SUMMARY

• Over 8 years of extensive experience as a Business System Analyst/ Business Analyst, in insurance, pharma and Healthcare, using IT business analytics and SDLC (Systems Development Life Cycle)
• Subject matter expert specializing in Business Analysis, Amisys, Facets configuration, Benefitsconfiguration, Eligibility & Pricing configuration, medical billing, Claims processing, and Healthcare Payer Domain.
• Extensive experience in the Medical Management, caremanagement and Hospital based applications.
• Experienced in interacting with businessusers to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), General system Design (GSD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Hands on experience in designing, developing and documenting Validation Master Plan (VMP), Standard Operating Procedures (SOP), Installation Qualification (IQ), Operation Qualification (OQ), Performance Qualification (PQ) and Validation Summary Report (VSR)
• Performed quality reviews/approval of validation documentation for various software configurations/releases (with a focus on SDLC) of the Electronic Data Capture and Clinical Data Management product, RAVE, to assure their suitability for client audits to include compliance with 21 CFR Part 11 and CDISC standards.
• Experience in working with Microsoft Office suite (word, excel, Access, Visio), Power Point and Outlook) for documentation, analysis and presentation.
• Experience in development of Process Flow Diagram, Use Case Diagram, Activity Diagram, and Sequence Diagram by using UML methodology using tools such as Rational Rose and MS Visio.
• Strong experience in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
• Extensive knowledge of Medicaid (MMIS), Medicare, Procedural and Diagnostic codes and Claims Process.
• Experience in utilizing SAS Procedures, Macros, and other SAS applications for data extraction, data cleansing, data loading and reporting.
• Proficient in developing & automating reports, iteratively build & prototype BI dashboards using Tableau to provide insights at scale, solving for analytical needs of business team.
• Experience with BI tools, Micro Strategy, Tableau, Cognos.
• Proficiency using Tableau Server, Tableau Desktop, Tableau cloud, Tableau Online from versions 8.x to 10.x.
• Unique experience with HEDIS guidelines criteria for Medicare and Medicaid abstraction
• Worked on the implementation and conversion of ICD - 9 to ICD-10 codes.
• Good Management, Execution and Documentation skills, cultivated strong relationships with Technical team, Vendors and Clients.
• Adept in writing SQL queries for data extraction, manipulation, analysis, and validation, generating user reports and proficient knowledge of Relational Database Management Systems (RDBMS), and Data Warehousing.
• Experience in conducting GAP analysis, SWOT analysis, User Acceptance Testing (UAT), Impact analysis, Risk analysis and mitigation plan, dept in writing SQL queries for data extraction, manipulation, analysis, and validation, generating user reports and proficient knowledge of Relational Database Management Systems (RDBMS), and Data Warehousing.
• Worked in Oracle, DB2, SQL server, MS Access.

TECHNICAL SKILLS:

Business Modeling tools: MS Visio

Project Management: MS Project, Microsoft Office Suite and MS share point

Management Tools: Word, Excel (Pivot Tables), Power point, One note, Outlook, MS Access, Quality center

Data bases: MS Access, SQL, Oracle, DB2

Environment: SDLC, Rational Unified Process (RUP), JAD, Waterfall, Agile, RAD, Change Control Process

EDI Healthcare Transactions: 834 (Memberships), 835 (Payments from Payer), 837p (Professional Billing),837i (Institutional Billing), 4010, 5010, 270, 271, 276, 277, 278)

Reporting tools: Tableau, MicroStrategy, Excel, Cognos.

PROFESSIONAL EXPERIENCE:

Confidential - CA

Sr Business Analyst

Responsibilities:

• Worked closely with medical management, claims, provider services and member service team to understand their day to day operations and identify gap analysis.
• Created Workflow documentation for Utilization Management, Case and Disease Management, and Quality Improvement teams.
• Act as a subject Matter Expert from Medical Management to Case net platform (TruCare)
• Perform detail analysis and provide recommendations on existing processes, requirements and workflows.
• Assisting users with questions and issues usingTableau. Working with various infrastructure teams andTableausupport team to help improve dashboard response time.
• Created Rich dashboards using Tableau Dashboard and prepared user stories to create compelling dashboards to deliver actionable insights.
• Deductible Rules and Limit Rules, Stop Ages/Waiting Periods and ServiceDefinitions.
• Designed and documented, code & testFacetsMedical Plan, Product, Provider, Pricing, Subscriber/member, Claims, Utilization Management, Finance, Billing, Accounting, Customer service, workflow, security, etc. Application configurations to support new and existing business requirements for migration projects, new implementation and current production.
• Demonstrate understanding and experience with SQL queries.
• Works with UI team to create the User Interface screenshots and presented to thebusinessfor their approval.
• Using MS VISIO to create Use Case diagrams and Sequence diagrams so that the development team and other stakeholders can understand thebusinessprocess.
• Works with theBusinessTeam to review UAT validation scenarios and execute the UAT test cases.
• Assist in creating training materials for hospital employees to get them familiarized with the new technological advancements to be incorporated by the hospital.

Environment: SDLC, UML, SQL, MS Word, MS EXCEL, MS PowerPoint, JIRA, ableau(Desktop/Server.

