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Business Analyst Specialist Resume Profile

SUMMARY OF QUALIFICATIONS:

  • Subject Matter Expert with 10 years of IT experience. 6 years of Medicaid/Medicare experience. Strong knowledge of MMIS Systems and expertise in areas MAR, Eligibility/Enrollment, Third Party Liability TPL , Medicare Buy In, EPSDT CHCUP .
  • SME MARS Management Admin Reporting for New Hampshire Medicaid Expansion Project. NH is creating new Benefit enrollment plans and aid categories to support the ACA Medicaid Expansion Effort. Design and implement the Management Administrative Reporting module for NH. The changes include new fund codes, benefit plans and aid categories for CMS Federal Expenditure and Budget Reports.
  • Implemented MAR Sub-System including Screens, Dashboard, Batch System, Reports and Interfaces.
  • Monthly Reconciliation Reports, CMS 372 series reports, CMS 64 series reports, Expenditure reports, Recipient Reports, Provider Reports and Medicare Participation Reports. Implemented Claims Interfaces, Recipient Interfaces, CHCUP interfaces, TPL Interfaces. Claims FFS, Encounter Drug etc.
  • Worked on MAR MMIS Sub area as a senior developer on the Delaware MMIS implementation.
  • Transitioned to the role of TFAL Techno Functional Lead for MAR on the Florida MMIS Implementation.
  • Experience with Federal and State HIXs Healthcare Marketplaces .
  • Experience in Individual/SHOP Benefit Enrollment EDI Transaction Standards, Configuration and
  • Management for the ACA/Obamacare project.
  • Strong knowledge and understanding of Health Insurance Plans including Medicare Part A, B, C and D.
  • Strong knowledge of data migration and conversion.
  • Strong DBMS knowledge with extensive experience in SQL query language. Experience with relational and
  • XML databases.
  • Vast experience working with Stakeholders like Clients/Owners, SMEs, QAs, Developers, Testers and Users.
  • Extensive experience with State and Federal CMS clients.
  • Experience in developing Use case diagrams, Business flow diagrams, Activity and Sequence diagrams using tools like MS Visio.
  • Excellent organizational skills in conducting JRD/JAD sessions Conducting walkthroughs, surveys and interviews, with a vast experience working with various cross functional teams.
  • Familiarity in conducting GAP analysis, User Acceptance Testing UAT , SWOT analysis, Cost Benefit analysis and return of interest ROI Analysis.
  • Adept at preparing Business Requirement Documents BRD , defining project scope/plans, Functional
  • Specification Documents FSD and delivering project/status reports.
  • Strong knowledge of Software Development Life Cycle SDLC , with excellent understanding of various methodologies like, Agile, RUP and Waterfall.
  • Strengths include quick learner, problem-solving capability, and ability to work as team player and lead
  • the teams demonstrated ability to achieve tight deadlines.
  • Excellent written and oral communication skills.
  • Graduate from Top 20 engineering school in India.

TECHNICAL SKILLS:

  • Technology : C, Pro C, SQL, PL/SQL, .NET, Visual Basic, Shell Scripting,
  • Platforms : Solaris, HP-UX, Windows.
  • Databases : Oracle, DB2, Microsoft SQL Server, Postgres, MS Access, MarkLogic
  • Tools : TOAD, Putty, Filezilla, etc. SDLC Methodologies : AGILE, RUP, WATERFALL Business Modeling : MS Visio
  • Requirements Management : MS Project, MS Office.
  • Change Management : HP Propriety interChange, CMS propriety CALT
  • Analysis/Modeling : UML, JAD, GAP Analysis, Business Definition Requirements, Business Process Mapping, Analysis, Research, Requirement Gathering, Requirement Documentation, Use Case Modeling

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst Specialist

Configure and manage the systems to handle all the EDI Traffic between the Federal Health Marketplace and the issuers. Configuration of EDI 834 version 5010, 820 version 5010 and other EDI transactions. Manage the transfer of EDI 834 transactions between State Market Places and Federal Marketplace.

Responsibilities

  • Management of all EDI individual enrollment transactions between FFM and Issuers.
  • Management of all EDI individual enrollment transactions between SBMs and FFM.
  • Generate reports for senior management.
  • Create user stories and other artifacts to implement new requirements and fix defects.
  • Work with CMS management and SMEs to oversee the implementation and maintenance of the system.
  • Work with Adobe Team to onboard new issuers through the Adobe Live Cycle platform.

