- Business Analyst with 7 years of experience in Healthcare. Focused on Business Analysis, System Analysis, Enterprise Solution, Business process redesign/reengineering and improvement.
- Hands on experience with in - depth understanding of Business Requirement gathering, BusinessProcess flow, Business Process Modeling (BPM) and database/data warehouse experience.
- Strong experience working in key phases of the Software Development Life Cycle(SDLC) such as thePlanning, Design, Analysis, Development and Testing for the software/system development process.
- Advanced business writing skills for preparing Business Requirement Document (BRD), Use CaseSpecifications and Functional Specifications.
- Well acquainted with Workflows and Unified Modeling Language (UML) diagrams such as, Use casediagrams, Activity Diagrams, State, Collaboration / Sequence Diagrams.
- Actively used Joint Application Development (JAD) and Rapid Application Development (RAD)Sessions to converge early toward a design acceptable to the customer and feasible for the developersand to limit a project’s exposure to the forces of change.
- Experienced in multiple SDLC methodologies such as Waterfall, Agile, SCRUM and Rational UnifiedProcess (RUP).
- Proficient in writing test cases and test scripts and executing tests.
- Expertise in gathering /eliciting business requirements, detailing, converting business requirements to technical requirements using different tools and techniques.
- Compelling Multi-Tasking and organizational ability, with the capability to develop and implementstrategies.
- Ability to work cohesively with all Stakeholders to formulate Functional models and prototypes to meetstakeholder expectations, and Workflow optimization.
- Excellent Communication and interpersonal skills, capable of acting as the arbiter between client anddeveloper with respect to project implementation.
- Extensive experience working with end users to answer their questions and gather feedback for requirements during all phases of project.
- Hands on experience of performing quantitative data modeling, forecasting based on available data, and decision analysis.
- Experience in multi-tasking such as managing numerous simultaneous projects with great attention to detail.
- Experience in solution assessment, validation and applying critical thinking for problem solving approach.
Business Modeling Tools: Axure Pro, MS Visio, MS Office Suite, Enterprise Architect, Balsamiq, Smart Draw.
Methodologies: Agile, Scrum, RUP, Waterfall
Requirement Management Tools: Rational Requisite Pro, SharePoint
Applications/Environments: MS Office, Crystal Reports, Oracle, SQL Server, Oracle Work Flow, Microsoft TFS
Languages: HTML, XML, SQL, Shell Scripts, JAVA/J2EE in Eclipse and IDE transition
Defect Management Tools: JIRA, RALLY, Bugzilla, SharePoint, HP Quality Center, Microsoft TFS
Confidential - Deerfield
Sr. Business Analyst
- Acted as a liaison between Business Area Subject Matter Experts (SMEs) & development team throughout all phases to SDLC.
- Presented new Business solutions to stakeholders before initiating the project.
- Development and maintained project plans and contributed to project being on schedule and meeting client’s needs.
- Key player in gathering and documenting the requirements that were critical to the business process and using those requirements to design application software using a Use Case approach.
- From the preliminary phase analysed the GAP’s and other issues (from requirement) that could arise in future during project being build and individually solved them.
- Conducted JAD sessions to identify the business flows and determined whether any current or proposed systems were impacted by the EDI X12 Transaction, code set and identifier aspects of HIPAA.
- Involved with the pre-implementation tasks coordinating with project coordinators for contractual work, change management, quality and impact analysis.
- Created project status reports to implementation managers as and when needed.
- Handled ICD-10 claim processing in test environment.
- Interviewed several business area experts and SME’s, asking detail questions and carefully recording the requirements in a format that can be reviewed and understood by both technical team and the business people.
- Facilitated Functional Requirement reviews and walkthroughs with the designers and the developers.
- Planned, coordinated, and monitored project levels of performance and activities to ensure project goals are met on time
- Interviewed business people to gather business wants and needs around project ideas and translated them into business and technical requirements.
- Build project schedule after charter approval using MS Project.
- Interacted both with clients and as well as end users to capture the process and gather User Requirements.
