We provide IT Staff Augmentation Services!

Sr. Business Analyst Resume

Bethlehem, PA

SUMMARY

  • Over 7+ years industry experience of as a Business Analyst identifying business needs and determining solutions to business problems for Health care and Health insurance projects.
  • Solid understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment) and also Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
  • Thorough understanding of consistently developing and maintaining the health care industry databases, health care insurance and health care industry related aspects. Experienced in HIPAA compliance.
  • Broad noledge of Test plans, Test cases and test scripts from the Requirements Document.
  • In - depth noledge of Rational Unified Process (RUP) risk engineering, data modeling and mapping, and design using UML (Unified Modeling Language), Rational Rose and Visio.
  • Experience working in Medicare and Medicaid projects. Experience in claims processing and billing, Medicare/Medicaid billing and claims management.
  • Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
  • Wide noledge of Healthcare Insurance including Medicaid Information Technology (MITA), Medicare Procedural and Diagnostic codes, Claims Process and Medicaid Management Information Systems (MMIS)
  • Excellent noledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837,270,271,276,277,834,835.
  • Highly experienced on implementing HIPAA standards and good Knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare).
  • Well versed wif HIPAA, Facets, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
  • Strong noledge of HL7, HIX (Health Insurance Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA). worked wif Rational tools like ClearQuest, ClearCase, Rational soda, Rational Rose.
  • Expertise in handling issues and getting it solved in a quick and efficient manner.
  • Excellent in SQL and Tableau wif extensive experience on analyzing large datasets, business intelligence, data mining, predictive modelling, data visualization and data governance.
  • Involved in SSIS, SSAS, SQL Server Reporting Service (SSRS), Executing Queries and Running Store Procedures.
  • Used Rational Rose, and MS Visio for business process modelling and designing data flow diagrams.
  • Exceptional Documentation Skills for writing Use Cases and Functional Requirement Documents.
  • Expertise in creating Use Case diagrams, Activity diagrams, Data Flow Diagrams (DFD), Sequence diagrams, State diagrams based on UML Methodology and business process flow diagrams using MS Visio/Enterprise Architect/Rational Rose.
  • Experience in Rational Unified Process (RUP), Rational Requisite Pro, Rational ClearQuest, and Microsoft Project.
  • Belief in team work, dedication, and professional ethics wifin the working environment.
  • Conducted Joint Application Development (JAD) sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema and system design.
  • Proficient wif plans, schedules, leads, and coordinate tasks in projects, defines, documents, and validate new business and project/system requirements and develop business work papers for more complex functionality in order to assist wif software developers
  • Worked 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).
  • Organized, goal-oriented, self-starter, and ability to master new technologies, manage multiple tasks while following through from start to completion.
  • Experience in User Acceptance Testing, Smoke Testing, Regression Testing Performance Testing and Functional Testing.
  • Collaborated wif QA team to create and implement test plan and test cases for User Acceptance Testing (UAT). Involved wif the whole UAT to ensure the performance of the system and application.

PROFESSIONAL EXPERIENCE

Sr. Business Analyst

Confidential - Bethlehem, PA

Responsibilities:

  • Organized sessions for the insurance purpose of defining the functional business requirements, and documented these requirements and composed detailed design specifications.
  • Strong noledge of managed Claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, Medicare and Medicaid Insurance Billing, HIPAA, EDI, HEDIS, NCQA, 834,835,837 Compliance issues, and Electronic Health Records, Electronic Medical Records.
  • Hands on consistent development and maintenance of the healthcare industry databases, health care insurance and health care industry related aspects wif adherence to HIPAA compliance.
  • Good noledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience wifin life and disability in health plans.
  • Maintaining noledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations.
  • Extensively involved in designing the SSIS packages to export data from various sources like Oracle, SQL Server, and MS Access etc. to SQL Server database.
  • Hands in Preparing Test Plans for each release, written Test Cases and executed them as part of Functional Testing. Prepared Test Reports and Deliverables and submitted for version releases.
  • Assist internal departments by analyzing software anomalies, providing technical information, answeringcomplexapplicationsquestions, and providing alternative options for problems wif extended correction time.
  • Assisted in writing BRD for theRegulatoryReportingUnit under the system streamlining project
  • Performed Data mapping, logical data modeling, create class diagrams and ERD diagrams and used SQL queries to filter data.
  • Acted as User Acceptance Testing (UAT) coordinator, monitored business testing, and interfaced wif the development team regarding defect status and fixes daily.
  • Used JIRA for User Story requirements management throughout the Agile Sprints and development life cycle.
  • Working wif business and technical teams and representatives, enforcinggovernancerules and standards as well as teaching project team’sgovernanceconcepts and expectations.
  • Conducted 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.
  • Worked on challenging environment dat allows me to utilize my master's degree in InformationSecurity and further my analytical and technical skills.
  • Knowledge in Creating EDI Testing process, documentation, and performance matrices. Technical Specification, Schedule meetings wif technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
  • Prepared Business Process Models dat include modeling of all the activities of the business from the conceptual to procedural level.
  • Worked on the BRD document and derived the FRS into system use case diagrams.
  • Assisted in process modeling conducted and participated and facilitated in JAD/ JAR sessions wif system users; halped wif design walkthroughs wif stakeholders for base lining architecture.
  • Performed testing for Medicare, Medicaid claims for Medicaid Management Information System (MMIS) using MITA guideline.
  • Involved wif testing team in important phases of Testing Life Cycle like Unit Testing, Integration Testing, Regression Testing, Business Functionality Testing and System Testing, User Acceptance Testing (UAT) and Load Testing.

Business Analyst

Confidential - Irving, TX

Responsibilities:

  • Worked to provide operational problem management to manage Health Insurance Exchange solution application problems as they occur during the Maintenance Operations phase of the project, including issues associated wif all system components outlined in this RFP.
  • Involved in implementing policies and procedures which includes process flows, guide sheet for all important responsibilities as part of development of Medicare Operations Manual.
  • Knowledge in Claims processing, HIPAA standards, EDI (Electronic data interchange) Transaction Set 837, 270/271, 276/277, 278, 834, 835. Having extensive domain noledge in MMIS, EPIC, EDI X12, HL7, HIPAA, System, Medicare and Medicaid, CMS Compliances/Regulations
  • Worked wif managed care plans, Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service (POS) plans, Coordination of Benefits (COB), Explanation of Benefits.
  • Good noledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience wifin life and disability in health plans.
  • Maintaining noledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations.
  • Gathered requirements and implemented Managed Care Medicare programs and maintained all EDI payer files for private, Medicaid and Medicare insurance plans.
  • Hands on SDLC tools and methodologies, requirements definition, documentation of functional and technical specifications.
  • Worked on Data mapping, logical data modelling, created Class diagrams and ER diagrams and used SQL queries to filter data wifin the Oracle database.
  • Made use of Use-Cases, Sequence and Collaboration Diagrams to demonstrate software architecture and interaction of system components before prototyping. Used Rational Rose, Requisite-Pro for requirement traceability.
  • Worked closely wif QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
  • Involved in White Box Testing of the Java Code wif developer in Unit Testing phase.
  • Extensive and proficient noledge of how to analyze, configure and test data of various types using MS Office, MS Project, SQL, XML, ClearQuest, Quality Center/Test Director, RQM, QTP, Rational, Oracle, ALM, QNXT, SharePoint, Agile, Waterfall.
  • Expertise in MS Office, MS SharePoint, MS Visio, JIRA, wif hands on experience in Data Analysis and Reporting using Advanced MS Excel, SQL. Hands-on experience in Database Management Systems such as SQL Server and Oracle.
  • Involved in managing bugs using Defect Tracking Tool JIRA, reviewed each defect and assigned development team to resolve problems.
  • Hands on Testing and validating claims processed by Claim processing system for Medicaid and Medicare advantage plans.
  • Strong understanding in Smoke, Functional, Regression, Performance and User Acceptance testing for the highly structural and complex systems. Extensive experience in Black Box Testing, Functionality Testing, System Testing, Regression Testing, UI Testing, User Acceptance Testing (UAT), Bug tracking system & process and Database Testing using SQL.
  • Participated wif QA team in different phases of testing such as System testing, Functional testing, Regression testing and Integration testing for Quality Analysis.

