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Sr. Business Analyst Resume

Houston, TX

SUMMARY

  • Over 8 years of HealthCare industry experience of as a Business Analyst in identifying business needs and determining solutions to business problems for complex software projects.
  • Exposure to creation of Business Requirement Documents (BRDs), Functional Specification Documents (FSDs), Use Case Documents, Acceptance Criteria Documents (ACDs), Functional Requirement Document (FRD), Business Rules Spreadsheets (BRS) and Requirements Traceability Matrix (RTMs).
  • Solid understanding of the concept of business processes, risk analysis and the methodologies of SDLC (Agile, Waterfall, Scrum).
  • Experience in conducting Joint Application Development (JAD) sessions to gather requirements from various stakeholders and SME’s.
  • Strong knowledge of Business Process Modeling assessing "As Is" & "To Be" scenarios and performing GAP analysis, Risk Analysis and documentation of Use Cases and User Stories.
  • Expertise in Scrum Practices like User Stories, Story Slicing, Backlog Grooming, Release Planning, Sprint Planning, Sprint Review and Sprint Retrospective.
  • Experienced in all phases of the Software Development Life Cycle (SDLC) Waterfall methodology, Agile methodology (Scrum), Rational unified process (RUP), Rapid Application Development (RAD) and comprehensive knowledge of Requirements Elicitation, Requirements Analysis, and Business Process Analysis.
  • Develops problem solutions by describing requirements in a work - flowchart and diagram, studying system capabilities, analyzing alternative solutions, preparing system specifications.
  • Experience with various Facets modules such as Subscriber/Member, Claims, Plan/ Product in implementation of payer or provider applications Facets and various Facets modules such as Subscriber/Member, Claims, Plan/ Product.
  • Strong operational knowledge of Health Insurance Portability and Accountability Act (HIPAA) and experience in HIPAA Transactions.
  • Experience providing primary analysis for business processes running on EDI standard.
  • Extensive experience in HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 278 (review information), 835 (payment or remittance advice) and 837 (health care claim) with EDI.
  • Extensive knowledge about the various types of health insurance programs such as Medicaid, Medicare (part A, B, C and D), PPO (preferred provider organization), HMO (health maintenance organization) and the healthcare standard Health Level Seven (HL7).
  • Experienced working on Health Care Reform projects such as Health Insurance Exchange (HIX).
  • Experienced in the hospital services and business sectors of Medicare and Medicaid for inpatients, outpatients, billing methodology and computer technology administration of Medicaid (MMIS).
  • Experienced working with EHR (Electronic health record) and EMR (electronic medical record) team for data requirement.
  • Professional in the administration and management of a Medicare Prescription Drug Program and Medicare compliance initiatives.
  • Knowledge and Experience to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
  • Responsible for assuring all required design inputs are captured and incorporated into product labeling development and design changes.
  • Expert in Healthcare Payer systems - Claims, Billing with backend data mapping, data integration.
  • Proficient in creating UML diagrams, Context, Use Case, Sequence and Activity diagrams using MS Visio.
  • Advanced proficiency in Microsoft, particularly Word, Excel, PowerPoint, and MS Project.
  • Extensive experience with MS Visio for drawing flow charts and screen mock-ups and MS Project for status reporting and planning.
  • Hands-on with data analysis and data validation using SQL.
  • Strong experience in Application Design (Prototyping, Screen Mock-ups), wireframes and UI design.
  • Proficient in evaluating SQL queries for data extraction, manipulation, analysis, and validation, generating user reports and proficient knowledge of Relational Database Management Systems (RDBMS), and Data Warehousing.
  • Good knowledge of various database languages (SQL, MySQL).
  • Strong experience in resolution of issues within HP Quality Center and Jira.
  • Experience in maintaining the Requirement Traceability Matrix (RTM) tableto track all the requirements in BRD.
  • Strong experience in resolution of issues within HP Quality Center and Jira.
  • Strong working experience in the Data Analysis and Testing of Data Warehousing using Data Conversions, Data Extraction, Data Transformation and Data Loading (ETL).
  • Assisted QA Team in defining the Test Plans, Test Cases and test execution.
  • Strong understanding in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project follow the Business Requirements.
  • Hands on experience in User Acceptance Testing (UAT) to ensure all the User Requirements were met by the application.

