PROFESSIONAL SUMMARY:

• With over Eight years of experience as a Business Analyst & Project Management within the healthcare domain, me has experience working on highly complex transformation and change projects along with business process re - engineering. As a specialized healthcare business analyst, me has adequate noledge within Health Administration -
• Claims processing (auto adjudication), ICD 9/ICD 10 Conversions (Healthcare Reforms), EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, HIE, HL7/X12 protocols and standards, launching healthcare products and services, Medicare, Medicaid, CDHP (consumer driven health plans), CCDs and ETL processes. Throughout my experience me has utiilized techno-functional skills to provide Executive Management with the development and implementation of interactive business tools and the strategic analysis, vital for use in their decision-making.
• me am very well versed with SDLC and has thorough experience in project and BA documentation like Business Requirements Elicitation, Issue List monitoring, Business and System Requirements, Design Documents, Traceability Matrix, Business Process testing, Business Verifications and Validations, End-to-End Testing and User Acceptance Testing.
• Experience working with PMO and executing plans and projects under given timeline
• Experience working on green belt business process transformation and reengineering projects using LSS (LeanSix Sigma) methodologies and toolsets.
• Conducted Root Cause Analysis, Time studies, Process Mapping exercises, performance and risk matrices etc. using various tool sets.
• Designed and reviewed various documents including the System Requirement Specifications (SRS), Business requirements document (BRD), Use Cases, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Document and communicate changes throughout the user organization, supporting Information System Change Management (ISCM) and compliance
• Good understanding of Healthcare Industry standards, Electronic Data Interchange (EDI), HIPAA Code Sets, Regulatory changes including ICD9-ICD10 conversions
• Experienced in facilitating Joint Application Development (JAD) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development teams
• Extensive Knowledge of Medicare, Medicaid, procedural and diagnostic codes
• Experience in System Integration and Retirement projects following mergers and acquisitions
• Experience in Risk and Regulatory Compliance associated with archival and disposal of data
• Facilitated project meetings, reviews, walkthroughs, and customer interviews to gather requirements and relevant information for Business analysis
• Experienced in handling Change Management, writing Test Plans and executing Test Cases
• Experienced as BA analyst in Defect Tracking and extensively involved in User Acceptance Testing
• Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations\
• Experienced with project management, planning, Issue/Risk management, budget and resource management, Executive reporting
• Knowledge of Medical and Pharmacy Claims Processing,and HIPAA regulations
• Experience with writing ad-hoc SQL queries as well as designing Business Object reports
• Extensive Knowledge of Medicare, Medicaid, procedural and diagnostic codes

PROFESSIONAL EXPERIENCE:

Confidential, New York City, NY

Sr Business Analyst

Responsibilities:

• Liaison between the vendor (Optum One) and NYU Executives/business owners to manage project expectations, vision and changes
• Create documentation explaining new service provided to Confidential users
• Prepare documents to define and communicate project timeline and tasks for each team involved in the program
• Develop thorough understanding of Care Coordination initiative and analytics requirements of various teams to develop a streamlined project plan using MS project and MS Visio
• Provide thorough understanding and expertise on compliance with legal and regulatory terms related to employees data and consent values for patients
• Create Test Plans for validation of the data repository of Optum One with NYU EMR, Payer claims data and HIE data
• Provide Project Governance support by maintaining PMO documents
• Coordinate sessions to facilitate common discussion forum for both vendor and client teams and understand the future path and goals related to the project.
• Extensive noledge of Benefits Management: Work with Managed Care team to understand costs and numbers of pharmacy claims to get them populated in Optum One
• Work with Optum One team to get accurate analytics on Benefits program for NYU patients
• Understand Consumer expectation and manage stakeholders across various departments
• Hold sessions and meetings with customers to go through the application and give feedback to the vendor
• Create and maintain project roadmap to include various payer claim files in the patient

  matching process

• Conduct weekly meetings to discuss data integration issues, coordinate onboarding of future files and new contracts signed with more payers
• Liaison between the Care coordination team and Patient Matching team to identify and resolve IT related risks and issues
• Liaison between the business stakeholders and the IT teams to maintain the patient matching timeline and create project plans for new payers files joining in
• Maintained a fully functional patient matching process by identifying issues from Care coordination team and resolving them with the halp of vendor IT teams

