- Over 9 years of experience in the field of Information Technology in the Healthcare-Life Sciences / Pharmaceutical / Pharmacy Benefit Management PBM / Insurance domain encompassing business systems planning, procedural development, reporting and validation.
- Extensive Knowledge of Medicare, Medicaid, procedural and diagnostic codes
- Experience in Conversion of HIPAA X12 4010 transactions to X12 5010 transactions and knowledge of ICD 9 - ICD 10 conversions
- Developed Functional Requirements FSR Business Requirement Documentation BRD , Traceability Matrix, Handle requirement change and User Conflicts.
- In-depth knowledge of Risk Analysis and Risk Management, Process feasibility studies, System Analysis and Gap Analysis.
- Experience in documenting requirement using Unified Modeling Language UML , Use Case and Activity Diagrams , Sequence Diagrams, and also building Business Process Flow Charts tools using Ms Visio.
- Skilled in Automated and manual testing, Reviewing Test Cases, assist in overall testing process by activities such as Change and Defect Management and conducting User Acceptance Testing UAT . Testing tools also include, Quick Test Professional QTP , Quality Center QC , Test director, Win runner, Load Runner, and Rational suite.
- Experienced in Requirement Gathering, Business Systems Planning, Procedural Development Implementation, Business Process Mapping, Problem Solving/Workarounds and Business Contingency Planning/Disaster Recovery, Creation of Domain Models and Creating Reports for Analytics
- Understanding and mapping of the various ICD9/ICD10 Codes applicable for tracking of diseases for which diagnostic testing is done in the area of Biochemistry.
- Knowledge and experience in implementation of HIPAA and NCPDP standards.
- Experience in preparing documentation which is in compliance with 21 CFR Part 11, Medicare Part D requirements, HIPAA ANSI X12 Transaction sets, and in accordance with NCPDP National Council for Prescription Drug Programs Standards.
- Experience in Project Management and Project Planning. Thorough understanding of Business Analysis, various SDLC methodologies such as RUP, Waterfall and Agile. Giving emphasis on system analysis, Elicit Requirements Gathering, application testing and final roll out.
- Collect, Analyze, Organize and Document business requirements, schedule user requirement gathering meetings, conduct one-on-one interview with stakeholders, related SME's and Project managers. Organize JAD sessions in close coordination with Stake holders and developers..
- Accomplished in Business Analysis, System Analysis, Quality Analysis with extensive experience in business products, operations and Information Technology on the capital markets space specializing in Finance such as Trading, Fixed Income, Equities, Bonds, Derivatives Swaps, Options, etc and Mortgage with sound knowledge of broad range of financial instruments.
- Knowledge of Claims Processing.
- Application of Software Development Life Cycle SDLC , with thorough understanding of various phases such as Requirements, Analysis/Design, Development, Testing and Implementation.
- Extensive experience with Business Use Cases, Functional Use Cases, Business Process Models, Test Cases.
- Extensive experience in process modeling using UML, flowcharts, sequence diagrams, activity and diagrams.
- Strong knowledge of UML, RUP, Rational Suite including Rational Rose Requisite Pro, Clear Quest and Clear Case, Microsoft Visio.
- Experienced in conducting Joint Application Development JAD sessions with SMEs, Business Analysts, Software Developers and Quality Assurance teams for New Corporate Accounts or Clients.
- Excellent communication, interpersonal, analytical skills and strong ability to perform as part of a team in for four years in CMMI accredited and CMS Compliant Medicare Part D companies.
- Worked with ETL Developers and Process Analysts in preparing the requirements data and functional , and writing documenting work flows and process flows
- Understanding of the Lab Requirements mandated by the College of American Pathologists
- Strong attention to detail and proficient in working in high pressure environments with tight deadlines
- Involved in revising existing systems and procedures to correct deficiencies and maintain effective data handling, conversion, scheduling, multitasking of functions, tasks input/output requirements and storage.
- Well versed in support coordination with onshore and offshore teams located worldwide.
- Ability to work in a fast paced, dynamic environment and handle multiple tasks.
- Quick Learning skills with motivational ability to quick adapt with all aspects of businesses within short period of working environment. Dedicated in maintaining professionalism, work ethics and quality in par with the business standards.
- Application Servers / OS:
- Macintosh, MS Windows 2000, XP, Vista, Win 7 NT4.0,Win9x,Win2000, Novell, DOS, Win2003
- SQL Server, MS SQL, MS Access, Oracle.
- Tools /Applications
- Business Process Modeling: Action Workflow, Gap Analysis, CASE wise, UML, MS-Visio.
- Methodologies: Software Development Lifecycle SDLC methodologies, Rational Unified Process RUP , Waterfall, Agile, Quality Function Deployment QFD for Software Development, Joint Application Development JAD ,
- Full Lifecycle Software Development Tools Methods: Object Modeling Technique, Use Case Method, basic data modeling techniques.
