SUMMARY

• Over 7 years of Experience as Business Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis, Joint Application Development JAD sessions with clients and referring to accessible documentation and procedure.
• Functional Knowledge of Medicaid Management Information System MMIS .
• Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Extensively Knowledge in the Member Enrollment and Billing information.
• Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, ICD - 9 ICD-10, codes 834, 837,835, and 270, 271.
• Strong knowledge of ICD-9/ICD-10 business analyst with healthcare.
• Able to understand and implement Processing ICD-9 ICD-10
• In dept. knowledge of Software Development Life Cycle SDLC methodology such as Agile, Waterfall and RUP .
• Efficient in writing Business Requirements Document, Use Case Specifications, Functional Specifications and Workflows.
• Strong knowledge of Use Cases, and Activity Diagram.
• Involved in Facet Implementation and conversion of 4.21
• Extensive Experience in Functional, Integration, Regression, User Acceptance UAT, System.
• Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
• Designed and implemented basic SQL queries for testing and report/data validation
• Experienced in client interaction, deep understanding of business systems functionality and technicality.
• Proficient in Developing and executing Test Plans, Test Case, Test Scenarios, also performing functional, usability testing and ensuring dat the software meets the system Requirement.
• Knowledgeable about preparing RTM documents
• Experience in developing project plan and estimating project timeline.
• Excellent working knowledge in Project Life Cycle and clear understanding of Project Management.
• Experienced in performing Gap analysis by identifying existing technologies, documenting the enhancements to meet the end-state requirements.
• Excellent business communication and presentation skills. Adapt at creating, editing, and coordinating extensive communication networks, to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
• Organized, goal-oriented, self-starter, and ability to master new technologies manage multiple tasks while following through from start to completion.
• Experienced in analyzing business requirements at all stages of Software development of life cycle SDLC .

TECHNICAL SKILLS

SDLC Methodologies: Waterfall, Hybrid (Waterfall - Scrum), Agile - Scrum

Programming: PL/SQL, T-SQL

Requirement & Project Management: JIRA, Requisite Pro, Quality Center, MS Project, SharePoint

UML Modeling Tools: MS Visio, Rational Rose

Testing Tools: HP QC, HP ALM

Documentation Tools: MS Office (Word, Excel, PowerPoint)

Reporting Tools: Cognos, Tableau, SSRS

Databases: Oracle, MS SQL Server, MS Access

Operating System: Windows, Unix, MAC

PROFESSIONAL EXPERIENCE

Confidential, Richmond, VA

Sr. Healthcare Business Analyst

Responsibilities:

• Prepared Business Requirements Documents, Functional Requirement Documents.
• Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery
• Performed GAP analysis by performing the system analysis between the scheduling systems and documented the gap items.
• Conducted JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.
• Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.
• As scrum master communicated dependencies and potential risk to the completion of the sprints including resources, costs and systems.
• Created data mappings to transform the data according to business rules.
• Developed Test Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Prepared various diagrams by using MS Visio.
• Prepared documents for the wireframe and prepared a data dictionary for the same
• Managed testing for various functionalities using Quality Center tools.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Maintained a close and strong working relationship with teammates and management staff to achieve an expected QA result for the project team.
• Conducted project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC .

Environment: Agile Scrum, MS Office, MS Visio, MS Project, JIRA, SharePoint, Rally, UML, SQL

