SUMMARY

• Seven years of experience as a Business Data Analyst in Health Care.
• Worked on different EDI healthcare transactions like 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions.
• Detail understanding of ICD 9/ANSI/HL7 to ICD 10/ANSI/HL7coing standards in Medicare and Medicaid domains of the healthcare industry.
• Experienced in working with Business Impact Analysis Template BIAT to analyze and document the effect of proposed changes on the project schedule and costs.
• Proficient in business requirements gathering and writing including the EDI transactions from 4010 to 5010.
• Good Understanding of PPACA HIX and HL7
• Good understanding of MMIS, MECT and MITA.
• Possess excellent business writing skills required for documenting Business Requirements Document BRD , Functional Requirements Document FRD , and Non-Functional Requirements Document NFRD .
• Expertise in BusinessAnalysis andvarious Software Development Life Cycle SDLC methodologies like Waterfall, Agile/SCRUM, RAD, Rational Unified Process RUP methodology.
• Experienced in Data Warehouseconcepts, ETL Extract Transform Loading , DataMigration, Using Informatica
• Extensive experience in PL/SQL programming: Procedures, Functions, Packages and Triggers
• Developed detailed Requirements specifications through JAD sessions, interviews, on site meetings with business users IT team.
• Proficient in creating and transforming business requirements into functional requirements by using Use cases diagrams, Activity diagram, Class diagrams, Sequence diagrams, Test Cases, Test Plans.
• Good knowledge of FACETS, and Transaction Manager for 4010-5010 migration.
• Documented Traceability to ensure all the features for the project has been captured and mapped back to the requirements in the BRD.
• Experience with claims process and adjudication in the Medicare, and Medicaid.
• Expertise in writing SQL Queries, Views and Stored Procedures in Oracle.
• Broad knowledge of testing concepts and hands on experience writing test cases, test plans and planning test strategy using testing tool Quality Center.
• Quick learner, reliable and confident working independently as well as in a team.
• Exceptional track record for meeting deadlines and submitting deliverables on time.
• Highly motivated team leader with excellent communication, presentation and inter-personal skills, always willing to work in challenging environments.

Technical Skills

PROFESSIONAL EXPERIENCE

Confidential

Business System Analyst

Responsibilities:

• Gathered business and Functional requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
• Used the guidelines and artifacts of the Rational Unified Process RUP to strategize the Implementation of Rational Unified Process effort in different iterations and phases Inception, Elaboration, Construction and Transition of the Systems Life Cycle methodologies. Prepared various artifacts for all the phases of RUP.
• Led JAD sessions with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure
• Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non functional requirements.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Used SSIS to read source data from complex flat file structures e.g. EDI 837 PID, 835, 270/271 .
• Performed the Gap analyses of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
• Worked with the QA Quality Assurance team for designing Test Plan and Test Cases for the User Acceptance testing. Defined test cases, creating test scripts, analyzing bugs, interacting with QA / development teams in fixing errors and User Acceptance Testing UAT .
• Created functional flow diagrams, context diagrams and other high level diagrams for documenting the functionality of separate modules using MS-Visio and UML.
• Analyzed HIPAA 5010 related to 837,835, 270, and 271. Transactions and performed GAP analysis between the 4010 and 5010.
• Responsible for GAP analysis of ICD9-ICD10.
• Analyzed business requirements, performed source system analysis, prepared technical design document and source to target data mapping document.
• Used MS Project to maintain the project schedule and track its status.
• Involved in the statistical analysis of data. Extensively involved in Querying the Database using SQL and PL/SQL as a part of Data Analysis.

Environment: UML, RUP, MS-SharePoint, ETL, SSIS, Oracle 10g, DB2, MS-Project 2000, MS-VISIO, TestDirector7.6, WinRunner7, PL/SQL, SQL Server 2000,EDI, Facets, HIPAA compliances.