Confidential

Sr. System Business Analyst/Project Coordinator

Responsibilities:

• Partnered with several stakeholders and decision makers to understand the problem domain and brainstormend various solutions to an integrated solutions development.
• Managed communications between various teams involved in order to smoothly transition and navigate the transformation process.
• Worked on applications with ETL processes and documented their retirement requirements and TEMPeffects on their users and data
• Work with Clinical and Provider Project to insure that Neutrality exist between ICD-09 and ICD-10 clinical and provider operations.
• Assist with prioritization of application retirement initiatives based on ICD9-ICD10 conversion program
• Assisted with creating project roadmaps to show dependencies with ICD9-ICD10 conversion initiatives
• Developed thorough understanding of existing processes and the required hand-offs between severall systems and teams in order to develop a streamlined solution and process.
• Conduct Joint Application Review (JAR) sessions and ELABORATION sessions to facilitate common discussion forum for Business and IT teams, and gather required information pertaining to applications, data and related IT infrastructure.
• Create Business Requirement Documents (BRD), Technical and Design specifications document(TSD), Report Specification Document(RSD) and Solution Design Document to provide detailed information about the application, data and processes being retired, archived or integrated.
• Create RACI Matrices to explain roles and responsibilities across multiple business and IT teams
• Document process for archival and purge of data related with the application being retired
• Coordinate across Business stakeholders, Legal teams as well as Internal Audit teams to confirm regulatory compliance of overall retirement projects and archival/purging of associated data
• Act as a liaison between the Business team and the OPTIM archiving team to facilitate proper archival of data, and creation of appropriate access and processes for future retrieval
• Designed Metadata Repository to storedata definitions for entities, attributes & mappings between data warehouse and source system data elements
• Hold and manage meetings with customers to understand their requirements
• Work with Benefits Project to insure that Neutrality exists between ICD-09 and ICD-10 Benefits
• Liaison between the Business and the IT teams to define processes for retirement of applications, as well as ensuring that migration to new environments is completed with minimal business impact
• CreateTest plans to simulate new environment prior to retirement/integration to identify gaps & risks.
• Assist business owners and stakeholders in formulation of mitigation strategies for identified issues & gaps
• Overall responsibility for all Business Analysis deliverables

Environment: Oracle, DB2, Mainframe, OPTIM (IBM), MS Word, MS Excel, MS Visio, MS Project

Confidential, Boston, MA

Business Analyst

Responsibilities:

• Elicited and gathered user and business requirements through open ended discussions, brainstorming and prototyping.
• Worked on preparing new products and services in line with Healthcare regulations
• Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
• Performed GAP analysis to compare the existing system with the proposed system and documented new requirements and features.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Worked on HIPAA 4010 and 5010 / ICD 9, version for all EDI transactions.
• Created specifications for EDI HL7 (A28, A31, ADT) and X12 (837/835) transactions that weretransmitted between Claims Editor and Legacy Billing application and external Payers
• Involved with the coders in evaluation of CPT and ICD-9 codes to ensure that the diagnosis meets medical necessity for the specific CPT code.
• Developed Business Requirement Document and Use Case Specification Document for Use Cases
• Responsible for converting the business requirements into functional and non-functional requirements.
• Conducted JAD sessions for communicating with all project directors and stakeholders and created process workflows, functional specifications and project initiation artifacts.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Developed straightforward DBMS queries, with noledge of HL7 and XML interface messaging.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Extensive analysis on claim processing system allowing the user to inexpensively capture information regarding patient, summary of medical history, symptoms (ICD-9 codes), and treatment (CPT).
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of 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 Enrollment hence analyzing and documenting related business processes.
• Involved in Service Oriented Architecture (SOA) of the claims processing system
• Understand the As Is system and develop the To Be concept and prepare the System Process Maps.
• Performed extensive requirement analysis including Data analysis and Gap analysis.
• Defined Functional Test Cases, documented, Executed test scripts
• Successfully conducted JAD sessions, which halped synchronize the different stakeholders on their objectives and halped the developers to has a clear picture of the project.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Coordinated QA activities across Functional QA and Performance QA teams
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational BPM.
• Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
• Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Requisite Pro, Rational BPM, Agile, HL7Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, Rational Clear Quest, Rational Clear Case, UML,RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Confidential