Confidential

Functional Lead Claims

Responsibilities:

Requirement Validation Sessions

GAP Analysis

Design Sessions

System Documentation

Business Modeling

Confidential

Techno Functional Area Lead

Responsibilities:

  • Techno Functional Lead for Medicare Buy In, TPL, MAR and CHCUP area Analysis, Design, Implementation and Documentation.
  • Team Lead for Medicare Buy In, TPL and CHCUP area in achieving the CMS Certification.
  • Team Lead for Medicare Buy In, TPL and CHCUP area in HIPAA 5010 Implementation.
  • Team Lead for Medicare Buy In, TPL and CHCUP area in Solaris to HP UX Migration.
  • Team Lead for Medicare Buy In, TPL and CHCUP area in ICD 10 Implementation.
  • Implemented MAR Reports and Interfaces. Monthly Reconciliation Reports, CMS 372 series reports, CMS 64 series reports, Expenditure reports, Provider Reports and Medicare Participation Reports.
  • Worked with EDI Team for 837, 835, 834, 820, 270, 271 transactions.
  • Responsible for translating Business Requirements into Technical, Functional and Non-Functional specifications.
  • Involved in preparing the Test Scenarios: Unit testing, Integration testing, System testing and Regression
  • testing.
  • Developed and maintained all operational and technical flows using MS Visio and Power point.
  • Used Rational Rose and MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models.
  • Documenting organizational policies and procedures in the context of system requirements.
  • Work with business users to problem-solve and identify workable solutions.
  • Develop workflows that demonstrate current and proposed business requirements.
  • Documented complete program and project goals, objectives, constraints, assumptions, risks, and facilitated processes by working with the project team, and stakeholders.
  • Prepared and delivered project plans and identified major milestones for each stage as per the AGILE
  • methodology.
  • Conducted JAD sessions to define project tasks and to reduce the time frame required to complete deliverables.
  • Key Achievements:
  • Maintenance and Implementation of Medicare Modernization Act Interface.
  • Maintenance and Implementation of CMS Entitlement Database Interface.
  • CMS Certification
  • Maintenance and Implementation of TPL Recovery/Capitation/Financial Adjustment/Cost Avoidance Process.
  • Implementation of TPL Reports and Interfaces to external vendors.
  • HIPAA 5010 Compliance
  • Solaris to HP UX Migration
  • Consulted Louisiana MMIS on selection of TPL Vendor.

Confidential

Senior Developer

Responsibilities:

  • Customization and implementation of Management and Administrative Reporting.
  • Customization and implementation of TPL Reporting.
  • Modification and Implementation of Claim Edits and Audits. Worked in the area of Hospice Claims.
  • Modification and Implementation of Claim Pricing Logic Changes.
  • Prepared and analyzed As-Is and To-Be in the existing behavior and performed Gap analysis, and created workflow scenarios, designed new process flows and documented the Business Process and various Business Scenarios and activities of business from conceptual to procedural level.
  • Involved in preparing the Test Scenarios: Unit testing, Integration testing, System testing and Regression testing.

Confidential

Senior Developer

Responsibilities:

  • Writing source code in Pro C to covert the legacy data to new system data.
  • Involved in preparing the Test Scenarios: Unit testing, Integration testing, System testing.
  • Conducted training workshop for mid-level management, developers and business analysts.
  • Created process flows for my areas in Microsoft Power Point.

Confidential

Software Developer

Responsibilities:

Programmer

  • Involved in preparing the Test Scenarios: Unit testing, Integration testing, System testing and Regression testing.
  • Environment: .NET, Microsoft SQL Server

Confidential

RFID Technical Analyst

Responsibilities:

  • Evaluate RFID Software Offerings.
  • Conduct RFID Demo sessions.
  • Programmer

Environment: SAP, Visual Basic.

Confidential

Software Developer

Responsibilities:

Programmer

  • Involved in preparing the Test Scenarios: Unit testing, Integration testing, System testing and Regression testing.
  • Environment: Oracle Apps, PL/SQL.

Confidential

Software Developer

Responsibilities:

Programmer

  • Involved in preparing the Test Scenarios: Unit testing, Integration testing, System testing and Regression testing.
  • Environment: Oracle Apps, PL/SQL.

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