- 7 years’ of experience as a Senior Business Analyst/ Business System Analyst in the Healthcare services domain with a track record of managing complex IT projects.
- Expertise in SDLC methodologies which includes significant experience in RUP, Waterfall and Agile methodologies.
- Extensively used JIRA and Rally to write, gather and document Integration and Epics, Features and User Stories requirements from Business Owners and External Vendor teams.
- Coordinated with scrum master and product owner in grooming the product backlog, and break Epics into distinct PBIs for each sprint.
- Expertise on Create Business Requirement Document (BRD), Functional Requirement Document (FRD), Technical specification Document (TSD), Requirement Traceability Matrix (RTM), Scope Statement and other project related documents.
- Highly proficient in working with users and stakeholders to elicit, analyze, communicate and gather requirements using techniques such as Brainstorming sessions, Workshops, Observation and Existing systems documentation/procedures, JAD, User Interviews and to identify Functional, Non - Functional, Business and System Requirements and then subsequently document them.
- Expertise on Business Process Mapping, UML forBusiness Process Modeling, Wireframes, Use Cases, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams, Collaboration Diagrams, Class Diagrams and document them using Microsoft Visio.
- Strong experience in Data Modeling, Data Mapping, ETL, Data Quality Management, Data Analysis, Requirement Analysis, Business Modeling, Data Migration, Data profiling, Dimensional Modeling, Entity Relationship Diagrams ERD, SQL and reporting process.
- Experience inDataMining,Datamapping and Data modeling and good understanding of the ETL tools like SSIS, Data Stage and Informatica Power Center.
- Extensive experience in working with a plethora of BI reporting tools like Power BI, Tableau, Microstrategy and Cognos for the visualization of data reports generated using SSRS.
- Experienced with differentRelational databases like Teradata, Oracle and SQL Server.
- Extensively used tools such as JIRA, Confluence, Rally, TFS, HP Application Lifecycle Management (Quality Control), Rational Requisite Pro, Rational Rose, Clear Quest, MS Visio, MS Office, MS Access, MySQL.
- Experience with Microsoft SharePoint to manage project related documents.
- Excellent skills in designing Test Plan, Test Cases and Test Scripts. Prepared and maintained the Test Matrix, Requirements Traceability Matrix and conducted GAP Analysis.
- Excellent team player with a strong analytical and decision-making skills that influence outcomes greatly.
- Excellent communication (both written and oral), interpersonal and documentation skills.
Methodology: Agile SCRUM/SAFe, Waterfall, RUP
Language: SQL, Java, C/C++, XML, JSON, Jerkins
Operating System: Windows, UNIX, Mac OS
Database: SQL Server, Oracle, MS Access
ETL Tools/BI Tools: SQL Server Integration Services (SSIS), Informatica Power Center, SAS, SSRS, Power BI, Tableau, Microstrategy, Cognos, Business Objects
Business Modeling Tools: Rational Rose, MS Visio
Productive Tools: MS Office Suite, MS Visio, MS Project, Sharepoint
Project Management Tool: MS Project, Rally, JIRA, Sharepoint
Confidential, Norfolk, VA
Senior Business System Analyst
- Performed duties as facilitator, engaging with business stakeholders for discussions on their needs, and providing documentation in a tracking format for the technical staff to review and analyze against the user requirements.
- Used JIRA to maintain product backlog and sprint backlog and to create and track user stories, Sprint planning, tracking and managing sprints, created status reports and burn down charts.
- Facilitated and participated in Agile rituals including,productbacklog release, backlog stand-ups, and sprint planning, release planning, Iteration sprint review and retrospectives.
- Tracked status reports involving multiple projects using MS Project.
- Conducted JAD session, Interview session, brainstorming session to solve the problems and enhance the workflow.
- Created Process Work Flows, Functional Specifications, and responsible for preparing Software Requirement Specifications (SRS), Functional Specification Document (FSD).
- Prepared Business Context Diagram,Use Case diagramsand corresponding Activity Diagrams using MS Visio to depict the workflows to be incorporated into the development ofBusiness Process Management (BPM).
- Worked extensively on performing 'AS IS' and 'To BE' Process analysis, GAP analysis and drafted Project Analysis documentations On Pega CRM (UM Intake application ACMS).
- Monitored system enhancement through UAT testing. (Users include member, provider, intake user, clinician and intake manager for both Commercial Business and (GBD) Government Business Division).
- Managed and coordinated for the Production check out before the release to identify the overall functionality and involved in the release deployment and Post Go Live activities (Including Physician Clinical review process in ( Confidential Care Management Platform) ACMP.
- Worked on Medicare Advantage (A, B, C), Medicare Part D (MA-PD), Medicaid Options (Under 65 and Over 65) and Managed Care (Care, Disease and Case Management and in Insurance regulations and Claims Processing and claim scrubbing in HMO, PPO, Medicare and Medicaid.
- Defined and developed specifications for federal reporting specific to Medicare Advantage.
- Worked on the creation of an incentive program for providers (Specialty & PCP) to encourage patient-centered care while establishing sustainable growth rate in per capita total cost of care spending for Medicare Advantage beneficiaries.
