- Motivated, Goal - driven and a passionate professional with bachelor’s in dental surgery, 7+ years of Clinical and non-clinical experience.
- Collaborative servant leader with strong problem solving and communication skills. Adept at building and leading cross function team, excellent vendor and risk management skills.
- Excellent communication, organization, Team coordination, Project management, Time management and customer service skills with attention to details.
- Advanced research, writing, analytical skills with ability to take a directive and perform efficiently under pressure.
- Self-starter, Independent and critical thinker, with focus on target/deadline without micro-management and oversight.
- Proficient in using MS Office (Visio, Project, Macros, Word, PowerPoint, Outlook, and Excel), Prezi online presentations, online tools to develop animated videos for presentation. Ability to navigate through project tracking tools like SharePoint.
- Agile/Scrum and Waterfall Methodologies for Software Development Life Cycle (SDLC cycle). Experience working with Database management tools like MS SQL Server.
- Adept at creating, coordinating and facilitating Joint Application Development sessions and interviews, reports, project status reports, PowerPoint presentations, e-mails.
- Proficient in conducting GAP Analysis, SWOT/MOST/PESTLE Analysis, Cost Benefit Analysis, Risk Analysis, Impact Analysis, Time tracking and ROI as well as expert use of Surveys and Questionnaires in gathering info.
- Well versed in Project Management tools like MS Project for status reporting and planning.
- Extensive knowledge of Medicaid Management Information Systems (MMIS), Health Insurance Portability and Accountability Act (HIPAA) standards, HEDIS standards, Electronic Data Interchange (EDI) and implementation of HIPAA code sets, ICD-9, ICD-10 and using FACETS/ QNXT for claim processing.
- Performed in-depth analysis of workflows, data collection, report details, and other technical issues associated with the software. Developed and implemented the validation sessions for the current and future state analysis and documentation.
- Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) EDI transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
- Well versed with Agile/Scrum work environment and familiarity with writing user stories, and following the development process through user story acceptance.
- Exceptional skills in healthcare business process review and design use cases,documentation, gap/fit analysis, impact assessment, testing and training
- Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD).
- Expertise with ISO, Six Sigma, CMM standards.
- Functional and analytical knowledge of TriZetto Facets.
- Successful in bridging the gap between healthcare clients and the software developers
- Extensive knowledge on performing Process reengineering by documenting and evaluating existing business processes.
- Award for critical thinking, efficiency, competency, teamwork, communication and social skills
Methodologies: Rational Unified Process (RUP), Agile/ Scrum, RAD, Waterfall
RDBMS Tools: MS SQL Server, My SQL
Tools: MS Office, MS Word, MS Excel, MS Power Point, MS Access, Visual use case, MS Visio, UML, Rational Rose, Rational Requisite Pro, Lucid chart, MS Project, MS Visio, MS Macros, MS Project, SharePoint, HP ALM/Quality Center, HP Service Manager, IBM-SPSS, Clearquest, Clear case, LoadRunner
Operating Systems: Windows Vista, Windows XP Professional, Mac OS
HIPAA Tools: TSO, File Aid, HIPAA ANSI X12 EDI Transactions (837/835/834/270/271 )
Industry Standards: HIPAA, SOX, ISO, Six Sigma, CMM
Confidential - Bethesda, MD
Sr. Business Analyst
- Extracted the business requirements from the end users keeping in mind their need to request for information about medical services offered to the customers and documented it for the developers.
- Processed Medicaid claims and worked on X12 format of EDI 837 for Medicaid claims.
- Analyzed System Impact including MMIS Tables, Windows, Reports and Interfaces to external entities.
- Involved in the day-to-day implementation of the Agile methodology of application development with its various work flows, artifacts and activities.
- Effectively implementation of the System Development Life Cycle SDLC, the BABOK and RUP methodologies from Initiation to Deployment.
- Analyzed HIPAA 5010 impact on external data warehouse and data warehouse extract process and mapping of MMIS database and data warehouse.
- Performed Gap Analysis of 5010 EDI transactions using implementation guide to identify the changes in the segments and data elements.
- Was responsible for data mapping of HL7 messages into relational database.
- Documented Functional Requirements Specifications (FRS), Business Requirement Document (BRD) and Functional Requirement Document (FRD).
- Involved in the day-to-day implementation of the Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts and activities.
- Followed the Business Rules, and ensured that HIPAA 5010 compliant Rules are followed to display minimum benefit information that the Provider is required to pass on the EDI X12 transactions.
- Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
- Involved in analyzing the claims on basis of Primary and Secondary Payers and performed Medicare subsidy eligibility check for employee group plans.
- Involved in mapping and validation of different EDI transaction used for claims filing like ANSI X12 837 (I, P, D) for claim submission, ASC X 12 270/271 for the eligibility/benefit inquiry and response, ASC X12 276/277 for the claims status enquiry and response and ASC X12 835 for the healthcare claim payments.