PROFESSIONAL EXPERIENCE

Confidential - Houston, TX

Sr. Business Analyst

Responsibilities:

  • Worked with key project stakeholders and business partners to plan and convey business vision for capital projects.
  • Participated in review and analysis of business requirements, adding additional cases as needed, insuring they are complete and testable.
  • Worked in Agile development environment & writing user stories with frequently changing requirements and feature set.
  • Conducting meetings with Subject Matter Experts (SME's) to understand the workflow of the business and their application processes.
  • Facilitated JAD sessions with management, development team, users and other stakeholders to refine functional requirements.
  • Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
  • Worked on translating business requirements into functional specifications.
  • Performed the requirement analysis, impact analysis and documented Business Requirements Document (BRD) using Rational Requisite Pro.
  • Worked with claims data for claims subject area, Enrollment and billing data for membership subject area.
  • Worked on Health Insurance Exchanges (HIX) member eligibility, enrollment, premium reconciliations, Medicaid/Medicare provisions of the Affordable Care Act (ACA) direct-to-consumer requirements, etc.
  • Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
  • Worked with EDI team, developers and production support team at various stages of the project.
  • Developed the transaction process more accurate and real time regarding 837 including HIPAA Government Regulatory Compliance.
  • Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle.
  • Supporting the design team for designing the best UI/UX for the web portal.
  • Created use-case scenarios and storyboards in MS Word and MS PowerPoint for better visualization of the application.
  • Used SQL queries to filter data within the Oracle database tables for Data mapping, logical data modeling.
  • Documented the evaluation of various reporting tools like Oracle Analytics/Business Objects, made recommendations about the product depending on the reporting requirements.
  • Manage the development of multiple reports in order to consolidate information that would assist upper management of various departments in making enterprise decisions via Tableau.
  • Tracked bug fixes using JIRA.
  • Worked with QA testing teams, while interacting with business users and gathering user's requirements to develop necessary Test plans, Test Cases and Test script.
  • Involved in GUI testing, Integration testing and Unit testing.
  • Performed Unit Testing and User Acceptance testing (UAT) and documented detailed results.

Confidential - Cleveland, Ohio

Business Analyst

Responsibilities:

  • Responsible for business analysis, requirement specifications and identifying the resources and implementation of the project.
  • Interacted with stakeholders and gathered requirements as per the business needs.
  • Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (Agile Methodology).
  • Created a task plan for the team identifying the key deliverables and the respective deadlines.
  • Analyzed Business Requirements and segregated them into high level and low-level Use Cases, Activity Diagrams using Rational Rose according to UML methodology.
  • Conducted requirement-gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD).
  • Conducted AS-IS and TO-BE analysis of the business process using GAP analysis.
  • Conducted and facilitated Joint Application Development (JAD) sessions to reduce time spent in moving information between stakeholders and team members.
  • Analyzed various inbound and outbound interfaces to determine the impact of HIPAA.
  • Analyzed the business requirement as per the HIPAA rules and regulations.
  • Participated in analysis of HIPAA compliance and EDI transaction sets and actively participated in designing of EDI transactions using new HIPAA version.
  • Active member for the policy review to implement the requirements for Medicaid, Medicare and CHIP benefits per CMS guidelines.
  • Gathered information and knowledge HIPAA as well as developed the transaction process more accurate and real time regarding 837 including HIPAA Government Regulatory Compliance and also integrated the system with HL7 process.
  • Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
  • Worked with Source System Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
  • Identified critical areas of business risk and modified business processes to reduce risk using Risk-Management Process.
  • Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
  • Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.
  • Performed testing for Medicare, Medicaid and claims for Medicaid Management Information System (MMIS).
  • Assisted in development of test cases based on functional requirements for claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
  • Wrote test cases and test plans for related and assigned scripts as per test strategies defined in project and testing team guidelines in Quality center.
  • Created Error Files and Log Tables containing data with discrepancies to analyze and re-process the data.
  • Played a key role in planning UAT and implementation of system enhancements and data migration and conversions.

Confidential - Chicago, IL

Business Analyst

Responsibilities:

  • Conducted detailed and comprehensive Business Analysis by working with end users and other stakeholders to identify the system, operational requirements, and proposed enhancements.
  • Utilized SDLC Methodology to configure and develop process, standards and procedures.
  • Worked in Agile Development environment with daily stand up meetings, writing user stories, planning sprints, burning points, reviewing, grooming, many more.
  • Conducted JAD sessions with business units and stakeholders to define project scope, to identify the business workflows & task analysis, and determine whether any current or proposed systems are impacted by the new development efforts.
  • Worked extensively on Gap analysis, Root Cause Analysis and Impact analysis of issues to requirements to meet the gap and redesign of the user interface.
  • Developed detailed use case models and supporting specifications.
  • Developed business requirements document (BRD), User stories, User requirements and functional requirements.
  • Monitored Change Requests and documented requirements, integrating them with Use Cases.
  • Created use cases, activity diagrams and process diagrams using Microsoft Visio.
  • Created 837(P, I, D) claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837(P, I, D), 835,276/277 and 278.
  • Involved in creating documents and diagrams for Claims Processing.
  • Extensively worked with HIPAA Privacy FACETS application groups and experience in EDI transactions, ASC X12 transactions like 270,271,277.
  • Implementing Claims Processing and Provider Services for Medicare Advantage PFFS Plan.
  • Created Process Models for (a) Initial Enrollment, First Billing and Payment and (b) Post Enrollment - Subsequent Recurring Billing and Payment.
  • Processed Enrollment/Claims/ Billing and A/R Reconciliation within FACETS.
  • Maintained a traceability matrix of the requirements and created test cases, as well as testing matrix of the test cases and any corresponding defects conducting business validations, covering the following deliverables: FACETS Providers, Facets Claims and Facets Membership and Operational reports.
  • Track and archive monthly receipts and payments, update budget tracking programs.
  • Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
  • Uploaded documents produced onto SharePoint, an intranet website for all Technology Information Group members to download, revise and upload shared documents.
  • Extensively used tools such as Rational Rose, Rational Requisite Pro, UML, MS Visio, MS Project, MS Office, MS Access.
  • Validated business rules and all artifacts with users, approval and sign off.
  • Created as-is and to-be process models, specifications, and process flow diagrams.
  • Reported and analyzed all application defects, user issues and resolution status to the higher.
  • Derived the requirement dependencies by working with other business analysts from different modules.
  • Involved in implementing data access, storage and validation routines on the database server using Structured Query Language (SQL).
  • Responsible to import the data from reports into Microsoft Excel and Word.
  • Coordinated between test team, development and business team in clarifying the functionality issue and requirement specification.
  • Validate test plans/scripts and perform final reviews of test results.
  • Supported in creating test cases to check the functionality of the enhanced application.
  • Analyzed the Business Requirements Document (BRD), prepared detailed Test Cases for the UAT.

