PROFESSIONAL SUMMARY:

• Over 8 years of proactive IT experience as a Business Analyst within the healthcare industry focused on both payer and provider side with knowledge of SDLC methodologies particularly RUP, AGILE - SCRUM and Waterfall with expertise in software design, development and testing.
• Excellent knowledge of Medicaid, Medicare (Part A, B, C, D), Procedural and Diagnostic codes and Claims Process.
• Strong knowledge of HL7 Standards, HIX, EHR - Electronic Health Records, EMR - Electronic Medical Records, CMS regulations, Meaningful Use Compliances, Health Care Reform, EMTALA, PPO, POS and HMO.
• Well versed with clinical workflows and EHR/EMR systems like Care Radius, Cerner and McKesson
• Experienced in Membership, Billing and Claims Payment Processing in relation to HIPAA 4010A/, EDI codes 834, 837,835, 270/271, 276/277 and 820, and ICD-9/ICD-10.
• Excellent knowledge of Medicaid Management Information Systems (MMIS)
• Proficient in Trizetto Facets implementation and conversion of 4.41/ 4.51 / 4.71 / 4.81/5.01.
• Experienced in conducting different requirement gathering techniques like Brainstorming, JAD sessions, Focus Analysis, Reverse Engineering, Survey, Document Analysis, Interview, Prototyping and Observation.
• Experienced in authoring various documents such as Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Experienced in GAP analysis and AS is to be process.
• Proficient in requirement analysis and creating Use Cases, Sequence Diagrams, Activity Diagrams, Class Diagrams using Object Oriented Analysis and Design (OOAD).
• Adept experience working with ETL (Extract, Transform and Load) of data into a data warehouse/data mart and Business Intelligence (BI) tools.
• Extensively used DDL and DML Commands in SQL for back end testing.
• Involved in reviewing test procedures, defining test cases, reviewing and maintaining test scripts, analyzing bugs and User Acceptance Testing (UAT).
• Dedicated, results-oriented and motivated team player with excellent communication, analytical, leadership, interpersonal and problem solving skills.

TECHNICAL SKILLS:

SDLC, RUP, Agile, Microsoft Project, Microsoft Office, Rational Rose, Microsoft Visio, Rational Requisite Pro, Clear Quest, Test Director, Rational Clear Case, Rational Enterprise Suite, Test Director, Erwin, WinRunner, C, C++, Java, .Net, XML, UML,HTML, Oracle, MS SQL Server, MS-Access, Windows Family, Familiar with UNIX and LINUX, SQL Server, Sybase, DBS, Business Objects.

PROFESSIONAL EXPERIENCE:

Confidential, Fort Washington, PA

Sr. Business Systems Analyst

Responsibilities:

• Worked for operating support group involved in multiple projects for the claims and compliance department.
• Worked on EDI 270/271,276/277, 835 &837 for the claims department and interacted with Affinity’s compliance, special investigation department & PA state DOH(Department of health)
• Worked extensively with vendor Red Card who was contracted to send letters on Confidential ’s behalf on a quarterly basis
• Created data mapping documents based on Red Cards specification which involved working with Facet claims, membership & plan data model
• Extensively used SQL queries to fetch data from different claim & membership table(CLCL CLAIM,CDML CL LINE,MEME MEMBER,SBSB SUBSC)
• Interacted with affinity’s Medical management, Customer service & Intake team (provider authorization)
• Designed screen mockup/layout after taking input from customer service, intake team.
• Designed the look & feel of the CDRS front end (auth grid search screen)
• Validated HCPCS & CPT codes in Facets, worked with configuration analyst for configuring missing CPT & HCPCS codes in Facet
• Developed mapping documents based on Clearing House’s specs & CAQH core operating rules
• Mapped clearing house provided service codes to Facet by developing crosswalk tables
• Worked with plan data model in Facet front end (2X) & backend (CMC PLDS PLAN DESC, CSPI CS PLAN, CMC SETR TIER)
• Documented claims extraction process using Visio and worked with provider relation & membership department
• Performed Root Cause Analysis for errors found in facet for membership and claims status
• Conducted offshore testing with cognizant team in Chennai India
• Facilitated issue resolution and created RFC’s presenting in CAB (change advisory board) meetings
• Performed UAT, modified requirement to improve functionality based on user input