Sr. Business Analyst

Responsibilities:

• Analyzed existing reports and defined systems requirements and process workflows
• Analysed current processes and did Gap Analysis for gathering requirements for new Healthcare reforms and standards
• Conducted JAD sessions with PM, SMEs; facilitated interviews with end users and hospital administrators to collect systems requirements
• Used the HL7 messaging protocol to send and receive healthcare data, including patient information and various lab reports information in a standardized format in order to ensure that the data was universally understood and organized
• Created Project management plans for managing on time delivery using MS Project along with writing test cases, and systems integration test plans in Test Director.
• Built a business process model using Rational Rose and Visio.
• Responsible for gathering requirements, creating artifacts for Rational Unified Process (RUP) - use cases, systems architecture document, supplemental requirements document, architecture diagrams; verifying technical production infrastructure; designing and executing performance tests; and documentation.
• Create Functional Requirement Specification for the Data Warehouse and different functionality which were being designed into the Data Warehouse.
• Developed test scripts and test cases with different scenarios and organized them according to the Functional Requirements Specifications.
• Performed requirement analysis, went through use cases according to the flow of patient data and rules of security sharing.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
• Wrote Test Cases in Mercury Quality center that would test various Test scenarios.
• Assisted in data mart design and prototyping
• Assisted in designing and validating source target mappings and transformation logical data model required to support information requirements.
• Assisted the project manager in preparing the project schedules, milestone tracking, resource allocation using Microsoft project.

Environment: Windows XP professional, MS Office suite, Load Runner, XML, MS Visio, Mercury Quality Center.

Confidential

Business Analyst

Responsibilities:

• Capture business rules for routing of workflow items based on key business data elements
• Created RACI matrix for common suspension issues and related resolution resources
• Support Pega Development teams in creating iterative code packages and testing
• Capture requirements for Management Reporting for workflow and productivity
• Create Use Cases for Claim Adjuster actors to run reports and process workflow items
• Support development of a Security Rule Base to define Roles within the new system
• Coordinate between Technical, Business and QA teams for verification of information and facilitate communication

Environment: Pega PRPC, Rational Req Pro, MS Word, MS Excel, MS Visio

Confidential

Business Analyst

Responsibilities:

• Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
• Interacted and arranged meetings with Business and End users to gather business requirements for changes triggered by Government regulations and HIPAA, Business needs and Process improvement.
• Prepared User Requirements Document (URD), Business Requirements Document (BRD) and Functional Requirements Document (FRD).
• Worked closely with project manager in setting realistic project expectations and in evaluating the impact of the changes of the organization and plan accordingly
• Received the Client and Business users appreciation for the implementation of Prescriber NPI update and E-prescribing changes
• Developed Flowchart and process diagram using Microsoft Visio
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Developed Test Cases to validate the requirements and documented the Traceability Matrix for Test Cases and Requirements
• Worked on Required Traceability Matrix (RTM) for traceability of requirements.
• Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements with the support from SME’s
• Ensured the accuracy and consistency of the data during the data loading process

Environment: MS SQL Server, UML, HP Quality Center, MS Office Tools, MS Outlook, MS Visio.