Confidential, Herndon, VA

Healthcare Business Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Gatheird high-level requirement for all the external projects in a release.
• Performed the requirement analysis, impact analysis and documented the requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Developing a single application to process data from multiple integration points, convert the data for reporting purposes and feed data into mainframe system to be compliant to reporting requirements.
• Performed Analysis on Data mapping between different data models.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatics was used for ETL process and Business Objects.
• Created ICD-9-CM/ICD-10-PCS comparison document and dealt with DRGs.shift through CMS files.
• Documented ICD9 to ICD 10 mappings one to one/one to Many according to the GEM files from CMS with the functional and structural changes related to the conversion
• Involved in Able to understand and implement Processing ICD-9 ICD-10
• Worked on EDI transactions: X12,835, and 837 P.me to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes
• Executed the test cases and test scenarios using HP Quality center QC .
• As Scrum Master maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts.
• As Scrum Master facilitated all aspects of the scrum framework, including sprint-planning sessions, backlog-grooming session, daily scrums product demos, sprint reviews and sprint retrospectives.
• Prepared Business Requirement Documents BRD's after the collection of Functional Requirements from System Users dat provided appropriate scope of work for technical team to develop prototype and overall system.
• Facilitated and led JAD sessions aimed at functional requirement walkthroughs for all the impacting projects and updated the documents based on recommendations if any .
• Created various reports such as billing payment reports, Billing Grouping Payment and discount reports
• Use HP Quality Center to house all test documentation and report/track all issues and defects Defect Management .

Environment: Rally, MS Visio, HP QC, UML, MS Office, Agile Scrum, SSRS

Confidential, Louisville, KY

Healthcare Business Analyst

Responsibilities:

• Propose strategies to implement HIPAA 4010 in the new MMIS system and eventually move to HIPAA 5010
• Created BRD Documents
• Coordinate with stakeholders and project manager to gather functional and non-functional requirements during JAD sessions.
• Performed a High-level analysis of the requirements from a business perspective to determine the feasibility of constructing the new application.
• Responsible for gap analysis in changing old MMIS to new MMIS.
• Served as a Relationship between internal and external business community Claims, Billing, Membership, Customer service, Healthcare Management and the project team.
• Assisting the project manager in creating the business case and project plan.
• Followed the UML based methods using Rational rose to create Use Cases, Activity Diagram, dat include Functional and Non-Functional specification to hand off to development teams.
• Recorded requirements in the Requirement Traceability Matrix RTM defining each technical requirement in detail.
• Analyzed business processes and worked with management and improved and implemented the solution to ensure compliances.
• Assisted in Conducting UAT User Acceptance Testing to make sure dat all the user requirements are catered by the application.
• Involved in preparing a simple and detailed User Manual for the application, for an intended novice user.

Environment: RUP, SQL, MS Office, MMIS, MS Visio, SharePoint, Lotus Notes, Rally, Rational Tools

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

• Evaluate, recommend and support computer telephony integration technologies to support Delta's Sales Support Center for US Domestic and International call centers.
• Facilitate vendor review and business requirement sessions for various initiatives.
• Gather business requirements and work with vendors to complete Statement of Work documentation from initial phase to final implementation.
• Coordinate and manage Call Center Softphone implementations and resources according to project standards and methodologies.
• Prepare and deliver project deliverables according to company project standards and methodologies.
• Coordinate and participate in all phases of testing including User Acceptance Testing.
• Manage the implementation of all system components using techniques dat preserve system integrity.
• Actively engage as the Point of Contact for Delta's Sales Support Center, US operations and liaison for international operations.
• Coordinated and implemented Delta Sales Support Center's Call Center Telephone solution between Delta, Salesforce.com and inContact Cloud Solutions technology.
• Integration included an ACD, IVR, Softphone and Workforce Management for 250 users including US Domestic, Singapore and Latin America.
• Coordinated WIN7 transition for all DSS call center agents under the Delta WIN7 effort which allowed better efficiency and higher performance metrics.
• Coordinated the implementation of the Sales Support Center's initial Call Center Integration between Salesforce.com and Avaya CTI Softphone technology. Integration included an Avaya CTI adapter, Genesis CTI Server, Salesforce.com, Sales Edify IVR - 120 users, US Domestic and Montreal which reduced answer time and increased customer productivity.

Environment: Rational Requisite Pro, SharePoint, UML, MS Visio, Winrunner, MS Access