SUMMARY

• Over all 8+ years as a Business Systems Analyst within the Healthcare and Human Services domain.
• Adequate knowledge in Health Administration - Claim’s processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans).
• Expert level knowledge in developing Business, System and Functional Requirements, Design Documents, working with requirements traceability matrix.
• Strong knowledge of Software Development Life Cycle (SDLC - Feasibility Requirements Analysis, Design, Construction, Testing, Implementation, Support) and Rational Unified Process (RUP) and UML methodology.
• Extensive hands-on and HealthCare management experience in a variety of projects involving the customization, design, development, implementation, and testing of automated systems to support the Medical Management Information System (MMIS) as well as day-to-day business operations.
• Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
• Experience with Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 implementation guidelines & electronic formats including 270/271, 276/277, 700, 701, 810, 820, 834, 835, 837, 997, and NSF formats for interfaces and images to third party vendor applications including NEIC, SSI, ESI, Datatrac, Medtrac, Cube, Medicare, and several others using COBOL, Metafile, Visual Basic, Unix, DOS, Assembler, C, FTP, Windows and various other communication packages.
• Experienced in Facets and its modules such as Claim, Member/Subscriber, Billing, Provider, Medicare, Medicaid and experienced with several Facets Batches.
• Excellent understanding of Data services, Data ETL using SQL query tools and applications.
• Experience with various tools for planning, tracking and managing projects and requirements using Atlassian JIRA, Rally (CA Agile Central), MS SharePoint server and MS Project Professional.
• Expertise in Metadata Management, Data Profiling & Quality, Data Governance and Master Data management (MDM).
• Extensive success in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) in an SOA environment.
• Experience in analyzing the Medicaid Eligibility Determination System standards for documenting Business requirements document and Functional requirements document of the system.
• Experienced in analyzingbusinessrequirements in all stages of SDLC methodologies such as Agile, Scrum, and Waterfall.
• Working knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Thorough working knowledge of SharePoint and MOSS, (TFS) Team Foundation Systems and Visual Studio Team System (VSTS).
• Experience in executing SQL Queries to provide the testers with sample test data.
• Experienced in Agile, Waterfall, RUP, RTC (Rational Team Concert) and Rapid Application Development (RAD) methodologies.
• Extensive experience in IBM Rational Team Unifying Platform containing tools such as IBM Rational Unified Process (RUP), RequisitePro, ClearCase, ClearQuest and Rose.
• Proficient in creating Business Requirement Documents (BRD), Functional Requirement Specification (FRS) document, User Requirement Specifications (URS) document.
• Experienced in Facets online modules such as Billing, Provider, Claims and Membership modules.
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, MS Excel, MS Access, MS Visio, technical assessment tools, MicroStrategy Data Warehouse Data Modeling and Design.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Knowledge of healthcare standard Health Level Seven (HL7).
• Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• Expertise in assisting the Testing Team in creating the Test Plans, Test Cases and Test Scripts and efficiently prioritize and manage the defects using the Defect Tracking system.
• Proficient in developing and executing Test Plans, SQL and PL/SQL queries, performing functional, usability testing and ensuring that the software meets the system requirements.
• Experience in User Acceptance Testing (UAT) and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT).

PROFESSIONAL EXPERIENCE

Confidential, Peoria, IL

Sr. Business Systems Analyst

Responsibilities:

