SUMMARY

• Extensive experience of 6 years, in design, development and implementation of business applications within HealthCare domain.
• In depth understanding on handling every aspects of the project from requirement gathering, documentation to working with development team and test plan execution.
• Thorough understanding of healthcare industry including Enrollment, Eligibility, Benefits, Claims, Medicare, Medicaid, Affordable Care Act (ACA) and implementation of HIPAA key EDI (ANSI X12) transactions
• Experience with FACETS solution for healthcare and strong understanding of Managed Care such as HMO, PPO, & Long Term Care.
• Work in health care sector with prime focus on claims adjudication, Migration, Provider, Eligibility and prior authorization for Medicare and Medicaid program
• Expertise in documenting the Business Requirements Document (BRD), Technical Requirement Document (TRD), generating the UAT Plan, maintaining the Traceability Matrix and assisting in Post Implementation activities.
• Experienced working in FACETS online modules such as Billing, Provider, Claims and Membership modules
• Good Knowledge in Health Care Transaction, EDI HIPAA X12 transactions (837,835,834,270/271,276/277) Inbound and Outbound 837 Institutional, Professional, Dental and Pharmacy Claims.
• Worked on requirements of the 835 HIPAA projects, 276/277, 278, 837, and HIPAA EDI Transactions across enterprise.
• Knowledge and expertise in working with Claims, Provider, Enrollment, Finance, Benefits, and Vendor Management Business Areas.
• In - depth knowledge and experience in full SDLC with Agile/SCRUM and waterfall methodologies.
• Well versed in Data Extraction, Data Compilation, Data Analysis, Data Manipulation and Data Validation using SQL queries in a MS SQL Server environment.
• Proficient in Requirement Management, including gathering, analyzing, detailing and tracking requirements.
• Specialize in HIPAA 5010 implementation Experienced in software development life cycle such as Waterfall, Agile/SCRUM methodologies, Business Analysis and Modeling.
• Extensive expertise in the writing and interpretation of Story Card, User Stories, Use Cases, Functional Requirements, Screen Specs, and Data Mapping Documents
• Performed DATA MODELING, DATA MIGRATION, consolidate and harmonized data. Hands-on data modeling experience using Dimensional Data Modeling, Star Schema, Snow-Flake, Fact and Dimension Table, Physical and Logical Data Modeling using Erwin .
• Strong knowledge of the Software Development Life Cycle (SDLC) methodologies such as Waterfall, Agile, Scrum and RUP.
• Proficiency in MS Visio in creating, analyzing and implementing business workflow diagrams including use case diagrams, activity diagrams, state diagrams, sequence diagrams, collaboration diagrams and deployment diagrams.
• Expert in Business Requirement gathering, Business Process flow and Business Process Modeling, Analysis and design documentation.
• Expert in creating all sorts of business artifacts such as Business Requirement Document (BRD), Functional Requirement Document (FRD), Use Cases, UML diagrams, Data Mapping Documentation, Requirement Traceability Matrix (RTM)
• In depth knowledge in developing Use Case Diagram, Activity Diagrams as per UML, methodology and business process flow diagrams, data flow diagrams, process flow diagram through Microsoft Visio.

TECHNICAL SKILLS

Methodologies: Waterfall, RUP, Agile (Scrum and XP)

Project Management Tool: Microsoft Project and MS SharePoint

Requirement Tools: UML IBM Rational Requisite Pro, Power Designer

Database Management: SQL, SAS, CRM, Suite, Tableau, MS Access

QA Testing Tools: ALM/Quality Center, QTP, JIRA

Business Modeling Tools: MS Visio, Smart Draw, Balsamic

PROFESSIONAL EXPERIENCE

Confidential, Newark, DE

Business Analyst

Responsibilities:

• Conduced Joint Application Development (JAD) sessions and walk in interview with the business users to gather requirements.
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
• UsedFACETSAnalytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
• Provided business and mapping expertise during a transition of the EDI applications from the GXS Application Integrator (AI) to GIS.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High-Level Requirements.
• Expertise in implementing the agile, Rational Unified Process and Waterfall Methodologies throughout the Software Development Life Cycle of the project.
• As an IT professional focusing mainly on the core-business of healthcare IT-HL7 Interface analysis and integration of applications (e.g., EHR, PHR) from clinical and public health perspective to help providers in their quest to achieve meaningful-use. And promote self-management of chronic diseases (diabetes, cancer) that improves quality of patient care
• Provide technical, business, management expertise, and support the Department of Health and Human Services and Centers for Medicare and Medicaid Services \(CMS\) in building and maintaining a comprehensive enterprise architecture program
• Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process
• Created the test data 837P, I, D and tested multiple fields for HIPAA validation and business edits.
• Involved in the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
• Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc).
• Was responsible for Medicaid Claims Resolution/Reimbursement for state healthcare plan using MMIS.
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
• Strong knowledge of Facets and actively involved in end-to-end implementation of Facets Billing, Enrolment, Claim Processing and Subscriber/Member module.
• Developed Data Conversion Strategy for converting data from the existing site to the new site.
• Experience in Manual, Automation & Performance testing tools like HP Quality center (QC)/Application Lifecycle Management (ALM), Quick Test Pro (QTP)/Unified Functional Testing (UFT), JIRA, Load Runner.
• Strong experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C & D, and Insurance Claims.
• Extensive experience working with Enrollment, Claims, Provider, Finance, Benefits, and Vendor Management Business Areas.
• Prepared Demo on SharePoint for various Business to get new approvals like the Therapist and Nursing divisions.
• Involved in developing the test scenarios and test cases and helped in developing QA Test plans for Functional, Integration and Regression Testing.
• Utilized Agile Methodologies to configure and develop process, standards and procedures.
• Organized and facilitated Agile and Scrum meetings, which included Sprint Planning, Daily Scrums or Stand-ups, Sprint Check-In, Sprint Review & Retrospective.
• Tracked the day-to-day activities, responsible for new requirements and enhancements associated with EMR EPIC system.
• Retrieving Membership, Claims and Provider Data using a SQL TOAD - Data Analytics and analyzing using MS Access and FACETS Data Models.
• Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release
• Created specifications for EDI HL7 (A28, A31, ADT) and X12 (834/837) transactions that were transmitted between Claims Editor and Legacy Billing application and external Payers

