SUMMARY

• Over 7+ years of experience as a Business Analyst.
• Expert in application/system development life - cycles; concurrent development strategies, process streamlining, iteration modeling, rapid application development (RAD), and waterfall, Agile and RUP methodologies
• Dynamic experience as professional in domains of healthcare and financial industry.
• Understanding of insurance policies like HMO and PPO and proven experience with HL7, HIPPA 4010 EDI transaction codes such as 270/271(inquire/response health care benefits),276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice), 837(Health care claim).
• Ability to multiple tasks and work independently as well as in a team.
• Good team player with excellent written and verbal communication and interpersonal skills
• Experienced in customer/client interaction, deep understanding of business systems functionality and technicality.
• Partnered with subject matter experts to gather and develop detailed business requirements for system implementations and service requests.
• Strong noledge and experience in Healthcare industry with Functional noledge of Medicaid Management Information System (MMIS).
• Exposed to usingICD9/ICD10/ANSI/HL7 coding standards in Medicare and Medicaid domains of teh healthcare systems and industry for both inpatients, outpatients, Reimbursement methodology.
• Experienced in gathering requirements for HIPAA EDI Transactions (837,834, 835,270,271) in various phases of implementation.
• Gather and create requirements for custom business applications, billing applications, reporting, IVR, Web and contact center solutions.
• Exposed to using ICD 9/ICD 10 coding standards in Medicare and Medicaid domains of teh healthcare systems and industry for inpatients, outpatients, Reimbursement methodology.
• Exposed to Medicaid operations experience
• Skilled in developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams.
• Proficient in gathering business and technical requirements from both formal and informal sessions through interviews, NetMeeting, questionnaire, video conferencing, JAD sessions and conference calls.
• Strong noledge of Use Cases, Sequence Diagrams, Collaboration Diagrams, Activity Diagrams, and Class Diagrams.
• Good noledge of Medicaid Management Information System (MMIS) experience.
• Good noledge of PegaSystems experience
• Extensive noledge of teh Order Management (OM) & Supply Chain Management (SCM) starting from teh Point of Sale (POS) to SCM which include Warehouse Control System(WCS),Retail Control System(RCS),Transport Control System(TRCS).
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from teh Provider/Payer side
• Worked on healthcare standards such as HIPPA 4010, 5010, Section 508 Compliance, ICD-9, ICD 10 and SOAP.
• Good noledge of Facets like Claims, Membership, Billing and experience in end-to-end testing of these modulus.
• Experienced with teh end-to-end Blue Chip claims processing system
• Experienced with FACETS and NASCO
• Experienced in creating Test Plans. Thorough hands on experience with designing test cases covering all test conditions and eliminating redundancy and duplications
• Extensive experience in Functional, Integration, Regression, User Acceptance (UAT), System, Load and Black Box Testing.
• Expert noledge of SOAP, REST API, Service oriented architecture and Mainframe
• Good Management, Execution and Documentation skills.
• Excellent noledge of MS Office especially MS Excel, Power Point, Word etc.
• Worked with Electronic Medical Records (EMR) noledge like EPIC MODULES {Inpatient (ClinDoc and CPOE), OpTime/Anesthesia, Pre/PostOp, PACU Orders, Ambulatory, Willow, Stork, Cadence/Prelude/Radiant/ADT}, CENER and ALLSCRIPT

TECHNICAL SKILLS

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

Process/ Modelling Tools: Rational Rose, Requisite Web, Requisite Pro, DOORS, MS Visio, Lombardi

Databases: MS Access, SQL Server

Quality Management: HIPAA, CMMI, CMM

Languages: SQL, HTML, C, C++

Operating System: WINDOWS 98/2000/NT/XP, UNIX, LINUX

Office Tools: MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, MS Outlook, SharePoint

Project Management: MS Project

Testing/Tracking Tools: WinRunner7.01, Test Director 7.01, HPQC, ALM, SOAPUI, QTP

PROFESSIONAL EXPERIENCE

Confidential, MD

Business Analyst

Responsibilities:

• Assist with creation and maintenance all necessary documentation and training materials for Epic Ambulatory application
• Performed analysis, design, development and maintenance of teh Epic Ambulatory applications and other clinical information systems.
• Write, edit, index, or revise a variety of technical, user documentation such as articles, reports, Acquisition Strategy documentation, brochures, and, or manuals for a wide range ofuses.
• Ensure accuracy and completeness of technical documentation.
• Experience with EPIC user and provider record provisioning, including teh development of role-based access, security classes, and user profiles
• WorkedwithHL7,EDIANSI 4010 and 5010 Standards. Involved in a migration process and respective GAP Analysis.
• Experience in Epic Resolute product implementation and deployment
• Hands on experience with Epic Hospital Billing and Ambulatory
• Experience with Epic Healthcare Information Systems.
• Thorough noledge of Eligibility and membership Affairs. Also noledge of HIPAA, X12, and HL7 standards and Medicaid provider best practices.
• Conducted user interviews, gatheird requirements, and analyzed teh requirements.
• Worked with teh business team to collect teh business requirements, security and service level requirements and documented them.
• Created specifications for EDI HL7 (A28, A31, ADT) and X12 (837/835) transactions that were transmitted between Claims Editor and Legacy Billing application and external Payers
• Set up team SharePoint site including templates for client tracking KPIs, document repositories, team calendar and a task tracker
• Transfer customer documentation into SharePoint document management infrastructure
• Analyzed set behavior and contribution to business performance, critical business metrics & tracking underlying business trends using Business Objects.
• Facilitated JAD sessions between technical and regulatory teams for meeting requirements as well as solving problems on a daily basis
• Liaison between customer business units and teh technical team
• Participated in teh logical and physical design sessions and developed design documents.
• Designed new process flows for teh existing system as well as for teh enhanced system.
• Conducted and lead status report meetings with teh business and teh IT team on a weekly basis.
• Manage Scope and change throughout teh life cycle of teh product.
• Performed collection, coding, assessment and reporting of adverse event data using ARISg.
• Worked in teh ARISg Implementation of teh EHR-Pharmacy Module.
• Developed Team SharePoint web site utilized for holding team only data, IT Public data, web tools, and Change Management calendar
• Setup and maintain teh internal SharePoint site for our Service Management department, our Knowledge Base repository, and any related departmental websites under teh Service Management department scope
• Recommend tactic to implement HIPAA 4010 ( EDI X12 837,834,278,270) in teh new System
• Worked on Electronic health record system as a CRM web based application.
• Working Experience in Electronic Submissions in standard format E2B.
• Knowledge of regulatory issues including State, Federal, AABB, CAP, CLIA, and JCAHO.

Environment: MS Project, Microsoft Visio, Sharepoint, EPIC, FACETS and Business Objects

Confidential, Austin, TX

Business Analyst

Responsibilities:

• Conducted meetings with teh team members to organize and finalize teh working hours and resources.
• Prepared a detailed BUR (Business User Requirement) document to explain working of teh project to teh stakeholders.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Involved In teh new MMIS which replaced teh existed MMIS and significantly enhances teh claims processing and related activities for DCH-managed programs, such as Peach Care for Kidsand Medicaid.
• Defined in scope and out scope requirements.
• Verified assumptions and constraints with teh team members.
• Extensively used data mapping from source to target and target to source for Sun to Oracle migration of database.
• Involved in teh full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.me.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analyzing and documenting related business processes.
• Worked on HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Analyzed, designed, and coded several online subsystems for teh Medicaid System.
• Work with DHHS and Department of Mental Health Services to ensure all BPM requirements related to: Computerized physician order entry (CPOE), clinical data repository (CDR), Electronic Health Record, Clinical Research and Pharmacy has been captured.
• Business and system process implementation of healthcare management Identity and Access Management using RSAM GRC
• Met with various HMO, PPO, Medicaid/Medicare, and Tricare / Champus Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
• Wrote test cases from teh use cases and uploaded teh test cases to HP Quality Center.
• Defined system requirements in teh detailed design process.
• Executed Test Cases Manually, once teh application is stable and documented teh successful or unsuccessful completion of each test case in HP Quality Center (QC) for End-to-End Scenario based testing.
• Managed teh team of consultants responsible for developing on-demand Medicaid Management System reports.
• Extensively involved in regression, integration, and UAT testing.
• Worked in mainframe environment and used SQL to query various reporting databases.
• Worked on java code with teh developers to verify table and column names from teh database to be transferred.
• Conducted a comprehensive data analysis to determine HL7 messages elements and their mapping to teh standard analysis mechanism to enable maximum reuse.
• Adequate noledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans).
• Involved in teh full HIPAA compliance lifecycle from Gap Analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Developed and conducted statewide HIPAA 5010 and ICD-10 awareness program for all IDS staff in Tenet.
• Used MS Visio to designed and develop Use Cases Scenarios, Use Cases Models, Activity Diagrams, Sequence Diagrams, State chart diagrams using UML.
• Actively involved in Requirement Analysis, Business Analysis, Use-Case Analysis Involved and developed comprehensive Test Strategy, Test Plans, Test Case and Test Scripts and documented them in HP Quality Center (QC).
• Developed HL7 messaging for bi-directional case and disease report exchange, in text and XML formats, in accordance with HL7 specifications
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Gatheird requirements for teh inputs in teh Competitive Intelligence System from teh stakeholder’s including methods like personal interviews, questionnaires, surveys, JAD sessions and joint team meetings. Identified systems requirements that would halp create teh CI System by meeting up with teh technology team and then having a JAD session to include SME’s from teh business side.
• Consulted with healthcare third-party Administrator Company to develop conversion specifications for member, enrollment, and authorizations.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Developed teh systems implementation project management plan with milestones and steps from procurement of vendors to project implementation and maintenance.
• Validated teh test data in DB2 tables on Mainframes and on Teradata using SQL queries.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs. Ensured that critical requirements are not missed.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for in corporation in a phased, iterative manner.
• Interacted with client and teh Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Designed and created a mainframe process to automate mass distribution of emails for class registration reminders, class cancellation notification and class offerings for courses listed on individual training plans.
• Analysis of new Business Requirements and preparation of teh Functional Design Specifications
• Interacted with clients like SPF Securities to finalize their website look and contents.
• Analysis of teh new requests specified by teh end users for teh future releases and discussion with teh functional and technical teams.
• Communicated changes to requirements promptly and precisely to all personnel involved.
• Identified and clearly defined functional issues and support IT development staff throughout teh design, development, unit testing, and implementation phases of teh software development life cycle.
• Analyzed and translated business requirements into system specifications.

