- Innovative and Result - oriented Business Analyst with extensive and progressive experience boosting in business process engineering and Software Development Life Cycle (SDLC), including analysis, design, development, testing and implementation of software applications for HealthCare Domain.
- Extensive Work Experience on various Healthcare applications and worked with system managers and system architects for understanding various systems.
- Over 7 years of working experience as a Business Analyst interacting with Project Stakeholders and SMEs to understand the Requirements and Specifications for new applications along with re-engineering the existing applications.
- Experienced at Identifying and Documenting critical requirements through Analysis of Department Work flow and Information flow.
- Extensive and In-depth experience in gathering Business and Functional Requirements, developing Project Plan, Business Requirement document, Functional specification document, communication plan, Use Cases, Test Plans, Test Scripts conducting Gap Analysis and Impact Analysis.
- Hands on experience in implementing Rational Unified Process (RUP) methodologies to drive projects including creation of RUP artifacts (Project Charters, Vision Documents, Use Cases, Iterations Plans, and Supplemental Specifications).
- Proficient and hands on skills working on Mockups and Wireframes using Balsamiq and Microsoft Visio.
- Extensive Hands on experience in Creating and maintaining Requirement Traceability Matrix concerning design documents using tools like Requisite Pro, MS Excel and TopTeam.
- Extensive working experience in Medicare and Medicaid projects.
- Knowledge on Obama - Affordable Care Act (PPACA), Small Business Health Options Program (SHOP), Family and Medical Leave Act (FMLA), HMO, PPO and POS.
- Clear understanding of ICD-9-CM and ICD-10-CM/PCS and well versed with ANSI X12 HIPAA and HL7 (v2 & v3).
- Extensive knowledge of Health Insurance Portability and Accountability Act (HIPAA).
- Extensive experience in Claims adjudication with a Clear understanding of industry compliance standards like EDI X12 transactions (834, 837, 835, 270/271, 276/277).
- Experience in testing Electronic Data Interchange (270, 271, 834, 835, and 837) according to HIPAA Compliance 4010, 5010, ICD-9 and ICD-10.
- Experienced in conducting and facilitating Joint Application Development (JAD) sessions and interviewing Subject Matter Experts (SMEs).
- Experienced in modeling Use Case Diagram and Activity Diagrams using UML.
- Involved in Designing and Developing Acceptance test plans and implementing them at UAT.
- Proficient in using MS-Word, MS-PowerPoint and MS-Project.
- Hands on experience on SQL server, RDBMS, Data Warehouse, Microsoft Access, designing and normalizing techniques on the database tables.
- Experience in writing queries for Data Analysis and QA report testing.
- Worked on data visualization tools Tableau and Qlikview.
- In-depth Knowledge and hand on experience of Various Business Intelligence tools.
- Extensive Documentation Skills.
- Proven ability to contribute significantly to projects independently and in a Team environment.
- Exceptional communicator with strengths include quick learner, strong organizational and planning skills, work well under pressure, results-oriented, leadership, self-motivating and versatile in problem solving.
Project Methodologies: AGILE/ SCRUM, Waterfall and Rational Unified Process (RUP)
Project Tracking Tools: MS Project, HP Quality Center, JIRA, Rally, IBM Rational clear Quest
Microsoft Tools: Word, Excel (Pivot Tables), Power Point, One Note, Outlook, MS Access
Database Tools: SQL Server Oracle, PLSQL
Business Analysis Tools: UML, Balsamiq, MS Visio, Lucid chart, TopTeam, Tableau, Qlikview and Sharepoint.
Business Artifacts: Project Charter, BRD (Business Requirement Document), FRD (Functional Requirement Document), SRD or SSD (Software Specifications Document), Risk Management, Mockups, Use cases, Activity Diagrams and RTM (Requirement Traceability Matrix)
EDI Healthcare Transactions: 834 (Memberships), 835 (Payments from Payer), 837p (Professional Billing), 837i (Institutional Billing), 4010, 5010, 270, 271, 276, 277, 278
Operating System: Linux (Redhat, Ubuntu, Debian, CentOS), UNIX, Windows
Testing, ETL (Reporting), Tools: MS SSRS, Oracle TOAD, HP Quick Test Professional, SAP-Business Objects, Crystal Reports, Micro Strategy
Healthcare: FACETS, HIPAA, COBRA, Obama Care, NASCO, FMLA, SHOP, Medicare, Medicaid, ICD 9, ICD 10, Claims Adjudication, RCM, EMR, EHR,COB, EOB
Confidential, Hartford, CT
- Part of the initial discovery phase of the project to determine what functionalities are in scope, time estimates, risk and resources. Strategize the priority, planning and scheduling of functionality release.
- Analyzed the project charter and Business case to ensure that the proposed solution met the business requirements.
- Gathered Requirements by conducting meetings, Interviews and JAD sessions with SMEs, business users and Stakeholders.
- Conducted thorough market analysis & research to advice recommendations for adding new functionalities, enhancements to the existing Provider portal
- Worked on HL7 v2 framework to exchange and retrieve electronic health information.
- Involved in enhancing the billing and order management using the BSS (business support system) application and MMIS.