Tools: Agile, MS Excel, Visio, SQL server 2008, Facets 5.01, outlook, share point

Confidential, New York, NY

Sr. Business Systems Analyst

Responsibilities:

• Exercised control throughout all the sprints of the Project life cycle
• Involved in creating project Charter and SOW for implementation of the project.
• Prioritize user stories and assigned to different sprints.
• Facilitated daily stand ups and managed task board with user stories and board.
• Prepared and tracked burn down charts and velocity charts for timely delivery of projects.
• Prepared product backlog working with product owner and other SME.
• Efficiently interacted with designers and software developers to understand application functionality and navigational flow and keep them updated about business user’s specifications.
• Involved in designing and defining User Interface Requirements (UIR) and visual patterns by creating wireframes, screen mockups and story boards.
• Coauthored initial project glossary and an initial business case, which included business context, success criteria (revenue projection, market recognition, and so on), financial forecast and an initial risk assessment.
• Developed understanding of various transactions involved in transition from HIPAA 4010 to HIPAA 5010 like Eligibility, Benefit, Claim submission transactions
• Analyzed and validated requirement for HIPAA 5010 and gathered requirement for ICD10.
• Analyzed and documented differences between the AS-IS and TO-BE processes.
• Worked on EDI 270/271 (Claim Eligibility Inquiry) /276/277 (Claim Status Check) /837 Claim Submission /835 (Claim Remittance).
• Developed mapping documents for ICD 9 to ICD 10 application.
• Performed UAT, Regression testing on EDI 835 and format.
• Analyzed all ICD10 codes and validated the outcomes.
• Supported User Acceptance testing (UAT) and collaborated with the QA team to develop test plans, test scenarios, test cases and test data to be used in testing, based on business requirements and application knowledge.
• Interacted with the developers to report and correct bugs.
• Created and maintained Issues Log and ensured timely resolution of all items

Tools: MS Office Suite, MS Visio, Agile - Scrum, Oracle, SQL, PL/SQL, Quality Center, Windows Server 2003, Java, Java Script, Business Objects, Facets

Confidential, Los Angeles, CA

Sr. Business Systems Analyst

Responsibilities:

• Facilitated JAD sessions with business partners to identify business requirements for Best Practice Advisory Alerts System and create high level Business Requirements Document
• Reviewed and analyzed business requirements and Epic Clarity model in order to build conceptual model of project
• Developed Activity Diagrams for exact illustration of the process flow
• Organized and performed presentations with business and subject matter experts in order to demonstrate current progress of the project
• Performed analyzes of Oracle SQL codes and Crystal reports on Oracle database by using TOAD tool to understand construction of Best Practice Advisory Alerts System in Epic Clarity model
• Analyzed construction of Enterprise Data Warehouse (EDW) in order to coordinate with Best Practice Advisory Alerts System of Epic Clarity data model.
• Identified needed fact tables, their look up tables and fields through deep analyzes on Epic Clarity data model by using TOAD tool.
• Documented identified useful data from Clarity data model on Excel spread sheet
• Supported developers during building new tables and updating existing tables of Staging area called APPL STG QA
• Analyzed new built tables in order to match them with previous analyzes and fix issues
• Created Functional Requirements Matrix (FRM) in order to document all functional requirements for ETL jobs for BPA project
• Checked built tables and data of Source system called CLINSR
• Updated structure of existing ETL data mapping templates for Integration process
• Matched identified and built target data with source data and map them on ETL spread sheets
• Created and documented logics and transformation rules on ETL maps for Integration process
• Attended weekly team meetings in order to review progress of Best Practice Advisory Alerts project. Moreover, organized daily stand up meetings with developers and architect in order to fix minor issues
• Uploaded current created documents as Conceptual Model, BRD, and ETL mappings to SharePoint
• Presented ETL documents on meetings with Project Manager, Quality Assurance team and Business Partners and move process to data integration stage.