Confidential

Business Analyst

Responsibilities:

• Helped manage risk analysis and mitigation plans, status reports, and client presentations prepared business process models, defined milestone deliverables, and established critical success factors.
• Worked on HL7 to provide framework to carry out transfer of electronic healthcare information.
• Worked on insurance data related to Medicare, Medicaid, and Insurance claims.
• Led JAD sessions with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure
• Conduct workflow, process diagram and GAP analysis to derive requirements for existing systems enhancements.
• Identified, researched, investigated, analyzed, defined and documented business process and Use Case scenarios.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD Object Oriented Design using UML and Visio.
• Writing the detailed user needs, Gathered business, functional requirements during inception phase, documented and delivered functional specification documents, and assisted architecture analysis and design using UML and Rational tools.
• Prepared and maintained requirements traceability matrix RTM throughout the project lifecycle.
• Conducted GAP analysis assessment regarding ICD 9 to ICD 10 conversion and business work flows from legacy system to the detailed financial transaction interface
• Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle.
• Used General equivalence Mappings GEM to convert ICD 9 to ICD 10.
• Formulating the systems of project to parallel the business strategies.
• Analyzed research on operational procedures and methods and recommended changes for improvement with an emphasis on automation and efficiency.
• Wrote SQL queries in MS Access for data manipulations.
• Assist with user testing of systems, developing and maintaining quality procedures, and ensuring that appropriate documentation is in place.
• Develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.
• Used Test Director with QA team for testing.
• Interfaced with SME's to prepare BPR documents for ongoing projects.

Environment: RUP, MS Project, ANSI X12 EDI, Rational Rose, Data Mapping, MS Visio, MS Word, MS Excel, Medicare, Medicaid, Rational Requisite Pro, ETL, Oracle , MS Access. PL/SQL

Confidential

Business/Data Analyst

Responsibilities:

• Assisted in identifying project scope, to conform to the regulatory compliance related to X12 837 I/P and 835.
• Worked with Facets data models for Claims, Membership Eligibility etc.
• Prepared the Business requirement Document BRD and functional requirement document FRD , working with Requirements Traceability Matrices RTM , re-engineering business processesfor the enhancement of the existing services.
• Created complex Mappings, Transformations, Tasks and Sessions to optimize the ETL performance in Microsoft SSISfor Data warehousing project
• Used Oracle SQL Loader feature for loading the data from Flat files and XML
• Created standard and Ad hocreports using Cognos Impromptu designed catalogs and defined User Classes, Security and Privileges.
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagramsaccording to UML methodology thus defining the Data Process Models.
• Played a key role in project planning activities, User Acceptance Testing UAT , and implementation of the system enhancements and conversions.
• Involved in Relational database design and mapping of Data Warehouse.
• Conducted Business Process As Is/To Be sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.
• Involved in Data Analysis for data mart system for the process of report generation.

Environment: Rational Requisite Pro, SharePoint, Rational Clear Case, RUP, Spec Builder, UML, HTML, SSIS, SSRS,SQL Server , Oracle MS Visio, Data mapping, PL/SQL, T-SQL

Confidential

Business Analyst/ ETL

Responsibilities:

• Analyzed business requirements, functional requirements, tested high level and low level Use Cases and Activity Diagrams / State Chart Diagrams using Rational Rose, thus defining the Data Process Models.
• Designed the ETL processes using Informatica PowerCenter to load data from Teradata, MS SQL Server, Oracle XML, Flat File and Excel spreadsheets into the target Oracle database
• PreparedBusiness Requirement Document BRD and Functional Requirement Document FRD for the enhancement of the existing services.
• Held regular JAD sessions with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed and issues were resolved beforehand.
• Tracked stakeholder requested enhancements and changes using Requirement Traceability Matrix RTM .
• Designed and implemented reports, score cards and dashboards using Cognos
• Experience in an outsourced healthcare insurance operations environment and understanding of MECT and MITA.
• Involved in working with Multi-Dimensional Model, Star Snowflake schemas and other Data Modeling and Data Warehouse Applications.
• Analyzed Claims adjudication related transactions like 835, 837, 270, 271, 276 and 277 transactions both inbound and outbound .
• Prepared UML diagrams Activity diagrams, Sequence Diagrams, Use case diagrams for Extensions.
• Implemented the entire Rational Unified Process RUP methodology of application development with its various workflows, artifacts and activities.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter the data within the Oracle database.
• Worked with QA lead in validating Test Plan and Test Scenarios.
• Executed test scripts in different cycles to get the perfection and logged defects in defect tab of Quality center.
• Executed test casesmanually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual s for resolution.
• Involved in the Statistical Analysis of Data. Extensively involved in Querying the Database using OracleSQL as part of Data Analysis
• Produced a variety of routine and ad-hoc reports, packages for senior management using advanced MS Excel Functions.

Environment:MS Project, SQL, Rational Requisite Pro, Rational Rose, Microsoft Visio, Load Runner, Rational Clear Quest, Informatica, XML, Teradata, Oracle .