Confidential -CA

Business System Analyst

Responsibilities:

• Responsible for business analysis, requirement specifications, project planning and identifying the resources and implementation of the project.
• Responsible for facilitating the identified risks and issues by tracking these through the SDLC, scheduling and recapping team meetings.
• Coordinated product complaints through Track Wise. Initiated investigation and identification of root cause for defects returned from the field under FDA and GMP guidelines using CAPA Track Wise.
• Drafted SDLC documents such as GxP assessments, 21 CFR Part 11 assessments, user requirements specifications (URS), design specifications (DS), traceability matrices (TM) for computerized systems.
• Responsible for interaction with business stake holders, gathering requirements and managing the delivery, covering the entireTableaudevelopment life cycle
• Involved in gathering requirements and translated the business details into the Functional Specification Documents that described the different types of processes.
• Assisted business analysts in leading JAD sessions and developing documentation for Technical Requirements and Functional Specifications for all automated workflow using Visio to ensure reusability and validation with the new technological platforms.
• Adhered to the change control methodologies while deploying the code from development, Quality Assurance and Production
• Managed all types of functional change requests in the 'patient' module of the application, including defects, enhancements, issues and documentation changes with a flexible workflow process using Quality Center.
• Coordinated withbusinessowners,businessanalysts (BAs), quality assurance (QAs),developers, user acceptance testers (UATs), and change advisory board members for routine enhancements/change requests
• Worked closely on documentation in regard to GMP and traced it through various procedures to ensure quality and avoid contamination.
• Developed the Project using the Iterative RUP model. The Project was streamlined through all phases of the Rational Unified Processes (RUP) model starting from Inception through Transition. Used a Functional Decomposition strategy to divide system into sub-systems.
• Evaluated application testing results and recorded the discrepancies using Quality Center to track, analyze and report on them.

Environment: User Acceptance Testing (UAT), Oracle SQL 2012, Rational Clear Quest, MS Access, Windows, Rational Test Manager, MS Office's 2012, CSV files other various Data Source's, JIRA, Tableau(Desktop/Server).

Confidential -Philadelphia, PA

BusinessAnalyst

Responsibilities:

• Conducted requirements gathering meeting for all reports/extracts with business team.
• Worked closely with data architects to improve data's performance by reducing the number of calculated fields and thus optimizing performance
• Worked closely with care management team to Improve quality outcome of members.
• Mastered the ability to design and deploy rich Graphic visualizations using Tableau
• Preformed Facets Configuration for Group/Subgroup/Class/Plan/Product/Billing Entity, Provider, and Subscriber/Member.
• Reviewed and Updated Claims with Eligibility issue for that were driven thru Claims Facet Workflow.
• Preformed updates to Member for PCP assignment. Created a process to report and troubleshoot issues on Members not aligned correctly for assigned Plan, network set arrangement, and PCP assignment.
• Produced Monthly Status reports to management for all groups' build/maintenance functions.
• Written desktop procedures for facets functions.
• Created FRD by mapping requirements back to system tables and fields with appropriate logic.
• Scheduled, Facilitated and managed JAD sessions with business team members from various business teams.
• In the beginning of the project worked with PM in making the Project Charter describing the business need of the project and also reviewed the scope document and provided inputs.
• Performed GAP analysis to derive requirements for existing systems enhancements
• Worked closely with QA on UAT and reviewed their work from time to time to make sure the work done is in alignment with the desired specifications.
• Implemented new agile processes planned and coordinated sprints with project management in a Waterfall/ hybrid environment.
• Worked with SQL queries for data manipulations.

Environment: UML, MS Visio, SQL Server 2000, MMIS, Microsoft Office, Agile, Oracle, Quality Center, JIRA Tableau(Desktop/Server).

Confidential, Cleveland, OH

Business Analyst

Responsibilities:

• Documented business requirements and communicated these requirements to the development team for the design and implementation of business solutions.
• Prepared use cases and data flow diagrams to analyze the impact of ICD 10 diagnosis codes embedded in different systems and applications
• Provided Production support toTableauusers and Wrote Custom SQL to support business requirements.
• Coordinated with Business Owner, Application Vendor, Business Project Teams, Payers, and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the 5010-compliancy requirements
• Extensively worked with EDI transaction 837 (Professional & Institutional) following the HIPAA compliance EDI standard format of x12
• Worked on Data cleansing and loading application using ETL,Tableau and SQL Server.
• Developed Functional Specification document for each sprint including Interaction diagrams, and User stories.
• Worked closely with office of health care reform on current issue from CMS on 834 files. Raised tickets with CMS and triage the issues on basis of severity.
• Created DMR mapping spreadsheets, Source to Target mapping documents including the transformation rules
• Developed BSDs for business services related to eligibility verification, and enrollment.

Environment: HIX, UML, MS Visio, MS Office, SQL Server, Office 365.

Confidential

Jr Business Analyst

Responsibilities:

• Gather requirements by conducting meetings and brainstorming sessions with end users and SME and document them using Requisite Pro - the documentation tool offered by Rational.
• Facilitate JAD sessions involving the management, development and user teams for clarifying requirements and facilitating better communication.
• Perform Gap Analysis of the processes to identify and validate requirements.
• Extensively involved in data modeling, Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle data base.
• Review the Test Plan developed by the testing team for testing the application.
• Assist the QA personnel in the creation of Test Cases using Rational Test Manager.
• Involved in performing version control and defect tracking activities using Rational Clear Case and Rational Clear Quest.
• Involved in facilitating UAT and getting sign off from the users.

Environment: Water Fall-Scrum, Oracle, PL-SQL, Framework Manager, VISIO.