SUMMARY

• Experience in assessing scope of the project and defining the business case.
• Ability to perform Gap analysis, impact analysis and feasibility study.
• Requirements management and change control.
• Expertise in creating Business Requirement Document (BRD), Functional Requirement Document (FRD/FRS) & Requirements Traceability Matrix.
• Active involvement with QA for data verification on different databases.
• Able to act as a line of communication between stakeholders, business users and technical teams to clarify any questions on requirements.
• Experience in developing surveys and interview questionnaires for interviewees and selecting the target population segment.
• Strong experience with ORACLE RMB in automating payroll deduction and Process high - volume group bills.
• Complete knowledge about Revenue Cycle Management from life cycle of a patient, through a typical healthcare encounter from registration to final payment.
• Handled all sizes of groups and membership, added customers one at a time or in large groups typical of acquisitions using Oracle RMB.
• Strong analytical, complex problem solving, solution design, and documentation skills to provide businesses advance strategies to improve their processes and revenue in a changing environment.
• Strong Proficiency in using UML techniques to design and create Use Case Diagram and Activity Diagrams using tools like MS Visio and Rational Rose.
• Strong knowledge about Revenue Cycle Management from administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.
• Experience in organizing and conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
• Extensively used tools like HP Quality Center and Rational Requisite Pro for defect tracking and requirement management.
• Capable of using SQL to extract data for data mining and extraction in order to perform the needed analysis tasks.
• Excellent interpersonal skills, organizational skills and strong detail oriented and self-motivating skills.
• Possess strong analytical and problem solving skills with the ability to adapt to a new environment and meet stringent deadlines.
• Involved in UAT Test Planning, Test Cases, Issue Resolution, and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements.
• Ability to succeed in time-bound projects with stringent deadlines and multi-cultural environments with solid determination and dedication towards customer and team satisfaction.

TECHNICAL SKILLS

Project Methodologies: RUP, Agile SCRUM and Waterfall.

Process Modelling: Use Case Diagrams, Data Flow Diagrams, Activity Diagrams, Wireframe Modelling

Project Management: Project Charter, Scope assessment, Gantt Chart, Scope & Vision Document

Languages: C, C++ and Visual Basic

Markup Languages: HTML, XML

Requirement Management Tools: Rational Requisite Pro, HP Quality Center, Oracle

Project Management Tools: HP ALM/Quality Center.

Packages: MS Office

PROFESSIONAL EXPERIENCE

Confidential, CA

Sr. Business Analyst

Responsibilities:

• Worked on various features for billing, payment processing, debt and lapse
• Worked on the Functional Offerings of Oracle Insurance Revenue Management and Billing
• Maintained bond maintenance portals and assisted in functional requirements.
• Gathered requirements for Oracle RMB applications. Formulated the BRD and FRD accordingly to meet the needs of the user.
• Used database tables and prepared SQL queries
• Created Functional requirements in adherence to business requirements
• Provided inputs to create software maintenance.
• Assisted in developing the test scenarios.
• Worked with internal team in resolution of defects of the system.
• Provided inputs for customization of Functional Offerings of Oracle Insurance Revenue Management and Billing
• Followed the UML based methods using MS Visio to create Activity Diagrams, Sequence Diagrams and created screen mockups using Visio
• Played an instrumental role in developing a solid network of suppliers and ensured that all vendors were in 100% compliance with the company's quality assurance standards
• Assisting business users in defining UAT test cases and plans.
• Assisted QA teams to document test cases and test data in Quality Center
• Examined, analyzed and model Test plans, Use Case Model cases & Test procedures based on RUP methodology
• Performed Gap analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements
• Involved in the continuous enhancements and fixing of production problems
• Used SQL Server to build high performance data integration solutions including extraction, transformation and load packages for data ware housing
• Involved in walkthroughs and meetings with development team to discuss related issues
• Wrote clear, concise detailed System Requirements Specification (SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance
• Assisted in the Security Configuration in the application
• Was instrumental in the assisting testing and execution of Database Script and ORMB Application using Unix-Oracle-Database as per the requirements

