SUMMARY

• Sr. Business Analyst wif8+years of Healthcare industry experience in Clinical and Non Clinical Healthcare Applications wif good experience ingathering business requirements, business process flow, Training Skills & Quality Assurance.Experienced working in complex, cross functional, multi - dimensional and geographically dispersed team environments.Motivated, self-starter wif exceptional team building, leadership, and interpersonal skills
• Results-driven, versatile consultant wif over5plus years of experience inBusiness Analysis,Build, Operations,ProductDevelopment, Quality, AssuranceImplementation,Training and Project management.
• Experienced inClinical, EMR, EHR,PACS,HR and Interfaces
• In-Depth Domain Expertise on Clinical and Non-Clinical functionalities and processes
• Skilled at conductingHigh Level JAD Sessionswif Subject Matter Experts and End-Userstoanalyzethe current and proposed business processesfor effective outcomes (Rapid Application Development, project meetings, reviews, walkthroughs, and customer interviews. Conducting User Acceptance Testing (UAT) and verifying performance, reliability and fault tolerance issues).
• Experience inclient (physicians, nurses and other healthcare providers) interaction, strong clinical knowledge, excellent analytical, technical, communication, organizational, projectmanagement, interpersonal and team skills
• Strong understanding of systems and applications wif the ability to develop and apply system solutions to operational requirements
• Experience in working closely wifEnd Users, translaterequirementsintotechnical specifications
• StrongClinical, providerand Payerworkflow knowledge.
• Strong knowledge ofUse Cases, Sequence Diagrams, FSDS, Collaboration Diagrams, Activity Diagrams, Class DiagramsandData Flow Diagrams (DFD)using Visio.
• Good Understanding of Sql and Database functionality
• Experience in leading a Team inDocumenting Product Performance, Integration, Interface,Migration via Manual Testing of an Application
• Effective in strategically enabling enterprise and Business solutions, while working wif cross-functional, cross-organizational teams.
• Excellent knowledge of standard industry methodologies like Software Development Life Cycle (SDLC), Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP), Agile (SCRUM)
• Analytical skills includeSurveillance and Utilization Review (SURS), budget forecasting, managed care rate setting, and cost benefit analysis and benefit modeling.
• Experience in true Agile/SCRUM/XP environment
• Experience using Agile automation test frameworks
• Strong Interactive Training and Presentation skills
• Strong Knowledge on claim processing andEDItransactions me.e. Claims Inquiry and Response, Receipt and Verification of claim forms(837), Claim Payment and advice(835), Eligibility Inquiry, Certification Request and Response(278), Benefit Enrollment(834), Order and Payment Remittance(820)
• Experience in developing Test Scenarios, Test Plan and TestCasesas per the business process requirements
• Good knowledge and experience inSoftware Development Life Cycle(SDLC)
• Excellent understanding ofICD 9, ICD 10, HCPCS, and CPT.
• Knowledge on HIPAA institutional, professional and commercial claims, and up-gradation of ANSI 4010 to ANSI 5010.
• Handled domestic and international projects
• Exposure and Experiencein Handling the Operations ofonsite and offshore models.
• TEMPHas Experienceand knowledgeon CCHIT Certification process andMeaningfulUse ofEHR.

PROFESSIONAL EXPERIENCES:

Confidential

Sr. Healthcare EDI Analyst

Responsibilities:

• Transaction Monitoring, Adjustments, Special Issue Resolution, Processing mass changes, Exchange Transitions and Program management, Standard Operating Procedures (SOPs) & Business Requirements.
• Part of Team supporting all phases of the design, development and implementation of an Enrollment Resolution and Reconciliation process for health insurance exchanges.
• Support in developing case database.
• Work wif the technical and development team to resolve identified issues in a timely manner
• Responsible for troubleshooting and resolving errors in 834 and 820 transactions for health insurance exchanges and performing root cause analysis
• Trained 20 analysts and worked as team lead.
• Work as SME and do weekly meeting wif Center of Medicare and Medicaid services staff to discuss complex case analysis
• Review documented training material for accuracy and assist in end user training and support
• Participate in design sessions, report on project progress and identify potential risks and issues
• Responsible for analysis of discrepancies in the eligibility reconciliation process for multiple stakeholders and continuous process improvement of the reconciliation process
• Provided training on the transactions and on the reconciliation processes
• Work wif the technical and development team to resolve identified issues in a timely manner
• Review documented training material for accuracy and assist in end user training and support
• Worked in a changing and fast pace environment to meet the guidelines as outlined by the CMS
• Met the performance goal as set up by the management.
• Environment: MS Word, MS Excel, Ultra edit, Notepad, SharePoint, VPN, FileZilla, HICS, Decision Matrix,

Confidential, CA

Sr.Business Analyst

Responsibilities:

• Assisted in creating Project Plan, Road Map. Designed Requirements Planning and Management document.
• Conducted GAP Analysis and documented the current state and future state, after understanding the Vision from the Business Group and the Technology Group.
• Gatheird requirements from claims business area, prepared process flows and diagrams for the project.
• Performed gap analysis for HIPAA 4010/4010A - 5010 conversion - Involved in the documentation of HIPAA 5010 changes to EDI 837 transaction.
• In depth knowledge of HIPAA/EDIX12 v5010 healthcare related file formats including 834, 837, 276, 277and 820.
• Communicate wif X12 and ICE for new information on 5010 and all standards
• Resolve client issues wif mapping and X12 education
• Create maps for all X12 transactions inbound and outbound formats in accordance wif health plan guides.
• Performed gap analysis of ICD 9 to ICD 10 conversion for procedure and diagnosis codes in accordance wif the HIPAA compliant.
• Effectively elaborated the current process and gave a clear picture of the proposed process for the projects in the organization and aggressively worked towards timely completion of high priority tasks.
• Knowledge of electronic health record (EHR)
• Maintained and submitted periodic/monthly status reports to the Program Manager to serve as the team’s assessment of the project and its schedule.
• Led the change control process for changes submitted for the BRD after the document was submitted to IT department.
• Worked wif IT team to resolve issues and clarify business requirements from the business owners.
• Strong technical experience encompassing the complete lifecycle of project - design, development, testing, validation, deployment and support wif strong focus in EDITranslator tools, Transactions, Data format and Standards..
• Documented the UAT plan for the project and worked wif the UAT Team to ensure every acceptance criteria for the requirements TEMPhas been included in the UAT task plan.
• Maintained the traceability matrix to uniquely trace the identified business requirements of general design to testing as proof that requirements requested has been developed into a solution and tested.
• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team

Environment: MS Office, MS Visio, Caliber RM, SQL server and Oracle, Agile( Scrum), HPQC 10, HTML, MS Project, JIRA, SharePoint

Confidential, CA

Sr.Business Analyst

Responsibilities:

• Sr. Business Analyst in New Family Care Team Project.
• Senior Business Analystrolefor SCA/SCC/SCT/POC/CPOE implementation
• Task management and resource management by managingBusiness Analysisplans for clinical systems
• Acting as the primary contact between the customer and Siemens project resources
• Worked wif MS IT andthe physicians and clinicians on the design and critical decision points for theCernerCPOE project
• Installation, configuration and administration of GENTRAN and SQL Servers
• Developed Schemas of EDI ANSI X12 Claims (837) and Eligibility forms in XML.
• Development Schemas of 837 Claim billing, 276 Status, 834 Enrollment, 835 Claim Payments, 820, 270-278 and many otherhealthcaremaps.
• Worked Wif HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims
• Led high level meetings wif Subject Matter Experts (SME) for understanding the business process flow and ensure on deliverables
• Conducted high level demos for impartingtraining to physicians and nursing staff onClinicalsflow and ensure the adaptability for the transition
• Supported a hospitalCernerWorkflow/Rules environment; developed and implemented a custom
• Advance directive workflow to meet joint commission requirements
• Participated in usability testing for Cernerdevelopment and testing of the clinical summary and supporting documentation prior to GA
• Extensive experience working in the adaptability tool, particularly wif triggers and in strategically designing forms wif applicability, form usage, order sets, and EDR considerations in mind
• Actively worked on theanalysis, development and approval ofCernerimplementation and support efficiencies
• PhysicianView AdvancedNursingApplications, PatientManagement Applications, LCR, Patient Care, Ad Hoc Reporting
• Nursing documentation, order processing, COR, nursing care plans, and radiology implementations
• Helped the organization manage care processes across multiple disciplines and departments
• Provided the care team wif easy access to the information they needed, when they needed it
• Promoted consistent hand-offs of tasks between caregivers, helping to reduce the human element in delays and errors
• Supported the clinician in following the organization’s care delivery standards and achieving its best practice goals
• Enables the care team to promote continuous improvements in quality and practice at the point of care