- Used SQL queries to perform data integrity testing and for Back-End Database Validation.
- Worked on claim adjudication system including Inter-Plan Teleprocessing Services (ITS), Health Reimbursement Arrangements (HRA), Flex Saving Arrangements (FSA), Blue Card Program, Blue Exchange transactions, and Health Savings Account (HAS)
Environment: MS Visio, MS Project, MS Office,SQL, Quality Center, UML, Traceability Matrix RTM, Agile, RUP, MS SQL, Rational Rose, Requirement, Rational Requisite Pro, Rational Rose, Clear Quest, EHR, JAVA, FACETS, Facets extensions
Confidential, Saint Charles- MD
EDI Analyst/Business Analyst
- Built an Information Security Risk Assessment (ISRA) for the secure exchange of health insurance data as part of the Affordable Care Act (ACA).
- Responsible for implementing payers onto the Health Care Exchange (HIX) for the Affordable Care Act.
- Strong working knowledge of the 834, 837 & 835 EDI Healthcare files and Transactions.
- Thorough knowledge of ICD-10 codes and CPT codes for both Mental and Medical Health and worked extensively with Inbound and outbound 834 Transactions processing systems.
- Compile, validate and report system-wide metrics to attest meaningful use of EHR to the Centers for Medicare andMedicaidServices.
- Created, altered and implemented T-SQL Stored Procedures for the use of processing consumer data and developing new web delivered tools.
- Collaborate with federal clients (CMS, NIH, ONC) and standards development organizations such asHL7to develop
- Responsible forUATproject planning like creating testing scenario, test plans, and test scripts.
- 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.
- Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA).
- Developed Schemas of EDI x12 Claims (837) and Eligibility forms in XML.
- Lead SCHIP, CMS request to be able to identify the Medicare eligible candidates.
- Perform responsibilities of conducting research on IT requirements and business requirements in UATareas.
- Responsible for support and enhancement requests for a SQL data warehouse and transactional database.
- Performed Regression,UAT, Integration, User Interface, GUI, and Usability Testing and wrote test cases and test scripts, execute test scripts and analyzed outcomes.
- Wrote user acceptance testing (UAT) scripts and led testing/ quality assurance for bothHL7ADT interface and the application.
- Generated and maintained SQL Scripts to perform back-end testing on the oracle database.
- Tested and implemented HIPAA 4010 and 5010 and ICD 10, version for all EDI transactions.
- Produced customer functions, complicate SQL commands in Business Object Enterprise XIR2 and Oracle 10g, Crystal Reports XI environments.
- Assist clients in resolving billing issues for Medicare,Medicaid, and private insurance.
- Thorough knowledge of ICD-10 codes and CPT codes for both Mental and Medical Health and worked extensively with Inbound and outbound 834 Transactions processing systems and coordinated in working sessions for testing; communicate risks/issues to ICD-10 project leads.
- Involved in creating sample mappings for the conversion of EDI x12 transactions code sets.
- Coordinated with QA teams in the execution of User Acceptance Testing (UAT)
- Acted as an SME on various subject areas including state reporting, death benefits, Medicare, Bill review and RX eligibility.
- Troubleshooting utilizing CPT4 & ICD-10 codes and ManagedHL7interfaces for PM/EHR software and Lab computers and performed requirements gathering, business process mapping and re-engineering as a part of health exchange readiness efforts for leading public health plan entering state HIX market.
- Lead projects to design a state-customized Financial Management solution for Health Insurance Exchange (HIX).
- Involved in HIPAA/EDI Medical claims analysis, design, implementation and documentation.
- Developed various test cases for testing HIPAA 8371/P/D 834/835 and 276/277.
- Ensured that the Pre-UATactivity is performed accurately and efficiently.
- DevelopedUATtest process and monitored SIT execution phases.
- Troubleshoot EDI, and XML document errors and troubleshoot translation and mapping errors.
- Developed EDI specifications and applications structures for data feeds and mappings for integration between various systems, including XML and performed back-end testing on the Oracle database by writing SQL queries
- Handle the tasks of helping the organization staff in planning data sets forUAT.
- Created Test Strategy Planning (TSP) and assisted testing team to implement test plans duringUAT kickoff.
- Wrote test plans and tested individual transactions for Medicare / Medicaid transactions (835 and 834).
Environment: RUP, UAT, Agile, SAS, Big data, Microsoft Office Professional), Microsoft SharePoint, Oracle, SQL
Confidential, NYC, NY
Sr. Business Analyst
- Played key role in System Development Life Cycle Process consisting of: Design and Gap Analysis, Business Requirements, Systems Requirements, Test Criteria, and Implementation to have the outputs of project dealt with the automation of correspondence directed to Insurance policy owners.
