- Over 10 years of proactive IT experience working as a Business Analyst with extensive knowledge and experience in Software Development Life Cycle (SDLC) - Waterfall, Agile Scrum an RUP.
- Strong experience in developing Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM), Test Plan and Test cases.
- Adept in JAD facilitation, interviews, document analysis, requirements workshops, site visits, and surveys.
- Expertise in UML (class diagrams, object diagrams, use case diagrams, sequence diagrams, and activity diagrams)
- Proficient in conducting User Acceptance Testing (UAT) and verifying performance, reliability and fault tolerance issues.
- Expertise in Bug Tracking system and Process using HP Quality center, Remedy and Rational Clear Quest.
- Well versed in developing QA test plan, test conditions and test cases; ensuring adequate technical and functional testing of applications and products.
- Expert in Incident management, Problem management and Change management.
- Strong exposure to Data Warehouse and Data Management Lifecycle concepts including ETL (Extract, Transform and Load), Data Profiling, Data cleansing and Metadata management and Business Intelligence (BI) tools.
- Strong knowledge in Healthcare Analytics using R programming and data visualization using Qlikview
- Adept in employing simple and complex SQL queries for data profiling and data validation.
- Experienced with standard tools for Project Management and Analysis - Microsoft Office, Visio, Rally, Jira and MS Project Professional.
- Professional with excellent work ethics, team oriented individual with strong analytical and planning skills.
- Adept knowledge in healthcare industry focused on both payer and provider side - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare(Part A, B, C, D), Medicaid, CDHP (consumer driven health plans)
- Strong knowledge of HL7 Standards, HIX, CMS regulations, Meaningful Use Compliances, Health Care Reform, EMTALA, PPO, POS and HMO.
- Well versed with clinical workflows and EHR/EMR systems like Care Radius, EPIC Clarity, and McKesson
- Experienced in Membership, Billing and Claims Payment Processing in relation to HIPAA 4010/, EDI codes 834, 837,835, 270/271, 276/277, 820 and ICD-9/ICD-10.
- Excellent knowledge of Clinical Trials and FDA 21 CFR Part 11 compliance
- Proficient in Trizetto Facets implementation and conversion of 4.41/ 4.51 / 4.71 / 4.81/5.01.
- Microsoft Project
- Microsoft Office
- Rational Rose
- Microsoft Visio
- Rational Requisite Pro
- Clear Quest
- HP ALM/Quality Center
- Rational Clear Case
- Trizetto Facets
- R programming
- MS SQL Server
- UNIX and LINUX
- SQL Server
- Business Objects
Confidential, New York, NY
Sr. Business Analyst/Project Analyst
- Conducted the JAD Sessions with stakeholders to define business rules and process flows for Population Health Care Management and Utilization Management clinical pathways based on patient risk levels.
- Documented the high level requirements and approved workflows in BRD
- Provided BRD walkthrough to the offshore Altruista Health development team.
- Employed UML to create use case diagram and activity diagrams.
- Developed wireframes for UI changes and documented data element dictionary to define UI elements using MS Visio
- Documented interface mapping specifications for the file feeds from client DB2 database to Guiding Care interface
- Performed detailed analysis with business to define operational and performance reports for daily, monthly and quarterly frequencies
- Developed test cases and test plans on the basis of requirements and also did manual testing of the functionality of the application to ensure functional integrity
- Clarified QA team issues and reviewed test plans and test cases developed by development team and QA team to make sure all requirements have been covered in and tested properly.
- Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
- Identified bugs during the test phase and reported them using HP ALM.
- Maintained Traceability Matrix throughout the project.
Environment: Agile, Microsoft SQL, UML, MS Visio, DB2, HP ALM, Microstrategy
Confidential, New York, NY
Sr. Business Systems Analyst
- Worked for operating support group involved in multiple projects for the claims and compliance department.
- Worked on EDI 270/271,276/277, 835 &837 for the claims department and interacted with Emblem’s compliance, special investigation department & NY state DOH(Department of health)
- Worked extensively with vendor Red Card who was contracted to send letters on Emblem’s behalf on a quarterly basis
- Created data mapping documents based on Red Cards specification which involved working with Facet claims, membership & plan data model
- Extensively used SQL queries to fetch data from different claim & membership table(CLCL CLAIM,CDML CL LINE,MEME MEMBER,SBSB SUBSC)
- Interacted with Emblem’s Medical management, Customer service & Intake team (provider authorization)
- Designed screen mockup/layout after taking input from customer service, intake team.
- Designed the look & feel of the CDRS front end (auth grid search screen)
- Validated HCPCS & CPT codes in Facets, worked with configuration analyst for configuring missing CPT & HCPCS codes in Facet
- Developed mapping documents based on Emdeon specs & CAQH core operating rules
- Mapped Emdeon provided service codes to Facet by developing crosswalk tables
- Worked with plan data model in Facet front end (2X) & backend (CMC PLDS PLAN DESC, CSPI CS PLAN, CMC SETR TIER)
- Documented claims extraction process using Visio and worked with provider relation & membership department
- Performed Root Cause Analysis for errors found in facet for membership and claims status
- Conducted offshore testing with cognizant team in Chennai India
- Facilitated issue resolution and created RFC’s presenting in CAB (change advisory board) meetings
- Performed UAT, modified requirement to improve functionality based on user input
Environment: Agile Scrum, Rally, MS Visio, MS Outlook, Share point, FTP, MS Excel, MS Project, UML, XML, Java, Oracle, TOAD, Facets 5.01
Confidential, Detroit, MI
Sr. Business Systems Analyst
- Facilitated JAD sessions with business partners to identify business requirements for EPIC Care Everywhere and create high level Business Requirements Document
- Reviewed and analyzed business requirements and Epic model in order to build conceptual model of project
- Developed Activity Diagrams for exact illustration of the process flow
- Organized and performed presentations with business and subject matter experts in order to demonstrate current progress of the project
- Performed analysis of Oracle SQL codes and Crystal reports on Oracle database by using TOAD tool to understand construction in Epic Clarity model.