- Presentation and General Business Tools: MS Office MS PowerPoint, MS Word, MS Excel and Word Perfect , Business Objects, MS Project
- Testing Tools: Rational Enterprise, SQL, Quick Test Professional QTP , and Quality Center QC Test Director, Win Runner, Load Runner and Rational suite.
- Interacted and arranged meetings with Business and End users to gather business requirements for changes triggered by Government regulations and HIPAA, Business needs and Process improvement.
- Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
- Prepared User Requirements Document URD , Business Requirements Document BRD and Functional Requirements Document FRD .
- Worked closely with project manager in setting realistic project expectations and in evaluating the impact of the changes of the organization and plan accordingly
- Developed Flowchart and process diagram using Microsoft Visio.
- Performed a baseline assessment of Hospital-Provider systems and related interfaces, existing service level agreements, policies, and operational business procedures for readiness to comply with ICD-10 requirements
- Actively worked on Data analysis and Report analysis with respect to ICD-10 impact
- Analyzed System flows, work flows, and process flows of various department of the hospital with respect to applications
- Identified risks, problems, requirements and concerns of the Hospital in order to comply with ICD-10 changes by conducting interviews
- Exposed to Billing, Coding and Claim reimbursement process and analyzed Data flow
- Mapped the collected data with the existing data provided by the hospital departments
- Gained understanding of the hospital working system including registration, scheduling, radiology, laboratory, pharmacy, patient accounting, HIM, claim processing
- Performed Unit Testing and User Acceptance Testing and documented detailed defects.
- Developed Test Cases to validate the requirements and documented the Traceability Matrix for Test Cases and Requirements
- Followed the RUP based methodology to create Use Case, Activity/ State Chart, Sequence, and Collaboration Diagrams.
- Worked on Required Traceability Matrix RTM for traceability of requirements.
- Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements with the support from SME's
- Ensured the accuracy and consistency of the data during the data loading process.
- Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
Environment: MS SQL, UML, Windows 7, MS Office, Business Objects, Gantt Charts, Swim-lane Process Flow, MS Project, MS Visio, Quality Center, QTP.
- CSG is an implementation company catering to the State of Indiana Department of Medicaid. As a Business Analyst and a part of the gap analysis and implementation team, the role is to understand the EDI Transactions, Pharmacy Transactions from an NCPDP perspective and current ICD9 codes being used by the State. The objective is to conduct a gap/impact analysis in order to adhere to HIPAA Compliances required by CMS for the years 2012 and 2013. The duties performed for this role are as follow:
- Understanding and assessment of the current EDI Transactions used
- Understanding and assessment of the current Pharmacy Transactions from an NCPDP 5.1 perspective
- Understanding and assessment of the current ICD 9 codes used by the State
- Creation of a Gap/Impact Analysis Document for changes of the EDI Transactions 837, 835, 276/277, 270/271
- Creation of a Gap/Impact Analysis Document for changes to Pharmacy Transactions real time and batch based on NCPDP 5.1 to NCPDP D.0 , specifically concerning the data elements
- Creation of a Mapping Document for ICD9 Codes to ICD 10 Clinical Modifications and Procedural Codes.
- Creation of Gap/Impact Analysis Document for the Prescription Drug Point of Sale System
- Creation of Gap/Impact Analysis Document Operational Analysis Document for the Drug Utilization Review System
- Creation of Gap/Impact Analysis and Operational Analysis Document for Medicaid Subrogation
- Creation of Gap/Impact Analysis Document and Operational Analysis Document for the Drug Rebate Analysis and Management System
Environment: MS Office Suite, MMIS, POS, GEMS, Document Analyzer, SharePoint
- Performed Gap Analysis, conducted walkthrough sessions and acted as a liaison between the business users, stakeholders and the various teams involved in the project to perform requirements, quality and risk analysis.
- Involved extensively in the inception phase of the project for understanding the Scope, feasibility of the implementation and define the risk factors involved.
- Experienced in gathering requirements for clinical trials data using BASE SAS for the developers to establish deliverables and reports for regulatory agencies like NDA, IND, FDA.
- Working with Medicare operational management to monitor, trend, and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
- Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
- Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products.
- Gathered business requirements by interviewing business users and Subject Matter Experts SME .
- Conducted Joint Application Development JAD sessions with IT groups. Identified the Key Changes.
- Analyzed business/system requirements using requirement arbitrage and assigned appropriate priorities.
- Effectively managed the requirements and requirement change requests during various phases of the project life cycle.
- Ensured that all the requirements, enhancements and defects for that particular release have been developed, fixed and tested by creating traceability matrices between all the project artifacts.
- Work with business users to ensure that the user stories are good, has business values and story points.
- Facilitated the story board discussions of the user stories for portal design and usability.
- Provided the project manager with regular status updates assisting the overall project management initiative.
- Performed requirement walkthrough sessions with the Dev and QA teams with the aim to develop testing strategies and test plans such that test cases reflect the user needs.
