PROFESSIONAL SUMMARY

• Strong knowledge of US Healthcare domain in Payer space and Managed Care Organization MCO .
• Currently working in the capacity of Senior Business System Analyst for a MCO that reports Medicaid and Medicare Encounters to state and Federal agencies.
• Successfully implemented 4010 to 5010 conversion, ICD International Classification of Disease 9 to 10 conversion, regular 5010 to PACDR Post Adjudicated Claim Data Reporting projects for a MCO.
• Experience working in an Iterative, Agile and Waterfall models with complete involvement in all the phases of Software Development Life Cycle SDLC .
• Excellent understanding of EDI-X12 Electronic Data Interchange 837, 835, 277, 997, 999 standards on both 4010 and 5010 format.
• Knowledge of National Council for Prescription Drug Programs NCPDP formats, used for reporting Pharmacy compound, non-compound drugs and over the counter drugs transactions to the state.
• Proficient in Requirements Elicitation by using Interviewing, Workshop, Prototyping, Brainstorming, Interface Analysis, Document Analysis, Business Rule analysis and Functional decomposition techniques.
• Expert in determining requirements by using structured, repeatable process to document, analyze, prioritize, organize and validate requirements.
• Expertise in documenting clear business needs by writing Business requirement document BRD and Functional Specifications document FSD .
• Strong experience in Requirements Modelling by creating Business Process Model Notation BPMN , Use-Case models, User Stories, AS-IS, TO-BE process models, Entity Relationship Diagrams and Activity Diagrams.
• Manage team of business analysts, mentor and train team members by providing insights to healthcare domain.
• Excellent communication and negotiation skills in communicating requirements to stakeholders, making consensus across the board and getting requirements sign off.
• Managing requirements by creating Requirements Traceability Matrix and maintaining baselines of approved requirements.
• Lead Change Management by identifying, assessing and managing changes to the requirement.
• Creative and problem solving by bringing innovative ideas to resolve complex problems.
• Skilled in building relationships with stakeholders and effectively working in onshore-offshore collaboration model.
• Proficient in writing Sequential Query Language SQL and a good understanding of Relational Database Management System RDBMS concepts.
• Assist users to develop and execute unit test, functional, regression and acceptance test plans.
• Always stay on top of the reforms, recent trends and technologies in healthcare industry.

SKILL SET

PROFESSIONAL EXPERIENCE

Confidential

Senior Business System Analyst

Description: Confidential provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. They partner with providers and governments to provide quality, cost-effective health care solutions. They are also responsible for reporting and reconciling Encounters sent or received in HIPAA or proprietary formats to/from state and Federal agencies.

Projects Undertaken:

1 4010 to 5010 conversion for 7 Medicaid states and Centre for Medicare and Medicaid Services CMS

2 ICD 9 to 10 conversion

3 Florida Managed Medical Assistance MMA

4 New Jersey State Medicaid expansion

5 New York State Medicaid MEDS-III to PACDR conversion

Roles and Responsibilities:

• Perform business analysis by working with business users and technical staff to identify, gather, analyze and document business system requirements and business rules
• Engaged with business users to document current work flow processes and collaborate with users in identifying, defining, and documenting process improvement options and alternatives, as directed by business needs
• Manage team of business analysts for the projects undertaken and mentored team members on domain.
• Appreciated by client at various forums for successful implementation of one of the crucial and complex project without major issues reported by business users after system went live. This project also set the benchmark for other projects in pipeline
• Engaged with Project Management Office PMO to come up with a risk mitigation plan for any type of risks or dependencies, a requirement might possess in meeting the project timelines
• Performed Gap Analysis between 4010 and 5010 format and propose solution for gaps
• Analyzed the impact of ICD-10 qualifiers and codes for encounters reporting and provided solution to technical team after reviewing implementation guides
• Perform data mining, utilizing analytical and technical expertise to resolve encounter fallouts
• Organize and present business analysis results clearly and concisely to programming staff
• Conduct requirements walkthrough, make consensus and get requirements sign off
• Lead remediation of encounters through periodic workgroup meetings between business and development
• Analyze state rejections, companion guides, implementation guides, X12 files and propose solution based on the state requirements for Encounters reporting
• Develop requirement traceability matrix to maintain and baseline requirements
• Provide support to business users during application development, testing and acceptance testing

Confidential

Senior Business Analyst

Description: Confidential formerly known as Enterprise Data System EDS decided to develop a single healthcare claim adjudication product that should incorporate features of three existing legacy applications owned by them. The legacy applications were MetaVance commercial claims adjudication system interchange MMIS Medicaid Management Information system and Atlantis Case Management solution . The goal was to meet the demands of both commercial Payer's and state Medicaid. This product should be robust and must be capable to compete with the current claim adjudication systems in the market. This product was developed based on Iterative model of application development.

Roles and Responsibilities:

• Lead Benefits Management module, work with other module leads in all the iterations of product development.
• Created AS-IS model by understanding the current legacy applications and Business Rules
• Created TO-BE process model of the new application being developed by using BPMN diagrams and Use-Cases
• Facilitated brainstorming sessions, Focus group sessions with the Subject Matter Experts SME and other stakeholders to review the TO-BE models and get their insights about the additional features new system can possess
• Documented the artifacts in the Business Process Specification Document BPSD
• Repeated process to organize, prioritize, verify and validate requirements
• Conducted requirement walkthrough meeting with different cross functional team, bringing everyone to consensus and get requirement sign off
• Provided domain training to team members located at different regions
• Managed requirements by creating Requirements Traceability matrix
• Worked with team of architects to create prototype of the proposed system by using Wireframes
• Provided support to business users during application development, functional testing and acceptance testing, for all iterations

Confidential

Business Analyst

Description: Confidential a jointly owned business of EDS and Towers Perrin. ExcellerateHRO was an IT services company offering a flexible portfolio of administering benefits services, payroll services and administration services to mid-size and large organizations around the world.

Roles and Responsibilities:

• Conducted requirement elicitation by interviewing stakeholders and facilitating workshop sessions
• Modified plan summary document for each client to meet the requirements of new plan year by doing document analysis and business rules analysis
• Created impact analysis document when employees wish to modify benefit selection for both current plan year and new plan year due to a qualifying life event
• Mentored offshore team members while working in an onshore-offshore model
• Successfully implemented Open enrolments for 5 major organizations at a time
• Performed data analysis by writing and executing SQL codes, generating reports for the business users
• Actively participated in process improvement tasks at the client site created training manuals and helped business users in understanding the system by providing training
• Special accreditation from client and organization on successfully completing Open Enrolments within timeframe with exceeded expectations

Confidential

Business Analyst

Description: Confidential had been the industry's leading healthcare IT provider for more than 40 years. It helped Government and Commercial Payers, Providers in running their Healthcare business by optimizing budgets and improving the quality of their services.

Roles and Responsibilities:

• Performed impact analysis for the enhancement requested by client to support their business.
• Prepared User stories, Use Case Model and provided assistance in creating User Acceptance Test plan
• Created AS-IS models in order to understand the authorization process for different clients
• Provided support by acting as an SME for domain related questions by technical or testing team
• Analyzed data by creating and executing SQL queries and running basic Unix script commands
• Conducted trainings for vertical associates on healthcare domain.