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Sr. Business Analyst Resume

Baltimore, MD

SUMMARY

  • Qualified professional with 7 Years of extensive experience in the field of Business / Systems Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare & Medicaid Industry.
  • Concrete knowledge of a Medicaid and Medicare systems.
  • Substantial experience in the health care industry with health insurance, Medicare & Medicaid plans, claims management, pharmacy management, and other health care services.
  • Extensive success in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) in an SOA environment.
  • Experience in Individual/SHOP Benefit Enrollment EDI Transaction Standards, Configuration and Management for the ACA/Obamacareproject.
  • Experience working with HL7 v2.3 - 2.7 and v3.0, X12 and expertise in HL7 segments, fields and transactions.
  • Extensive knowledge inReportWriting, utilizingCrystalReports.
  • Expert in Disaster Recovery Planning, Executing and testing.
  • Good knowledge of HIPAA standards, EDI (Electronic data interchange), ICD-9, ICD-10 coding, HCPCS and CPT, Health insurance plans - Indemnity plans, Managed Care plans (HMO, PPO & POS), Affordable Care Act, CHIP.
  • Have good knowledge ofBusinessfunctionalities like Medicare (Part A, B, C, and D), Medicaid, ACA/ObamaCareCommercial claims, AR Reduction, Bulk Billing and Insurance specific trends.
  • Solid understanding of SDLC execution for enterprise solutions,businessprocess analysis, requirement elicitation and analysis,softwareand vendor selection, custom development and/or package implementation, testing and vendor management.
  • Good Knowledge of HIPAA Compliance Lifecycle, HIPAA Insurance Regulations.
  • Knowledge of healthcare Insurance Exchange (HIX).
  • Strong understanding of data warehousing, database structures andbusinessintelligenceconcepts.
  • Skilled and experienced in creating and updating InfoMaps / business process maps, following the ITIL framework, under tight timelines.
  • Knowledge about HIPPA policies, PHI, HL7 standards, X12 standards, ICD-9 and ICD-10 conversions and migration.
  • Good knowledge in the analysis of HIPAA compliance and EDI transaction sets and actively participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes.
  • Proficient in Technical and Business Writing, Business Process Flow, Business Process Modeling, Business Analysis and Testing various methodologies.
  • Good working knowledge in Claims processing, Medicare/Medicaid, HIPAA Regulations, Facets and 276, 277, 837P, 837I, 837D, 835 and 834 EDI Transactions for health care industries.

TECHNICAL SKILLS

Operating Systems: Windows 95/98/2000/XP, Macintosh, UNIX

Modeling Tools: MS Visio, MS Studio, True Comp

Modeling Languages: UML, OOAD, Object Modeling, RUP, AGILE

Programming Languages: SQL, PL/SQL, Java, .NET Framework, C#, Visual Basic

Database Management Systems: Oracle9i, MS Access, MS SQL Server, TOAD

Microsoft Tools: MS Office, MS Front Page, MS Outlook, MS Project, MS Visio

Rational Tools: Rational Rose, RequisitePro, Clear Case, Clear Quest

Testing Tools: Test Director, Quick Test Pro, Mercury Quality Center

PROFESSIONAL EXPERIENCE

Confidential, Baltimore, MD

Sr. Business Analyst

Responsibilities:

  • Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
  • Conducted user interviews and documented business and functional requirements.
  • Elicit business requirements and draft business and functional requirements documentation, and desk-level procedures for health insurance exchanges in compliance with the Affordable Care Act (ACA).
  • Responsible for developing and reviewing HL7 business requirements, functional specifications, project schedules, documentation and test plans.
  • Played a key role in the development, outline and implementation of aBusinessContinuity and DisasterRecoveryPlan.
  • Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
  • Worked on implementation of Affordable care act enrollment and reconciliation modules on the EDI tool called Enrollment manager.
  • Responsible for analysis and evaluation of Medicare and Medicaid beneficiaries’ entitlement data along with Medicare Advantage Prescription Drug ( “MAPD”) plans’ enrollment, premium and plan payment data.
  • Worked on broad range of technologies, including business process tools such as Microsoft Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, MicroStrategy Data Warehouse Data Modeling and Design.
  • Member of the Corporate Center Sector Continuity of Business (CoB) Management Team responsible for monitoring and governing business unit compliance with CoB planning and testing requirements for the denial of access, denial of service, call tree, tabletop, end user computing and crisis management programs.
  • Prepared theSoftwareSpecification Document for the application based onbusinessuser information.
  • Worked closely with the developers to convey medical billingsoftwareservice update requests to meet the client's needs.
  • Provides a single source for all current and past contract documents in theSelecticarepository, and update regularly.
  • Evaluated Business Continuity -Disaster Recovery exercises with business units, identified gaps and provided recommendations for improvements to plans.
  • Developed and implemented Change Management process using IT Infrastructure Library (ITIL) standards to eliminate potential risk of software & infrastructure changes.
  • Oversaw project deadlines associated with implementation ofhealthcaresoftware. Manage all aspects of the client medical billing practices for the entire life cycle.
  • Analyzed and identifiedPBPdata elements to effectively implement Seniorbusiness.
  • Generated usagereportincrystalreportswhich could later on be exported to other formats such as Word, XLS, PDF, etc.
  • Held the primary responsibility in developingPBPReceived,PBPProcessed,PBPSuccess Rate modules.
  • PerformedCost-Benefit analysis on several locations for feasibility study andoptimizationof real estate portfolio.
  • Conducted JAD Sessions periodically with various stakeholders at various phases of theSoftwareDevelopment Life Cycle (SDLC) to discuss open issues and resolve them.
  • Developing HL7 Mirth Channels to support EMR applications that are integrated using Mirth Connect for various transaction types.
  • Member of project teams charged with retrofitting health care systems to comply with Affordable Care Act (ACA) regulations.
  • Translated excellent knowledge of Health Insurance Portability & Accountability Act (HIPAA) to business analyst direct reports.
  • Been a part of Architecture and modeling team and have used SOA (Service Oriented Architecture).
  • Created screen-mockups using iRise to review the requirements and provide feedback on the screen design. Also, used Microsoft Paint to create ad-hoc screen mock-up to review with the users.
  • Closely monitor and control Process Readiness, Release management, Rollback criteria, and DisasterRecoverydocument.
  • The reports that are developed comprise, the information onPBPcalls received in that queue, total calls that went through the entire process and ended up in the final payment process, and finally the success rate with respect to the date, month and year analysis.
  • Collaborated with department leads, project members, and vendors in completing a network security assessment questionnaire and obtained all required documentation (password policy, backups/disasterrecovery, access control, etc.)
  • Analyzed competitor sites as well as evolvingObamacareregulations to inform roadmap decisions.
  • Used reporting tools such asCrystalReportsand Hyperion Essbase.
  • Created standard HL7 and non-HL7 message sets to be used with the interface message flows based on interface requirements.
  • Made the primary and secondary were part of the COOP team and made sure the training extended three levels. Risk assessment and management of risks, vulnerabilities and the implementation of cost-justifiable countermeasures.
  • Improve operational efficiency and ensure processing accuracy for the CMS-ES project, supporting the Affordable Care Act (ACA).
  • Analyzed the data warehouse project database requirements from the users in terms of the dimensions they want to measure and the facts for which the dimensions need to be analysed.
  • Created schedule and ensured execution of live and desktopdisasterrecoveryexercises. Worked with both internal service, external supplier, and system owner to resolve any issues.
  • Providing support for new vendor mergers; Meditech, HL7, EPIC, Mirth, Cloverleaf standards and interface experience for clients and drug data per HIPPA standards.
  • Monitor the Change Management process for infrastructure or technology changes that would impactDisasterRecovery.
  • Developed backend calculations required to produce volatility and correlation matrix using SAS.
  • Design Visio process flowcharts for the enhanced Customer Complaint Handling System. Prioritize documentation schedule for multiple projects.
  • Created the foundation for the implementation of a Continuity of Operations plan (COOP), Establish and disperse the line of succession documentation.
  • Involved in fullSoftwareDevelopment Life Cycle.
  • Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
  • Crafting governance plans, facilitating service definition efforts, writing SLA documentation, and leading roadmapping efforts for ECM service delivery.

Environment: Visual C++, SQL Server, UML, Agile, MS Office Suite, ationalSoftwareModeler, Business Intelligence, iRise, Test Director, Visio, Rational Clear Case, Clear Quest. EDI, HL7, EMR, Facets. ICD-9/10. Claims Management, HIPAA X 12 4010/4010 A. BM TOAD DB2, SQL, IBM MVS Mainframe 0S/390, JCL, ISPF, TSO, File-Aid, AppWatch,UltraEdit, soapUI, XML, Altova XMLSpy, HPSM, SharePoint, ALM and Quality Center, etc.