• Requirement gathered from R&D, clinical trial data, scientist, research associate, regulatory affairs, sales and marketing, medical library.
• Analysis of inbound and outbound interfaces and extensions to FACETS claims processing system
• Completed Data Mapping for Group and detail Product analysis and report writing
• Involved in all phases of the development and implementation of an Enrolment Resolution and Reconciliation process for health insurance exchanges
• Responsible for troubleshooting and resolving errors in 834 and 820 transactions for health insurance exchanges and performing root cause analysis
• Analysis of the Facets data model to ensure optimal system performance and tuning
• Configured facets modules such as Claims, Membership, Billing, Benefit and plan
• Worked on writing the Use cases, User stories by using the Rational Tools such as Requisite Pro and RTC (Rational Team Concert) for the health care web application.
• Assisted in development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Worked with database team to define database requirements and load procedures for successful Business Objects reporting. Tested fully all the generated reports to make sure the data accuracy and meeting the specifications given by users.
• Used Rational Requirement Composer RRC for requirement gathering and (Rational Team Concert) RTC for project planning and implementation.
• Created complex OLAPBusinessObjectsReports connecting to Oracle Data Warehouse Databases.
• Maintained and modified reporting module documentation and SQL for the Oracle Views, ensured integration with client reporting tools likeBusinessObjects,Cognos.
• Worked on different EDI healthcare transactions like 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions.
• Gathered requirements and prepared functional documents for Facets.
• Utilized SDLC Methodology to configure and develop process, standards and procedures.
• Conducted JAD sessions with business users and Subject matter expert 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.
• Involved in various versions of the documents generated during the project were maintained and managed using Rational ClearCase and performed defect tracking using Rational ClearQuest.
• Assisted in reviewing the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Created application on the front end in Excel, which included User Login Security, and interfaced with data on the SQL Server.
• Well-versed in documentation of Business Requirements Documentation (BRD), Functional Specifications Documentation (FSD), Current-State and Future-State Process Models, Performance Indicators.
• Managed and prioritized user stories using JIRA. Worked with the development team to identify blockers and provide resolution.
• Work with team to identify best way for receiving C-CDA (HL7transactions) from EMR systems in a HIPAA compliant manner.
• Analyzed the existing reports of the reporting system in the database. Checked the consistency of the data after ETL process using SQL queries.
• AnalyzeHL7transmissions and monitored Interoperability and interface connectivity.
• Involved in analysis for wide range of Six Sigma and Web-based initiatives, including user requirements.
• Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.
• Involved in the analysis, design and automation of client/ server applications using Oracle and SQL.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Created a Requirements Traceability Matrix (RTM) kept a track of product backlog, sprint backlog, and time estimates using agile tools like Jira.
• Prepare Test Plan and Test Strategy documents.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment
• Validated generated XML output with expected values with data sets.
• Creation of Features and User Stories for the DBT (Define, Build & Test) teams in Agile SAFe implementation.
• Performed requirements analysis, business process modeling, usability and 508 compliance activities supporting development projects.
• Created detailed test plans and testing strategies and ensure these are executed extensively, which includes executing SQL queries to retrieve data and test.
• Worked with the UX team to develop UX wireframes, navigation flows and interaction rules using UX design principles and best practices
• Performed User Acceptance testing (UAT) & End to End testing in interaction with Offshore QA/Dev teams for various system releases & pushed them to production.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Completed Data Mapping for Group and detail Product analysis and report writing
• Involved in claim adjudication process of facets application
• Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical Specification and documented in Mercury Quality Center.

Confidential, Trenton, NJ

Business Systems Analyst

Responsibilities:

• Prepared project plans using MS Project and coordinated timelines as guided by the Project Manager
• Coded the Data Conversion Programs which migrates data from ACSES internal old system and the NJKiDS which is in Oracle 10g and extract data from NJKiDS and sends files to ACSES since the implementation is the region wise implementation. Converted the Case Details, Case Member Details, Member Demographic Details and Receipt Details.
• Gathered requirements and prepared Use Cases (General System Design documents and Detailed System Design document) by interviewing tax agents, users and clients.
• Created the SQL scripts for demonstrating the prototypes and for verifying the result sets
• Collected information and requirements about different Entities and attributes from FDS.
• Completed GAP analysis in detail on all entities in CCL for a source system.
• Involved in verifying accuracy of billing information and codes before processing Medicare and Medicaid forms, as well as other third-party insurances.
• Worked on Medicaid and CHIP program requirements, including complete end to end life cycle data flow of eligibility, enrollment, claims, encounters, payment and post-payment
• Involved in working with various bug tracking tools like HP Quality Center, Rational Clear Quest and JIRA and a very good understanding of the Defect Life Cycle.
• Involved in developing several COBOL DB2 stored procedures for claims pre-adjudication process
• Prepared questionnaire based on the System Analysis Performed for all entities.
• Coordinating with Developers and Testers through (Rational Team Concert) RTC for project release.
• Conducted extensive Joint Application Development (JAD) sessions for all business-related issues.
• Involved in Logical & Physical Data Modeling. Database Schema design and modification of Triggers, Scripts, Stored Procedures in Sybase Database Servers.
• Created and/or revised TSQL/SQL queries and stored procedures to process, analyze and move big data and implement data integrity initiatives for various business units.
• Established a RUP centric business analysis methodology.
• Prepared High Level Logical Data Models and BRD’s (Business Requirement Documents) supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors to analyze and document business data requirements.
• Developed business proposals and RFP responses and trained others in this capability.
• Helped design scope documents and the Request for Proposal (RFP) after extensive ROI analysis and coordinated with top management for the approval process.
• Responsible for cost estimation and timelines for various Business Intelligence reports
• Involved in configuring the Data mapping between Oracle and SQL Server.
• Did system analysis, programming, testing, implementation, maintenance and documentation of COBOL, DB2, SQL programs.
• Involved in conducting project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.
• Built models containing query subjects, query items, and namespaces from scratch as well as from imported metadata.
• Worked with claims and configuration departments to resolve and reduce provider issues by analyzing and researching Medicare and Medicaid guidelines, fee schedules, and provider credentialing, contracting and licensing requirements
• Provided data modeling support for numerous strategic application development projects.
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Documented the meeting minutes with issues of about discussed and solutions resolved.
• Involved in gathering reporting requirements from the business users. Involved in building data warehouse application.
• Presented the mapping document with all business logic applied for the system to Project Manager.
• Gathered information and documented on Conceptual design and technical design for phase III systems.
• Prepared Use cases and activity diagrams for a source system using Enterprise Architecture (EA) tool.
• Created the test cases for all the Use Cases using EA tool.
• Developed XML schema for data retrieval and processing to improve system flow through metrics
• Created test scripts for all the test cases in PL/SQL.
• Develop and implement Test Plans adjusting test strategy to the requirements of the particular product release. Maintain Traceability matrix and manual tests in Quality Center.
• Designed DataStage ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
• Developed Test Cases for Unit Testing, Regression Testing and User Acceptance Testing (UAT).
• Provided support for User Acceptance Testing with UAT cases and resolving any issues with the users and performed UAT and participated in writing test plans, and developed different testing strategies like Black Box testing, and Load testing.

