SUMMARY

• Healthcare Business Analyst with Over 7 years of diversified experience in areas like Business Analysis and Testing.
• Experience in working with Microsoft Office suite (word, excel, Access, Visio, Power Point and Outlook) for documentation, analysis and presentation.
• Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare - Medicaid, HIPPA, HIX on EPIC software applications
• Expertise in Software Development Life Cycle (SDLC), Use Cases, Business Process Modeling Notation (BPMN), Object-oriented Analysis and Design, Rational Unified Process (RUP) and Rational tools used during all four phases of RUP: Inception, Elaboration, Construction, and Transition.
• Hands on experience working on Eligibility determination of Medicaid, SNAP, TANF and Food Stamps.
• Strong knowledge of Families First/TANF, SNAP/FS, Child Care, TennCare Medicaid and TennCare Standard policies.
• Facets is a product which handles enrollment, claims processing and other allied services pertaining to the Managed Care.
• Developed and run periodic global "ITSM monthly Performance metrics report" with scheduled reports in ServiceNow and compared with ITSM Scorecard with focus on strategic KPIs.
• Develop KPIs and provide ITSM performance metrics reports using ServiceNow Performance Analytics Module.
• Processing claims through EDI 837 files to FACETS system and also worked on scenarios for complete claims lifecycle
• Performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
• Responsible for verification and validation of inbound HL7 messages (NEW, STR, END, PRD, DRG, ALM, TMS), these message types and segments are customized.
• 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.
• Extensive knowledge of Medical Management Information Systems (MMIS), and National Provider Identification (NPI).
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence).
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270, 271 for healthcare benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication)
• Extensive experience working with vendors and various internal customers of clinical, financial and patient care to develop new HL7 interfaces.
• Extensive experience working in back end tester by writing SQL Queries and PL/SQL scripts on large data warehouse systems involving Terabytes worth of data.

TECHNICAL SKILLS

• C++
• SQL
• HTML
• SAS
• MS-Access
• Oracle PL/SQL
• ASP.NET
• MS SQL Server
• DB2
• Microsoft .NET
• Frameworks
• ASP.NET
• SAP
• Flash
• JavaScript
• PVCS Tracker and SharePoint
• HTML
• XML
• Macromedia Dream Weaver
• MS-Front Page
• MS Word
• MS Excel
• MS PowerPoint; (Lotus
• HTTP
• TCP/IP
• FTP
• MS-Visio
• Rational Rose
• Irise (User Experience)
• MS-Project
• PVCS Tracker
• SDLC
• SDM
• Agile
• Waterfall
• Object Oriented Analysis and Design (OOAD)
• Rational Unified Process (RUP)
• Unified Modeling Language (UML)
• Rapid Application Development (RAD)
• Joint Application Development (JAD)
• Facets Applications: Medical Plan
• Application Support
• Billing
• Claims Processing
• Provider
• Subscriber/Member
• Utilization Management
• NetworX

PROFESSIONAL EXPERIENCE

Confidential, Doral, FL

Sr. Business Analyst

Responsibilities:

• Responsible for executing Epic workflow / flow sheet analysis, system setup and configuring Epicambulatory and inpatient templates according to the specialty clinic patient order sets.
• Acted as primary liaison between the client departments and the Information systems IT department; performed analysis, review, and estimation of client requests.
• Tracked the day-to-day activities, responsible for new requirements and enhancements associated withEMR system.
• Maintain ITSM ServiceNow applications such as Incident, Problem, Change, Request, Demand.
• Facilitated JAD sessions with all levels of the business community for requirements gathering, project development, design considerations, impact and risk analysis.
• Worked in various technologies such as EpicCare Ambulatory, EpicCare Inpatient, Citrix, HL7 (v 2.3/2.4), PACS, DICOM, XML, Java, .Net, Oracle and HTML.
• Monitoring the migration of BMC Remedy with ServiceNow and developing ITSM/ITIL processes, roles, business procedures to support (ITSM) best practices.
• Aligned requirement documentation with use of UML for object oriented software development.
• Ensured that each test case was documented with expected results and actual results. Documented errors and bugs on an issue log. Worked with the developers to ensure that issues were understood and corrected in a timely manner. Once issues were resolved, processed test cases again to validate that the errors and bugs were fixed. Processed weekly status reports showing status of all test cases. Once implemented, assisted end user to ensure functionality.
• Incorporated HIPAA standards, EDI (Electronic data interchange), and code sets, ICD-9 /CPT.
• Testing of Epic billing reports (hospital billing and insurance billing) for Epic billing output and interface accuracy.
• Create and executerevenue cyclemedication Epic billing data and reports from decision support and billing systems. Analyzed all related medical codes for accuracy to ensure maximum benefit allowed is accurately billed.
• Ensure thatdata interfacing into the application meets business needs- both for ongoing interfaces and one-time data conversions.
• Liaised with end users on system design challenges and preferences in relationship to clinical processes and procedures; presented these findings to application. Development team, making recommendations according tobilling workflowand end user needs.
• Provided rotational 24X7 on-callrevenue cycle and billing applications technical application support.
• Troubleshoot and track issues and problems related to Epic ambulatory care solution and inpatient management system. Developed Epic patient billing representative training manual, provided new hire operational and application training.

Confidential, Indiana

Business Analyst

Responsibilities:

• Used Queriesto generate monthly HEDIS report using 12 month rolling measurement period from Clinical data repository
• Gathered requirements from wide variety of stakeholders using various elicitation techniques and documented them.
• Assisted in interfacing EMR system with decision support analytics that summarize patient profiles
• Directed and participated with others in the planning, development, implementation, maintenance, and evaluation of clinical or business application systems as assigned.
• Participated in the analysis and documentation of current and future needs as well asworkflows through interviews,gathering data regarding regulatory requirements, operation procedures and hospital/departmental policies
• Formulated Business Requirements usingAgile / Scrum methodologies to decompose requirements into Epics and User Stories iteratively
• Functioned as a liaison to the system users and stakeholders to translate business requirements into technical requirements, data flows and process flows.
• Provided feedback to physicians and others regarding performance profiles and data trends
• Performed GAP analysis assessed As-Is processes through user interviews, data collection and analysis, design and evaluation of To-Be process solutions.
• Create and update training documentation and provide user training on ITSM tool.
• Responsible for leading and coordinating User Acceptance Testing UAT, System Integration testingSIT,and Regression Testing RT by working along with the QA team.
• Analyzed CMS comparison documentation highlighting changes of 5010 format and ICD10 diagnosis and procedure codes.
• Prepared written documentation for application changes or replacements and coordinates staff and managed project plans for their implementation.
• Participated and developed documents and validated comprehensive test plans complying with current standards, design to produce successful and failed outcomes
• Involved in developing training manuals for users to help them understand the business process
• Prepared a comprehensive set of wireframes to ensure the consensus onUIwith the help of SME and by continually interacting with the network Physicians for feedback.
• Educated analysts and programmers on business requirements, objectives and operational needs and the relevant system applications.
• Designed and created Excel sheets and used decision tree to provide market analysis charts.
• Used data mining tools performed in a SQL database to analyze EHR data
• Played a key role in theuser acceptance testing UAT, and implementation of system.