Confidential

Business Analyst / Systems Analyst

Responsibilities:

  • Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
  • Worked directly with the Enterprise Process Change Organization & Legal Compliance departments to implement operational processes to comply with regulations, including the Affordable Care Act (OBAMACARE) & various other regulations of ACA.
  • Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
  • Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
  • Responsible for creatingcrystalreportsand dashboards for the client usingBusinessObjects.
  • Used Rational Unified Process (RUP) as aSoftwareMethodology and was involved in the development of the application from inception to transition phase.
  • CreatedDisasterRecoverydocuments and procedures for the client's Data Center Services team, including server, database, application and storage area network groups.
  • Worked on BusinessIntelligence in Creating Data structure and Data model diagrams utilizingCrystalReports.
  • Identified howbusinesscaters to ANOC and EOC reports for different plans and mapped Senior data elements with that ofPBP.
  • Documentedsoftwarevalidation plan to define "what" is to be accomplished through thesoftwarevalidation effort and scope, approach, resources, schedules and the types and extent of activities, tasks, and work items.
  • Worked with developers,businessusers, stakeholders, andanalystsat various levels at different stages of theSoftwareDevelopment Life Cycle (SDLC) to explain the requirements and to help resolve issues.
  • In accordance with the Affordable Care Act (ACA -Obamacare); CTHIX was setup by State of CT to facilitate the purchase of health insurance at affordable prices.
  • PerformedSoftwareRequirements Traceability Analysis to tracesoftwarerequirements to (and from) system requirements and to risk analysis results.
  • Extensive experience in EHR /EMR systems and Computerized Provider Order Entry (CPOE) with good knowledge of HL7 and Meaningful Use.
  • Created requirement documents for the development of the new HIX connector product that would integrate the exchange enrollment data with the existing core applications.
  • Workwed into Healthcare claims process, EDI transactions, EMR (Electronic Medical Records), DSM (Direct Source Messaging) HIPAA (Health Insurance Portability Accountability Act), EOB, ANSI 837 UB92, 5010, HIX.
  • Completed the documentation of Claims Scenario’s for the source system.
  • Actively involved in CTHIX build validation and implementation.
  • Provided support to CMS/ Federal and State stakeholders on objectives relative to PPACA -HIX by performing the following duties in an agile (scrum) SDLC environment.
  • Design Visio process flowcharts for the enhanced Customer Complaint Handling System. Prioritize documentation schedule for multiple projects.
  • Captured requirements and developed SDLC process documents to realize the requirements, includingdisasterrecoveryprocedures, and production run books for implementation of an automotive account. Used content management methods to minimize documentation production and maintenance efforts.
  • Defined new set of validity, translation and compatibility custom edits along with HIPAA HL7 edits for the system in order to process the new 5010 version of claims format.
  • Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintainace), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/Advice).
  • Understood EMEVS, the State’s Electronic Medicaid Eligibility Verification System; HIPAA compliant ePACES (Electronic Provider Assisted Claim Entry System) and Computer Sciences Corporation, State’s Medicaid and Medicare Intermediary, and their roles in Medicaid Claims processing.
  • Analyzed the laws and regulations (HIPAA, HL7) before implementing the electronic medical record software.
  • Used SoftTest software with pseudo code to ensure test cases covered all branches of project's code impacting the system. (The system is an IBM mainframe based system that contains the master set of customer information used to bill customers.).
  • Involved in performance testing of Medicaid client server claims processing system, Medicaid MCC / MCO and Medicaid Management Information System (MMIS).
  • Used Interface Explorer to test and debug interfaces by creating instances of source (client) and destination (server) end point applications for sending and receiving the HL7 messages.
  • Document the implement the following DR strategy; remediate current risks and power constraints with the data center and bring the Recovery Time Capability (RTC) into alignment with new and evolving Disaster Recovery (DR) and Business Continuity Planning (BCP) Recovery Time Objective (RTO) requirements. Relocate the existing data centers to address the power constraints, floor safety, insufficient cooling, and fire suppression, and improve the RTC for the data center and business line requirements.
  • Support the Federal Government (CMS) in developing a data warehousing and business analytics solution to support the high data volumes and future business needs related to the Affordable Care Act.
  • Developed HL7 messaging for bi-directional case and disease report exchange, in text and XML formats, in accordance with HL7 specifications.
  • Documented requirements associated change requests with requirements and connected requirements with Use cases.
  • Devised semi-annual business continuity and disaster recovery plans.
  • Maintained and validatedDisasterRecoverydocumentation Quarterly.
  • Reviewed HL7 messages to confirm that they meet state specifications for interface testing
  • Worked with exposure to Electronic Medical and Health Records (EMR & EHR)/Automated Health Care Systems, ICD-10 conversion, HIPAA and other HIT standards
  • Evaluated and analyzed EDI transaction sets 276/277 (Claim Status Request/Response), 270/271 (Eligibility Inquiry/Response), 837 (Claim Transaction) and 278 (Healthcare Service Review Information)
  • After Executive confirmation did Gap analysis to assess needs that could not be met by core EHR.