Confidential, San Antonio, TX

Business Analyst

Responsibilities:

• Evaluated business process requirements to ensure proper system configuration (i.e., identifying key decisions, process changes, pain points, interface issues, training considerations, etc.)
• GatheredBusinessRequirements, interacted with the Users, Designers and Developers, Project Manager and SMEs to get a better understanding of theBusinessProcesses.
• Developed Test Cases and prepared test scripts using SQL to test transformation logic in the data
• Gathered and analyzed the User Requirements from walkthroughs and interviews with thebusinessgroups and in-house stakeholders, and many other departments like accounting, fund management, human resource and thus converted User Requirements intoBusinessRequirement Documents (BRD).
• Involved in complete and thorough testing of the entire SDLC, including version and change control using rational clear quest and rational clear case.
• Used Electronic Medical Record (EMR) to extract useful information regarding patients for claim submission to the insurance company.
• Involved in various Facets Data models like Gateway, Claims, Membership, Provider, Billing, Capitation, Invoice,Benefits, Product and Plan.
• Created and maintained requirement documents for Facets for the different modules like Billing, Member enrollment and Claim adjudication.
• Participated in functional design sessions, creates and executes SQL test scripts, and aids in the solution of data issues.
• Facilitated Scrum meeting with technical/non-technical team, Accounts updating, data analysis and sharing with XML patterns, SMEs to clarify business rules & solve impediments, rectifying the regulatory issues with SME's and translated Functional requirements into User stories using JIRA.
• Conducted JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.
• Created UML Diagrams including Use Cases Diagrams, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams and Deployment Diagrams, using Rational Rose and MS Visio and thus defining the Business Process Model and Data Process Models.
• Participated in solving Billing issues from the FACETS Problem Log for Trizetto and Billing Entities.
• Coordinate with Health Insurance Exchange (HIX) program staff and other stakeholders to define and develop requirements for correspondence generation across various business lines.
• Worked with Source system Subject Matter Expert (SME) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Experience in data warehouses and data marts forbusinessintelligence reporting and data mining along with developing and documenting process flows forbusinessprocesses.
• Requirements Elicitation, Analysis, Communication, and Validation according to Six Sigma Standards.
• Involved in implementing Scaled Agile Framework Enterprise (SAFe), and prepared the Teams for Agile Release Train (ART) sessions.
• Involve in design of the Test plan, Test Strategy and developed Test Cases.
• Assisted in designing or presenting conclusions gained from analyzing data using statistical tools like Microsoft Excel, SAS and others
• Worked in Agile Methodology, worked on all phases of software development life cycle to build the different phases of Software development life cycle.
• Extensively used agile methodology's best practices during the SDLC.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure, features and functionality with the new business design using the "As Is" and "To Be" methodology.
• Documented and evaluated test cases/test results/feasibility study of various ETL tools like DataStage/Informatica.
• Assisted in developing business case which included results of the business-impact assessment, gaps identified, alternative solutions, risk assessment, preliminary work plans, resource requirements, and a budget for completing the initiative.
• Involved in verifying software system complied with HIPAA Security and Privacy Rules. Identified sensitive data categories. Monitored compliance with Section 508
• Analyzed the test results from QA teams using Performance Studio Analysis to create various scenarios.
• Involved in writing test cases and test scripts for the User Acceptance Testing (UAT)
• Involved in UAT, test plans, documentation of test reports, etc.