- Worked extensively with MS office suite for preparing status reports
Environment: Windows 2007, SAS, MS Project, Agile, MS Visio, Oracle, MS Office suite.
- Elicit Requirements by understanding, analyzing the current process and documenting all Key Performance Indicators KPI keeping in mind the end users.
- Identified system integration requirements, coordinated the collection and verification of the business needs.
- Identify business and functional requirements for design layout.
- Documented requirements including source-to-target mappings with use case specifications
- Created conceptual and logical data models, Data mapping in coordination with data warehouse developers.
- Responsible for generating reports by using sections, breaks and filters.
- Used SQL queries to verify the system functionality and provided the users with the needed data and information during the operational phase.
- Facilitated Joint Application Development JAD sessions to identify business requirements.
- Liaison with the IT, vendor and business user to drive the required solution.
- Assisted project manager with project scoping, project plan and monitoring.
- Employed Agile development process to bring higher quality software development cycles into the project.
- Maintained and updated test plan, test cases, test scenarios and test environment in QC throughout the SDLC. Conducted functional walkthroughs, User Acceptance Testing UAT , and assisted the development of User Manuals for customers.
- Involved in Preparing Defects Reports and prepared Test summary reports.
- Administered Requirements throughout the project life cycle including scope/change management.
Environment: Windows NT, MS Visio, HTML, Microsoft Share Point, MS Office, MS Excel, Ms SQL, MS Access, QTP, QC, Test director.
- Confidential is a global health service company, dedicated to helping people by providing Short Term Disability Insurance STD , Long Term Disability Insurance LTD , Life, General Accident GA and Business Travel Accident Insurance BTA coverage in the United States. The company strives to enhance employee health and productivity through health and wellness programs and lower overall costs.
- As a Business Analyst and a part of the implementation team in Confidential, the role is to understand the existing business process for the Contracts Management System, gather requirements and create documentation for an improved Contract Management Process in a system-agnostic manner for the following products Short Term Disability Insurance STD , Long Term Disability Insurance LTD , Life, General Accident GA and Business Travel Accident Insurance BTA . The objective is to elicit requirements for an improved and effective group insurance Contract Management business process for a potential Contract Management tool implementation. The duties performed for this role are as follow:
- Understand current Contract Management business process for all group insurance products by interviewing SME's and team members
- Assisting the Requirements Lead in formulating Workshop Session agendas and facilitating Workshop/JAD Joint Application Session agendas
- Create, analyze and finalize the improved Contract Management business process workflows for all the group insurance products
- Creating documentation for all identified data models such as Domain Model-Data Mapping, Data Dictionary and ER Diagrams from Legacy Systems, Book Of Record and CLM Solution Tools for Question Tree co-relation purposes
- Creating Business Rules and User Interface Rules for data elements/fields
- Utilizing the Waterfall Methodology in creating the requirements for eventual Contract Management tool implementation in a system-agnostic manner
- Creating artifacts for weekly distributions to the business and maintaining the Requirements Traceability Matrix
- Creation of feedback update template for incorporating business feedback and updating requirements
- Performing and tracking feedback analysis
- Handling of and coordination with a team of Off-Shore Resources in India.
Environment: Waterfall Methodology, LIMS, MS Office Suite, Livelinks, LiveMeeting, CLM Contracts Tool
- As a Business Analyst in the Government Pricing/PPD Division, the focus is on maintaining the data integrity based on the flow of information from various sources and interfaces into the Government ODS System Operational Data Store which in turn feeds data to various applications including the GP I-Many for completing calculations based on laid out government regulations for products sold to the government. In line with this, the responsibilities are as follow:
- Technologies and new ways to manage health.
- Abbott Laboratories is a global broad-based health care company devoted to discovering new medicines, new
- Acted as a liaison between business clients and technical personnel to acquire and record requirements for upgrades, enhancements and new projects.
- Processed DBCR Database Change Request documentation and coordination with technical team
- Discussed and documented impact analysis for numerous interface changes while being part of the team representing the Reporting and Analytic Finance team
- Updated SDDs Software Design Documentation
- Applied pharmaceutical data understanding as per Government Pricing.
- Ran queries monthly to verify tie-outs for the business prepared by the technical resource to provide support for applications solutions supported by the Reporting and Analytic Finance team with emphasis on the Corporate Finance Cognos Planning Models.
- Created and published reports using Query Studio
- Followed existing CMMI and Sarbanes Oxley compliant protocols incorporated in daily procedures.
- Built effective partnerships with business and systems communities by demonstrating an understanding of the interdependencies between application functionality and associated business processes to provide best service.
- Manages application service requests problem resolution, new functionality, testing, and documentation .
- Interfaces with partner systems personnel to collaboratively resolve issues.
- Provides functional application and business expertise to support end users or interface partners.
Environment: Lotus Notes, Microsoft Visio, Squirrel, GITS Government Issue Tracking System Application, PTA Packet Tracker Application , MKS Integrity Code Promotion Request Query Studio.