Environment: OOAD, UML, RUP, TQM, Business Modeling and Data Modeling iRise, Medicare (Part A, B, C, and D), Medicaid, ACA/ObamaCareCommercial claims, AR Reduction, HL7 2x, Bulk Billing and Insurance specific trends: - Except Bulk Billing and ACA/ObamaCareCommercial claims, FACETS, Ultra EDIT, Text Pad, SharePoint, FTP, HIX, HIE, Business Intelligence, Rational Rose, Agile, ITIL, ITSM, Rational Requisite Pro, MS Visio, Clear Case, Clear Quest, EDI, Facets. ICD-9/10. Claims Management, HIPAA X 12 4010/4010 A.

Confidential, Durham, NC

Business Analyst

Responsibilities:

  • Studied businessrequirements and conduced User Interviews to identify and document the data discrepancies and their sources as related to Government Contract Compliance (GCC), Government Disclosures, Government Pricing, Customers, Products, Product pricing.
  • Responsibility included modifications to a customer’s mainframe system to support new product features or regulatory requirements and, in some cases, involved a system upgrade.
  • Prepared Time andCostestimate for the above feature to be implemented.
  • Identified and documented data model processes and system deficiencies for the HIX eligibility & enrollment.
  • Converted Business Requirements to the Functional Specification and Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
  • Implemented numerousbusinessoptimizationprojects and reporting tools that improved efficiency, reduced expenses, laborcosts, and maximized profit by automating outdated manual processes.
  • Maintained documents using SharePoint and the effect of proposed changes on the project schedule andcosts.
  • Enhanced test cases using GUI checkpoints, Database Checkpoints, Text checkpoints and Bitmap checkpoints
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • Developed the strategy for developing and implementing new EDI (HL7 and X12) (Electronic data interchange) interfaces and converting historical clinical and data.
  • Analysis for making system compliant with HIPAA. Involved in making the Medicare patient profiles being compliant with the HIPAA regulations.
  • Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
  • Documented Requirements for Management Reporting out of Clear Quest using Crystal Reports.
  • Worked on Client/Server tools like SQL Server Management Studio to administer SQL Server.
  • Established a RUP (Rational Unified Process) centric business analysis methodology.

Environment: MS office 2003, Enterprise Architect, Crystal reports MS Project, Agile, Rational Test Manager, XML Spy, Data Stage, Rational Requisite Pro, Rational Clear Case, Clear Quest, Rose.

Confidential, Sacramento, CA

Business Analyst

Responsibilities:

  • Designed the business requirement collection approach based on the project scope and SDLC methodology.
  • Gathered requirements from business users and tracked them using Rational Requisite Pro.
  • Assist in the set-up of the new hospital web portal and document new business processes to support training roll out.
  • Wrote Test Cases in MS Excel for user registration, access to training material, and activity log-in, reviewed the test cases and finalized
  • Worked to establish departmental data management approaches for genomic biomarkers/data and biosample coding categories with regard to EMR records.
  • Gathers requirements from Sales team, EMR vendor, Physician offices,Surgery Centers and Hospitals.
  • Created workflow scenarios, designed new process flows and documented the Business Process and various Business Scenarios and activities of the Business from the conceptual to procedural level.
  • Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology

Environment: - MS Office, Test Director, MS Project, MS Visio, Unix, Oracle, Toad, Rational Requisite Pro, Rational Rose

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