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Business System Analyst / Functional Analyst Resume

Providence, RI

SUMMARY

  • An experienced business systems analyst with 9+ years of practice in Healthcare industry in claims, enrollment and benefits. Helped companies stay compliant by following CMS standards and reducing penalties which eventually halped increase the revenue and work efficiency.
  • Has thorough noledge of Medicare and Medicaid requirements along with an experience of working on various government programs.
  • Working as an independent consultant, gave me an opportunity to learn the best of practices performed across the industry and taught me a sense of responsibility towards time sensitive projects. After spending six months in Dubai due to my husband’s project, a result - oriented individual who can work independently, in a team or can lead a team, is looking forward to halp benefit other companies and put to use the extensive noledge along with analytical and problem-solving skills.Business Skill:
  • HIPAA ANSI X12 4010-5010, CPT and ICD-9 / ICD-10 Codes, MMIS, FACETS, Medicare, Medicaid, CMS compliance regulations, Government programs, Vendor management, API / Webservices

TECHNICAL SKILL:

  • MS SQL Server
  • Microsoft Office
  • JIRA
  • Kanban board
  • SharePoint
  • Crimson editor
  • UML
  • Rational series
  • MicrosoftVisio
  • IBM Blue works
  • Crystal Reporting
  • SDLC: Agile Methodology and waterfall

PROFESSIONAL EXPERIENCE

Confidential, Providence, RI

Business System Analyst / Functional Analyst

Responsibilities:

  • Worked on print vendor replacement project to halp build new USB ports to handle multiple API calls and reduce the time spent in printing these documents and increasing company’s efficiency.
  • Worked on Fraud framework vendor replacement project to reduce losses incurred due to the ongoing claims fraud which were not caught by old method.
  • Worked on impact analysis of HICN and SSN replacement with MBI number, whose requirements were provided by the CMS board.
  • Worked on projects related to Government Programs: analyzing requirements for the enhancements of the existing plans (Plan 65) and gathering requirements to introduce additional benefits to the new as well as existing members before the next enrollment period begins.

Confidential, Prussia, PA

Business System Analyst

Responsibilities:

  • Created functional requirements documents, participated in design development discussions to make sure deliverables are falling in the sprint cycle for the Webservices / API development project and enhancements for Provider Manager - Contract Manager Applications which in turn will increase company’s revenue and clienteles.
  • Lead grooming session along with the daily construction board stand ups / SCRUM sessions with the offshore development team. Also, maintained the Kanban boards for Initiative Analysis and tracked features, stories and defects using Jira tool.
  • Reviewed and tested the JSON response created by the developer to validate thedatain the back-end Oracle Database
  • Extensively mapped Facets data model with Provider manager data model and Contract Manager data model.
  • Assisted the company in meeting contracted CIGNA client deadlines which directly impacted revenue of the company

Confidential, Ewing, NJ

Business System Analyst

Responsibilities:

  • Adhered HIPAA and CMS regulations for insurance & Medicaid claims, for various projects related to Government programs and business development to maintain company’s compliance status.
  • Read the state of NJ and CMS contracts to give requirements to the vendors dat processed Dental, Vision, Medical, Pharmacy and Lab claims for HNJH
  • Analyzed transaction flow of various EDI XII HIPAA Healthcare Transactions to halp reduce penalties. Assisted business holders in processing TAI and 999 rejected encounters.
  • Thoroughly understood and Implemented 5 key aspects of HIPAA - Transactions, Identifiers, Codes, Privacy and Security to avoid becoming non-Compliance issues and reduce penalties
  • Also worked closely with business on resolving issues related to FACETS and its enhancements.
  • Actively worked with SQA team to design test plan for SIT testing

Confidential, Austin, TX

Sr. Business Analyst

Responsibilities:

  • Worked on ICD 9 to ICD 10 crosswalk by grouping and mapping thousands of codes as per the guidelines provided by CMS
  • Coordinated the upgrade of Transaction Sets 837 and 835 to HIPAA compliance
  • Performed gap analysis 837P and 835 transactions for HIPAA 4010 and HIPAA 5010
  • Performed data analysis, created data mapping and data interface documents
  • Worked efficiently with business users and IT team in War room to solve the issues on time to maintain the project timeline
  • The project followed Agile Scrum methodology

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