Confidential, Bethesda MD

Business Analyst

Responsibilities:

• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS
• Conducted Business validations for different FACETS modules Providers, Claims, enrolment and Membership
• Worked with SME close to understand Claim Adjudication Process setup in Facets.
• Extensively used Agile Methodology in the process of the project management based on SDLC.
• Worked on solving the errors of EDI 834 load to Facets through MMS.
• Manipulated HL7 data in XML transmissions to match vendor specifications using Java Scripting.
• Maintained business and technical specifications for the submission of Medicaid EDI X12 837 and NCPDP formatted Encounter Claims.
• Extensive experience working in back end tester by writing SQL Queries and PL/SQL scripts on large data warehouse systems involving Terabytes worth of data.
• Extensively involved in performing integration testing for EPIC 2017 upgrade
• Expert in conducting GAP analysis, User Acceptance Testing (UAT), Cost benefit analysis and ROI analysis.
• Experience with Trizetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Used Facets to receive, store and send HIPAA-standard transactions (835, 837, 270, 271, 276, and 277) and to administer HIPAA privacy rights.
• Build and validate ADT interfaces from Epic to numerous lab system
• Build and validate charges interface from numerous lab system to Epic
• Supported integrated testing activities for Epic 2017 upgrade and Epic rev cycle
• Performed integrated test scripts for various scenarios involved in Epic OpTime/Anesthesia, Orders, Grand Central, Cadence, HIM, HB and PB
• Involved in testing connectivity, Data flow, Data validation, Error Handling, transformation of HL7 messages between Epic and various Ancilliraious via Integration broker
• Worked on bridge engine to track HL7 messages from Epic to third parties like labs, radiology, etc.
• Performed application testing and integrated testing and created test result document for reporting
• Wrote scenarios to test third party applications such as Soarian, BioMed, Vanderbilt etc, which integrated with Epic
• Developed test cases and test scripts and assisted Quality Assurance activities, with system integration testing and user acceptance testing (UAT), developing and maintaining quality procedures and ensuring that appropriate documentation is in place.
• Responsible for identifying and documenting business rules and creating detailed Use Cases
• Developed ETL mappings, testing, correction and enhancement and resolved data integrity issues.
• Created the conceptual, Logical and Physical Model for the data warehouse with emphasis on insurance (life and health), mutual funds and annuity using Erwin data modeling tool.
• Participated in the process of internal and external auditing activities and developed timelines for project delivery, and

Confidential, Newark, NJ

Business System Analyst

Responsibilities:

• Performed felid-by-field mapping of interface between parent EMR system and downstream system.
• 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).
• Worked closely with the development team and offshore testing team to coordinate the testing
• Prepared ETL standards, Naming conventions and wrote ETL flow documentation for Stage, ODS and Mart, used Change Data Capture (CDC) to simplify ETL in data warehouse applications.
• Expertise in Facets extension development, Facets Testing, Facets Interfacing
• Has exposure in the Design, development and maintenance of commercial projects using Waterfall Model and Agile Model.
• Agile and Waterfall methodologies were present and identified deficiencies, created a defined business cases, and upon approval, implemented strategies for the department and adjacent teams.
• Worked on HL7 inbound and outbound interfaces. Define data specifications and map out data crosswalks. Understanding of interface messages and triggers such as A01, A02, A03, A05, A08 and A17, Merge messages, appointments, and other types of HL7 messages; ORM, ORU, DFT, MDM and MFN.
• Configured, analyzed, and tested Epic Resolute Hospital, Home Health, and Hospice Billing applications based on end user workflows, state and federal regulations, and patient needs.
• Performed Data Analysis, writing SQL Queries for Testing and Troubleshooting against Data Warehouse.
• Performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
• Ability to analyze 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
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
• I assisted the Epic Resolute Hospital Billing and Epic Security team with successfully completing Phase I and Phase II of their system Go-Live.
• Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications
• Generated reports using SQL server Reporting Services (SSRS), and created user friendly templates, indexes, using XML and worked on project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Worked with the business to identify rules for the automatic generation of letters and correspondence for the Lead cases.
• Accomplished projects and design documents on HIPAA 835 and 837 calculations and EDI transactions, Health Statements and Explanation of Benefits, Healthcare Reform and 5010 CMS occurrence and field expansion for 835 and 837 EDI formats
• Identified gaps in the existing Lead survey and assessment, developed in Phase I, and documented them in the TRD and the survey specification document.
• Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications