- Passionate, detail - oriented, results-driven Business Systems Analyst wif 8+ years’ experience in Healthcare Information Technology domain wif focus on Business Analysis, Software Development Life Cycle (SDLC) and Business Process Reengineering. Certified Scrum Master wif proven ability to work wif self-organizing and cross functional teams.
- Experienced in waterfall methodology and agile methodologies like Scrum, Scaled Agile Framework (SAFe 4.0), Kanban, hybrid methodologies like Water-scrum-fall methodology. Knowledge of Extreme programming (XP), Spiral, lean- agile, Scrumban and RUP methodologies.
- Possess excellent business, analytical, and interpersonal skills wif the ability to communicate wif Developers, Architects, Subject Matter Experts (SMEs), Business Stakeholders, Testing team and Senior Executives.
- Experienced in Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology and Medicaid Management Information System (MMIS).
- Well versed wif current healthcare industry standards such as CMS, MMA, HL-7, ICD9, ICD10, HIPAA (4010 and 5010) EDI X12 standard Transaction sets (834, 835, 837, 820, 270/271 and 276/277) HHS, SOX and FDA.
- Designed and documented Business Process Re-engineering, Business Process Modeling, Historical Data Reports Analysis accompanied by conducting and facilitating elicitation sessions such as survey/questionnaires, Interviews sessions, brainstorming sessions, Focus group sessions, Requirement workshops, Interface analysis, Document analysis, and Joint Application Development (JAD) sessions wif internal as well as external stakeholders
- Proficient in authoring Business Requirement Documents (BRD), Functional Requirement Specification (FRS), Software Requirement Specification (SRS), Use case Document, and Software Design Specification (SDS).
- Experience in conducting SWOT Analysis, Cost Benefit analysis, Gap analysis (As Is-To Be analysis) and ROI Analysis.
- Good noledge in Web based development utilizing Python
- Experience in building Unified Modeling Language (UML) diagrams including Use Cases, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams, and transforming the requirements gathered into functional specifications focusing on Workflow Analysis and Design, User Interface Design, Data flow, Process flow.
- Professional experience using advanced SQL coding in various platforms, such as Oracle, Teradata and SQL server for data mining and report generation.
- Experience wif full software development life-cycle, architecting scalable platforms, objects oriented programming, database design and agile methodologies.
- Experienced in Logical and Physical Database design & development, Data Conversion, Normalization and Data modeling using Erwin and SQL Server Enterprise manager.
- Participated in requirements gathering and analysis, as well as Design sessions to understand the needs of the users.
- Constantly updated wif new and emerging data technologies and trending
- Comprehensive experience in all phases of the Software Development Life Cycle (SDLC).
- Proficient in SAS, SQL programming, Excel, Access, PowerPoint.
- Extensive industry analytics experience using statistical analysis and predictive modeling.
- Strong background in statistics and mathematical optimization, forecasting and simulation.
- Proficient in using SQL queries either by making them from scratch or modifying existing queries to analyze information from company databases.
- Experience validating Finance codes, Medical Codes and Fee Tables in QNXT against Configuration.
- Immense noledge in Health care payer operations, Interfaces, Reports, Letters and system Migrations, Health Administration - Claims processing (auto adjudication), Claims pricing and testing, HIPAA, enrollment, Medicare, Medicaid.
- Involved in various projects related to Data Modeling, Business/Data Analysis, Design and Development for both OLTP and Data warehousing environments.
- Designed Use Cases, Activity Diagrams, Sequence Diagrams, Class Diagrams.
- Strong expertise in business process mapping tools and techniques.
- Extensive experience wif modeling tools and techniques such as Unified Modeling Language (UML), use case diagrams, sequence diagrams, activity diagrams, class diagrams, As-Is and To-be diagrams ..
- Strong noledge in using Microsoft Office products such as MS Visio, MS Word, MS PowerPoint, MS Excel.
- Profound noledge of creating SQL Queries used for database administration.
- Proficient at developing User interfaces, conducting JAD Sessions, data modeling.
Project Management tools: MS Project 2016, Web conferencing, JIRA 7.0, MS SharePoint, MS Office 365 online, Trello, Workfront 18.1
Requirement Management Tools: Jira 8.0, HP ALM/QC 12.0, Rally 2015.2, Confluence 6.0, Rational DOORS 9.4, Team Foundation Server (TFS), SharePoint, ServiceNow, Slack, JAMA
Business Modeling Tools: MS Visio 2016, Balsamiq, Mockup screens, Google Drawings, Rational Rose 7.0, Lucid Chart.
API and Testing Tools: HP Quality Center, Selenium, Swagger, QTP (Quick Test Professional), HP ALM (Application Life Management), Postman, Bugzilla, JAMA
Business Intelligence / Reporting Tools: SAS Base 9, Informatica 10.0, Tableau 2018, MicroStrategy, MS office 365 online, Google Analytics, QlikView 12, Cognos Analytics v11
Database and Data Analysis Tools: SQL Server 2008 R 2/2012/2014/2016 , Oracle SQL v19.1, MS Access, Teradata, MySQL Workbench, H2, Axway B2Bi
Confidential, Topeka, KS
Business Systems Analyst Lead
- Responsible for conducting Joint Application Development (JAD) Sessions to elicit, analyze and understand business requirements and priorities.
- Through self-directed activities act as a liaison between the client and technical groups, using superior communication skills to elicit, document, analyze and validate requirements.
- Ensured all artifacts compiled wif HIPAA 5010 policies and guidelines.
- Worked on EDI transactions like 270, 271, 834, 837 and 835.
- Gathering requirements and preparing functional documents for the claims management system.
- Worked wif the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements wifin the claims management system.
- Involved in business analysis and project management, coordinating between the team members according to the business requirements.
- Created and maintained procedures and documentation.
- Organized and conducted meetings, briefings, demonstrations, conducted JAD sessions, and wrote minutes of project meetings.
- Worked wif the project manager for planning and organizing the project activities, and in communicating wif other business center managers and stakeholders of the project.
- Actively resolved day-to-day technology needs of the business unit wif a focus on the analysis of processes.
- Worked wif the project manager to estimate best/worst case scenarios, track progress wif weekly estimates of remaining work to do, conducting informal meetings ad hoc and as needed.
- Involved in project planning and coordination. Followed AGILE Methodology.
- Experienced in mapping of various Healthcare modules (Patient, Member, Provider, Claims, Authorization) wif XML, FHIR, JSONS and various ICD10 codes
- Apply industry-specific expertise to recommend improvements to the development, enhancement, and maintenance of a client’s business systems, processes, and products using high-maturity methods, processes and tools.
- Combine industry expertise wif a thorough understanding of information technology to develop innovative business solutions.
- Influence the strategic direction of Drug Rebate processes to clients.
- Lead analysis team.
- Lead requirements management and associated change management processes on the team.
- Lead configuration management and associated change management processes on the team.
- Coordinate and participate in System, SIT, UAT, Unit Testing and defects management.
- Direct development of visualization, and user experience elements of solution design.
- Develop and maintain internal and external relationships to manage scope, schedule and expectations on the team.
- Lead business studies and present study results regarding Drug Rebate to client senior management.
- Coordinate and participate in proposals, feasibility studies, and new business development activities for Drug Rebate.
- Leverage industry noledge and client relationships to assess the business implications of the application of technology to the current and future business environment and to identify new business opportunities.
Confidential, Rocklin, CA
Sr. Business Analyst
- Worked on PowerMHS built environment which includes various sub-systems such asClaims (Claims Processing & Claims Loading), HIPAA/EDI transactions, Provider Enrollment, PA (Prior Authorization), Client, Common Components, COB/TPL, Rate Settings, Drug Rebate, Reference, Managed Care, Interfaces ..
- Served as the Business Analyst, led the enterprise-wide Business Integration projects, providing business, data, and technical requirements analysis to ensure that new lending model met the industry quality standards.
- Wrote and prepared business requirements documents (BRDs), functional specifications documents (FSDs), use cases, and gap analysis documents and data mapping documents.
- Worked on collecting requirements for procedure codes (CPT/ HCPCS), MEDICAID member benefits and provider contracts
- Responsible for documentation of different Medicare Benefit terms and Programs Configuration library.
- Evaluated the Medicaid coverage and the rebate agreement from the Centers for Medicare and Medicaid Services (CMS)
- Worked on Pharmacy claims benefits and proprietary functionalities to such as support multiple coverage, prescriber edits and prescriber block lists.
- Tested various claims processing while working on different projects such as Interims Payment Recapture, J-codes Rebates, Prior Authorization, Voids and Comprehensive waiver in both UAT and E2E testing environments.
- Did requirements gathering for upgradation of Sharepoint-based Medco internal directory.
- Responsible for gathering requirements from the stakeholders and created product backlog wif user stories.
- Responsible for conducting Joint Application Development (JAD) Sessions to elicit, analyze and understand business requirements and priorities.
- Planed the sprint planning meeting and backlog grooming sessions.
- Defined, prepared, reviewed, and accurately analyzed business readiness metrics and interpreted them intomeaningful User stories.
- Involved in directing a team in the customizations and rollout of Model N’s web based commercial modules utilized for enterprise-wide contract management, rebate processing, managed care, compliance and pricing. Responsibility included overall technical and project/program life cycle, cost, earned value performance reporting, and schedule management using Microsoft Project.
- Worked wif user to define user acceptance criteria. Involved in UAT testing (User Acceptance Testing) and Implementation.
- Government Disclosures, Government Pricing, Customers, Products, Product-Pricing.
- Using SQL queries, investigated data discrepancies between various source systems such as INTERACT, COACT, CARS/IS, Rebates- Chargeback and the Data Warehouse and the PricePoint and Sales Data Marts.
- Imported data from SQL Server and Excel toSASdatasets. Performed data manipulation by merging several datasets and extracted relevant information
- Used SAS as an ETL tool to load data from flat files and databases into SQL Server and Teradata environments.
- Defined the information hierarchy of the design and planned the layout using wireframes.
- Worked extensively through Agile development methodology by dividing the application into iterations.
- Interfaced wif, and interviewed, cross-functional stakeholders to generate requirements.
- Created Data mapping, logical data modeling coordinating wif data architects, created class diagrams and ER diagrams and used SQL queries to filter data wifin the database.
- Followed the UML based methods to create: Use Cases, Activity Diagrams, Sequence Diagrams using MS Visio.
- Performed Data analysis from the data warehouse along wif business intelligence solutions delivery team.
- Conducted and automated the ETL operations to Extract data from multiple data sources, transform inconsistent and missing data to consistent and reliable data, and finally load it into the Multi-dimensional data warehouse.
- Coordinated the development and testing of BI reporting processes.
- Coordinated wif the test team to check the weekly status and report the same to the project manager.
- Conducted UAT wif stakeholders and business users.
- Performed Data Profiling of current state of data in the Data Warehouse by doing Data Analysis using advanced SQL Queries and Microsoft Excel, finding Gaps in Data and formulating solutions for the same.
- Assisted the team members to develop Service Oriented Architecture (SOA), and data warehouse system (EDW) to utilize data mining for data analysis.
- Performed SQL queries for retrieving, organizing the database wif general commands such as select, create, update, and joins.
- Conducted Data analysis using SQL on the backend databases for producing mapping documentation and transformation rules for developers
Confidential, Sacramento, CA
- Gathered and documented the requirements in Requisite Pro those are critical to the business mission and using those requirements to design application software using a Use Case approach.
- Completed ONC Health IT certification for each new product version by providing feature documentation to ICSA Labs.
- Extensively used Rally Toolset for Test Case Repository Management
- Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
- Prepared BRD, Business Cases, and presentation to the clients, Business Re-engineering proposals.
- Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
- Good understanding of POS system, Medical Claim processing, Health Care plans, HIPAA, Facets, PPO, COPAY, Retails.
- Experience wif TriZettos Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
- Responsible for business system analysis of customizing the BPS Risk Management product wif involvement through the whole SDLC.
- Credential confirms experience, skills and competency as a Health IT professional as it relates to the implementation and management of electronic health information.
- Implemented automated COB processing of Medicare claims into Facets
- Developed Use Case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagrams so that developers and other stake holders can understand the business process by using UML.
- Wrote and analyzed defects using Rational Team Concert and Quality Center.
- Created and executed manual test cases, create test plans and suites, analyze metrics and implement metric reporting in in Quality Center and Rational Quality Manager for functional, regression and integration testing. Facilitated and managed Joint Application Development (JAD) sessions wif committee of SMEs (Subject Matter Experts) from various business areas.
- Analyzed and Documented Business Requirement Document (BRD), Functional Specification Documentation, and System Requirement Documentation, using UML methodologies
- Created Test cases and Test Plans in Rally Tool.
- Used SDLC (System Development Life Cycle) methodologies such as the RUP and the waterfall.
- Involved in the documentation and technical writing of the requirements in an elaborate way.
- UsedJIRAfor issue tracking, user story management, requirement traceability, and velocity of the team.
- Created user stories, progressively decomposing epics to smaller user stories and prioritization of product backlog in coordination wif the Product Owner.
Jr. Business Analyst
- Worked as primary liaison between business partners and clients and conducted Impact analysis of the current functionality wif the to-be business processes to provide recommendations and finalize business requirements.
- Facilitated Joint Application Design (JAD) sessions to focus on defining Health Claims Processing and gathered requirements by conducting Questionnaires, Requirement workshops and Interface analysis.
- Used Jira to create issues and issue logs, configure work request template, change request template and problem request template for the users.
- Designed and reviewed various documents including the Business requirements document (BRD), Use Case Specifications, Functional Specifications Document (FSD) and Requirement Traceability Matrix (RTM).
- Documented business processes for the creation of the enterprise mobile application.
- Actively participated in wireframe and storyboard creation for the application and facilitated the numerous feedback iterations wif stakeholders and end users.
- Worked wif Business users to create UML diagrams like use case, sequence and activity diagrams using MS Visio.
- Performed CRUD operations on SQL & stored procedures using SELECT & JOIN for drill downs to pull data while being actively involved in reading data from varied file types, created standard and ad-hoc reports using SQL.
- Developed Conceptual and Logical data models and created data dictionaries for the data models.
- Data cleansing and data mapping were done for validating the database structure in OLAP.
- Involved in updating system Test Plans and guided Software Quality Team in Developing Test Strategies during various Test Cycles. Assisted in Developing Test Scenarios and Deriving Test Cases based on Business Requirements, Technical Specifications in Test Director.
- Coordinated wif the UAT testing group and provided technical assistance in planning and implementing Test Schedule for UAT. Worked wif Application Development Team on Test Issues and conducted daily status meetings wif Development and User Team during UAT.
- Involved in systems integration testing, web services API testing using SOAP UI and Postman API testing tools.
- Created various Reports & Dashboards wif Tableau & Power BI to create reports according to user requirements.