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Prepared documents such as Business Requirement Document and Functional Requirement Document.
• Configured business rules to change billing processes as needed.
• Configured the system to handle billing processes to support reinsurance billing, as well as manage fees and adjustments.
• Prepared requirement traceability matrix for HIPAA compliance, various business rules depending on the state and ensuring the metavance functionalities are in compliance.
• Interacted extensively with End users and Technical leads to review and obtain sign-off document across all business functional areas - Provider, Claims, Customer Service, Products, Group/Member, Billing/Finance, Security and Utilization Management.
• Gathered requirements and formulated the documents for enrolment in Oracle RMB
• Worked on Group billing, list bill processing and individual billing.
• Setting complex multi-level group structure.
• Calculation of fees and discounts, Stop loss calculation (both individual and aggregate).
• Knowledge of 837, 835,834,276,277, 270,271 HIPAA EDI and X12 transactions.
• Wrote and Executed SQL Queries to ensure data accuracy for the data.
• Verified correctness of data after the transformation rules were applied on source.
• Worked on 837, 835, 834 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validations for loops, segments, elements, qualifiers and code sets.
• Worked on Metavance used to support HIPAA version 4010 and 5010 and transactions type like 837, 834, 835, and 276/277.
• Worked on different Electronic Data Interchange (EDI) formats such as X-12, formats.
• Ran Oracle RMB batch jobs to create Bills for customers and interfacing payments to accounts
• Conducted and participated in JAD sessions to ensure the users, Developers, QA were on the same platform.
• Analyzed the business processes driving application development and suggested enhancements for functional and usability.
• Responsible for documenting and managing Scope creep and handling complex issues to enhance the business.
• Discussed and created mock up screen and presentations on the new enhancements desired for the application.
• Was also involved in the data migration effort to migrate the data from the legacy billing system to Oracle RMB.

Confidential, Nashville, TN

Business System Analyst

Responsibilities:

• Created documentations on enhancement reflecting Revenue cycle management improvement for providers.
• Facilitated JAD sessions taking into consideration the agenda and meeting minutes with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure.
• Gathered and educated the team involved on Health level 7 (HL7) specifications.
• Conducted GAP analysis and created AS- IS and TO- BE workflow to better understand the mechanics of the existing system.
• Performed analysis and review of concurrent discharge charts for quality of ICD 10 CM coding and assuring correct DRG of knowledge for optimum reimbursement.
• Performed GAP analysis of 4010 and 5010 EDI transactions using implementation guides to identify the changes in the segment and data elements.
• Gathered requirement for Claim management (KPIs) for Confidential Vision, Claim Management.
• Discussed and created mock up screen and presentations on the new enhancements desired for the application.
• Created Business & Functional Requirement Document (BRD) along with Physical and Logical Data models for Claims process from legacy system.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
• Provide the overall coordination and support of all internal Electronic Data Interchange (EDI) objectives and tasks.
• Facilitated UAT for the users.
• Worked with QA team to test the application quality and perform UAT, conducted root cause analysis for UAT environment.
• Also built the requirement for QA testing on HP ALM (defect management and tracking software tool).

Confidential

Business Analyst

Responsibilities:

• Assisted Project Manager in creating project charter, project plan using agile methodology for SDLC
• Gathered Medicaid specific requirements for health coverage under Medicaid Advantage and prescription drug plans.
• Conducted GAP analysis and created AS- IS and TO- BE workflow to better understand the mechanics of the existing system.
• Facilitated the resolution of project-related issues, identified risks and mitigation steps to manage risk
• Performed analysis and review of concurrent discharge charts for quality of ICD 10 CM coding and assuring correct DRG of knowledge for optimum reimbursement
• Facilitated JAD sessions taking into consideration the agenda and meeting minutes with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure.
• Performed GAP analysis of 4010 and 5010 EDI transactions using implementation guides to identify the changes in the segment and data elements.
• Performed impact analysis by identifying the functional business areas and supporting information technology that will be impacted by the conversion from ICD 9 to ICD 10.
• Ensured backwards compatibility from HIPAA 5010 and ICD-10 crosswalk framework
• Created Business & Functional Requirement Document (BRD) and (FRD) and Physical and Logical Data models for Claims process from legacy system
• Applied the SQL scripts to the test database and execution of the scripts on the database
• Gathered client specific business requirements and translated it in a proper manner to the developers, and ensured that these requirements were completely tested and Responsible for creating business work flows and processes using Rational Rose for creating management reports based on the analysis.
• Assisted in gathering requirements for the Care Management (CM) and Disease Management (DM) Programs.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
• Provide the overall coordination and support of all internal Electronic Data Interchange (EDI) objectives and tasks.
• Facilitated UAT for the users.
• Worked with QA team to test the application quality and perform UAT, conducted root cause analysis for UAT environment.
• Project management, update and controlling to ensure on time delivery using MS Project.