Business Analyst Resume
Dallas, TX
SUMMARY
- Healthcare Business Analyst with 4+ years of hands - on experience turning business needs to software solutions for complex implementations.
- In-depth knowledge of payer operations including claims, enrollment, eligibility, underwriting.
- Extensively used Agile Scrum and Waterfall Methodology as the development SDLC.
- Good experience in the EDI transactions and knowledge on EDI transaction process flows.
- Strong experience and understanding of health care industry, claims management process, Medicaid and Medicare (Part A, B, C and D) Services.
- Hands-on experiences with Facets support systems to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
- Expert in creating Use Cases, Use Case Diagrams, Class Diagrams, Sequence Flows using MS Visio and UML concepts.
- Excellent experience in Medicaid design, Process design operations and web-based MMIS systems.
- Worked with different Business Areas like Claims, Enrollment and Pharmacy to analyze and implement proposed ICD 9 - 10 Code changes.
- Worked on FACETS batches like XPF andMMSto upload bulk data into the FACETS system through the HIPAA gateway by generating keyword files to enroll, modify or terminate providers and members.
- Expertise in MS-Excel,SASfor data mapping, data modeling, Process modeling and generating reports. Proficient in MS-Project and possess experience in analyzing financial reports, and extracting account data
- Strong knowledge of healthcare standards such as HIPAA 4010, 5010, ICD-9 and ICD-10.
- Experience in 834 - Benefit Enrollment and Maintenance, 837 - Claims processing and Encounters, 835 - Claim Payment/Advice.
- Utilized complicated SQL queries to analyze and validate test databases for data integrity
- Used SQL extensively to perform back end testing.
- Strong understanding of ICD-9, ICD-10-CM, ICD-10-PCS codes, HCPCS, CPT codes and claim forms and reimbursement forms.
- Maintained Traceability Matrix to track the Business Requirements from design phase to testing phase keeping track of all requirements in the BRD.
- Experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases.
TECHNICAL SKILLS
Project Methodologies: RUP, UML, Agile SCRUM, Waterfall
Business Modeling Tools: Microsoft Visio, Rational Rose
Testing tools: HP Quality Center, Ultra Edit
Database: MS SQL Server, MS Access, and Oracle
Architecture: SOA, client-server application
Documentation Tools: Quality Center/HP ALM, Sharepoint, JIRA, Rational Requisito Pro.
PROFESSIONAL EXPERIENCE
Confidential, Dallas, TX
Business Analyst
Responsibilities:
- Reviewed Business Requirements with Project Manager and Lead Developer to learn the functionality of the application.
- Wrote business case scenarios for HIPAA EDI Transactions 270/271, 276/277,837, 999 acknowledgment request.
- Validated HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835, 999 acknowledgement for enrollment transactions and performed UAT.
- Executed Test cases manually by composing 270, 276,837 EDI files and dropped inbound and check response 271,277,835 using interleaves and outbound.
- Logged defects in Quality Center (QC) and interacted with the developers to resolve technical issues.
- Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and Technical Specification in Excel and exported them in HP Quality Center.
- Logged errors reported defects, determined repair priorities, did regression testing and close by using HP Quality Center.
- Attended Daily Scrum Meetings and Design Review meetings.
- Organized weekly and biweekly meetings with testers to discuss testing progress and address any major concerns with the testing effort
- Involved in FACETS Implementation, including end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
- Served as a liaison between business users and IT team and Implemented business process analysis, business process modeling and business process re-engineering techniques.
- Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize FACETS features not provided by the legacy systems.
Environment: Agile, Quality Center (ALM), Microsoft Visio, SSRS, Microsoft Project, Oracle, UNIX, MS Office Suite, SharePoint, SQL Server
Confidential, Franklin Lakes, NJ
Business Analyst
Responsibilities:
- Instrumental role in introducing and enforcing new Scrum methodology in MHS with the Express One methodology, a new approach to requirements gathering, software development life cycle (SDLC) process and software testing life cycle (STLC).
- Worked on Pharmacy claims benefits and proprietary functionalities to such as support multiple coverage, prescriber edits and prescriber block lists.
- Organized weekly and biweekly meetings with testers to discuss testing progress and address any major concerns with the testing effort
- Sent weekly dashboard reports to management with updates of testing progress
- Involved in planning and implementing both high-level and detailed system and integration test plans
- Attended weekly testing status calls to update corporate on our testing progress and address any testing concerns
- Served as a liaison between business users and IT team and Implemented business process analysis, business process modeling and business process re-engineering techniques.
- Worked on the EDI 834-file load toFacetsthroughMMS(Membership maintenance sub-system).
- Responsible for understanding the “As Is” business process and defining the “To Be” business process.
- Worked with the project manager to ensure project sign off closing procedures are adhered to
- Used Sharepoint as document repository and for project tracking and version control for documents.
- Did requirements gathering for upgrading of Sharepoint-based Medco internal directory.
- Performed overall Requirements Management and built the Requirements Traceability Matrix.
Environment: SQL, SDLC, SharePoint, RUP, Rational Rose, Rational Pro, MS Visio Professionals, Test director, Use Case Analysis.
Confidential, Indianapolis, IN
Business Analyst
Responsibilities:
- Extensively studied 5010 requirements and the existing EMR application being sold by the company.
- Logged all the issues with the old application and suggested improvements to the business team for review.
- Created wireframes for the new application design based on the old applications design.
- Performed typical BA related tasks such as requirement gathering, conducting meetings, and documenting them.
- Helped the QA team conduct the testing process by setting up the test environment.
- Used HP QTP in executing the test cases, logging them and directing it to the right team for any issues encountered during the testing phase.
- Involved in deploying the application at various client location.
- Involved in training the clients and conducting walkthroughs.
- Created Data Mapping, Database Queries, and Data Dictionaries.
- Participated in defect review meeting and providing technical expertise on how to resolve the issues related to configuration and/or test scenarios
- Performed UAT testing with the offshore team
- Involved in application maintenance by logging and fixing the post deployment issues.
Environment: Agile, Scrum, SQL, SDLC, SharePoint, RUP, Rational Rose, Rational Pro, MS Visio Professionals, Prototyping, UM, JAD session, Test director, Use Case Analysis.
Confidential, Atlanta, GA
Junior Business Analyst
Responsibilities:
- Responsible for the requirement-gathering phase and project plan.
- Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
- Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837, 835, and 834.
- Analyzed HIPAA 5010 related to 837,835, 834. Transactions and performed gap analysis between the 4010 and 5010.
- Used Requisite Pro for writing/analyzing project vision, goals, specifications and requirements.
- Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in Rational Rose for the Business Use Case and System Use Case.
- Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc.).
- Interacted with database developers for formulating the ER diagrams and data flow diagrams.
- Worked with a QA lead in validating Test Plan and Test Scenarios.
- Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release
Environment: Rational Rose, Microsoft Visio, IBM ClearQuest, Microsoft Project, Oracle, UNIX, MS Excel, MS Access