- Identified needed fact tables, their look up tables and fields through deep analyzes on Epic Care Everywhere by using TOAD tool.
- Documented identified useful data from Care everywhere data model on Excel spread sheet
- Analyzed new built tables in order to match them with previous analyzes and fix issues
- Updated structure of existing ETL data mapping templates for Integration process
- Matched identified and built target data with source data and map them on ETL spread sheets
- Created and documented logics and transformation rules on ETL maps for Integration process
- Designed and developed Qlikview dashboards for different KPIs like Length of Stay based on different specialities, admissions/re-admissions and Meaningful use metrics.
- Attended weekly team meetings in order to review progress of project. Moreover, organized daily stand up meetings with developers and architect in order to fix minor issues
- Uploaded current created documents as Conceptual Model, BRD, and ETL mappings to SharePoint
- Presented ETL documents on meetings with Project Manager, Quality Assurance team and Business Partners and move process to data integration stage.
Confidential, Louisville, KY
Sr. Business Systems Analyst
- Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
- Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
- Prioritize user stories and assigned to different sprints.
- Facilitated daily stand ups and managed task board with user stories and board.
- Prepared and tracked burn down charts and velocity charts for timely delivery of projects.
- Prepared product backlog working with product owner and other SME.
- Efficiently interacted with designers and software developers to understand application functionality and navigational flow and keep them updated about business user’s specifications.
- Involved in designing and defining User Interface Requirements (UIR) and visual patterns by creating wireframes, screen mockups and story boards.
- Developed understanding of various transactions involved in transition from HIPAA 4010 to HIPAA 5010 like Eligibility, Benefit, Claim submission transactions in Facets tables
- Analyzed and validated requirement for HIPAA 5010 and gathered requirement for ICD10.
- Analyzed and documented differences between the AS-IS and TO-BE processes.
- Worked on EDI 270/271 (Claim Eligibility Inquiry) /276/277 (Claim Status Check) /837 Claim Submission /835 (Claim Remittance) in Facets lifecycle.
- Developed mapping documents for ICD 9 to ICD 10 application.
- Performed UAT, Regression testing on EDI 835 and format in Facets.
- Analyzed all ICD10 codes and validated the outcomes.
- Supported User Acceptance testing (UAT) and collaborated with the QA team to develop test plans, test scenarios, test cases and test data to be used in testing, based on business requirements and application knowledge.
- Interacted with the developers to report and correct bugs.
- Created and maintained Issues Log and ensured timely resolution of all items
Confidential, Danville, PA
- Followed Agile approach of development throughout the project
- Facilitated JAD session meetings with stakeholders (Medical Director, Laboratory Manager and Wellness specialists) and developers to perform Requirement Gathering & Analysis by actively soliciting, analyzing user requirements and prepared the requirements specification document for the solution.
- Ensured the compliance with HIPPA for electronic healthcare transactions.
- Developed activity diagrams and sequence diagrams to analyze the requirements and recommend solutions.
- Performed data analysis on Amysis database for membership related requirements
- Involved in creating User Stories with acceptance criteria and documented acceptance scenarios to facilitate test driven development.
- Documented specifications for calculating scorecards based on biometrics results for wellness programs.
- Assisted the technical team in translating application functionality into application architecture.
- Participate in the bug review meetings.
- Developed Test Plan, documented and executed test cases and reported the bugs in Quality Center.
- Perform UAT with the users and document user manual
Environment: Agile Scrum, Rally, SQL, UML, Java, Quality Center, SVN, MS Office.
Confidential, Parsippany, NJ
- Performed Gap analysis, requirements gathering and for enhancements to existing systems and processes.
- Performed analysis on Investigator Brochures, NDA periodic Reports, PSUR, and e-CTD.
- Documented specifications for Regulatory Report Authoring & Publishing management Systems
- Worked with the Documentum Query Language and Documentum wrapper.
- Prepared use case models based on Business Requirement documentation gathered through interaction with users and the stakeholders.
- Created and maintained the Requirements Traceability Matrix (RTM).
- Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
- Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
- Identified and analyzed the data requirements for the various site teams and made sure that the required data is available in the testing environment.
- Worked directly with software engineers to ensure clear communications on requirements and defect reports.
- Designed and developed scenarios based on business requirements.
- Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test before releasing the application.
- Validated the scripts to make sure they have been executed correctly and meets the scenario description.
- Involved in project status meetings, QA review meeting, and System Test meeting.
Environment: Rational Requisite Pro, MS Visio, Oracle, J2EE, Java, UML, SQL, Quality Center.
Jr Business Analyst/Research Analyst
- Collecting Information on the Production Quality Standards and Manufacturing Equipment Quality of over 15 Small and Medium Enterprises (SMEs) in the Pharmaceutical Cluster in Ahmedabad.
- Evaluating the Manufacturing Facilities as per the norms of the Food and Drug Control Office, Government of Gujarat.
- Preparing a Needs Assessment Report on improvements required in the quality standards to meet the Government requirements.
- Making presentations to the SMEs to ensure an action plan for implementation of the improvements suggested in the Needs Assessment Report. Submitting the Final Report on the activities done to the Council for Healthcare Industry and UNIDO.