Environment: XML, XSL, SDLC, Mainframes, Rational Clear Quest, Rational Clear Case, JAVA, Rational Requisite Pro, Rational Rose, UML,RUP, HP- Mercury Test Director, HP quality center, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Involved in gathering Requirements from stakeholders.
• To prioritize teh stakeholders developed a stakeholder list and stakeholder assessment matrix.
• Identified and validated business rules and data elements.
• Developed and maintained Requirement Work Plan and assessed teh Performance metrics of teh team members.
• Has extensive noledge in Insurance products like HMO, PPO, Managed Care, and HIPAA Regulations.
• Conducted Risk Analysis and developed mitigation plans.
• Updated System Requirements Document (SRD) and Business Requirements Documents (BRD).
• Designed Functional Specification Documents.
• Implemented custom data collection systems. Systems allowed Cingular to move all online and IVR data collection in-house.
• Analyzed teh laws and regulations (HIPAA, HL7) before implementing teh electronic medical record software.
• Requirement gatheird from R&D, clinical trial data, scientist, research associate, regulatory affairs, sales and marketing, medical library.
• Validated codes for billing process which included ICD-9 and ICD 10, SNOMED codes and various modifiers where applicable in compliance with HIPAA 4010 and HIPAA 5010.
• Involved in gathering clinical data and supported application development. Data includes patient’s admission status, discharge details and transfers. Also tested claims and diagnosis reports of teh patient.
• Measured and analyzed discrepancies identified from enrollment/eligibility files (834 transactions) and payment files (820 transactions) to outline/initiate improvements and ensure control of teh processing gaps
• Involved in HIPAA assessment and HIPAA X12 EDI transaction (834, 835, 837, and 270/271) mapping and identified changes that needed to be done to comply with HIPAA regulations.
• Coordinated between healthcare insurance companies and my company to implement payor qualification guideline changes and updates to ensure compliance with all regulatory agencies.
• Developed User Interface prototypes to capture and validate requirements.
• Conducted meetings with client team and technical team.
• Conducted Business Analysis and Requirements Analysis activities to in corporate HIPAA andMedicaidprovisions for Design, Development and Implementation Project.
• Proposed strategies to implement HIPAA 5010 in teh new MMIS system.
• To gather requirements for new MMIS, conducted JAD Sessions.
• Created and Maintained Weekly Status Reports for teh requirements team and to update teh project schedules and deliverable plan.
• Extensive noledge of Billing, Enrollment and Claims processing.
• Interacted with various departments and business groups to update and configure Nasco and Facets.
• Worked on claim Adjudication module of FACETS.
• Adjudicated medical benefits claims.
• Measured and analyzed discrepancies identified from enrollment/eligibility files (834 transactions) and payment files (820 transactions) to outline/initiate improvements and ensure control of teh processing gaps
• Developed UAT test cases associated with functional requirements.
• Used GAP Analysis to conduct AS-IS and TO-BE Analysis.
• Developed Requirement Traceability Matrix and Change Request Form.
• Used Microsoft SharePoint for managing requirements documents.
• Involved in developing test plans, test scenarios and test scripts and participated in System Testing.
• Involved in integration testing on FACETS system to verify HIPAA compliance from .
• Analyzed teh EDI X12 data elements in teh existing system to validate it against teh data elements required in new system.

