supporting both the Business and Technical teams in all Phases of Software Development Life Cycle (SDLC) by using different Methodologies like Iterative, waterfall, agile - scrum and Rational Unified Process (RUP).
- Extensive experience in Business Requirements gathering and writing skills with expertise in developing and documenting Business Requirement document (BRD), Functional Requirement Document (FRD),Software Requirement Specification (SRS) across the deliverables of a project.
- 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.
- Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
- Good working knowledge of Claims processing, Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction Set EDI X12 837, 270/271, 276/277, 278, 835, Implementation and Knowledge of HIPAA code sets, ICD-10 coding and HL7.
- Experience with HIPAA 5010 EDI healthcare transactions and ICD 10 codes.
- Broad knowledge of Medicare, Medicaid, PPO, HMO, POS, diagnostic codes and claims process.
- Experienced in Data Warehouse Environment including Data Analysis, Data Modelling, Data Mapping, Data Integration and Data Migration using ETL tool- Informatica.
- Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users as well as trained users to use the system configured.
- Working with QA and testing teams in close co-ordination in developing Test Plans, building Test Conditions and Test cases, creating test data, analysing bugs, Interacting with development team to fix the errors; Facilitated User Acceptance Testing (UAT) with client representatives.
- Good working knowledge of Microsoft Office Suite including - Word, PowerPoint, Excel, Access, MS Visio, Rational Rose, Rational Requisite Pro.
Business / Modelling Tools: MS Power BI, Adobe Dreamweaver, MS Project, MS Visio, MS Excel, MS Word, MS PowerPoint, Rational Rose, Adobe Photoshop
Requirements Management Tools: Rational Requisite Pro
Databases: SQL Server, Sybase, MS Access, Oracle
SDLC Methodologies: Rational Unified Process (RUP), Agile, Scrum, Waterfall, Iterative
Operating Systems: Windows 95/98/2k/NT/XP/Vista/Window 7
Testing Tools: HP ALM, Quick Test Professional (QTP), Load Runner, Rational Test Manager, Rational Clear Quest
Business Analyst / Project Coordinator
- As an active member of PDP team, interacting with developers, business users and subject matter experts (SMEs) to analyze and configure PBM Web-Portal functionality based on Business Requirement.
- Gather and analyze requirements for Member eligibility (Group and Individual), Coordination of Benefit (COB), Billing and Payment to develop PBM (Prescription Benefit Management).
- Worked on Configuration and integration of Member Enrollment, CMS, Drugs, and Plans, Pharmacy, Claims, Clinical and AR/AP (member activity) Management sections.
- Create and Analysis of Data Transaction Reply Report (DTRR), Schedule meetings with Business team and Developers on project status.
- Conduct JAD sessions with Business Team and Developers to discuss the Code implementation and configuration of Web Portals.
- Performed Regression testing on both internet and intranet Web-portals to check compatibility between two code releases.
- Create and Maintain Requirements, Test Cases and Test Plans
- Coordinate with BSA to analyze User requirements, Current operational procedures, functional specifications and User data processing.
- Run Batch eligibility query (BEQ) files; check Transaction Code (TC) and Transaction Reply Code (TRC) to make sure Member enrollment has been completed.
- Perform object-oriented analysis, discuss findings with Developers to make sure both teams are on same page during the development process.
- Attend walk through meetings for Requirements Review, Analysis and Approval of them.
- Worked on System and Integration testing and used Mantis (Bug tracking tool) to report and monitor issues in code, Perform Manual Testing to make sure issues have been fixed.
- Deal with CMS Member Pending Enrollment on daily basis like Low income Part (LIP)-D, Late enrollment penalty (LEP) etc.
- PBM in corporate complete Member Enrollment and Eligibility check, Drugs Prescription, Plan design, Claim adjudication and Verification, Call chain, Rx enquiry, Clinical requests handling etc.
- Developed Traceability Matrix including BRD and FRD to track down different defects related to Member enrollment & eligibility, Claims adjudication, Clinical request from members.
Environment: UML, SQL, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access), Clear Quest, Requisite Pro, GEM, JIRA, SharePoint, .Net, Java, HTML, XML, CSS.
Confidential, Birmingham, AL
Business System Analyst
- Worked on QNXT including Claim processing (online and batch adjudication), Case management, Customer service, Member/subscriber administration, Provider network management and reporting.
- Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
- Responsible for system integration testing of 837 claim files, 834 eligibility files and 270/271 interface files to ensure required interactions are met during the SDLC process.
- Validated Inbound and outbound 837 transactions, including but not limited to the loading and correcting any errors with the process of EDI inbound and outbound files
- Validated outbound 835 transactions including but not limited with vendor on QNXT mapping and system configuration.
- Business Process Analysis/End User Education/Business Requirements Documentation
- Validated System configuration, including enrolment, provider and benefits modules
- Creation of queries and reports to assist Health Plan Operations with the analysis of data relating to claims, members and providers.
- Worked with the Business Representative to understand requirements and priorities and ensure that building of pharmacy claims processing system was aligned appropriately.