Tools: Agile, Rally, MS Excel, Visio, SQL, Outlook, UML, Share Point, XML schema, J2EE, Quality Center, Epic Clarity, Crystal Reports, Oracle

Confidential, Bryn Mawr, PA

Business /Data Analyst

Responsibilities:

• Gathered Requirement from the Client to fulfill the application need for Horizon Clinical Implementation.
• Facilitated JAD sessions to collect requirements from system users and prepared Business Requirement Document that provided appropriate scope of work for the technical team to develop a prototype for the overall system.
• Identified processes for developing and documenting detailed business requirements, collecting data from end-users and analysts.
• Performed GAP analysis to identify the deficiencies of the current system and to identify the requirements for the proposed system
• Created Use Cases from Business Requirement Documents capturing business needs based on HIPAA standards.
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Refined the requirements and Business Process Models to detailed level appropriate for technical analysis and system design.
• Designed and developed new Interfaces based on business requirements and system’s needs.
• Extensive Analysis of HIPAA rules to in corporate in the development of utility applications which were not HIPAA compliant.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Tracked issues that were detected and updated the status of existing issues based on the daily meetings with the off-shore team.
• Used COGNOS to create reports and communicated these reports to senior management and stakeholders.
• Used SQL queries to extract data from different databases including testing and production for data validation and data analysis.
• Provided technical and procedural support for User Acceptance Testing (UAT).
• Conducted training workshop for end users.
• Involved in preparing detailed user manual.

Tools: RUP, UML, Lotus Notes, MS Office suite, MS Project, DB2, Rational Clear Quest, Rational Clear Case, Rational Requisite Pro, SQL, PL/SQL,HTML, XML, Windows XP

Confidential, Princeton, NJ

Business Analyst

Responsibilities:

• Closely interacted with Clinical Research & Development Management and Leadership teams, regarding sensitive handling of confidential information and comprehensive attention to accuracy and quality.
• Participated in functional requirement gathering and design review meetings which resulted in the creation of Views based on responsibilities in Siebel 8, as well as creating i-Help applets within the application.
• Documented specifications for CTMS business processes, including report design in Siebel Analytics to meet organizational needs, serving also as a CTMS Administrator, super-user and technical support.
• Analyzed data, made recommendations, Identified and implemented areas of improvement within CTMS - Siebel 8.0
• Researched, analyzed and presented best practices in a Clinical Trials Study environment to determine the best overall solution to leverage metrics with the support of CTMS-Siebel 8.
• Developed, wrote and published training materials, user manuals and process flow maps as well as e-learning systems for the CTMS Siebel 8.0 System.
• Trained Clinical Program Study Managers in person and through MS Live Meeting on different areas of CTMS on data feeds and Trip reports.
• Tested, executed, and reviewed User Acceptance Test (UAT) scripts.
• Responsible for ensuring end users continue to update and maintain the system on a daily basis and identified and implemented new areas to utilize the system to increase efficiencies.

Tools: Siebel 8.0 Clinical Trial Management System (CTMS), Oracle 11g, Microsoft Project Enterprise Edition 2007, Citrix, Siebel Analytics.

Confidential, Danville, PA

Business Analyst

Responsibilities:

• Gathered requirements from business users and from walking through COBOL programs, legacy use cases, and program specs.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Analyzed and tested various Common Eligibility Outbound Interface Process and other Inbound/Outbound Facets interfaces.
• Documented the data flow for claims life cycle in facets.
• Defined Functional Test Cases, documented, executed test script in Facets system.
• Strongly worked with MMIS database dealing with on demand claims, policy change

Tools: Windows 2000/XP, SQL Server, Agile, MS Project, Enterprise Architect, MS Access, UML, MS Office, MS Visio, Facets, MMIS