Confidential, Minneapolis, MN

Business Analyst

Responsibilities:

• Implemented the SDLC for the developing life cycle and followed the standards process in the application.
• Follows Standard Operating & Medicare Compliance Procedures also determined eligibility for TANF, Food Stamps and/or Medicaid Programs.
• Well versed in gap analysis in changing old MMIS mixed up with testing new MMIS.
• Utilized Visio diagrams, data flow diagrams, use case diagrams and process flow diagrams using the CMS-MITA guideline.
• Got involved in designing future state processes for HIPAA transaction processing EDI's 837,835, 270, and 271.
• Responsible for indexing of the tables in that data warehouse. Used senior level SQL query skills (Oracle and TSQL) in analyzing and validating SSIS ETL database data ware house processes
• Experience in Agile / Scrum methodology in writing user stories/epics and acceptance criteria using JIRA.
• Created data mapping documents based on client specifications which involved working with Facets claims, membership & plan data model.
• Prepared client process maps for the consumer, broker, employer and provider transactions for the Facets process.
• Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA).
• Delivered business requirement documents, functional specification documents, Use Cases, test plans, and requirement traceability matrices.
• Assisted in developed a supporting care management plan for Needy people by utilizingHl7data in real time.
• Involved in Conflict Resolution during and after JAD sessions between the technical team and the Business team
• Understood the product to be built, gathered requirement and created BRD/FRD documents.
• Analyzed corporatehealthcarebusiness processes to develop customized solutions.
• Created test cases for the new data warehouse objects and managed defect tracking using HPQC (Quality Center).
• Working with Medicare operational management to monitor, trend and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
• Interacted withhealthcareclients to gather requirements, objectives, and input and output requirements.
• Performed execution of test cases manually to verify expected results.
• Ensured the accuracy and consistency of the data during the data loading process
• Assisted in developing Use case, Functional, Object diagrams using Rational Rose.
• Involved in designing DataStage ETL jobs for extracting data from heterogeneous source systems transform and finally load into the Data Marts.
• Prepared custom reports and performed SQL query, data analysis and verification on MS Access.
• Assisted in developing a detailed test plan and test cases to cover all the requirements.
• Identified different test scenarios from Test Strategy Documents.
• Used rational Rose to create UML diagrams such as use case, activity, sequence, class and component diagrams.
• Developed Flowchart and process diagram using Microsoft Visio.
• Analyzed, documented and delivered data mapping, performed risk analysis.
• Frequently communicated with developers to resolve technical issues.
• Analyzed the test results from QA teams using Performance Studio Analysis to create various scenarios.
• 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).

Confidential, Round Lake, IL

Business Analyst

Responsibilities:

• Responsible for providing Medicare Operations support, with a focus on leading configuration activities for Medicare Part D operations.
• Actively participated in Medical Management Information Systems (MMIS) and HL7.
• Reporting issues into the Facets system and Develop BRD’s FRD's, FDD's and Use Cases (MS Visio), process flows for the project and decks.
• Involved in delivering business requirement documents, functional specification documents, Use Cases, test plans, and requirement traceability matrices.
• Actively participated in EDI X12 standards inhealthcareinsurance
• Implemented and followed the Waterfall methodologies throughout the SDLC while working with multi-functional teams in gathering and analyzing the business requirements and convert it to FRS and created business process models from the requirement specification.
• Involved in creating requirements that comply with HIPAA andHL7regulations to protect the privacy of the employee insured under any policy and also regulations for claim submission that is required by Medicare and Medicaid policies.
• Actively participated in conducting interviews, JAD sessions, requirements workshops and brainstorming sessions for eliciting business requirements
• Followed the UML based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, and Sequence Diagrams.
• Collaborated with the QA testing team to develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.
• Involved in the User Acceptance testing UAT to check the reliability for end users.