Confidential - Madison, WI

Business Analyst

Responsibilities:

• Worked as a Business Analyst in agile methodology to do requirements gathering, analysis and planning, development & testing.
• Performed requirements gathering, analysis and planning, development & testing in Agile methodology.
• Participated in the research and gathering business requirements through conducting surveys, interviews and JAD sessions.
• Worked on a project with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
• Facilitated JAD session to find out the impacted area of functionality of Facets due to upgrade and cooperate with developer to come up with solution.
• Analyzed all required documentation from providers for successful enrollment into the Medicaid programs: Traditional Medicaid, Texas Health Steps Medical and Dental, and the Children with Special Healthcare Needs Services Program
• Involved in all SDLC stages under Agile process requirement analysis, implementation, testing (functional and use acceptance) and deployment.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• Involved with the QA team to Conceptualize, determine and develop test approaches and methods for Unit testing, Integration and Functional testing, Load and Usability testing according to the application complexity and test requirements.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Prepared and documented System Requirements and workflows for the Content Management Application tool.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
• Ability to analyses engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production issue and using this as a training opportunity for other team members
• Evaluated testing results for each potential release build using Test Director, Quality Center and Bugzilla reports, listing summarized bug information in priority sequence, recommended viability of release for production.
• Worked in an AGILE delivery model involving multiple scrum teams and daily stand-up meetings
• Implemented and tested the application with Agile Methodology for overall software test strategy and approach, project schedules, issue management, estimations and risk assessment.
• Participated in meetings to discuss the alignment between the two different software development processes used by Amex (waterfall model) and NAN (agile method).
• Created business plans for integration of front end applications to communication with the back end mainframe.
• Helped in writing Training manuals and helped business with the Training on a one to one sessions.
• Employed Rational Clear Quest for effective Change Management (Requirements Creep) and bug tracking during the testing lifecycle.

Confidential, Tampa, FL

Business Analyst

Responsibilities:

• Involved in all the phases of the System Development Life Cycle (SDLC) to ensure thatbusiness objectives were met.
• Worked on AGILE Environment with daily scrum meetings, grooming sessions, planning and sprint cycles.
• Met with various groups, including business owners, SMEs and marketing team, for requirements gathering in definition Stage.
• Worked on Facets Claims Processing for data validation and claims validation. Extensively worked on Claims Inquiry and Dental Claims Processing.
• Team of Business Analysts for creation of Business and Functional Requirements for the creation of Electronic Health Records (EHR).
• Gathered requirements for making changes to the existing Electronic Medical Records(EMR), Electronic Health Records(EHR) and Ambulatory Services for the existing Epic Interfaces.
• Involved in development of the system for data exchange from EMR, EHR to Electronic Lab Reporting Systems.
• Provided business and mapping expertise during a transition of the EDI applications from the GXS Application Integrator (AI) to GIS
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Worked on AGILE Environment with daily scrum meetings, grooming sessions, planning and sprint cycles.
• Good understanding of SDLC and STLC methodologies including Waterfall, Iterative, Agile and Scrum methodologies.
• Documented requirements, associated change requests with requirements and connected requirements with Use cases.
• Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Effective with the creation of artifacts and management of various roles specified by Rational Unified Process (RUP), Agile Methodology, RAD, Workflow Processes and Waterfall cycle method.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Utilized JIRA to develop and track Agile epics, stories and tasks and Performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
• Ability to analyses engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on Jira the quick resolution of the production issue and using this as a training opportunity for other team members

Confidential, MI

Business Analyst

Responsibilities:

• Conducting in-depth analysis of State's current Person Management,Placement, CaseServices and ProviderManagement processes.
• Creating System, Data and Process flow artifacts and dealing with processes, governance, policies, standards and tools as part of MDM to consistently define and manage the critical data of the organization.
• Used Microsoft tools like SharePoint and MS Office to transfer products details among the department while ensuring those products are releasable to the broadest dissemination standards.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in FACETS.
• Performed Gap Analysis for 5010 enhancement using the TR3 implementation guides and side-by-side HIPAA guides provided by CMS (Centre for Medicare & Medicaid Services)
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Interacted with the developers to report and track bugs using Test Director.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• To function as the coordinator for the project involving the conversion/sell over of members from legacy system to Facets.
• Test data entry into FACETS4.7 application in the test environment for creating groups, subscribers and family members.
• Worked on the Patient Management System (integrated version of Patient Information System with EMR/EHR)) is intended to remotely communicate with a compatible pulse generator from BSC CRM and transfer data to a central database (HIT EHR).Performed extensive requirement analysis including Data analysis and Gap analysis.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
• Implemented and tested the application with Agile Methodology for overall software test strategy and approach, project schedules, issue management, estimations and risk assessment.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
• Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
• Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.