SUMMARY

• Have in - depth knowledge of Software Development Life Cycle (SDLC) methodologies, assisting and working as Scrum Master on several projects, vast experience working in Agile, Waterfall, RUP methodologies. Primarily in Agile methodology. Handling Scrum team offshore and onsite.
• Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, Hl7 Standards, HIPAA, PPACA (Patient Protection and Affordable Care Act), Compliance issues, LOINC and SNOMED Mapping, HL7 Message Validation, ICD 9, Electronic Health Records, Electronic Medical Records.
• Proficient in creating business requirement documents BRD, functional requirements documents FRD, Use cases diagrams, Activity diagram, Class diagrams, and Sequence diagrams.
• Adequate knowledge in Health Administration Claims processing auto adjudication, COB, EOB/Drafts, Claims pricing and testing, enrollment, Medicare, MMIS, Medicaid, CDHP consumer driven health plans
• Worked with creating databases and structuring of Big Data on servers SQL and Sybase and in applications, using data generated from live and static feeds in a variety of formats.
• Knowledge ofHL7,HIE Health Insurance Exchange,EMR/EHR, Health Care Reform andPatient Protection and Affordable Care Act PPACAandFacets.
• Experienced in SDLC methodology for Agile Scrum and traditional Waterfall. Well versed with agile ceremonies and agile tools (JIRA, RTC). Worked with clients and business SMEs to create business (BRD) and functional (FRD) requirements including work break structure (WBS)
• Communicates effectively with all Stakeholders - Sponsors, Owners, Developers, Testers, UAT Community. Excellent UAT Tester, able to track properties of objects and elements from front-end to back-end tables
• Proficient in gathering requirements and developing Business and Functional Requirement Documents BRD and FRD. Developed Test Cases forUnit Testing,Regression TestingandUser Acceptance Testing (UAT).
• Used JIRA for defect tracking and reviewed them in subsequent iterations of the application development process and facilitated Triage meetings.

TECHNICAL SKILLS

Methodologies: Waterfall, RUP, Agile, Rational Unified Process (RUP)

Technologies/Tools: MS Project, Visio, Excel, Word, Outlook, PowerPoint, JIRA, Confluence, SharePoint, EHR, EMR

Databases & Tools: Oracle, SQL Server, MS Access

Office tools: MS Office (Word, Excel, Power Point, Outlook), MS Visio, MS Project

Modeling & UI Design: Balsamiq, In Vision, Visio Visual Designer, Confidential Process Designer.

Healthcare: ANSI X12, HL7, HIPAA, HIX, PPACA, EDI, HL7, Enrolment/Claims, Medicare, Medicaid, CHIP, DHR.

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

• Writing scripts to write/read HL7 data to/from Mirth DB and to different databases like Oracle, Microsoft SQL server and DB2.
• Participated in testing of Orion Rhapsody Route to receive and process HL7 ORU R01 Version 2.5.1 messages to Websurv and Testing of HL7 Message Validation and sending of ADT Messages like ADT A01, ADT A04 and ADT A08.
• Led scrum meetings for story grooming, pointing and refinement. Led discussions for release and sprint planning for stories and prioritization and updated JIRA.
• Participated in functional design sessions, creates and executes SQL test scripts, and aids in the solution of data issues andvalidated the test data in DB2 database on Mainframes using SQL queries.
• Worked with claims and configuration departments to resolve and reduce provider issues by analyzing and researching Medicare and Medicaid guidelines, fee schedules, and provider credentialing, contracting and licensing requirements
• Strong understanding ofFACETSandFacets Data Modelworking on data model and data extracts and experienced working inFacetsonline modules such as Billing, Provider, Claims and Membership modules.
• Converted CSVflat files into HL7 messages, Modifiedandtranslated segmentsofHL7 messagesto properly send to EPIC
• Provided Business Requirement Documentation BRD for the customers after thorough market and technology research and by analyzing current market trends.
• Worked as a part of scrum team, in an agile methodology with sprint cycles, daily stand ups and story implementation. large cross functional project and support teams
• Exposed to usingICD 9/ANSI/HL7coding standards inMedicare and Medicaiddomains of the healthcare systems and industry for both Inpatients and out patients.
• Performing UAT requirements analysis, create and execute UAT scenarios for various CIM Customer Information Management FUSION projects.
• Conducted and analyzed technology processes by requirement performance modeling UML and prepared essential groundwork.
• Serve as a point of contact for the client’s stakeholders and provided customer support in addition to team building with on and off shore agile teams. Working extensively in JIRA to upload Requirements, Test plans, Test Steps, Log defects and to follow up to fix.
• Monitored and conducted exploratory testing across development unit testing, integration testing, and system testing also to help ensure an acceptable handoff for official UAT.
• Create story board of back log items in Agile and develop item according to business needs.