Environment: Mercury Quality Center, Windows, MySQL, Facets, SQL Server, MS Office

Confidential, Chapel Hill, NC

Business System Analyst

Responsibilities:

• Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures
• Prepared teh business requirement document (BRD) and system requirement document (SRD)
• Facilitated Provider Enrollment, Setting up Provider profile & Trading Partner Agreement
• Set up Provider's Access to teh System. (Security Setup)
• Helped creating Provider Reports me.e. Financial, claim processing
• Created workflow diagrams, UML diagrams, use cases, process flow, and Provider Interface testing, Creating Test cases, Test Plans and Test Scripts
• Wrote FRDs for teh defects and enhancements and got approval from stakeholders for teh developers
• Worked on Technical design documentation (TDD) of teh claims processing system
• Analyzed HIPAA EDI transactions in XML and X12 responses and of 270 and 276 and looked for defects for amendment.
• Involved in end-to-end testing of Facets Billing, Claim Processing and Subscriber/Member module.
• Performed data analysis for various version changes of EDI messages on different sub-systems
• Performed GAP Analysis and risk assessments for FACETS upgrade which included effects on internally developed extensions and third party software for claims pricing.
• Performed task estimations and documentation of procedures
• Extracted patients Electronic Medical Records (EMR), Patients Medical Records from teh Medical Management system, for testing
• Designed, prepared and implemented test cases for system testing as well as for User Acceptance testing
• Involved in teh testing of web portal of New MMIS system
• Performed regression testing of FACETS application.
• Conducted integration testing and regression testing with developers in development and QA
• Help development team conduct SQL testing using SQL queries
• Conducted user acceptance testing with UAT team
• Acted as a liaison, writing documentation and increased project coordination

Environment: Mercury Quality Center, Windows, MySQL, Facets, SQL Server, MS Office, NASCO

Confidential, Pittsburg, PA

Business System Analyst

Responsibilities:

• Responsible for captured teh existing capabilities of teh current Application X-Pack
• Prepared a Reverse Engineering Business Process Document
• Communicated with Business Stakeholders for Requirement Gathering
• Established teh JAR sessions with Clearinghouse System SME
• Contributed in Technical Deep Dives for understanding teh Business Processes involved in Clearinghouse System
• Used SDLC and Agile Methodology for teh project
• Prepared session with X-Pack developers to demonstrate teh future X-Pack functionality
• Used MS-Visio to draw Sequence and Activity Diagrams
• Worked on ASC X12 Transactions like 270,271, 835, 277 and 837
• Wrote teh Vision and Scope of teh Project
• Responsible forMedicaidClaims Resolution/Reimbursement for state health plans using MMIS.
• Performed GAP analysis of as-is and to-be System
• Checked teh data flow through teh front end to backend and used SQL queries to extract teh data from teh database.
• Involved in writing complex SQL queries to extract teh data from Oracle database
• Performed UAT manually till user satisfaction.
• Connected to SQL plus in UNIX and created and executed complex SQL queries.
• Identified all Business Operations involved in Clearinghouse System
• Validated all teh Processes with X-Pack Experts, Technical and Development team
• Documented Business Processes involved in Clearinghouse System
• Created Summary Use Cases for next phase of Forward Engineering
• Created Surveys for Existing Customers (Health Care Providers) to gather teh future expectation of X-Pack Client like Institutions and Physicians
• Extensive used of UML to draw Business Process Flow, Use Cases Modeling, Sequence, Sequential Diagram and Activity Diagrams
• Assisted teh business partner in preparing UAT plan/scripts and assured project manager has taken steps for alignment of Operational Quality Checklist
• Assured entry/exit criteria are met for teh different phases of testing (e.g., Unit testing defects closed before hand off to System/Integration testing, high severity S/me anomalies are closed before start of UAT, successful UAT prior to production deployment).
• Conducted various sessions for UAT during last month.
• Wrote Test Cases, performed unit testing and integration testing
• Extensively used simple and nested SQL statements for testing purposes
• Analyzed test planning data using reports and graphs generated in Mercury Quality Centre
• Worked on Mercury Quality Centre in setting up and Customizing Project entities for Defect Module Screens.
• Worked as a Liaison between Stakeholders and IT department to fill teh Gap by Using Simple UML Diagram

Environment: s: MS Visio, MS Project, MS Office, SQL, Oracle, & PowerPoint, MS Word, MS EXCEL, UNIX, Windows