- Worked with HIPAA compliance ANSI X12 837 formats for both professional claims and institutional claims.
- Matched the requirements for Medicare and Medicaid programs which are related to the Social Security Act
- Coordinated and helped the developers with the HIPAA-EDI Transaction Code sets: 837,834,835,270/271,277/275 & 276/277.
- Analysed forms and successfully crosswalk details to corresponding ANSI X12 formats.
- Created work flow diagrams using MS Visio, Project, PowerPoint.
- Identifying the number of payers and clearing house where claims get submitted electronically or paper format and provide the in scope and out of scope list of payers for ICD-10 testing.
- Maintained dashboards through software’s like Tableau and Jira.
- Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines.
Confidential - Philadelphia, PA
- Responsible for proactively identifying opportunities for improvement throughout the business which could include working with department management to create a business case detailing the cost/benefit of the improvement.
- Created role-based matrix, decision tables when required as per the requirements through the project.
- Strong understanding of the business functionalities like Medicare, Medicaid, Tricare, Workers Comp, Commercial Claims, Bulk Billing, Denial Analysis and Insurance specific trends.
- Excellent knowledge and enacting of HIPPA transaction sets such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 835 (Payment or remittance advice).
- Successfully interpreted data to draw conclusions for managerial action and strategy.
- Optimized data collection procedures and generated reports on a weekly, monthly, and quarterly basis.
- Analyzed massive and highly complex data sets, performing ad-hoc analysis and data manipulation.
- Collaborate with both technical and business stakeholders to understand reporting and data requirements based on customer and internal needs.
- Responsible for identification and analysis of errors/inconsistencies in the data and provides timely resolutions.
- Reviewed MMIS (Maintenance Management information System) documents to understand the customer requirement.
- Worked on payer plan sponsor and EDI transaction like 837.
- Provide ad-hoc and structured reporting document to partners and stakeholders.
- Was involved in maintaining dashboards, reports, visualizations, and alerts that concerned business decisions.
- Create and maintain data sources.
- Identify, designed, coded and testedETL operations to support business analysis objectives.
- Identifiedgaps between 4010 and 5010 specifications.
- Tested and implemented HIPAA 4010 and 5010 and ICD 10, version for all EDI transactions.
- Acted as an SME on different subject areas including state reporting, death benefits, Medicare, Bill review and RX eligibility.
- Involved in creating sample mappings for the conversion of EDI x12 transactions code sets.
- Assisted clients in resolving billing issues for Medicare,Medicaid, and private insurance.
- Created lists of ICD 10 CM/PCS codes with reference to the usage percentile and provided to Stakeholders to determine if codes were best fit or all possibilities.
- Tested claims to ensure that the system would recognize and accept the ICD-10 changes.
- Used complex SQL queries to analyze the data pattern to accommodate the variousbusinessscenarios.
- Designed and documentBusinessRequirements by using HIPAA EDI guides and reviewed as well as interviewingbusinessprocess owners and companion guides.
Environment: Windows, Microsoft Project, Microsoft Visio, Balsamiq, HP Quality Centre, Rational Clear Quest, Quick Test Pro, JIRA, Python, Lucid Chart, Java Script, SharePoint.
Confidential - Philadelphia, PA
Business Analyst/ Quality Analyst
- Co-ordinate/develop/maintain test plans, statuses, defects, reports, matrices, strategies with business, developers and senior team members.
- Attended architectural reviews, JAD sessions and provided valuable contribution from a BA perspective.
- Trouble shooting, various real time issues of customers overall in a given region to specific location to single account or setup box; identified high quality and critical bugs and exceptions using Jira, Charles web proxy tool and Splunk.
- Used JIRA for requirement management, planning, execution, defects tracking and reporting.
- Logged, maintained & tracked defects, assigned type & severity levels, regressed scripts to assign status to defects, configure Test Director to auto-notify developers.
- Worked on X1 mainframe systems for integration, system, end to end testing.
- Participated and contributed in daily scrum meetings to track daily progress and performance.