Confidential, Pleasanton, CA

Sr.Business Analyst,iHelixEHR

Responsibilities:

• Responsible for Gathering,Designing,Build, Testing, Documenting andUpgradingofiHelixApplication
• Co-ordinate and conduct agile ceremonies - dailyscrums, release planning, sprint planning, planning poker sessions, retrospectives and demo's while continually helping the team in removing impediments, risk planning and mitigation, and continuous engagement wif business and stakeholders.
• Determined criteria using automation test framework
• Responsible for handlingonsite and offshore operational workflow
• Performed in-depth root cause analysis whenever any User Story failed and for any general issues
• Acted as a Liasonbetween Client and Development team by gathering and coordinating requirements fromClient, convertinginto TechnicalDocument
• Providing expert competency to carry out or participate in problem analysis and system design preparatory to development of programs.
• Assessment of Current,Future Clinicaland Financialworkflow and design pertaining to Clients requirement.
• Communicate effectively wif other areas and participate in the continual improvement of operations by developing standard protocols and techniques, to maintain, modify, devise new or existing software applications
• EDIwas implemented wif trading partners to ensure that care is coordinated between multiple care providers and orders/claims are seamlessly processed.
• Involved in claims processing throughEDI like EDI 820, EDI 834, EDI 837wif Payers.
• Worked closely wif the Product Owners to finalize the business process flows and groom the Product backlog
• Reported team velocity and burn down metrics to upper management using JIRA
• Design, prototype and develop iHelix EHR templates utilizing standard software development lifecycle processes.
• Strong configuration knowledge in Service and Price catalog Masters, Payer/Health Plan Master, Contract Master, Operational Hierarchy, Receivables Groupsand Billing periods
• Patient Access configuration for Outpatient admission process, Labor and delivery, ED, Treatment Series, EnterpriseScheduling, Patient Check-in/Out and Encounter Automation etc.,
• Worked on Master files such as Health professionals, Encounter Providers, Encounter locations, accommodation charge rules.
• Create reimbursementand payer contracts, Payer/Health Plan Master files, Reimbursement Expression referencing the in contract and Payer/Health Plan master files.
• Participate in the development and enforcement of policies, standards and procedures for application support, report development, version control & practice builds.
• Create and maintain documentation for supported systems and enhancements.
• Maintain up-to-date knowledge ofiHelixsoftware application suite, related interfaces and 3rd party software integration.
• Assist in the development of project plans by providing accurate deliverable timeframes.
• Worked wif Team towardsthe CCHIT Certification forIhelixSoftware

Environment: iHelixVersion 2011,Bugzilla, MySQL

Confidential, Arizona

Business Analyst

Responsibilities:

• Responsible for creating and reviewing business requirements, functional specifications, project schedules, technical documentation and test plans
• Involved in requirements discussions wif business units, ensuring all business requirements were satisfactorily met the user needs
• Gatheird user/business requirements by meeting wif business users and generated business models and use case analysis
• Interfaced wif internal clients and technical vendors on new feature requirements and conducted a thorough analysis of the system features to assist project team wif implementation of new features.
• Conducted individual and group (JAD) sessions wif business and technical units. Gatheird requirements by interacting wif the stakeholders by interviewing them, by preparing questionnaires and getting feedback which helped in developing application according to HIPPA Rules
• Responsible for defining the scope of the project, gathering business requirements, doing gap analysis and documenting them textually or wifin models
• Exposure to HIPAA Compliance requirements and HL 7 standards. Considered HIPAA rules while data validation and testing
• Verify accuracy of X12 HIPAA transactions
• Verify 834 X12 HIPPA production files for providers
• Process 834 monthly production files
• Involved in creating functional specification documents for the design, development and implementation of the project
• Designed/Implemented the performance testing environment for SQL Reporting Services using the SQL Tracer
• Developed SQL queries to test database
• Created SQL views and queries in SQL 2008 and 2010 wif SQL Management Studio
• Reports generation using SQL 2008.
• Analyzed and documented Business requirements and detail design of the software for full understanding of the business
• Contracted wif the Medicare Centers and Medicaid Services (CMS) to provide quick, easy, and affordable access to the health care service of their choice

Confidential

Executive Information Technology Department

Responsibilities:

• Responsible for Handling operations of a Hospital Information Systems in a Hospital
• Responsible for Initiation, Business Analysis, Testing, Implementation and Support of Clinical and Nonclinical Hospital Information system Packages (GE EHR and Wipro HIREPS) and ensure smooth functioning of the same.
• Study and Implement Clinical Healthcare Standards wifin Clinical Applications
• Experience wif EMR & HIS implementation lifecycle including requirements gathering, analysis, product build and configuration, quality assurance, training, documentation and support
• Successfully handled the training sessions to Physicians and Nursing staff and ensured the 100 % usage of the EMR Application
• Worked as project manager for Picture Archiving and Communication Systems (PACS) which is a computer based system that is used to acquire, archive, communicate and retrieve images and image related data for diagnosis and review at dedicated workstations. This is the first planned Enterprise PACS solution in India wif one centralized data center and six remote hospitals connected to it.
• Identified and prepared Use Cases,and Flow Chartsthus defining the Data Process Models.
• Conducted walkthroughs of the various functional documents and involved in the preparation of the test cases, test scripts and Project plan.
• Handled Successful Training sessions for Clinical and Nonclinical staff
• Worked as a liaison between the business users and the development team in resolving any design issues, change request approvals.
• Studied and developed Test Scenarios In regard wif End To End Processes and prepared Test cases and description
• Prepared Secured Check points for development team for executing in the Product
• Performed UAT (User Acceptance Testing)
• Handled post implementation training sessions to the end users on Applicationand Software Usage of various department.

Environment: GE HIS and Wipro HIRePS

Confidential

Clinical BusinessAnalyst and Product Specialist

Responsibilities:

• Collected requirements for various clinical modules like registration, physician order entry, Inpatient ADT, customer relationship management (marketing, customer database management, call management, claim management).
• Conducted gap analysis between existing and proposed system. Requirements analysis and documentation into system requirements specifications (SRS) for use by the technical team.
• Defined business processes for a module which includes business process detail, pre-requisite, user details, output, messages, attributes etc.
• Designed business flow and Multifunctional diagrams using MS Visio.
• Worked wif users to build the hospital information system and to assess their needs and requirements and configuring the systems in order to assist wif day to day patient care.
• Developed Test Scenarios in regard wif existing process
• Developed Test Cases and Test Scripts for development team to ensure QA
• Performed Manual Product testing step by step
• Implemented Lifeline-version 2.0, which is an integrated hospital information system.
• Done Master data entry and configurations which include creating new users, providing access rights to various modules to users, etc.
• Trained end users on the use of customized applications for various clinical modules like ward management, discharge summary, Computerized Physician Order Entry (CPOE), Inpatient packages etc.