Confidential, Irving, TX

Business Analyst

Responsibilities:

  • Responsible for establishing and maintaining positive business relationships with IT managers and clients, and ensuring that business objectives and priorities are aligned.
  • Involved in gathering business requirements from the end users and management.
  • Created high quality functional requirement specifications and supporting documents for business systems.
  • Conducted JAD sessions and elicited customer requirements by organizing interviews with internal/external stakeholders and subject matter experts (SMEs) to create subject specific questionnaires for clinical trials. S
  • Interpreted business objectives to support the implementation of technical software application.
  • Worked in Agile Development environment with daily stand up meetings, writing user stories, planning sprints, burning points, reviewing, grooming, many more.
  • Met with physicians, nurses, billing and administrative personnel. Documented the clinical, financial and administrative business practices, procedures and work-flows.
  • Defined the current clinical and financial business processes and practices.
  • Coordinated activities between business unit and technical staff, developed new methods, policies, and procedures to meet the business needs.
  • Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business Owners.
  • Reviewed administrative and clinical practices and procedures: point of care, scheduling, registration, clinical documentation, patient care, and charge entry, medical coding and diagnostic testing procedures associated with multiple business units.
  • Worked on complex business problems, analyzing and evaluating current business methods and procedures for improvements.
  • Extensive use of MS Office tools like MS Access, MS Word, MS Excel, MS PowerPoint MS Project for data migration and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML.
  • Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
  • Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.
  • Involved in set up of testing methodologies and improvement of process model.
  • Created Requirement Traceability Matrix (RTM) to ensure that the requirements are traced to the test cases.
  • Ensured that extremely thorough, effective and organized test process is implemented and delivered the highest quality product.
  • Analyzed the Business Requirements Document (BRD), prepared detailed Test Cases for the UAT.
  • Worked closely with the project team in planning, coordinating and implemented QA methodology on various phases of the application.
  • Interacted with the developers to report and track bugs using JIRA.

Confidential - Pottstown, PA

Business Analyst

Responsibilities:

  • Involved in developing business process models for projects and demonstrations at the Centers for Medicare and Medicaid (CMS) using business process model notation.
  • Conducted project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.
  • Prepared Business Requirements Documents, Functional Requirement Documents.
  • Conducted JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.
  • Creating documentation such as BRDs and FSDs (Business and Functional design specs) with elaborate Use Cases and process flows.
  • 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.
  • Manage company's EDI catalog for prospective EDI customers.
  • Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA).
  • Implement new services and programs via MMIS for the Medicaid program by directly interfacing with the customer and the system engineers on a regular basis.
  • Worked on FACET claim processing system and gathered and documented functional requirements in the Functional Requirements Document (FRD).
  • Performed GAP analysis by performing the system analysis between the scheduling systems and documented the gap items.
  • Analyze the document Medicaid EDI transactions issues related to implementation of HIPAA and ensure these issues are documented and addressed in the approach to the HIPAA.
  • Worked on analysis of FACETS claims processing system and gathered requirements to comply with HIPAA requirements.
  • Facilitated all aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.
  • Prepared various UML 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.
  • Involved with the UAT teams to write user acceptance testing (UAT) scripts and led testing/ quality assurance for both HL7 ADT interface and the application.
  • Maintained a close and strong working relationship with teammates and management staff to achieve an expected QA result for the project team.
  • Assisted in developing Test Cases for unit testing, prepared spreadsheet for testing criteria and screenshot for test results to complete expected and actual results.

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