- Worked with the team on FACETS claims processing system and gathered requirements to comply with HIPAA.
- Involved in testing all the features of EMR after the upgrades are performed.
- Played a Key role in assisting end users and Technical staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS (Data Base Management System).
- Extensively Involved with Capitation and Medicare - Free for service claims for PPO and POS members.
- Extensively worked with Member/Subscriber and HIPAA Privacy Facets application groups.
- Used Balsamiq to prepare Mockups and Axure to prepare prototyping.
- Followed UML based methods to develop Use Cases Diagrams and Activity Diagrams.
- Participated in design review to ensure the Integration of all requirements.
- Created Progress and Completion reports, which were then submitted to project management on a weekly basis.
- Defined Test cases, creating test scripts, analyzing bugs by interacting with QA teams in fixing errors.
- Involved in User Acceptance Test (UAT) for the final testing of the application in the deployment environment.
- Responsible for providing documentation to team for troubleshooting and resolving issues reported by system users.
Confidential, Spring field, IL
- Involved in working with the on-shore team.
- Conducted JAD session with stakeholders to gather requirements.
- Facilitated and managed meeting sessions with users and SMEs to review and capture Business requirement.
- Involved in translating the requirements into Functional and Business requirements.
- Implemented RUP methodology through Software Development Life Cycle (SDLC).
- Involved in drafting Business Requirement Document (BRD) and Functional Requirement Specification (FRS) using MS word.
- Designed Use Case specifications, Businessflow diagrams and Activity diagram using MS Visio.
- Co-ordinated Design reviews to ensure the integration of the requirements.
- Worked hand in hand with the Project managers, Business owners and Vendors on regular basis.
- Prepared Project Status Metric and reported directly to the project manager on weekly basis.
- Conducted Project status meetings on a weekly basis with Development and Testing teams.
- Assisted in development of training materials for new technology and process improvements. Provide training to users and user managers
- Developed training content and various training Modules for professional associations such as hospitals, Insurance agents
- Developed UAT Test Plans and Test Cases based on user requirements and functional specifications
- Designed Mockups using Balsamiq to present the individual GUI representation.
- Used Rational Clear Quest for defect tracking, facilitating and monitoring the process.
- Worked with business users and technical team to monitor the deployment of the application.
Confidential, Tampa, FL
- Acted as a liaison between Stakeholders: system users, clients and managers, who have a business problem and software development team for Requirements gathering.
- Involved in all phases of the Iterative approach of the RUP from Inception to Transition.
- Performed the requirements gathering activity in a structured ways by applying context free questions, Interview business area experts asking detailed questions, and surveys.
- Recorded the requirements in Vision Documents and Software Requirement Specifications (SRS) using RequisitePro.
- Effectively used Rational Rose and MS Visio for designing use case scenarios and work flows for documenting the requirements.
- Extensively Worked on EDI 270/271 (Claim Eligibility Inquiry) /276/277 (Claim Status Check) /837 Claim Submission /835 (Claim Remittance).
- Worked extensively on ICD 10 Procedural and Diagnosis codes.
- Worked on different EDI Transaction Code (270/271/835/837/834 ).
- Involved in Developing Mapping Documents for ICD 9 to ICD 10 application.
- Used General equivalence Mappings (GEM) to convert ICD 9 to ICD 10.
- Analyzed and validated all ICD 10 codes and their outcome.
- Worked on refining the functional requirements by facilitating JAD sessions with management, development team, users, and other stakeholders.
- Created use cases and data flow diagrams to analyze the impact of ICD 10 diagnosis codes embedded in different systems and applications.
- Used UML for Specifications, Documentation, and Construction of systems.
- Created Business Rules Document for the Claim Component and HIPAA.
- Developed business workflows on the claims module for the better understanding of the application and prepared a detailed BRD with all functional and non-functional requirements.
- Created User help documentation complying with the client's documentation guidelines.
- Facilitated brain storming sessions on Group Insurance, Eligibility, Benefit and Claims transactions in HIPAA.
- Created an Issues Log to track and resolve the issues in a timely manner.
- Reviewed Integration Test Plan for integration between modules.
- Worked with testing team to review Use case as testing plan during UAT.
- Efficiently interacted with Development team to understand application functionality and navigational flow and keep them updated about the specifications of the business user’s.
- Identified all risks associated with the project and proposed suggestions for mitigating the risk’s related to the business.
- Involved in gathering the requirements that were critical to the business process flow and using those requirements for the Business Requirements Document (BRD),
- Followed Agile with scrum SDLC
- Created and reviewed business requirements, functional specifications, project schedules, and documentation.
- Extensively Involved in the analysis phase for understanding the Scope of the Project, feasibility of the implementation, and defining the risk factors involved in the project.
- Conducted JAD sessions for communicating with all project managers, senior management, and other stakeholders.
- Involved in gathering functional and non-functional requirements.
- Involved in performing Gap Analysis of client requirements by communicating with business users.
- Worked extensively with MS- Visio to create the Use case and activity Diagrams.
- Involved in User Acceptance Testing (UAT) and Test Execution.
- Created SQL queries for backend testing.