Confidential, OH

Business Analyst

Responsibilities:

• Member of the HL7 EHR Interoperability workgroup and Member of the HL7 claims attachment workgroup.
• Reviewed Daily Transaction Reply Reports (DTRR) and the Monthly Membership Reports (MMR) while abiding by Federal Centers for Medicare and Medicaid Services guidance (CMS).
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• SQL's Database Diagram used to create Table Relationships, and testing of Table Relationship was performed to validate Referential Integrity.
• Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements withinFACETS.
• Interprets Claims Processing Business Rules, tests against MMIS functionality and translates differences into System Enhancements and/or Functional Defects.
• Assisted QA team by reviewing test cases and clarifying requirements to ensure complete coverage of requirements, worked in Agile environment and was able to bring projects to completion.
• Assisted quality assurance team to functional-test the new HL7 interfaces always keeping in mind HL7 and HIPAA guidelines, and coordinated user acceptance testing using derived test data
• Created UML Diagrams like Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Worked in Agile environment allowing teams to deliverprojectpiece-by-piece and make rapid adjustments as needed. Good understanding working in Agile and bringing projects to completion.
• Participating in business requirements session with different work streams and technology teams and analyzed gathered requirements, verified requirements and created business requirement document BRD.
• Produced Initial Medicaid Information Technology Architecture MITA State Self-Assessment Report to support the current Medicaid Management Information System MMIS Replacement Project.
• Direct knowledge and understanding HL7 collection process and the data transaction management and was responsible for data mapping of HL7 messages into relational database.
• Used Mercury Quality Center, assisted in the QTP setup, and reviewed scripts with the group for regression assurance of UAT criteria.
• Thorough knowledge of Eligibility and membership Affairs. Also, knowledge of HIPAA, X12, and HL7 standards and Medicaid provider best practices.
• Submitted and participated in daily defect review meetings emphasis was to help reduce the quantity of defects not being detected prior to UAT.
• Worked as a part of scrum team, in an agile methodology with sprint cycles, daily stand ups and story implementation. Create weekly reports to inform management about the status of the project. Used JIRA as the project management tool.

Confidential, New York City, NY

Business Analyst

Responsibilities:

• Performing business analysis, software validation and testing for client/server, multi-tier and web-based applications for EMR and commercial business for managed healthcare plans and Industries.
• Used a number of SSMS features Sys Dynamic Management Views and Graphical Execution Plans to resolve issues with slow running queries and poor SQL Server performance.
• Organized and facilitated Agile and Scrum meetings, which included Sprint planning, Daily Scrums or standups, Sprint Review and Sprint Retrospective.
• Testing the accuracy of iHelix inpatient EMR for Stage 1 meaningful use clinical quality measure calculation by using Cypress tool.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, using UML and Business Process Modeling
• Gathered and documented both internal/practice and external/ASBS mandated requirements. ASBS COE stipulations included long-term patient follow-up to consistently monitor and track outcomes, complications and co-morbidities in EMR form, in order to submit statistics to ASBS for research purposes, while complying with all applicable patient privacy and confidentiality regulations.
• Analyzed gathered requirements, verified requirements and created business requirement document BRD. Coached team members on how to effectively use Kanban and Scaled Agile Framework values as a guide.
• Have proven business insight and the technical know-how toimplement large-scale EMR and EHR engagements.
• Created detailed Use cases,BPMN flows,Functional Specifications, UML diagrams to remove ambiguity of the requirements communicated by clients or SMEs.
• Monitored testing across development unit testing, integration testing, and system testing also to help ensure an acceptable handoff for official UAT.
• Analysed various EHR EMR packages from several COTS vendors RemedyMD, Medical Manager for suitability and compliance. Recommended best product and installed software acted as intermediary between clinic staff and vendor development team
• Interacted with the developers for resolving the bugs reported in JIRA and various technical issues related to the requirements. Implemented and maintained JIRA for Agile project management.
• Tracked the day-to-day activities, responsible for new requirements and enhancements associated withEMR system.

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Instructed providers how to accurately complete the Medicare Provider Enrolment application on the Confidential Medicare website and the CMS PECOS System.
• Interacted with Product Owner & Agile Development Team on documenting Scrum artifacts like Product, Release & Sprint Backlog.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Queries, Stored Procedures, Triggers, Views, Indexes, Constraints were created on SQL Server to obtain the data used to populate Excel Pivot Tables/PowerPivot on the Front End, generating the final reports.
• Tested the changes for the front-end screens inFACETSrelated to following modules, test theFACETSbatches membership, Billing, Provider
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML and Business Process Modelling.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document BRD, and Systems Requirements Specification SRS.
• Create business requirements documentation (BRD), UML use cases, gap analysis, process models, mock-ups, test scenarios, concept diagrams and business activity diagrams.
• Architected Confidential solution framework to aggregate Patient’s all prior Health records from disparate EHRs using HIE’s RLS service and utilizing RESTful APIs, HL7.
• Participated in techniques such as SPRINT planning, Product Backlog management, agile estimation, daily SCRUM, metrics such as Burn-down & Velocity charts, Sprint summary report, Sprint review/retro meetings.
• Emphasis was to help reduce the quantity of defects not being detected in phases prior to UAT and help to establish regression automation. This was an Agile project for both local and offshore team members.
• Created epics and user stories in JIRA for product backlog. Prioritized release and sprint backlog with product owner and stakeholders. Defined testing scenarios and acceptance criteria. Addressed normal and exception flows including data validation requirements.