- Created project plan and WBS using MS project and JIRA (during design, development and testing phases)
- Updated the pharmacy retail locations to the ETL table and worked with HIPAA X12 EDI transactions (834, 837)
- Worked closely with ETL leads/Managers and performed data requirements analysis and documenting the analysis.
- Execution of daily, weekly and monthly reports and processes and the creation of ad-hoc reports.
- Broad knowledge of CCHP departmental processes, procedures and data.
Environment: QNXT, RUP, Rational Rose, Requisite Pro, MS Visio, RUP, MS Project, SQL, Oracle, HTML, XML, CSS, MS Access, MS Excel and MS Word.
Confidential, Long Beach, CA
Business System Analyst
- Provided Pharmacy expertise to Pharmacy SME's to supplement and expedite research and discovery of business processes and requirements.
- Coordinated with lead Pharmacy SME's in gathering and documenting information, requirements, and workflows.
- Document workflows in Visio and requirements in MS Word templates.
- Performed other research and documentation tasks to support the BPR project for Pharmacy stakeholders and SME's.
- Assisted PM and provided input for scope, goals, risks, constraints, timelines and interfaces for project planning and control also helped in document creation.
- Involved several working sessions and much 'offline' research/documentation with the key stakeholders and SME's from the Pharmacy department.
- Illustrated the existing process (AS-IS) versus the new process (TO-BE) via GAP Analysis which would provide solution to the business need using the diagramming tool MS Visio.
- Involved in business intelligence by gathering, analyzing, validating, and documenting the data elements.
- Created UML Diagrams such as Use Case, Activity, Sequence, Swim Lanes, Context Diagram, Data Flow, System Interfaces, Entity Relationship diagram (ERD) using the MS Visio.
- Involved in generation and execution of SQL queries to understand the processes used by the pharmacy department.
- Conducted meetings with the project managers to review the project plans.
Environment: Facets, SQL Server, SSRS, MS Visio, MS Office (Word, Excel, PowerPoint, MS Project, Windows NT, SharePoint, HP ALM, HP Quality Center, Agile, Microsoft outlook.
Business Systems Analyst
- Analyzed and tested Data Interface needs.
- Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
- Responsible for creating SIPOC, swim-lane, UML uses case business process representations.
- Used Curam framework to drive requirements, process flow documents, and subsequent design estimation. Used Query Analyzer, Execution Plan to optimize SQL Queries.
- Gap Analysis: Analyzed the client's applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
- Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication.
- Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA. Set up test environment to facilitate Test Plan.
- Worked extensively on both inbound and outbound transactions, creating test cases for multiple transaction types including 837, 835, 276, 277, 270 271.
- Maintained Requirement Traceability Matrix (RTM) for change requests and defect tracking.
- Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
- Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
Environment: Windows 2000/XP, Microsoft Office SharePoint, Rational Requisite Pro, MS Office, MS Project, SQL Server, MS Project, MS Visio, MS Access, EDI, HL7, Documentum 2.0., UML
- Coordinated IT projects and compiled project status reports, coordinates project schedules, manages project meetings, and identifies and resolves technical problems.
- Worked on Policy Submissions, Policy Changes, Policy Renewals, Rewrites and Reinstatements Functionalities
- Scheduled and conducted JAD (Joint Application Development) sessions for analysing and documenting requirements.
- Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases of the Software Development Life Cycle.
- Carried out AS-IS and TO-BE Analysis to showcase the improvements in business processes.
- Followed the UML based Methods using Rational Rose to create Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams.
- Used Requisite pro to input all the data elements, Use cases, and UI specifications.
- Prepared Business Process Models that includes modelling of all the activities of the business from the conceptual to procedural view.
- Aided management in standardizing web applications by preparing GUI standards and recommending alternative strategic solutions incorporated in a phased and iterative manner.
- Prepared Test Strategy and Test plan documents.
- Worked for multiple Sprints in Agile Methodology.
Environment: UML, RUP, Microsoft Office Suite, Microsoft Visio, Unix, Documentum, Windows NT/XP, Oracle, SQL, SQL Server, Sybase, VBScript, C#. DOORS, C++, NET, Business Objects
- Conducted Interviews and Brainstorming Sessions with stakeholders to gather requirements and end user perspectives in order to identify deficiencies and areas for improvement & enhancement.
- Identified As-is and To-be process maps as part of Gap Analysis for new functionality requirements, and thereafter prioritized them in order to align them with the project roadmap.
- Collaborated with Product Owners to write up and prioritize customer centric documents like User Stories for Product Backlogs.
- Interacted extensively with customers and user interface (UI) designers to determine ways to improve the UI feel and user experience.
- Created Mock-up forms for better visualization and understanding of the Graphic User Interface (GUI).
- Assisted the SCRUM Master in facilitating daily SCRUM meetings, Sprint Planning, Review and Retrospective meetings. Created Burn-down Charts to monitor the completion of work within time-boxes.
- Participated in Daily Stand-up meetings and worked with the team in resolving issues that could potentially cause delays in the sprint completion
- Conducted training sessions and updated Product Manual upon successful delivery of each sprint.
Environment: Agile Methodology (SCRUM), MS Visio, MS Office Suite, Java, XML, SQL, Smart Draw, Jira