- Monitored existing system functionality and makebenefitsset up recommendations, where appropriate, to maintain acceptable levels of automation in claims adjudication and accurate provider reimbursement.
- Ensured the quality and integrity of implementation ofbenefitschange requests using production validation and audit strategies.
- Provided support in time of regulatory audits of the Part D Reporting requirement.
- Worked Extensively with Inbound 837 I and 837 P, 835s (Out bounds) claims processing systems.
- Used Facets to receive, store and send HIPAA-standard transactions EDI (835, 837, 834, 270, 271, 276, and 277).
- Worked with Facetsteam on different modules like Claims processing, Claim Pricing, Provider network management and Reporting.
- Designed rich data visualizations to model data into human-readable form with Tableau.
- Worked on data mapping and logical data modeling; usedSQLqueries to filter data within the database tables.
- Interpreted Data Models and the SQL scripts to develop Source to Target Data Mapping.
- Worked with SQL queries to integrate and obtain data for analysis and reporting.
- Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).
- Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
- Designed, developed, implemented, and assisted in validating ETL processes - full ETL development lifecycle and maintained existing ETL processes and trouble shoot issues if they arise.
- Created detailed source-to-target ETL mapping specifications.
- Developed schemas for extraction, transaction, and loading (ETL) to expedite data integration between systems.
- Extensively helped ETL developers with the (SSIS) transformations to be applied during the data mapping from source to destinations.
- Designed and developed packages for data warehouse using Integration Services (SSIS)SQL Server.
- Worked and maintained SQL stored Procedures, User Defined Functions and Triggers for updating customer usage information in database.
- Worked with QA team to design and develop Test Plan and Test Cases to assist in performing User Acceptance Testing (UAT), Systems Testing, Integration Testing and Regression Testing.
- Created and managed RTM (Requirement Traceability Matrix) to track the process flow.
- UsedJIRA to plan, track and report issues and tasks on a predefined workflow.
Confidential, Salem, OR
Business System Analyst
- Followed agile methodology and participated/arranged daily sprints to keep the pace of task assignments and achieve desired target dates.
- 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.
- Proactively identified and removed roadblocks, which serves as impediments for the development team there- by leading to risk mitigation and timely delivery.
- Identified User Story points with the Developers and assigned user stories to Sprints in JIRA.
- Facilitated all scrum ceremonies for the Confidential Utilized Business Intelligence project while maintaining current, up-to-date status of events and team member activities in Rally/Jira (an Agile application lifecycle management tool).
- Prepared the Business Requirements Document (BRD), functional Requirements Document (FRD), User Stories and Acceptance Criteria for the enhancement of the existing services.
- Created Use Cases, Activity Report, Logical Components to extract Business Process Flows and workflows involved in the project using Rational Rose, UML and Flow Chart Tools such as MS Project and MS Visio.
- Conducted GAP analysis for process improvement between the As-Is and the To-Be risk assessment processes.
- Reviewed Medicaid MMIS vendor deliverable during System Development Life Cycle; worked closely with business and IT folks along with SME’s to amend, create, and updating process flow charts from “AS IS” to “TO BE” system.
- Responsible for Medicaid Claims Resolution/Reimbursement for state healthcare plan using MMIS.
- Worked in Medicare and Medicaid: Claims processing, Membership, and Eligibility Verification and care management.
- Involved in requirements gathered byinteracting with MMISbusinessanalystandtranslated thosebusinessneeds into a systems design specification.
- Created user stories and test cases detailed enough to ensure the new MMIS processes and payment of new claims.
- Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
- Analyzed, Troubleshoot, Maintained EDITransactions 837,835, 834, 276/277.
- Contributed to the development of powerful data analytics and visualizations with Tableau that were used to drive business decisions, including decision trees, clustering, and other predictive visuals.
- Extensive backend testing using SQL queries, generating the reports to ensure the data integrity and validate the business rules.
- Involved in Data Analysis, Data Validation, Data Modeling, Data Profiling, Data Verification, Data Mapping, Data Loading, and Data Warehousing/ETL testing.
- Involved in setting up the data strategy environment to perform ETL transactions.
- Used SSIS as anETLtool to create source/target definitions, mappings and sessions to extract, transform and load data into staging tables from various sources.
- Created complex Stored Procedures, SSIS packages, triggers, cursors, tables, views and SQL joins and statements for application.
- Created stored procedures and SQL statements for generating Ad-hoc Reports in SSRS.
- Involved in UAT of applications by providing users with test cases, scenarios, guiding them during testing process.
- Performed Integration Testing, System Testing & User Acceptance Test (UAT).
- Tracked the bugs and Stories status using JIRA.
- Developed the business anomalies workarounds and described them in documentation and presented the matter to the upper management for review using SharePoint.
Confidential, Woodland Hills, CA
Business System Analyst
- Used JAR sessions, brainstorming, questionnaires, and storyboarding techniques to derive ideas.
- Facilitated Sprint Planning meetings, Daily scrum, sprint review, product backlog refinement meetings and sprint retrospective meetings.
