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Senior Business Analyst/scrum Master Resume

Morristown, NJ

SUMMARY

  • A seasoned BusinessAnalystinHealthcare & Insurance industry with 8+ years of experience include understanding of Analysis, Joint ApplicationBusinessRequirement Gathering, Business Development JAD sessions with clients and referring to accessible documentation and procedure.
  • Exposed to Medicare and Medicaid domains of thehealthcaresystems and industry for inpatients, outpatients, Reimbursement Methodology and Medicaid Management Information System MMIS.
  • Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, 5010 X12, 834, 837,835, and 270, 271.
  • In dept. knowledge of Software Development Life Cycle SDLC methodology such as Agile, Waterfall and RUP.
  • Experienced in providing Medicare Operations support, with a focus on leading configuration activities for Medicare Part D operations and also in Requirements Traceability Matrix (RTM) and test plan.
  • Efficient in writingBusinessRequirements Document, user cases, HIPAA, Use Case Specifications, Functional Specifications and Workflows.
  • Developbusinessprocess models for projects and demonstrations at the Centers for Medicare and Medicaid (CMS) usingbusinessprocess model notation and enterprise architecture.
  • Strong knowledge of Use Cases, MITA and Activity Diagram and profound knowledge of EDI X12 standards inhealthcareinsurance.
  • Extensive Experience in Functional, Integration, Regression, MMIS, HL7, FRD, User Acceptance UAT, MITA, System.
  • Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
  • Designed and implemented basic SQL queries for testing and report/data validation
  • Experienced in client interaction, deep understanding ofbusinesssystems functionality and technicality.
  • Strong Knowledge and experience of EDI transactions, HIPAA, ASC X12 Transaction sets: 834 (Benefit Enrolment and Maintenance), 835 (Claim Payment/Advice, 837 (Claims and Encounters), 820 (Payroll Deducted and Other Group Premium Payment for Insurance Products) 270/271 (Explanation of Benefits (EOB) /Response to EOB), 276/277 (Claim Status/Claim Status Response).
  • Proficient in Developing and executing Test Plans, Test Case, FRD, TriZetto Facets 4.x and Medical Billing, Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
  • Knowledgeable about preparing RTM documents and also Experience in conducting SWOT Analysis, MMIS, MITA, Cost Benefit and ROI Analysis.
  • Experience in developing project plan and estimating project timeline.
  • Excellent working knowledge in Project Life Cycle and clear understanding of Project Management.
  • Experienced in performing Gap analysis by identifying existing technologies, documenting the enhancements to meet the end - state requirements.
  • Conducted “As-Is” and “To-Be” business analysis, Cost benefit analysis, GAP analysis, Impact, SWOT, Root cause, Interface Analysis, ROI Analysis and Risk Analysis.
  • In depth in conducting Knowledge of Life Insurance concepts including Adjustable death benefit and various flexibilities associated with it.
  • Conducted successful projects with the help of teams to achieve deadlines timely and proficiently AND Worked on FACET claim processing system.
  • Organized, goal-oriented, MITA, FRD, self-starter, and ability to master new technologies manage multiple tasks while following through from start to completion.
  • Experienced in analyzingbusinessrequirement at all stages of Software development of life cycle SDLC.

TECHNICAL SKILLS

Business Skills: Business Process Improvement, Business Process Analysis, Use Case Modeling, BPMN, Risk Analysis, Requirements Workshops, JAD Sessions, GAP Analysis, SWOT Analysis, Document Analysis, Impact Analysis, Data Analysis.

SDLC Methodologies: Waterfall, Waterfall-Scrum Hybrid, Agile Scrum,SAFe, XP, Kanban, Scrumban

Documentation Tool: Microsoft Word, Microsoft Excel

Collaboration Tool: Microsoft SharePoint, Confluence

Designing Tool: MS Visio, Azure, Balsamiq, Mock- up screens, Rational Rose

Requirement Management: JIRA, HP ALM, Rally, Version One, TFS

ETL tools: Informatica Power Center

Testing Tools: HP QC, HP ALM, Selenium, Load Runner, SOAP UI

Project Management tools: MS Project, Jira, TFS,Rally, HP Agile Manager

Databases: MySQL, Oracle, DB2, MS Access

Operating Systems: Windows, Mac OS, Linux

PROFESSIONAL EXPERIENCE

Confidential, Morristown, NJ

Senior Business Analyst/Scrum Master

Responsibilities:

  • Facilitated interview, one on one and brainstorming sessions with SME's User's in understanding the requirements pertaining to billing Origination to billing Processing.
  • Responsible for providing Medicare Operations support, with a focus on leading configuration activities for Medicare Part D operations.
  • Extensive knowledge of Medical Management Information Systems (MMIS) and HL7.
  • Assisted and written System Requirements Documents SRD, including Functional and Non-Functional requirements (FRDs ad NFRDs).
  • Reporting issues into the Facet system and Develop FRD's, FDD's and Use Cases (MS Visio), process flows for the project and decks.
  • Deliveredbusinessrequirement documents (BRD), functional specification documents, Use Cases, test plans, and requirement traceability matrices.
  • Profound knowledge of EDI X12 standards inhealthcareinsurance
  • Verified accuracy of billing information and codes before processing Medicare and Medicaid forms, as well as other third-party insurances.
  • Gatheredbusinessrequirements through interviews, surveys, prototyping and observing from account managers, finance manager, and independent advisors and got an accurate understanding of their needs.
  • Developed Use cases and activity diagrams and analysedbusinessrequirements and Working skills on Health Level 7 Interface (HL7).
  • Created UML-based feasibility studies and Use Case Models to communicate those ideas to the developers.
  • Followed the UML based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, and Sequence Diagrams.
  • Worked with SME's andbusinessusers to gain in-depth understanding of the business' mission, objectives, purpose and processes.
  • Responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records EMR/EHR/PHE/PMR, ASP technology, and full integration tools.
  • Enhanced thebusinessto articulate and prioritize their ideas and assisted in development of training materials for new technology and process improvements.
  • Collaborated with the QA testing team to develop the test plan, test conditions and test cases to be used in testing based onbusinessrequirements, technical specifications and/or product knowledge.
  • Conduct project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.
  • Involved in the User Acceptance testing (UAT) to check the reliability for end users.

Environment: MMIS, HL7, FRDs, FDD, Process Flow, EDI X, Srum, EMR/EHR, QA testing, & SDLC.

Confidential, Bethesda, MD

Senior Business Analys/Scrum Master

Responsibilities:

  • GatherBusinessRequirements from the Subject Matter Experts (SMEs) and document the requirements in the BRD. Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by theBusinessOwners.
  • Performed Analysis of ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
  • Organize meetings and led JAD sessions to ensure legal and compliance deadlines of CMS (Centers for Medicare and Medicaid Services) are met.
  • HIPAA 4010 - 5010 Conversion Analysis Involved in the documentation of HIPAA 5010 changes to EDI 837, 834, 835, 276, 277 Transactions.
  • Formulate system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards like ANSI.
  • Configured the Claim Processing in FACETS 4.51. Good knowledge about the workflow and backend Tables in Claim Processing.
  • Worked in Claims processing system for Pharmacy Benefit Management along with review, design and reconfigure of the FACETS in functional areas like Membership, Claims, provider, Enrollment and Service.
  • Effectively elaborated the Current process and gave a clear picture of the proposed process for the projects in the organization. Work aggressively towards timely completion of High Priority Tasks.

Environment: MS Visio, MS Office, CMMI, Rational Rose, Requisite Pro, SQL, Oracle.

Confidential, Danville, PA

Senior Business Analyst/Scrum Master

Responsibilities:

  • Followed agile approach of development throughout the project
  • Facilitated JAD session meetings with stakeholders (Medical Director, Laboratory Manager and Wellness specialists) and developers to perform Requirement Gathering & Analysis by actively soliciting, analyzing user requirements and prepared the requirements specification document for the solution.
  • Worked closely with Business Directors, Project Managers in various business areas to gather, analyze and document the requirements and supported the project manager throughout the development lifecycle.
  • Interviewed the stakeholders from different departments to identify their current needs and understand their Current Workflows and Ideal Workflows, to created process diagrams documented As-Is and To-Bebusiness processes.
  • Performed impact analysis during the project to manage requirements churn by checking the feasibility in maintaining triple constraints and discussing them in Daily Scrum Stand-up Meeting.
  • Ensured the compliance with HIPPA for electronic healthcare transactions.
  • Developed activity diagrams and sequence diagrams to analyze the requirements and recommend solutions.
  • Performed data analysis on Amysis database for membership related requirements
  • Involved in creating User Stories with acceptance criteria and documented acceptance scenarios to facilitate test driven development.
  • Generated UML Diagrams mainly, Use Cases, Activity Diagrams, and Sequence Diagrams to define the interactions between the user and the system using Microsoft Visio
  • Documented specifications for calculating scorecards based on biometrics results for wellness programs.
  • Assisted the technical team in translating application functionality into application architecture.
  • Participate in the bug review meetings.
  • Developed Test Plan, documented and executed test cases and reported the bugs in Quality Center.
  • Perform UAT with the users and document user manual

Environment: Agile Scrum, SQL, UML, Java, Quality Center, SVN, MS Office

Confidential

Business Analyst

Responsibilities:

  • Organized and facilitated JAD sessions to elicit the requirements and document the client requirements for the customization of the EHR andEDRdevices and converted the requirements into Business Requirements Document (BRD) and Functional Requirements Documents (FRD) as per the client’s requirements.
  • Interviewed the stakeholders from different departments to identify their current needs and understand their Current Workflows and Ideal Workflows, to created process diagrams documented As-Is and To-Bebusiness processes.
  • Worked closely with the PMO to develop the Project Plan and helped the SME’s in analyzing the reports for Project Execution. Was involved in requirements gathering with the clinicians and other healthcare practitioners
  • HIPAA 5010 and ICD 10 compliance check were carried out by developing a checklist of compliances.
  • Worked with the system architects in understanding and designing the User Interface as per the stakeholders needs by preparing a systems design document. Helped in Developing Functional and Technical Design Specifications
  • Assisted the Project Manager and the development team in understanding the requirements for developing generic (History of Previous Illness) HPI templates used to document each of the Chief Complaints
  • Actively documented theHPI templateswhichwere used by the patients with the diagnoses of bronchitis, otitis media, sinusitis, pharyngitis, and upper respiratory tract infection
  • Assisted the team in conductingTechnology Acceptance Model Questionnaire (TAMQ) which was used to assess participants’ perceptions towards ease-of-use, usefulness, and intent to use before and after the template changes.
  • Used IBM SPSS Statistics to analyze Pre and Post-Test Data. Participant’s responses were evaluated using descriptive statistics to obtain means of percentage.
  • UsedJIRA for Issue Tracking, user story management and Requirements Traceability weekly progress reports relating to the progress of the process were submitted to the Project Manager
  • Used the ETL Tool; Informatica Power Center for Data Mapping and performing transformations. Well versed with various Data Warehousing Concepts, Schemas, Data Marts, Data Structures, and ER Diagrams.
  • Used SQL Server for writing SQL Queries to perform Data Retrieval, Manipulation, Analysis and Validation.
  • Tested & Documented REST Web Services in JSON for the EHR systems & EHR Connect in Postman and assisted the QA lead in automating the Web Service Testingusing UFT
  • Formulated and executed Test Scenarios and Test Cases based on functional requirements documents (FRD) and helped to develop the Test Plan; performed Sanity Testing to validate reports and dashboards
  • Worked with Application Development Team on Test issues and conducted daily status meetings with Development and User Team during UAT, Coordinated with Project Management in Planning and Implementing Test Schedule for UAT

Environment: Hybrid Agile, MS Visio, MS Excel, JIRA, Tableau, Postman, JSON, REST Web Services, XML, UFT, HTML, IBM SPSS Statistics, SQL, JIRA

Confidential

Business Analyst

Responsibilities:

  • Facilitated and managed meetings sessions with committees of SMEs to define businessrequirementsfor 2 maincomponentsofthe CIMS systemforworkerscompensation Claims and Adjudication Forms Management and also Scheduling component.
  • Followed UMLprocesses and standard operating procedures (SOPs) in developinguse cases, use case diagrams, and othersupportingdocumentation.
  • Delivered Functional Design Specification Document for the Scheduling component.
  • Participated in the logical and physical design sessions, produced design documents.
  • Conducted bench marking activities to identify best practices.
  • Researched the various steps in the lifecycle and then constructed the system in such a way that the riskier claims could be easily identified and monitored.
  • Performed impactanalysis, went through all the use cases and workflows.
  • Conducted GAP analysis to derive requirementsfortheautomationprocess.
  • Workedextensively with SMEs in understanding and documentingtheirrequirementspertainingtotheissue.
  • Demonstrated good management of time and effective use ofresources in order to meet stringent deadlines.
  • Assisted the project manager in preparing the project schedules, milestone tracking, and resource allocation using Microsoft project 2000.
  • Involved in manual testing and UAT with the development team and QA team.

Environment: SDLC, Waterfall, MS project, MS office Tools (Word, Excel, PowerPoint and Visio), MS Project, .Net, BPMN Version 2.0, data warehousing, Rational Rose, and ClearQuest,Sybase Power Designer

Confidential

Technical support

Responsibilities:

  • Worked on 24/7 Technical and Customer support
  • Worked on High Priority tickets and addressed them within the SLA
  • Awarded for quality resolutions
  • Performed timely resolutions of Hi Priority tickets exceeding customer satisfaction.
  • Outstanding customer service/focus skills
  • Awarded twice for Highest customer satisfaction
  • Troubleshooting and handling technical issues.
  • Developed SLA based reports
  • Created trending reports for customer volume using SIEBEL CRM.
  • Analysis on various trending as well as customer centric service level agreements(SLA)
  • Issue resolution, tracking and radiation of Hi Priority issues.
  • Troubleshooting and handling technical issues.
  • Handled hardware and software issues related to internet.
  • Configuring Modems, Routers, Laptops.

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