- Involved in requirement gathering and database design and implementation of star-schema, dimensional data warehouse using Erwin.
- Extensively used Informatica client tools. The objective is to extract data stored in Oracle database, flat files to load finally into a single data warehouse repository, which is in Oracle.
- Led the development of a training program to train users on a custom web application and a Cognos ad-hoc reporting environment.
- Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
- Designed and Developed ETL (Extract, Transformation & Load) strategy to populate the Data Warehouse from the various source systems feeds using Informatica Power Mart, PL/SQL.
- Owned the entire reporting process. Interacted with the ETL team, developer(s), management, and account holders to get the requirements, document them, design templates, and write specifications.
- Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.
- Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
- Conducted financial analysis through various valuation methodologies and prepared capital budgeting documents.
- The Addenda version of the ANSI ASC X12 834 transaction set was selected as the HIPAA-mandated format for electronic enrolment and disenrollment in a Health Plan.
- Assisted JAD sessions to identify the business flows and determine whether the EDI X12 Transaction, Code set and Identifier aspects of HIPAA, impacts any current or proposed systems.
- Designed, developed, and maintained various Business unit reports by using Teradata, SQL, and Ms Excel.
- Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
- Gathered requirements and modeled the data warehouse and the underlying transactional database
- Perform Gap Analysis of the processes to identify and validate requirements.
- Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
- Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
- Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).
- Managed BIG Data projects with one utilizing skills in area of JMP-Pro, SQL Server Management Studio, SQL Server Analysis Services, Dimensional Modeling, etc.
- Involved in the testing phase right from the Unit testing to the User Acceptance testing.
- Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
- Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
- Use Cases and other Process Flow Models were designed using Visio and Rational Rose.
- Involved in jobs and analyzing scope of application, defining relationship within & between groups of data, Star Schema etc
- Brainstormed possible risk scenarios, thus formulating and implementing ad-hoc solutions to stay within project budget. Using Hadoop for Big data.
- Closely work with SAS team to understand and convert the code with ODI developer into SQL.
- Followed the UML based methods using Rational Software Modeler/MS Visio to create: Use Cases, Activity Diagrams / State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
- Tuned the batch programs and online transactions to alleviate performance problems.
- Developed & executed several Optimized queries in SQL on this data.
Environment: RUP, UAT, GAD (Gap Analysis Document), Agile, SAS, Big data, Microsoft Office Professional (Outlook, Word, Excel, Visio, Access), Microsoft SharePoint, Oracle, SQL.
Confidential, Waltham, MA
- Developed document current and future state plans and proposals and also what the system will do.
- Initiated daily meetings with End Users using one on one and group interviews techniques to better understand the requirements.
- Developed scope of the project and developed new business process along with process mapping and user task analysis. I also evaluated documentation analysis and business process analysis to identify the problem with the existing system and find out a new and advanced way to develop a business process which was able to make the process more accurate.
- Created Requirement Specification Documents, Use Case Diagrams, and Activity Diagrams
- Assessed the current status of business process modeling (BPM) and developed project Developing processes, standards, and strategies for development of BPMs.
- ConductedJAD sessionswith various SMEs and users to analyze and discuss project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts.
- UsedAgilemethodology to develop process and standards.
- Attended dailySCRUMand guided IT Developer regarding the defects.
- Developed the transaction process more accurate and real time regarding 837 including HIPAA compliance as well as integrated the system with HL7 process
- I have experience with Medicare part A, part B, part C, Part D as well as have experience with CHIP children Medicaid.
- Worked onEDI transactionslike270,271,834,837(I, P, D) and 835.
- Extensively worked in customization and configuration of Claims Processing applications in FACETS 4.71 involved in the reconfiguration of FACETS in functional areas, including Membership, Claims, Provider, Enrollment, and Service Modules.
- Gathered informationand knowledge on ICD 9-10 and HIPAA 4010/5010
- Developed specific system interfaces, documents operational requirements, develops test plans and also developed user guides, provides user training and supports the user in the development of work processes.
- Supported UAT to evaluate the system performance and also developed system plan to quality center, review design, view test cases.
- Maintained Change and Traceability Matrix throughout the project keeping track of the scope, timelines, and budget of the project.
- Collaborated with the development team to determine the security access and its tracking to ensure the privacy of End users.
- Conducted hazard/risk analysis to analyze potential risk that could affect patients as a result of new functionality introduced into the system.
- Provided weekly status updates to project stakeholders on the progress of project development activities.
Environment: MS Visio, MS Project, MS Office,SQL, Quality Center, UML, Traceability Matrix RTM, Agile, RUP, MS SQL, Rational Rose, Requirement, Rational Requisite Pro, Rational Rose, Clear QuestEHR, JAVA, FACETS, Facets extensions