- Responsible on creating user stories in an Agile Scrum framework in scratch using JIRA.
- Updated the core consolidated project plans: project schedule, tracking and oversight plans, cost tracking reports, etc., and maintain the project on-line database or site using MS Project.
- Performed SWOT and Gap analysis for the new functionality requirements.
- Modeled functional requirements using UML and MS Visio to create Use Case Diagrams, Activity diagrams, Sequence Diagram and logical Class Diagram for interaction between the various actors and system and to supplicate the Workflow Models.
- Worked on Members enrollment, Member services, Premium billing, Provider management, Claims processing, Provider reimbursement and Claims adjudication.
- Worked on Medicare and Medicaid compliance enhancements to pay/reject the claim per CMS and NCPDP standards.
- Checked that if receiving claims has all the required information or not.
- Analyzed and worked with transactions 837 (Claim for Institutional, Professional and Dental Claims), 835 (Claim Payment) (Claim status), 834 (Enrollment), 270/271 (Member eligibility).
- Developed data mapping documents based on the source system data for the developers; Used ETL transformations to copy columns and load data from data sources to the destination databases.
- Performed Data Analysis, writing SQL Queries for Testing and Troubleshooting against Data Warehouse.
- Implemented system using Informatica and the Warehouse in Teradata.
- Documented the dimensional models of ETL system.
- Extensively used ETL tool Informatica power center for extraction, transformation and loading process.
- Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
- Created and updated several PL/SQL Index, Views, Complex Stored Procedures and triggers.
- Performed data analysis and data profiling using SQL on various sources systems including Oracle.
- Worked on data visuals using Tableau to generate interactive dashboards and storytelling as per business requirement.
- Participated in various kinds of testing like (UAT) User Acceptance Testing, Functional Integration, System, Regression and Black Box.
- Logged the errors, reported defects, determined repair priorities and tracked the defects until resolution using ALM.
Confidential, New York, NY
Business System Analyst
- Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically with 837, 835, 834, 270/271.
- Participated in the planning, development, maintenance and configuration ofsystem.
- Attended and facilitated JAD sessions, Backlog Refinement Sessions, Sprint planning sessions and one on ones with business and technical stakeholders to define and finalize scope and objectives of the technical initiatives.
- Responsible for the requirement-gathering phase and project plan.
- Delivered data and system analysis documentation that in corporate the business and data requirements including technical requirements.
- Involved in the daily Agile/SCRUM meeting to update the task status at hand to the overall team.
- Sprint by sprint based on the stories in JIRA we used to execute the test cases on HP ALM and move the stories based on the acceptance criteria met or not.
- Performed the GAP analysis to find the Root Cause of the issues.
- Studied the current system and made AS-IS chart to depict the current system.
- Designed Use Case Diagrams, Workflow diagrams, and Activity diagrams.
- Managed and Billed Medicare, Commercial HMO/PPO claims on a daily basis.
- Generated all Medicare claims review and transmitted to Medicare.
- ValidatedEDI Claim Processes according to HIPAA compliance.
- Worked on documenting existing downstream with Benefits, Claim processing and Enrollment.
- Created high level requirements and standard product offerings for Member/Provider/Broker/Employer Correspondence with respect to HIPAA transaction sets (837/835).
- Worked on Medicare and Medicaid data and healthcare claims/enrollment processes.
- Delivered an EDW solution that provides an integrated data store to allow for analysis across subject areas such as customer, product, service, and transactional revenue. It provides a single, common repository of information used across the enterprise for data categories captured in the EDW.
- Performed data analysis and ETL data flow of Data warehouse, Reporting Datamart and different client systems, understand the transformation and mappings documents and write test specification.
- Designed Data mapping and filtering, consolidation, cleansing, Integration, ETL, customization of data mart.
- Used Informatica Power Center for (ETL) extraction, transformation and loading data from heterogeneous source systems into target database.
- Performeddata analysisanddata profilingusing complexSQLon various sources systems including Oracle andTeradata.
- Involvedin Data management, Data Analysis, Data Validation, Data Cleansing, Data Verification and identifying data mismatch.
- Created interactive dashboards and visualizations of user reports using Tableau.
- Performed in depth analysis on data and prepared ad-hoc reports in MS Excel and SQL scripts.
- Extensively worked on SQL queries and on data transformation and data mapping from source to target database schema.
- Generated Complex PL/SQL Queries, Sub queries, Co-related sub queries, Dynamic SQL queries etc. Programming in SQL Server - Using Stored Procedures, Triggers, User-defined Functions, Views, and Cursors.
- Worked with the QA (Quality Assurance) team for designing Test Plan and Test Cases for the User Acceptance testing- Defined test cases, creating test scripts, analyzing bugs, interacting with QA / development teams in fixing errors and User Acceptance Testing (UAT).
- Performed Functional, Negative, Positive, Integration, Regression, UAT and End to end testing.
- Responsible for creating the database design, coding and Unit Testing. Involved in tracking, reviewing, analyzing defects using JIRA.