Business Analyst

Confidential - CA

Responsibilities:

  • I worked on the project which halped manage, adjudicate, report and analyze the claims. Three different Platforms were used for the same, All the systems processed Medicaid and Medicare claims based on the different requirements.
  • Assisted the project managers wif the development of project schedules using MS Projects.
  • Following HIPPA guidelines by adhering to organization Billing policies and procedures.
  • Performed analysis on checking member eligibility, provider enrolment, member enrolment for Medicaid and Medicare claims.
  • Strong noledge of managed Claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, Medicare and Medicaid Insurance Billing, Hl7 Standards, HIPAA, EDI, HEDIS, NCQA, 834,835,837 Compliance issues, and Electronic Health Records, Electronic Medical Records.
  • Adequate noledge in Health Administration - Claims processing (auto adjudication), COB, EOB/ Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, HER, HIX, Medicare, Medicaid, CDHP (consumer driven health plans).
  • Leads analysis of existing business process and systems. Uses industry best practices and analytical techniques such as state charts, process modelling, decision tree analysis, and data flow diagrams.
  • Maintaining noledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations.
  • Recommends process and system enhancements to improve business performance and maximize the TEMPeffectiveness of available technology. Creates and analyse requirement models to increase understanding and uncover potential issues. Conducts impact and gap analysis of systems and business process workflows.
  • Prepared Business Process Models dat depicted modelling of all the activities of the business from the conceptual and procedural level.
  • Involve in developing appropriate action plan for claims reimbursement of HMO, Medicare, Medicaid, Medical billing, and Commercial Insurance Payers.
  • Acted as a liaison for projects wif other corporate departments, including Executive, Legal and Information Services as well as vendor relationships
  • Proficient in Developing and executing Test Plans, Test Case, FRD and Medical Billing, Test Scenarios, also performing functional, usability testing and ensuring dat the software meets the system Requirement.
  • Analysed the existing reports of the reporting system in the database.
  • Documented project artifacts such as Stakeholders Analysis, Business Requirement Document (BRD), Functional Requirement Document (FRD), Test cases and Test Plans
  • Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and Business Process using MS Visio.
  • Conducted user interviews, JAD sessions, brain storming and surveys. Gathered and analysed the requirements using Rational Requisite pro.
  • Developed the test plan, test conditions and test cases to be used in UAT testing based on business requirements, technical specifications and/or product noledge
  • Assisted in development of training materials for new technology and process improvements.
  • Assisting the QA team dat is responsible for all levels of Testing such as Positive testing, Negative testing, Integration Testing, Functional Testing, System Testing, Regression Testing and User Acceptance Testing (UAT), Black Box Testing, Gray Box Testing, White Box Testing, Smoke Testing, Browser Testing

Business Analyst

Confidential - Hartford, CT

Responsibilities:

  • Analyzed and Documented Business Requirement Document (BRD), Functional Specification Documentation, and System Requirement Documentation, using UML methodologies.
  • Conducted interviews, sessions, workshops to gather and document business requirements (BRD) and subsequently translate them into functional requirements (FRD).
  • Involve wif Automated Verification team, validating the member file feed coming from client carrier Medicare, Medicaid and Health Insurance.
  • Worked on Requirement Analysis to Develop Use Cases, Activity Diagrams and Sequence Diagrams. Hence developed and documented conceptual design of Application in System Specification Document.
  • Extensively interacted wif both user group and development team in coming up wif charts, sequence diagrams and swim lanes.
  • Managed and tracked change control process of requirements and design changes using Rational Requisite Pro. Documented the changes, issues and their impact on the system design and delivery
  • Prepared the Project Plan/Charter and the Business Requirement Document after analysing the requirement
  • Provided documentation such as requirements management plans, operational risk management plans, functional requirements, test plans and test cases.
  • Hands on Designing and analysing Use Case model and test procedures based on RUP methodology.Incorporated the best practice methodologies as advocated by the Rational Unified Process
  • Performed requirement analysis by gathering both functional and non-functional requirements based on interactions wif the process owners & stake holders and document analysis, represented them in requirements traceability matrix (RTM) using Requisite Pro. Performed user interviews, JAD sessions
  • Supported the assigned project manager wif creating detailed project plans and assisting in developing, scheduling and tracking project timelines and developing RACI charts
  • Acted as User Acceptance Testing coordinator and monitored business testing and interfaced wif the development team regarding defect status and fixes on daily basis
  • Used Agile SDLC to ensure newbusinessprocesses and system changes are documented, developed, tested, and promoted successfully.
  • Participated in data quality checks and ensured correction of data quality issues from source systems and improved reference data sourcing for facility, counter party and other relevant attributes.
  • Involved in design and implementation of Progression and Regression Tests and reviewed Test Plan and Test Cases.
  • Assisted and executed Test cases and test scripts per Functional Specifications of the application. Documented test/cases, test results, test procedure and reported to client.

Business Analyst

Confidential - Cleveland, Ohio

Responsibilities:

  • Involved in defining the scope and implementing business rules of the project, gathering business requirements and documentation.
  • Consulted wif healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
  • Involved inFacetsbilling module mainly in Back - End system process for membership's enrollment info to downstream system and involved in Front - End system process for the information feed toFacets-Facetsfile transfer.
  • Work wif System analyst and IS teams to understand the flow of data. Reviewed and analyzed data from various sources.
  • Gathered business requirements by driving user-group meetings and working wif various global, cross-functional and virtual teams and MDM application, conversion and integration requirements.
  • Worked in various Healthcare areas like Enrollment, Benefits, Claims, patient rights responses, provider handling, Expertise in US Healthcare EDI Transactions like 837 Claims, 835, 997 Acnoledgements, 834 -Member Eligibility, 270/271 Eligibility Inquiry, 276/277 - Claims inquiry).
  • Strong noledge of HL7, HIX (Health Insurance Exchange),EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA) and Facets.
  • Gathered requirements by conducting meetings and brainstorming sessions wif end users and SME and document them using Requisite Pro - the documentation tool offered by Rational.
  • Organized requirements into high level Use Cases and low-level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using Rational Rose and MS Visio.
  • Worked on consistent development and maintenance of the healthcare industry databases, health care insurance and health care industry related aspects wif adherence to HIPAA compliance.
  • Applied UML notations and methodology in developing models dat accurately represent the business process and workflows and clearly communicate them to the stakeholders.
  • Created Mapping Documents, Report Mockups and modified existing report mockups and finalized for development
  • Extensive experience creating statement of work documents (SOW), system requirement documents (SRS), functional requirement documents (FRD), test plans, preparing and answering request for information (RFI) and request for proposal (RFP) documents
  • Experienced in using the Rational Unified Process (RUP), Microsoft Office, Visio, Excel, MS Project & Project Server, Mercury Quality Center (MQC), and SharePoint
  • Provide technical expertise as an early engagement to different modules and enhancements to access impacts and define scope.
  • Formulated logical statements of business requirements researched and evaluated alternative solutions and recommend the most efficient solution for system design.
  • Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows.
  • In-depth noledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
  • Worked on Agile environment, participating in daily stand-ups and planning meetings. Worked directly wif client SMEs in gathering and defining business requirements. Presented recommendations to client and wrote functional requirements document
  • Hands in Creating test documents like QA Status Report, QA Summary Reports, QA Test Logs, Test sign-off, Maintain issue and defect databases.

Hire Now